Listening Lounge

Through the lens of Equity, Diversity, Equality & Inclusion, a think piece on 'Am I Allowed?' - how consent shapes our experience of birth.

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On Tues 15th July 2025, we were delighted to host our second online, 'Listening Lounge'. This free, podcast-style workshop is part of our 'Trusted Spaces' workstream, where we bring together members of the grassroots perinatal mental health community to explore how to genuinely nurture and embrace EDEI within our services.

The Listening Lounge is a Hearts & Minds Partnership project brought to you by our brilliant 'Root Makers' - a collaborative and diverse team of people from our sector working alongside Hearts & Minds to help work towards a more inclusive and equitable sector. You can find out more about the Root Makers here.

For this Listening Lounge, we focused on the topic of, 'Am I Allowed?' - looking at how consent shapes our experience of birth. We explored this through a springboard talk, deep-level listening, a creative film presentation, an optional wellbeing exercise and a generous panel discussion derived from lived experience and with plenty of room for change-making conversation. Our speaker was Leah Lewin (International speaker and perinatal educator and consultant) and joining us on the panel were Beth Rusell (Maternity experience midwife and Training Coordinator for Birthrights) and Sylwia Grzenkowicz, (SME Doula for Support Me CiC).

Leah, Beth and Sylwia were all incredibly generous in sharing their own experience of working with birthing people around the topic of consent as well as the wider repercussions of individualised experiences within the sector. The attendees asked some incredibly thoughtful questions which were reflective of not only the immense expertise within the PMH grassroots sector, but also the unwavering commitment to working with and for ALL families. There were a couple of questions we didn't get time to put to the panel, so if you skip to the end of this blog post, you'll be able to find their retrospective answers.

As a means of continuing the theme, Leah has been kind enough to write a think piece on 'Am I Allowed?' and we are delighted to share it here, on the Hearts & Minds blog:

Consent in healthcare is too often seen as a signature on a form or a quick “Yes” in a clinical moment. But in maternity and perinatal care—where choices carry profound emotional, physical, and psychological weight—reducing consent to a tick-box exercise minimises harm and ignores the complexity of people’s lived experiences.

For grassroots organisations supporting parents and carers, this question: “Am I allowed?” captures the fears and power dynamics many people bring to healthcare encounters. It also reflects the unspoken anxieties of healthcare staff operating in systems under immense pressure. As peer supporters, group leaders and VCSE staff, understanding consent as an ongoing conversation is vital to helping the people you serve feel safe, informed, and respected.

MOVING BEYOND IMPLIED CONSENT

In clinical settings, implied consent is often assumed when someone rolls up their sleeve for a blood pressure check or lies down for a scan. While this might seem harmless for routine tasks, it becomes deeply problematic when used in perinatal care—where interventions can be invasive, high-risk, and deeply personal.

The General Medical Council (GMC) states clearly:

“Implied consent cannot be assumed for interventions that carry risk, are invasive, or where a reasonable person may want further information before deciding.”

But for many parents with histories of trauma, whether physical, emotional, or cultural assumptions about consent can re-traumatise. One moment, a seemingly simple act, like a touch or request, can trigger deep-seated fear and mistrust. As grassroots leaders and peer workers, you may already hear these stories in your groups: people feeling silenced, pressured, or dismissed during critical points in their maternity journey.

This is especially true for minoritised communities where language, culture, neurodivergence, or disability can mask distress or lead to misinterpretations. Supporting individuals to recognise their right to say “Yes” or “No” empowers them to reclaim autonomy.

Organisations like AIMS (Association for Improvements in the Maternity Services) have highlighted how misuse of implied consent has led to rights violations. As a community ally, you can amplify this message: consent must never be assumed.

CONSENT AS AN ONGOING CONVERSATION

Consent isn’t a one-off. It’s a continuous dialogue. Saying “yes” to a vaginal examination once doesn’t mean agreeing to future examinations. Changing environments doesn’t change the need for explicit consent.

NICE guidance reinforces this:

“Women should be supported to make informed decisions throughout labour, with information provided in ways they can understand.”

As peer supporters and VCSE leaders, you play a unique role in preparing parents and carers for these conversations. Helping them understand that consent can be revisited and withdrawn at any time is critical. Equally, supporting them to voice their needs, even when this diverges from clinical recommendations can build their confidence in navigating systems often resistant to patient-led choices.

THE FEAR FACTOR: RISK, REPUTATION AND RELATIONSHIPS

You may also hear from parents that they felt pressured because healthcare staff feared being blamed if something went wrong. This fear is real in systems where professional reputations and inter-professional relationships feel fragile.

The Healthcare Safety Investigation Branch (HSIB) has documented cases where professionals felt trapped between advocating for individual choice and adhering to rigid institutional guidance, policies or protocols.

This fear can lead to coercion—directly undermining trust. Your work as grassroots organisations is crucial in breaking this cycle by:

• Helping parents understand their rights

• Supporting respectful challenge where care feels unsafe or coercive

• Bridging the gap between families and services to minimise misunderstandings

  
  

Remember: denying informed choice doesn’t erase risk. It shifts it—onto parents, their families, and ultimately the healthcare system itself.

MINIMISING TRAUMA THROUGH SIMPLE, ETHICAL PRACTICE

The act of asking, listening, and respecting choice is simple yet transformative. Research into Obstetric Violence shows psychological harm from consent violations often outlasts physical outcomes.

Trauma-informed principles offer a framework for grassroots organisations:

• Choice and Control – Encourage parents to ask questions and express preferences

• Transparency – Demystify processes and help them prepare for what to expect

• Collaboration – Foster peer spaces where decisions are shared, not imposed

  
  

By embedding these principles, your groups can reduce postnatal PTSD risk and strengthen trust—even when births don’t go as planned.

EMBEDDING CULTURAL RESPECT AND WELLBEING

Supporting parents to advocate for themselves also means recognising the systemic barriers they face: racism, ableism, gender and sexuality, language exclusion, religious and cultural erasure. Moving beyond “Cultural Sensitivity” towards Cultural Respect ensures diverse ways of understanding autonomy are honoured.

Equally, supporting staff wellbeing is critical. Burnout and moral injury among healthcare workers often ripple into patient care. Grassroots organisations can advocate for:

• Birth debriefs for both families and staff

• Training I developed in trauma-informed care and Obstetric Violence (Free From Harm)

• Policies that debias care frameworks (like the IMPACT framework I am developing with WRA UK, Southampton University and partner NHS RHO)

  
  

When systems support staff to listen and reflect, safer and more respectful care follows.

CONSENT AND HUMAN RIGHTS: A NON-NEGOTIABLE STANDARD

Consent is fundamentally about human rights. Article 8 of the European Convention on Human Rights protects bodily autonomy. Violations perpetuate fear, stigma, and systemic distrust—especially among marginalised groups already navigating inequities.

Building a culture where no one—parent or practitioner—feels they must ask “Am I allowed?” requires grassroots and community voices to lead the way.

POINTS FOR PRACTICE FOR GRASSROOTS ORGANISATIONS

• Regularly discuss consent in parent groups. Help people rehearse questions and responses

• Create peer-led workshops about navigating care conversations and collaboration

• Build relationships with local maternity services to influence practice

• Challenge assumptions when implied consent is normalised

RED FLAGS TO WATCH FOR

• Assuming implied consent for invasive or high-risk interventions

• Parents reporting coercion, “For their own good."

• Staff expressing fear of reputational damage as a reason to override autonomy

• Absence of documented informed discussions in care notes

Consent is not about permission—it’s about partnership. Grassroots organisations and peer supporters are uniquely placed to empower parents and carers, advocate for respectful care, and hold systems accountable. Together we can help reimagine perinatal care where dignity is non-negotiable and autonomy is a lived reality.

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If you'd like to find out more about Leah's work on birth consent and more please visit: www.theperinatalspecialist.com

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Here are two questions asked by attendees at this Listening Lounge, that we didn't have time to answer within the session. Please see below for combined answers from our guest facilitators:

1.

(What is) the panel's view on mixed messaging? This seems to come from all angles. The power of language is huge for us all (and its effect on us) but I wonder how this sits from a minority ethnics viewpoint but also from a Healthcare professional’s viewpoint now seeing support from the other side. Many parents have told us that (as healthcare professionals entering the birth-space themselves) they face more fear from almost expecting that they should know or knowing too much, fear going back into work etc.  There is so much to hold . . . and so much to be aware of in the language we use.  I think awareness is a key part here even if we don’t always get it ‘right’?

Beth Russell's answer:

Awareness is absolutely key, as humans we are never going to get it “right” every time, but we should certainly try our best to. Mixed messages might be improved through women and birthing people having continuity of midwifery and obstetric care. However, we have to, of course, keep awareness that the professionals they are seeing may have their own inherent biases which can affect the information relayed. Language is so important and I think all professionals working in this space have a duty to continually reflect on the language they use and how it can impact the people in their care. 

For many parents who are also healthcare professionals there are absolutely significant challenges (I was speaking to a colleague and friend about this recently!). The fears may be different and there are sometimes additional concerns at play for them such as knowing the flaws of the system, knowing the cultural norms of the hospital (if they choose to birth where they work), knowing the biases or opinions of colleagues (the worry of who will be working or not on the day they go into labour) alongside the normal trepidation many parents feel about giving birth plus sometimes grappling with vicarious trauma they may have experienced at work. It is a lot, and it is somewhere there are real gaps in ensuring care is truly trauma informed. 

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Leah Lewin's answer:

There is no one set of language that is correct, informed, or powerful. I think to overcome the challenges being faced, the approach needs to be inclusive rather than additive - ensuring that we are taking a fully trauma-informed viewpoint.

That doesn’t mean we have to understand every element of everyone’s culture, ability, needs, etc - but it does mean we must lead with respect.

There’s a confusing narrative here, and it’s important to recognise the difference between healthcare professionals, the institution, and those systems - compared to people in the community, the VCSE sector, and even universities.

There is still no standardised form of information that is easily accessible to all. That gap is reflected when we look at people’s communication needs - whether that be in animated format, video content, audio, written information - and then transcribed or translated.

There is no consistent, detailed information or direction that is appropriate and applicable for everyone - particularly for ethnically minoritised people, people in the LGBTQ+ community, those who are neurodivergent, physically disabled, or who have experienced forms of trauma (e.g., generational, religious, or cultural trauma).

These experiences are not being incorporated into the policies that inform care. And those policies inherently end up causing common biases, which means people are often already at a disadvantage.

There is an excessive amount of fear and re-traumatisation around language because of the power it holds. So again, having the option to share with people how to find appropriate language and communicate effectively without causing further harm is really important. And it’s not something that comes naturally.

There are a lot of belief systems that need to be dismantled - things that need to be unlearned - so people can communicate effectively and safely. At the moment, there is no standardised practice for that.

The biggest changes we’re seeing are where individuals are taking a proactive stance and actively seeking out information, training, support, and mentorship to ensure they can provide better care. But that’s happening at an individual level.

That’s why I keep bringing it back to the institution - that’s where it needs to be rooted.

2.

We hear a lot from institutions like Royal Colleges around informed consent - the idea being that people are giving the right information to make decisions about their care but there is still an emphasis on shared decision making. What are your thoughts on this?

Beth Russell's answer:

Personally, I really dislike the term “shared decision making". The decision is the woman or birthing person's to make and to own. The healthcare professionals of course play an important role in imparting information in a thoughtful, evidence based and unbiased as possible way and in facilitating informed choices by making services available. They have a legal duty to do this. But the decision is ultimately the woman or birthing person’s to make (and take responsibility for - which is scary enough as it is as a parent, without the waters being muddied by unclear language).

I am glad to see the subject being given more attention in national guidance and discussion, but it would be really helpful if perhaps “informed decision making” or “supporting autonomous decision making” were used instead as this is more reflective of what should actually be happening. Unfortunately, far too many women and birthing people find that in fact they are not being supported to make autonomous decisions - but that is a whole other discussion in itself!

Leah Lewin's answer:

They’re starting to move the conversation towards decision-making but actually, I prefer to think of it as a partnership. And in that partnership, the lead partner should be the pregnant person. And we’re not quite there yet.

When we look at the Royal Colleges and how they’re framing informed consent, they’re still perpetuating this idea of hierarchy - which will always create a power imbalance. That imbalance often results in the care provider being seen as the one in control, rather than the pregnant person. There needs to be more emphasis on the pregnant person being the lead in that partnership.

A very simple way to look at it: when you apply for funding, there always has to be a lead applicant. That person may not be doing the majority of the work or carrying the biggest load but they are the primary point of contact. The same principle should apply in healthcare. The pregnant person should be the default for communication, the lead in all decisions about their care. That is the only way to truly prioritise consent in decision-making.

Even the sanitised language around “shared decision-making” can imply that someone else still holds the authority. For example, if someone is birthing outside of guidelines, the language used can suggest that they’re “not allowed” to make that choice. That narrative - rooted in hierarchy - is upheld through language, and it creates barriers to true autonomy.

So no, I don’t think the Royal Colleges have it quite right yet. There’s still more work to be done.  That work starts by developing these conversations, tools, and policies in true collaboration with people, and with their families.

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We hope you found this think piece and Q+A section informative, thought-provoking and helpful in your grassroots support with families.

Special thanks to our Root Makers team who worked on the Listening Lounge: Lauren Parr from Make Birth Better, Manisha Sheth from Support Me CIC and Aileen White from My Birth Support CIC.

If you'd like to find out about the next Listening Lounge, as well as all the other Trusted Spaces that Hearts & Minds provides for the VCSE in perinatal mental health, please visit this page of our website. You can also sign up to our newsletter to make sure you don't miss a beat.