Informed Consent in Childbirth-Should I Really Have To Ask?

by | Jul 10, 2014 | Labor and Birth Advice

By Guest Blogger

Julie Perkins AAHCC of www.growing-families.com

I KNEW MY INFORMED CONSENT QUESTIONS INSIDE AND OUT

When I first became pregnant with my son, Matthew, I looked at all the different options for childbirth. I also researched risks and benefits of the different interventions typically used in labor and childbirth. I felt really knowledgeable after my husband and I attended Bradley Method® Childbirth classes with Liza Janda. We knew all the right questions to ask in any situation. Although I knew my informed consent questions, inside and out, I wasn’t ever really given a clear opportunity to use them. But should I really have to ask? Isn’t my caregiver legally obligated to inform me of all of the risks and benefits of any procedure?

A LONG AND PAINFUL BACK LABOR

I chose to deliver Matthew at an in-hospital birth center because they had a reputation for low intervention use. My labor was very long and painful. He had been persistently posterior for my entire labor. When babies are posterior, labors can be longer, more painful, cause intense back pain, and are very challenging.

WHEN YOU’RE IN LABOR YOU AREN’T ALWAYS ABLE TO ADVOCATE FOR YOURSELF

After 17 hours of labor my midwife came in and said “You have been stuck at 6cm for 4 hours, we are going to break your bag of waters to speed things up”. I was fully aware when I was offered an intervention I needed to ask for informed consent but, was this a question, or a statement? When you’re in labor, you aren’t always able to advocate for yourself for many reasons. You’re a bit occupied in the throes of some really hard work.  She should have informed my husband and me, of the risks and the benefits of the procedure. At the time, I wasn’t even sure if I had the right to say no because of the way it was said to me.

HAD I BEEN FULLY INFORMED MY DECISION WOULD HAVE BEEN DIFFERENT

I allowed them to break my amniotic sac, and my ability to cope ended abruptly. Labor went from manageable to unmanageable in one contraction. This wasn’t the natural progression that my labor was following and my body knew it. I wasn’t told that the procedure makes contractions more intense and that it usually only speeds labor by 30 minutes. Had I been fully informed, my decision would have been different!

“CHANGE IN TO YOUR GOWN AND WE ARE GOING TO START AN IV”

Between the birth of my son and the birth of my daughter I became certified as a Bradley Method® instructor. For my daughter’s birth I was fully aware that I had the right to ask informed consent whether posed as a question or a statement.So when I went into labor with my daughter and the Obstetrician stated “Change into your gown and we are going to start and IV” I told her I was fully aware of the pros and cons of IV’s and choose not to receive IV fluids.”  I also wore my own clothes, not the hospital gown.  I knew it was my decision.

 

SHOULDN’T EVERYONE HAVE THE RIGHT TO DECIDE

Here is the problem. Do you have to be a childbirth educator or go through a traumatic birth, first, to see the opportunity for informed consent? Shouldn’t everyone have the right to decide whether a procedure is best for them? Most people don’t even know it’s their right to ask.

If your care provider wants to do a procedure or a test you need to:

1.    Ask them to describe the procedure
2.    Ask for the risks in addition to the benefits of the procedure
3.    Ask if there are alternatives to this and also if the alternatives have risks and benefits.
4.    Most important ask if it’s okay to wait and do nothing at all.
5.    Then take time to talk about it and use your intuition before you decide.

You’re the one who has to live with the decision that is made, not your caregiver.

Here is what ACOG says about informed consent:

“Informed consent not only ensures the protection of the patient against unwanted medical treatment, but it also makes possible the patient’s active involvement in her medical planning and care.”http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Ethics/Informed-Consent

 Remember that often decisions are made in the best interest of the hospital or caregiver and not always in your best interest.  Ask for medical evidence of the need for tests and procedures. Then make your decisions WITH your care providers. Don’t let others make decision FOR you unless it’s a true emergency.