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Welcoming a baby is exciting, but labor and birth can provoke sticky medical and legal situations sometimes. Here, we explore patient rights and the meaning of informed consent.

Pregnant women who are planning to give birth at a hospital may feel like will receive the most appropriate care, and can rely on the safety net of modern medicine to ensure a good outcome. They may also, however, feel like they are on a conveyor belt of births where their own needs and wishes matter little.

 

Knowing what informed consent is, and what it is not, will help expectant mothers have the best possible birth experience and the best possible agreement with their healthcare provider.

What Is Informed Consent?

Informed consent is a legal phrase that has been around since the 1950s. It reaches far beyond simply submitting to whatever your doctor or other members of your medical team suggest — giving informed consent means fully understanding whatever medical interventions you will undergo before consenting. According to the American Medical Association, informed consent requires:

  • That patients are fully aware of their diagnosis
  • That healthcare providers explain all the details of the proposed treatment — what it involves and what purpose it serves
  • Knowing the benefits and risks of any procedure patients are consenting to
  • Healthcare providers to offer alternatives to the proposed procedure, and knowing the benefits and risks of any alternative procedure
  • Healthcare providers to explain what will happen if a patient opts not to undergo any treatment (or, in other words, if they refuse the treatment the doctor suggests)

The American Medical Association goes on to advise physicians to allow the patient to ask plenty of questions in order to be able to understand proposed procedures properly before agreeing to them. It also suggests the use of consent forms, which is common practice in hospitals. Consent forms will be often be presented in a template format. It is important for patients to understand that they don't have to sign consent forms as they are handed out, and that you can cross out parts or make additions before signing — in consultation with your doctor(s).

How does this apply to a labor and delivery? Many medical conditions that require treatment are not quite as urgent as labor and birth (which doesn't have to be a medical situation at all, of course). Because labor and birth can move very fast, and complications can arise quickly, you usually don't have as much time to ask questions and discuss treatment options.

Some of the issues that may come up for laboring women are:

  • Labor induction or augmentation with medications such as Pitocin
  • Artificial rupture of membranes (AROM), or the breaking of your bag of waters
  • Pain relief, including epidural anesthesia — which can, keep in mind, facilitate a speedy emergency c-section if necessary
  • Electronic fetal monitoring
  • Episiotomy, or making a cut in the vaginal wall
  • Cesarean section
  • Assisted delivery with forceps or vacuum
  • Interventions for your baby following birth

Obstetricians/gynecologists and other medical professionals who work on maternity wards in hospitals see all kinds of often dangerous complications every day, as well as many smoothly proceeding labors and births. They may have settled into a routine that is comfortable to them and that purely focuses on maximizing the chance of a good outcome (healthy mother, healthy baby or babies), and they may not pay as much attention to informed consent (and refusal) as they should. You, as the laboring mother, may not have time to make informed decisions.

To facilitate informed consent in some of the more common issues that crop up in the course of a labor and birth, I suggest that all pregnant women read up on possible complications in advance. The internet will certainly help you with this, but it is (as always!) important to stick to proven, scientific sources of information.

Women who already have a good idea of what they do and do not want during labor and birth can express their preferences in advance by creating a written, one-page birth plan for their doctor. Let's say that you would prefer a natural birth without induction, augmentation of labor, or an episiotomy. You can write this down and discuss the situations in which your preferences would not be able to be honored in advance.

During labor and birth, it is usually the mother's wish to have a natural childbirth that presents a problem in the context of informed consent, since hospital staff tend to favor the quick interventions that they feel result in the most predictable outcome. Those women who would like a fully medically managed birth will usually (but not always) end up with that by default, and are therefore likely to be happy with the care they receive.

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