When Counselling Becomes Coercion and Care Becomes Assault

NASOG welcomes the perspectives of its specialist members and encourages the profession to join national conversations around women’s healthcare. This week’s guest author

is Dr Kellie Tathem, NASOG QLD Councillor & Executive Committee Member.

Vaginal examination: a woman’s autonomy vs the needs of the health system

A Supreme Court of Victoria ruling this week, which awarded damages to a mother who was coerced into a vaginal examination during labour, warrants a deeper conversation. At face value, the situation is deeply concerning and must be taken seriously for the woman involved.

However, the full details of the case are not yet publicly known, and the circumstances may not reflect the broader clinical issues discussed here. Rulings against health professionals or systems may also create significant downstream effects for the broader health system, potentially increasing costs, straining already limited resources and deterring clinicians from this vital profession.

No one should ever feel coerced into care they do not want. A woman’s right to bodily autonomy is fundamental. Equally, all Australian women should have the right to access specialist obstetric care and their GP throughout pregnancy, so that decisions made in labour are not occurring in isolation but are grounded in prior informed discussions with clinicians trained to manage both normal and complex birth.

This right to autonomy must be supported by access to expertise. Without this, the burden of decision-making in labour can fall heavily on women at a time when clinical nuance and rapid change are common.

To understand this balance, it is important to consider why vaginal examinations are recommended in labour. Labour is clinically defined as regular uterine contractions that cause the cervix to open. For a baby to be born vaginally, the cervix must dilate to ten centimetres. Without a vaginal examination, it is extremely difficult to determine whether a woman is in early labour—which may last for days—or in established labour, potentially only minutes or hours from delivery.

This is not simply a technical issue. It is a clinical judgement that sits within the broader context of a woman’s pregnancy, her risk factors and her birth plan. These factors are best understood when there has been continuity of care with a coordinated maternity team, including GPs, midwives and specialist obstetricians.

Determining whether a woman is in established labour allows both the woman and her healthcare team to decide on the most appropriate level and location of care—whether at home, on a maternity ward or in a labour ward. It also informs decisions about appropriate pain relief and monitoring and whether escalation of care may be required.

The labour ward represents the highest level of care in a maternity unit. It is also the most resource-intensive, typically requiring one-on-one midwifery care and immediate access to medical expertise, including GPs, specialist obstetricians, anaesthetists and paediatricians. As such, it is a finite and precious resource, reserved for women in established labour or those requiring medical intervention to optimise safety.

In many ways, the equivalent of ambulance ramping is already occurring within maternity services. Just as vital signs determine priority in an emergency department, a vaginal examination provides crucial information to determine who most urgently needs a labour ward bed. Without this assessment, there is a real risk of admitting women in early labour while those in advanced labour remain in less appropriate settings—posing safety risks for both mothers and babies. Appropriate triage is essential and that triage must be supported by clinicians with the training to interpret risk in real time.

Perhaps the more important question is why a woman may decline a vaginal examination in labour. Has she had continuity of care with a trusted provider? Has she had the opportunity during pregnancy to understand when and why such examinations may be recommended? Has she had access to her GP and a specialist obstetrician who can help contextualise risk, variation in labour and the limits of prediction in birth?

No maternity care professional goes to work intending to cause harm.

What this situation highlights is not simply a moment in labour, but a gap earlier in the system. One of communication, trust and shared understanding.

To address this, we must move toward models of care that prioritise continuity; where women are supported by a coordinated team of GPs, midwives and specialist obstetricians throughout pregnancy, not just at the point of crisis. These professionals are best placed to provide balanced, evidence-based information, to manage complexity and to build the relationships that underpin true informed consent.

This is not about choosing one model of care over another. It is about ensuring that every woman has access to the full system of care, GPs, midwifery and specialist obstetrics, so that her choices are informed, supported and safe.

All women deserve patient-centred, informed care from clinicians who work in this space every day. They deserve the opportunity to discuss their preferences, their fears and their plans with their GP and a specialist obstetrician who can help position realistic expectations of birth, including when intervention may be recommended to protect safety.

Ultimately, we all share the same goal: a safe and healthy birth for both mother and child. Achieving that requires a system where women have consistent access to their GP and specialist obstetricians, supported by a coordinated maternity team.

When continuity, communication and expertise are aligned, both autonomy and safety are preserved.