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Pregnant women who are going to give birth at a hospital may feel like will receive the most appropriate care, and have 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 is not, will help you have the best possible birth and the best possible agreement with your 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:
- You know your diagnosis
- Details of the proposed treatment — what it involves and what purpose it serves
- Knowing the benefits and risks of the procedure
- Alternatives to the proposed procedure, and knowing the benefits and risks of any alternative procedure
- Knowing what will happen if you opt not to undergo any treatment
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 working on maternity wards 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 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 to 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 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 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. Those women who would like a fully medically managed birth will usually (but not always) end up with that by default.