The NSW Parliament Select Committee on Birth Trauma 1 held its sixth hearing on 8 April 2024 at Parliament House in Sydney, concluding the parliamentary inquiry. During its final hearing, the Committee heard the individual lived experiences of mothers who reported not having provided informed consent to hospital staff and experiencing serious mistreatment. The Committee also heard from women's health experts regarding the increase in mental health issues and illnesses in mothers following their experiences of traumatic births.
Informed Consent – Issues and Recommendations
The requirement that all medical health professionals are to ensure the informed consent of patients is recognised in principle 4.2 of the Australian Health Practitioner Regulation Agency (AHPRA) Professional Codes of Conduct 2. Such informed consent by a patient can only be given once they have been informed by a medical professional of the relevant information about a healthcare treatment, procedure or other intervention and any such associated risks 3
The Committee heard first-hand accounts from individuals who were not provided the opportunity to give informed consent during childbirth. These accounts included:
- that hospital staff failed to notify a patient that her daughter was stillborn before an emergency caesarean section;
- manually removed a patient's placenta without obtaining her consent; 4;
- made decisions about a baby's delivery without first consulting the patient; and
- administered drugs without obtaining the patient's consent.
Whilst it is acknowledged that informed consent cannot always be obtained in situations of extreme emergency, the Committee was advised that informed consent and information would ideally already have been provided in these instances 5.
The Committee was provided with numerous recommendations from individuals as to how issues relating to informed consent during childbirth can be addressed. These recommendations included but were not limited to:
- the implementation of a waiver and/or consent form prior to the commencement of any treatment, procedure, or other intervention 6
- the introduction of consistent experienced educator-led programs for women and their partners which will allow for the development of decision-making skills 7
- an increase in training on informed consent for educators in order to be able to adequately provide information to patients 8;
- the enactment of legislation which implements a legislative process of obtaining informed and non-coercive consent9; and
- the introduction of training for medical professionals regarding informed consent generally and what it constitutes 10
Need for Psychological Support
The Committee heard evidence that individuals who experience traumatic births are at a higher risk of experiencing postnatal depression and anxiety, and being diagnosed with Post-Traumatic Stress Disorder. The Australian Institute of Health and Welfare has reported that suicide was one of the most frequent causes of maternal deaths reported in Australia between 2012 to 2021 11.
The Committee was provided with recommendations as to how psychological support for mothers can be improved to address mental health concerns. Sahra Behardien O'Doherty, President of the Australian Association of Psychologists Inc., suggested that patients be able to self-refer to a psychologist of their choice 12. Dr Elizabeth Skinner, Academic and Co-founder of the Australasian Birth Trauma Association, suggested the introduction of guidelines for nursing staff, midwifery staff and General Practitioners, as to how signs and symptoms of a need for psychological support can be identified 13.
Conclusion
The Committee has held six hearings in Sydney, Wollongong and Wagga Wagga since 4 September 2023 and is due to publish its findings by 3 June 2024, which are expected to make recommendations to NSW Parliament with a view to reducing avoidable trauma in childbirth.
For further information regarding the Committee and how to access a claim for compensation in instances of avoidable injury suffered as a result of negligent medical care, please refer to part 1 of this series.
Footnotes
1
https://www.parliament.nsw.gov.au/committees/listofcommittees/Pages/committee-details.aspx?pk=318#tab-hearingsandtranscripts
2 https://www.ahpra.gov.au/Resources/Code-of-conduct/Shared-Code-of-conduct.aspx
3 https://www.safetyandquality.gov.au/our-work/partnering-consumers/informed-consent
4 https://www.abc.net.au/news/2024-04-08/nsw-birth-trauma-inquiry-holds-final-hearing/103680724
5 Page 55 – Transcript – CORRECTED – Birth Trauma
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6 Page 9 – Transcript – CORRECTED – Birth Trauma
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7 Page 12 – Transcript – CORRECTED – Birth Trauma
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8 Page 17 – Transcript – CORRECTED – Birth Trauma
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9 Page 25 – Transcript – CORRECTED – Birth Trauma
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10 Page 38 – Transcript – CORRECTED – Birth Trauma
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11 https://www.aihw.gov.au/reports/mothers-babies/maternal-deaths-australia
12 Page 32 – Transcript – CORRECTED – Birth Trauma
– 8 April 2024.pdf (nsw.gov.au)
13 Page 52 – Transcript – CORRECTED – Birth Trauma
– 8 April 2024.pdf (nsw.gov.au)
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