Beyond Consent Forms: Reclaiming Autonomy in Childbirth

Informed consent is one of the cornerstones of medical ethics. But what does it truly mean in the context of childbirth, where the pace of events can shift rapidly, pain clouds rationality, and a mother’s deepest vulnerability is laid bare? A recent ruling by the Singapore High Court stated that it is "impractical for doctors to obtain explicit consent for each act in a medical procedure." While the practicality of this argument might resonate with many clinicians, as a perinatal mental health counsellor who specialises in treating women with PTSD from traumatic birth experiences, I find myself asking: what are the emotional consequences of being treated as a passive participant in one’s own birth?

I have worked with countless women who carry deep emotional scars from their deliveries - not necessarily because of the physical trauma they endured, but because they felt disempowered, dismissed, treated as objects to whom things were "done." The violation of their personhood, not just their bodies, is often the root of their trauma. They didn’t feel seen, heard, or respected. And that sense of abandonment during one of the most significant moments of their lives is what haunts them.

I know what this feels like on a personal level. My first delivery took place in the UK - a gruelling 36-hour experience, 34 of which I spent labouring at home with the dedicated support of two NHS midwives. When it became clear I couldn’t progress further on my own, I was transferred to the hospital. After two hours of pushing with no result, I was told that a ventouse or forceps might be needed. I was beyond exhausted, in excruciating pain, and completely overwhelmed. And yet, even in that chaos, I remember being told what was happening. I didn’t feel in control, but I felt I mattered. The obstetrician was firm, but I still felt included in the decisions being made. In the end, I pushed my baby out without intervention, although I sustained considerable physical damage that took me a year to recover from.

My second delivery happened in Singapore, in a public hospital with a carefully chosen doctor, recommended by those in the know. After discussing my first birth and its complications, we talked through a planned c-section versus attempting another vaginal birth. I declined a c-section, and we then discussed the type of episiotomy that might be needed, how to minimise damage, and what my options would be. I felt empowered, seen, and respected.

Labour didn’t go as planned. My baby got stuck, his heart rate dropped, and everything started to spiral. The doctor told me a ventouse might help. It didn’t. Then he calmly told me he would try forceps. That didn’t work either. I remember him looking me in the eye and narrating what was happening. I don’t know if he was truly asking for consent at each stage - things were moving fast - but he made me feel taken care of. Like I still had a voice. Like I was still a person. Eventually, I was taken in for a crash c-section under general anaesthesia.

I came out of that birth experience physically shaken and emotionally raw. But I also came out of it with a deep appreciation for the care I received. That doctor’s calm, clear, and compassionate communication was pivotal in helping me feel safe, even in the scariest moment of my life. I believe it was a key reason I recovered as well as I did.

So when I read headlines suggesting that it is too burdensome for doctors to explain or seek consent during medical procedures, I worry - not just as a professional, but as a mother. Because what happens when women read these stories? They may start to avoid hospitals, refuse interventions that could save their lives or their babies, or walk into delivery rooms filled with mistrust. They may assume they must fight or resist, rather than collaborate with their care providers.

This growing distrust polarizes the birthing experience. On one hand, we have an understandable fear of being dehumanised in medical settings. On the other, we have clinicians under intense pressure, vilified on social media, doing their best in a high-stakes, time-sensitive environment.

We can do better - for both mothers and medical professionals. Can we equip obstetricians and midwives with better communication skills? Can we train them to recognise when a woman needs just a moment of eye contact, a brief explanation, a voice that says, "You matter"? Can we foster systems that support both the mental health of patients and the working conditions of healthcare workers?

We need a middle path. A place where mothers are not objects, and doctors are not adversaries. Where consent is not reduced to paperwork, but exists in every interaction. Where communication, respect, and compassion aren’t afterthoughts - they’re the standard.

Because it’s not too much to ask to be treated like a human being.