The recent Health-e News story about a 20-year old Limpopo mother accusing doctors of removing her womb without her knowledge or consent after childbirth has raised questions about when an emergency hysterectomy may be necessary and what patients’ rights are.
Professor Leon Snyman, from the South African Society of Obstetricians and Gynaecologists (SASOG) and head of Obstetrics and Gynaecology at Kalafong Provincial Hospital, explained what the law says about consent.
When will an emergency hysterectomy be considered?
The most common reasons are uncontrollable bleeding (postpartum haemorrhage). Doctors would first attempt uterus-preserving measures, which would include:
Medication to contract the uterus (tighten the womb);
Uterine (womb) massage;
Balloon tamponade (inflatable balloon to apply mechanical pressure); and
Compression sutures (use of stitches).
Removing the womb is NOT one of the first options doctors consider, and is performed only when uterus-preserving measures fail or when the situation is too unstable to allow time for them.
When can doctors remove a woman’s womb without her consent?
In almost all planned operations, doctors must obtain informed consent before performing a hysterectomy.
However, during or shortly after childbirth, when a woman continues to lose large volumes of blood despite measures taken, and her vital signs show that she is going into haemorrhagic shock, the surgical team has to act within minutes.
At that point, continuing to try alternative measures risks the patient’s life, and hysterectomy becomes the safest option to stop the bleeding definitively and save her life.
Can a relative give consent for this procedure on behalf of the patient?
Yes, in limited circumstances. But if the patient is unable to consent, for example if she’s unconscious, the National Health Act allows an order of priority for legally authorised decision-makers to give consent on behalf of a patient.
In order:
a person mandated by the patient in writing,
then a spouse or partner,
then a parent,
then a grandparent,
then an adult child, then a brother or sister.
If the patient is a minor, a parent or legal guardian would give consent. But if waiting to obtain that consent would place the woman’s life at greater risk, doctors may proceed with emergency treatment, including a hysterectomy, to save her life.
Do you have the right to ask questions and receive an explanation after an emergency hysterectomy?
Yes. It is highly unlikely the doctor will not explain that an emergency hysterectomy had to be performed, and explain the reasons why this decision was taken.
Even when this had to be done without prior consent, doctors still have a duty to explain what happened afterwards.
Patients should be told:
Why the hysterectomy was necessary;
What doctors found during surgery;
What treatment was performed;
How it may affect future fertility and recovery;
What follow-up care and emotional support are available.
This discussion should take place as soon as the patient is medically stable and able to understand the information.
Can the patient ask for her medical records?
Yes. Patients have the right to request copies of their medical records, including the operation notes explaining why the hysterectomy was performed. These records can help them understand what happened, and may be important if they later seek a second medical opinion or legal advice.
What should women do if they believe their womb was removed unnecessarily?
Request the medical records.
Lodge a complaint with the hospital.
Report the matter to the Health Professions Council of South Africa (HPCSA).
Contact the Office of Health Standards Compliance (OHSC).
Seek independent legal advice if necessary.
Prof Leon Snyman – head of Obstetrics and Gynaecology at Kalafong Provincial Hospital, and executive council member of the South African Society of Obstetricians and Gynaecologists (SASOG).
See more from MedicalBrief archives:
Legal action after Limpopo mother’s womb removed during Caesarean
MEC coughs up for hysterectomy in negligence case
Call for justice after forced sterilisations