In recent years we see an increasing number of people rights violations.
Most of these violations are related to healthcare rights, especially in regard to pregnancy, birth and parenting.
In this article we will look into the basic legal mistakes that are being made when providing medical assistance in prenatal care and at childbirth. You will be also provided with some research and statistics.
A huge number of violations in health care are made of small and significant legal mistakes. Most numerous legal mistakes occur in antenatal clinics.
Is a legal mistake made by medical personnel considered a violation? You can look at it in different ways. Today’s doctors are subjects to healthcare ministry orders and medical protocols. Obviously, when dealing with pregnant patients, a doctor may not realize that he or she is violating that person’s rights.
Violation of Rights
Violations of the rights during antenatal consultations
Large legal violations during antenatal consultations are often caused by doctor’s overconfidence. It’s very common that during a doctor's visit a woman will have to endure a vaginal examination and will be appointed to do a bunch of tests. This would be accompanied by reprimand comments on her knowledge “acquired on the Internet” and “not listening to a qualified specialist’s advice”. However, does this pregnant woman have a right to refuse suggested test? Yes, she does!
More often than not, such doctor does not realize that his or her actions could violate medical ethics, patient’s healthcare rights and laws. Such doctor may believe that he or she operates within the framework of orders and protocols.
Doctors, who interfere with private lives of their patients, violate their constitutional rights. Women who refuse medical care act within the law, because it defines that any medical assistance is to be provided on a voluntary basis and patient’s personal life is inviolable.
It may happen that while receiving primary health care, a woman can be chased by a medical institution after her data was recorded in the files of antenatal care. This may occur for example, following her refusal to undergo subsequent medical procedures. These situations may escalate and result in having to deal with police and other enforcement authorities. Such situations should be considered as direct violation of her rights.
Despite the fact that due date is a rough estimate, women who are being monitored via antenatal consultations, may still be pressured to hospital labour induction on that very date. This usually is accompanied by slight doctor’s intimidation that the contrary may "harm the child". An oftentimes pregnant woman does not realize that she can refuse such admission (hospitalization).
In this case, there is a direct violation of the law - the rights of the pregnant woman.
In Russia on a regular basis it happens that antenatal clinics will refuse accepting a patient, if she first tries to get registered later in her pregnancy (at after 27 weeks of gestation). This may happen, for example, when patient lives in a different to antenatal clinic catching area.
Most pregnant women are denied registration of sick leave, if they are not in the books of any antenatal clinic. This happens despite the fact that she has every right to it.
Violations of the rights in hospitals
Legal mistakes at antenatal clinics are often subject to postpartum period. A woman, who was discharged from a hospital postpartum, may be requested to pay a visit to the antenatal clinic. This can be done without prior inquiring whether woman requires such support.
Situation in maternity hospitals in Russia is rather upsetting. Therefore, every woman should know her rights during pregnancy and postpartum.
The biggest pitfall of maternity hospitals lies in fact that hospital staff has never met a woman in labour prior to her being admitted.
The second crucially important mistake is that the admittance registration procedures require numerous forms filling, which distracts birthing woman from the birth process and can be pretty irritating.
Furthermore, women are denied the right to have close family or other support to be present with her during labour. All over the world childbirth is managed by obstetricians. Unlike the midwives obstetricians always expect danger. Although it is a natural right of every birthing woman, hospitals that have labour standards can, for instance, deny a right to birth in a comfortable for her position.
Obstetricians don’t listen to the woman’s needs in childbirth.
Professional labour support personnel (e.g. midwives, doulas, therapists etc.) that is not employed by the hospital, is usually denied access to birthing women. It is also hard to change doctors or refuse one, once a woman is admitted to the hospital. In such cases women are offered to refuse hospitalization all together. You can hear in response the following: “Do you refuse the hospitalisation? We could call to the nuthouse”.
Although, according to the many researches, a healthy pregnant or woman in childbirth doesn’t really need a physician in charge. Actually for this very purpose the midwifery has been existed and developed.
One of the biggest mistakes made in many hospitals is when a newborn is not given to her mother straight after birth. Instead of promoting healthy bonding between them, newborns are placed in a general ward with strict times allowed for time together.
Rights during pregnancy and postpartum
Is there a way to correct legal mistake at the antenatal clinic and the hospital? Does a woman have a right to declare these mistakes?
It is certainly important to declare violated laws talking to physician and not to be afraid to complain.
Basically, all such mistakes are easy to fix by joint efforts. This way the medical staff will learn not to break the law in the future.
Legal mistakes occur due to legal unclarities. In medical care we can talk about the lack of transparency between all parties involved in the process, e.g. all of those who provide medical care for pregnant women / women in childbirth / parents. There must be a cooperation among medical institutions to provide quality care (automation).
Does the pregnant woman have a right?
1. The woman is not required to get registered at an antenatal clinic. Ideally, due to the laws, antenatal clinics should avoid such procedures to let women get medical aid or advice on-the-fly.
2. Just got pregnant a women should be exempted from heavy manual labour during pregnancy. Sometimes though women have to go through a long procedure to get doctor’s statement for a medical board and to bring it to her employer to obtain such an exemption.
In my view, when the fact of pregnancy has been determined, employers should support their pregnant employees, to do everything themselves and offer exemptions and offer other benefits.
3. Any sickness that prevents pregnant woman to continue performing her duties should give her a right to a sick leave until full recovery (for the extended period of time).
4. Pregnant women should be entitled to consultations from medical institutions within the all period of pregnancy. Such consultations should not transform into diagnostics or examinations. Oftentimes women just would like to ask questions to confirm their knowledge with doctors.
Unfortunately, often pregnant women’s rights are violated. For example, it can be difficult to obtain medical help without an ID or if you are an immigrant or a pregnant woman who go out without your documents. In Russia these people can be admitted to a Department of Infectious diseases in a maternity hospital for check ups with the sign “No prenatal record’.
This still happens despite of availability of quick tests that allow to have all the results almost immediately.
5. Pregnant women are entitled to refuse medical procedures (tests) partially and fully.
6. A pregnant woman has the right to proper nutrition during entire pregnancy. This can mean, for example, financial compensation for grocery shopping. Such compensations should be provided after a confirmation of her pregnancy and according to country regulations.
7. Birth outside of a hospital (OOH birth) should not be taken as an offense. According to human rights and freedoms, a woman has the right to decide whether she wants to conceive, when she needs medical assistance, where to receive it and who to be assisted by and supported, and so on.
Any prohibition during pregnancy against a woman in regards to this, directly or indirectly, will transform a woman into a slave, her pregnancy - into an incubator machine, and do not converge with the rules of human rights.
What are the rights of birthing women in the hospital?
1. Possibility to invite family members to attend birth (in fact this right is violated due to absence of designated areas for family members at many hospitals).
2. Woman in labor has the right to refuse wearing a hospital gown (in fact however, this is often impossible due to hospital protocols that require his and have their own determination of cleanliness ).
3. Pregnant woman has the right to choose a physician. This right should not be limited, since the laws back this statement, medical institutions should support the choice of the patient.
4. A pregnant woman has the right to solitude during labour or her being in a maternity hospital, or she may be observed without criticizing or disapproving until the time she stops it by her wish. None of signed agreements should take away this right.
5. Women in labour sometimes are handled roughly. This is a failure to comply with the rules of medical ethics and health care laws. Often in cases of home birth or when children do not attend regular check ups we see facts of medical confidentiality disclosure.
6. The right to receive a prenatal record. Often times, hospital discharge statements (e.g. an epicrisis) are not provided, however, a woman has every right to receive it.
What legal issues are important to be eliminated?
General issues and rights violations in health care for women (pregnant and at birth) are as follows:
1. Lack of legal knowledge about the patient's priority: patient (pregnant / woman in birth) has the highest degree of predominance of the rights to the medical personnel providing aid.
2. Pregnant women do not have the possibility of exploring the open hospital. It is necessary to create conditions for women during pregnancy and beyond - to explore the maternity hospital and staff during pregnancy and prior to childbirth.
3. Russian hospitals do not cooperate with foreign midwives for experience exchange, therefore the tradition of midwife-assisted natural childbirth is being lost. Hence, most of pregnant women have no idea about natural childbirth and traditional midwives.
All this can not be done if you do not pay attention to the violation of the laws.
The most important violation is a failure to recognise that individual rights are defined to protect personal freedom, this should be also applied to interactions with the state.
We see that in providing medical assistance to pregnant women and mothers patients' rights are violated. Namely, priority of her well-being, ethical and moral standards, respectful and humane attitude, respect of patient's cultural and religious traditions. This also includes providing perfect environment for the patient, while taking into account her physical condition and of all those involved in the process.
If the rights of a woman during pregnancy or at birth are broken, she should remember that this should be complained of and handled. All complaints should be first expressed verbally to the head of the institution (antenatal clinic or hospital). It may happen that the problem will be solved on spot. If this does not help, the problem can be addressed to higher authorities in writing. Remember that any written statement/complaint means receiving a written reply.
Oftentimes such claims/statements help to stop the violation of the law. Written replies can be a base for a court case (civil or criminal nature).
In 2015 the Russian Public Opinion Research Center (VTsIOM) conducted a survey on the quality of medical care.
65% - are dissatisfied
26% - did not make use of free medical care due to issues with the doctors, of which:
10% - were related to competence of the medical staff
6% - was related to indifference and the doctor's’ negligence
10% - were related to other problems .
About 54% of patients had only basic knowledge on their rights.
29% admitted that they were not aware of their rights.
About 40% of respondents had dealt with medical errors .
According to Sophie Borland, a Daily Mail correspondent on public health, the problems of such nature exist also in the UK . Half of hospital maternity wards still do not meet basic safety requirements, 7% considered "not entirely meeting the standards," and 41% "need improvement." According to the survey, almost 90% of British women give birth in the hospital, however if they could choose, only 25% would do hospital birth.
This shows us that in the UK women face same problem - lack of understanding between the medical staff and patients (pregnant/women in birth).
These days, physicians and legislators are trying to restore order in obstetrics health care using methods, which would oblige women to "obey" during pregnancy and childbirth.
I would like to repeat once again: during pregnancy and childbirth women are patients, who are provided medical assistance (including counselling), and patient rights should be the priority to physicians’ ones.
To achieve the highest quality of care for women during pregnancy, childbirth and parenthood, it is necessary to review the methods and instructions in providing such assistance, taking into account the correct understanding of the law.
Many mistakes and problems in medical care come from the lack of knowledge and understanding of the legal and moral standards in respect of the patient.
The medical community in particular needs to understand that the Constitution and various laws define the rights and freedoms of citizens (patients). They are recognized equally for everyone. Discrimination in honouring rights and freedoms for sexual, racial, national and language reasons is unacceptable. Childbirth and pregnancy are not to be excluded from such rights.
We must remember that a woman is the basis of the human species!
So to derogate, harass, or to minimize women's rights during pregnancy and childbirth is to violate her rights and freedoms. After all, the antenatal child during this period is an integral part of the woman.
The destruction of this concept is nothing but an interference with the institution into the family and private personal life.
It is necessary to change the approach of care in maternity wards: pregnant / woman in birth must be sure that coming to the hospital she will have respectful attitude and won’t transform to a patient under the treatment.
The maternity hospitals in particular should become family birth centres where a woman gives birth, while physicians just assist but not “control” birth and a woman in birth.
When all these facts are taken into account and complied with during the period of pregnancy and childbirth, we will see an improvement in the quality of care and nation’s health outcomes.
The text of the article is prepared basing on contributions in international conferences (city of Sudak, XII International conference “Actual Issues Of Midwifery, Obstetrics and Perinatology”, and Saint Petersburg, V International conference “Midwifery: Community Built in Love” by “Homeborn Child” journal and Midwifery Today, May 2016).
This article is unique. Original text: 7 основных прав беременной женщины и права роженицы. Правовые нарушения в женской консультации и роддоме
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- Всероссийский центр изучения общественного мнения (ВЦИОМ). //wciom.ru/index.php?id=236&uid=115370
- Всероссийский центр изучения общественного мнения (ВЦИОМ). //wciom.ru/index.php?id=236&uid=115326
- Sophie Borland. //www.dailymail.co.uk/home/index.html
- Правовые акты по состоянию на 2015-2016 гг.
- Старчиков М.Ю. «О судебно-медицинской экспертизе при рассмотрении судами гражданских дел о некачественном оказании медицинских услуг: проблемные вопросы и пути их разрешения».
- «//www.midwiferytoday.com/articles/homebirthissues.asp» by Sara Wickham, MA, BA, RM, is a direct-entry midwife in Maldon, England, and a midwifery lecturer at Anglia Polytechnic University. She is the UK country contact and a contributing editor of Midwifery Today