#consent

Over the past week or so I have seen the media come alive to denounce the defence lawyer who used the design of a woman's knickers in a rape trial. The woman had been wearing a lace thong. What you wear doesn't constitute consent, although I'm not particularly surprised by the fact that some people think that a woman is giving consent or asking for it if she wears a particular outfit or item of clothing as I think it is ingrained in society to judge women's sexual conduct and appearance, and any seeming links between the two. Boxers, lace thongs, thermals, French knickers, no knickers, none of these choices or any of those in between amount to consent. Consent is given freely, it's not coerced, pressured, threatened, enforced. Consent isn't written on your face or your t-shirt, it's not in the design of your underwear. Consent isn't having your arm twisted or your hand forced, consent isn't being held down or being scared. Non-consensual sex is rape, whoever the perpetrator is. Rape by a friend, spouse, partner, colleague, family member, teacher, boss. Rape is rape.

When I was a student midwife I wrote a piece for The Practising Midwife about rape, how it influenced my practice and the anxieties it had caused. When I read that back now, what leaps out from the page is the hurt and uncertainty and anger. I wrote about how I struggled with abdominal palpations and vaginal examinations. I fought against practices that made me feel as though I was exerting dominance over women who in turn assumed a position of submission. I struggled to believe I was gaining consent and that I wasn't hurting women, and it took a long time to come to terms with midwifery. I felt stupid and inadequate as I thought that if I told anybody how I felt I would have my suitability to midwifery practice questioned. One mentor did in fact tell me that I would never be a midwife. She made me feel threatened and scared during a vaginal examination, she pushed and pushed and pushed me. She made me feel stupid and she tried to crush me. Midwifery training opened old wounds and made me face some demons that were actually quite thinly veiled. It also made me realise that the truly exceptional midwives have as much love and patience for their students as they do for the women they care for. The mentor/life guru didn't ever push me or judge me, she never once told me I had to do something.

Now, as a qualified midwife, I have a tool kit. For me to be able to even consider a vaginal examination (VE) I need to feel safe, I need the door to be where I can see it, I need nobody to be stood behind me. I need to know the woman is comfortable, that we have discussed the VE prior to me having gloves on, that she understands the rationale for the VE, that she gives consent freely and does not withdraw consent at any point during the examination. I do this primarily for the women, but also for me. I don't want to feel as though she has been violated, but I don't want to feel as though I have violated her. In my antenatal clinic, as well as during labour, I discuss examinations with women, the guidelines, evidence base, rationale, perceived benefits, how it is carried out. The message I give women is clear: it is your body, your baby, your birth, your care, your choice. I avoid language that is persuasive or coercive, there is no 'I need to...' or 'I'm just going to...'. I hope there's no coercion. We discuss the fact that she can say no, ask questions, tell me to stop, at any point.

I hope I have a voice that's loud enough to stop other practitioners in their tracks if they aren't listening. If a woman says stop and isn't heard. I'm on her team, I'm her advocate, her voice when hers isn't heard. I'm the one this weekend who said to a doctor “You need to stop examining now, she's asked you to stop”. The doctor stopped. I was the one who gained the woman's consent to check her perineum after birth, the one she nodded at to carry on, the one whose arm she dug her very sharp fingernails into while I checked for trauma. I was the one who stopped, and I was the one who asked another midwife to help (with the woman's consent), and I was the one who cried on my own afterwards because I knew I had gained fully-informed consent, I knew I had listened, I knew I had stopped, yet I still felt I had violated her. I was the one who went reeling back to when I was a student and couldn't cope with VEs. I felt my biggest fears had bee realised.

I am the one who's spent the past few days reflecting and considering what I could have done differently, and how I can change my practice as I go forwards. I've heard comments in midwifery circles about women who decline male practitioners, “well they won't decline when they are screaming for an epidural and the anaesthetist is a man”, “how did they even get pregnant then?”. These narrow-minded attitudes are akin to the comment on the type of underwear worn by a woman who has been raped. A thong isn't consent, but neither is submissive acquiescence. Not really, not when she doesn't know she has a choice. A woman not saying no when your gloves are already on and your hand is already under the sheet and you're telling her “I just need to examine you” isn't consent. Not really. For me consent is inextricably linked to respect and compassion and dignity. If, as a midwife, you didn't value compassion, respect and dignity, would you value consent? And if you're not waiting for consent that is fully-informed and freely gained, are you providing care that is respectful, compassionate and dignified? In my opinion, no.