"I'd like to check you.”
“Let's get your IV started."
“We need to get baby on the (EFM) monitor for a bit.”
“At your next appointment we will XYZ.”
“I would feel comfortable/more comfortable if you XYZ.”
Sound familiar? I certainly hope not, but chances are your care provider has probably used these statements in relationship to tests and interventions during your pregnancy and birth experiences.
Generally speaking, our health care system does not allow much room for informed consent. Unless a person knows their rights, they often feel pressured and required to do as they're told (or as suggested), when it comes to procedures, tests, and interventions.
Informed Consent = Permission granted (or denied), typically that which is given by a client to a doctor for treatment with full knowledge of the possible risks and benefits. Informed consent protects a clients right to voluntary consent or refusal of any medical treatment, procedure, or intervention. This includes sufficient, evidence-based information to make a decision that reflects self-determination, autonomy, and control. (1)
Let's chat about informed consent in the context of maternal health care.
Do you have to consent to all prenatal testing? Do you have to consent to every intervention offered to you during the birthing process? The short answer is no.
According to Childbirth Connection, “When pregnant, giving birth and in the postpartum period, it is your responsibility to make informed decisions for yourself and on behalf of your baby. Informed consent is not a form or a signature.
It is your legal right to give — or deny — permission for care.
Making informed decisions about maternity care means finding the best available information on your options and using that information to decide what's right for you and your baby.”
Friends, informed consent always includes the right to informed refusal. If you are not given the option of refusal of a given test or intervention, then you are not being granted the right to informed consent.
Still unsure of what this looks like? Here are a few common examples of providers failing to grant informed consent. Note, they may come from a nurse, obstetrician, or midwife:
-Not disclosing risk or benefit of a given test or intervention
-Suggesting that there are no risks to certain interventions when research clearly states otherwise
-Communicating in a manner that implies no available alternatives
-Only offering "compromises" to a given test or intervention, rather than the right to deny consent
These tactics are disempowering. They take away a woman’s basic right for informed consent which removes her control over her own body and baby.
Your provider should be asking your thoughts and permission, not telling you what they would like or are going to do.
You should not just be included in the decision making process, you should a be in charge of the choices made about your baby, your body and your birth. Remember, you are ultimately responsible for choices made during your pregnancy, birth, and early postpartum.
Informed consent includes open dialogue between care provider and client where all questions are answered, and the client feels ready to decide the best route of care for her own body and baby.
Sometimes this process will lead a person to decline certain testing or interventions that are being medically recommended by their care provider.
What if the choice to deny care may put a mother or baby at higher risk for adverse outcomes?
According to The American College of Obstetricians and Gynecologists committee opinion on informed consent, it is still within the right of the client (as long as they are aware/awake enough to make decisions regarding their care) to not give consent and to decline tests or treatments.
Providers may not feel comfortable with a client practicing informed refusal. This is a result of either the unmet emotional need to maintain control or a result of fear. An experienced provider will have seen poor outcomes from time to time and may project their own past trauma on present, unique clients. This is a sign that you may need to choose a different care provider.
“The outcome of childbirth is not the only factor of importance in a mother’s well-being. Research suggests that the way in which a woman experiences pregnancy and childbirth is also vitally important
for a mother’s relationship with her child and
her future childbearing experiences”
(Fox & Worts, 1999; Hauck, Fenwick, Downie, & Butt, 2007)
A woman's emotional experience is just as valid and important as her physical well being. A woman's level of choice and control impact her experiences for better or worse.
It is very important to choose your providers carefully, and maintain open and respectful dialogue with them throughout your care. This is especially important during your birth experience.
It is also never too late to switch providers! Even during birth, you have the right to decline care from a provider who isn’t listening, being aggressive, or acting dismissive.
It is okay to ask questions until you’re comfortable with a choice.
You - not your provider - will live with the outcomes of the choices made during your pregnancy, birth, and postpartum experiences.
I know it can be a bit daunting taking charge of your health and the health of your baby, however, it is your responsibility.
Collaborate with your care provider, chat about your options, and be clear about how you’re feeling. You do not have to be an expert in a given field to find evidence based information and make informed choices. A trained and certified doula is can be a wonderful resource to help you navigate this.
Your maternity experience, no matter how it unfolds, will impact you and your family for life. Even and especially if it does not go as expected, maintaining control and the ability to make informed decisions during your journey can alter your memories of pregnancy and birth for the better.
(1) The Journal of Perinatal Education - Informed Decision Making in Maternity Care
Making Informed Decisions - Childbirth Connection
ACOG Committee Opinion - Informed Consent
"If parents are not told the full implications, including emotional effects of having every (prenatal) test, regardless of how benign they seem initially, they are unable to make informed choices that suit their own personal circumstances.”
- Childbirth International