Expectant Mom Says Her OB Tried to Induce Her Without Informed Consent

First time expectant parents are often faced with scenarios that leave them wondering, "Is that normal?" After all, if you've never been pregnant before, it can be hard to know if that particular symptom is common or if that exam was par for the course. For one expectant mom on Reddit, a recent check-in with her obstetrician left her asking that question, feeling "upset and mortified," and wondering if she should have been asked for her consent.

The Expectant Mom's Experience

The original poster (OP), writing under the handle Turtleshoes18, explained to the Baby Bumps subreddit community that while she might be a first time mother and "of a younger age," she believes her body "knows what it’s doing, and I should not interfere in anyway with my baby unless medically necessary (i.e. no induction, c-section, pain medication, etc. unless it is an emergency and necessary for me and my baby’s health)." The OP said at the time of posting that she was 38 weeks and 6 days along, seeing the same OB her entire pregnancy, and while she had some general complaints, her doctor has otherwise been a good provider.

"However, during my check up last week she did something that totally caught me off guard and honestly concerns me," Turtleshoes18 wrote.

She said she had a check-up scheduled for last Thursday but went in a day early because she wasn't feeling well and wanted to make sure everything was all right.

"Everything was fine thankfully, and my OB decided to do my check-up then since I was already there," the OP wrote. "Up to this point, she had tried to check my cervix twice, but couldn't reach it. They were both incredibly painful and uncomfortable experiences. The second time, she was clearly irritated with me and told me I was 'too tense,' and I needed to work on relaxing my muscles so she could reach my cervix." The OP said she had been uncomfortable but under the impression that her doctor was there to take care of her, so she didn't respond to the comment that she was "too tense."

During this most recent appointment, the OB tried to reach the expectant mom's cervix once more. "This time, it wasn’t painful, and she was able to determine I was 2cm dilated and 50% effaced already," the OP wrote. "I assumed that was that and she would promptly remove her hand from me, but then she began to literally push her fingers through my cervix and attempted to widen it. That was EXTREMELY PAINFUL. As it was happening, I was believing she was still just trying to feel how dilated I was, but as she kept going I had to pull away. She wouldn’t stop until I actually shoved myself up the table and away from her hand. At this point I was just like, 'Okay, that was horrible, but I guess it’s what needed to happen for her to know.'"

Turtleshoes18 went on to share that it was then that her doctor said she was doing something called "stripping," which she would do at the following check-up as well. "I was confused but left it at that," the OP wrote. "This morning, I looked up stripping and read that it is used to induce labor. I’m honestly kind of upset that she would do that before explaining to me and asking if if were okay. I'm of the opinion that my baby will come when my BABY decides to, not when I or doctors or whoever want him to. I really do feel she crossed a line, and I don’t know what to say to her when I go back this week."

She also explained that she's due on Christmas Eve and her doctor has repeatedly told her "that that isn’t a good time for her, and she would like the baby to come before then."

The OP concluded by asking her fellow Redditors if she's overreacting. "If she had just asked before or simply warned me that she was going to try stripping my cervix, I don’t think I’d be so upset and mortified," she wrote. "I feel like I can’t trust my OB, and I’m going to have to be on guard for the rest of my pregnancy and my birthing process. I feel like a child, but how are you supposed to tell your doctor who's delivered countless babies and had endless amounts of patients that you don’t believe what they’re doing is necessary and potentially dangerous for me and my baby?"

What Redditors Said

Commenters in the Baby Bumps subreddit overwhelmingly concluded that the OP was not overreacting. A Redditor named Bearily wrote, "Doc should absolutely get your informed consent before performing any medical procedure, especially something like a membrane sweep that could induce labor, especially if it isn't medically necessary. Seems appropriate to file a complaint with the hospital and explicitly tell your OB she needs to get your consent before performing any other interventions, barring an emergency situation in which you are unable to give consent. If you aren't comfortable filing a complaint while she's still your provider, maybe consider doing so after birth. I'd be furious. Sorry you're dealing with this!"

Sauce_is_bauce noted, "Regardless of whether it's a common procedure, the doctor should have explained everything beforehand and asked whether it was okay to proceed."

What Experts Say

As Redditors pointed out, the OP's experience raises questions related to informed consent, which protects patients’ rights to voluntary consent or refusal of any medical treatment, procedure, or intervention based on information regarding the risks, benefits, and alternatives of care.

The essential components of informed consent, according to the American College of Obstetricians and Gynecologists (ACOG):

• A doctor must have awareness and understanding of the patient's situation and possibilities and used language that is understandable to the patient.
• They must give adequate information regarding diagnosis, prognosis, alternative treatment choices, including no treatment
• Patient must be free to/of: Give consent freely, intentionally, and voluntarily, authorize provider to perform the procedure, coercion, pressure from forces beyond oneself, choose among options including other than what may be recommended.

An ACOG committee has also stated that pregnancy is not an exception to the principle that a decisionally capable patient has the right to refuse treatment—even treatment needed to maintain life. Therefore, a decisionally capable pregnant woman’s decision to refuse recommended medical or surgical interventions should be respected.

And when it comes to induction prior to 39 weeks specifically? A 2009 Practice Bulletin from ACOG on induction of labor supports obtaining informed consent from all women who are induced. The gist, according to California Maternal Quality Care Collaborative (CMQCC): "Informed consent discussions need to be documented in the medical record. Informed consent discussions should occur whether the induction is elective or medically indicated."

What Is "Stripping"?

"Stripping the membranes is a common obstetrical procedure performed on full term or post dates women with the intent to create the release of stimulating prostaglandins, which can induce the onset of labor," explains Felice Gersh, M.D., OB/GYN and founder/director of the Integrative Medical Group of Irvine in California and author of PCOS SOS. "In a woman who is already beginning to thin out and dilate her cervix, it can be successful. The less progressed the cervix is, the less successful the procedure will be. It should not be done in a pregnant woman with an unready cervix or someone who is not yet full-term. It is predominantly used in post-dates women to try to get them to begin labor spontaneously."

Dr. Gersh notes that given the practice's risk of causing rupture of the membranes and of increasing the risk of amnionitis, infection of the membranes, there's research discouraging its use. "In my opinion, stripping of the membranes should be rarely be done and only with the express consent of the pregnant woman," she says. "This is clearly an elective procedure and other options exist."

The Bottom Line

While it would be fantastic for expectant parents to be able to trust all health care providers to perpetually have their best interests at heart, the unfortunate reality of the matter is that's not always the case. As evidenced by this Redditor's experience, the conversations between patient and provider that are an expected part of prenatal care aren't necessarily happening. As Dr. Gersh puts it, "All things have risks and benefits, and these should be discussed."

Here's hoping the OP feels empowered by her fellow Redditors to assert her right to be asked for informed consent prior to procedures like stripping. And that her story raises awareness for other expectant parents who might find themselves in the same boat.