Informed consent is an important concept in pregnancy and childbirth. Decision making can be a stressful aspect of medical experiences. If you and your loved ones have the good fortune of being healthy, your pregnancy, birth, and well-child pediatric visits may present you with your first experiences making medical decisions.
All competent and oriented patients have a legal right to consent to or refuse medical practices. They also have a right to the information required to make an informed choice. This is a concept called “Informed Consent” or “Informed Refusal.” This article will teach you about the components of informed consent/refusal and provide some tips to help you make decisions you feel confident about.
Care Provider & Patient Roles in Informed Consent
During medical decision-making, it is the official job of your care providers to provide the information necessary for you to grant informed consent or refusal. It is the (unofficial) job of the family to be clear about what information they would like to have! While providers are familiar with the various aspects of information required by a patient’s right to informed consent or refusal, full disclosure is rare in medical situations. One primary reason for this, among others, is that common American consumers don’t have an interest in all of the details.
If you would like more information, you often must ask for it. Once you have gathered the information you need, clear decision making may be enhanced by time, space to process, and a sense of respect for your choices and your capacity to make a valid decision. Unless a situation is emergent you may always request time and respect or additional help from social work or non-medical professionals (such as clergy) as well as additional information.
Aspects of Informed Consent
In birth, fully informed decision making requires you to understand the most likely effects of a procedure or medication on the mother, the baby, and the labor. You also need to understand the potential risks, additional procedures necessary, alternative options, and the most likely result of doing nothing. The following five aspects are included in the legal definition of informed consent. The italicized questions may be helpful in eliciting the information.
- The diagnosis and the nature of the condition or illness calling for medical intervention. What’s wrong?
- The nature and purpose of the treatment or procedure recommended. What do you recommend doing for it? What will this procedure tell us or how will it help?
- The material risks and potential complications associated with the recommended treatment or procedure, including accompanying necessary procedures. How will this most likely affect my labor/mom/baby? Are there additional procedures that will be necessary? What are the potential risks of the procedure to labor/mom/baby?
- The feasible alternative treatments or procedures, including the option of taking no action, with a description of material risks and potential complications associated with choosing the alternatives or no action. Is there anything else we could try instead? What will likely happen if we don’t do anything?
- The relative probability of success for the treatment or procedure in understandable terms. Does it usually make a difference?
Gather Information Early!
Labor is rarely the ideal time to gather information to make an informed decision. Decision-making begins with prenatal care! Keep informed consent in mind and practice getting thorough information as you make choices concerning diagnostics, such as testing for gestational diabetes and group beta strep colonization. This will make the process familiar in case you face unexpected decisions during labor.
You can minimize labor decision-making by having conversations ahead of time with your care provider, childbirth educator, and doula about routine procedures during and just after birth and the most common birth interventions. Gather the information you need as you prepare a birth plan. It is not necessary to try to learn about the benefits and risks of every possible management tool in birth. If unexpected interventions become recommended during your birth, you can gather information at that time. Specific benefits and risks are dependent on the situation. Assuming you have a trusting relationship with your care provider, the factors affecting your decision will be most clear during labor. You may want to print this article and add it to your birth bag so that if you are faced with a difficult decision you can refer back to the recommended questions.
Tips for talking with your care provider
- Be considerate and respectful in your discussions. It is your job to treat your care providers as you would like to be treated and to set the tone for your conversations. Care providers on the defensive are much less likely to provide accurate information. If your care provider is defensive during prenatal conversations, regardless of your open mind and respectful manner, this is a red flag and finding a new provider is recommended.
- Ask for more information in the form of literature, evidence-based studies, and your care provider’s personal experience. Sometimes it is difficult for care providers to recognize the difference between the traditions/current trends of their field and evidence-based care.
- Once you have made choices or know your preferences, share your values, objectives, experiences, and special needs that led you to your desires. Care providers who understand your values and goals are much more supportive of your positions and considerate of your concerns. They will also be able to offer a more thoughtful professional recommendation if they know the core values that should be preserved as your unique labor and birth unfold.
**Note: If you are aware that additional time with your care provider will be necessary to ask questions or share your concerns/preference with her/him, it is courteous to call ahead and request a longer appointment. Care providers are less likely to be behind schedule first thing in the morning and after lunch.
Tips for making decisions during labor
- Give the ultimate decision to the laboring mom. Her involvement in making decisions is statistically the most significant factor in birth satisfaction. This can impact maternal wellbeing and bonding with your newborn. If her request is that a care provider or a loved one decides, respect her desire for the support of another’s leadership.
- Consider a period of rest before making a final decision. Getting in a tub of water, side-lying under the cover of warm blankets, or an injection of morphine or another pain medication can be useful if you do not have an epidural.
- Consider a vaginal exam. If you have not had an exam for a few hours or if the sensations of labor have changed since you last exam, it will provide you with information that may help you make a clear choice.
- Gather the opinions of your nurse, family, or others involved in your birth. It is your medical care provider’s job to provide accurate and thorough information, as well as a recommendation, but other’s may have perspectives or additional ideas that resonate with you. If you are considering an alternative suggested by anyone other than your doctor or midwife, it is beneficial to ask you doctor or midwife for their opinion on the alternative you are considering. You can always ask to talk to them again even if the initial decision conversation has past and they have left your room.
- Ask for time alone. Even if it is only for a few minutes, some space and privacy can help you find clarity about the decision.
- Apply decision-making methods that work well for you in other times, such as journaling, having a good cry, or visualizing each option going well.
- Try to avoid making non-emergent decisions out of desperation. Find at least two options that feel possible before choosing one.
Making Decisions About Pain Management
Work at coming to a point of confidence in your ability to handle the pain, rather than being in a state of panic, before making decisions. Find a place in your mind that accepts that you can do the work before you even if you don’t know how it will be possible. Focus on your awareness that you are okay and healthy. Once you reach that better-working place (excellent coaching may be essential) make your decisions between contractions rather than during a contraction. Whatever you decide, put all other options out of your mind for the next 30-60 minutes and settle into a rhythm given the choice you’ve made.
Informed Consent and Birth Satisfaction
Researchers have gathered data on women’s satisfaction with their birth experience. They have looked at factors such as: c-section vs vaginal birth, the use of pain medications, water birth, length of labor, and perception of pain. Interestingly, the number one most significant factor in satisfaction with birth is authentic participation in decision-making. Feeling truly informed, with your wishes understood and respected, throughout decision-making leaves your dignity in tact. It also validates you as a mother and everyone else as your support team.
Increased birth satisfaction is a remarkable gift of good informed consent practices. This memory, and the strength and beliefs you draw from it, may be a resource throughout life. Informed consent is one aspect of your birth story that you do have control over. Taking the time to learn how to elicit these good conversations and choosing to work with care providers who welcome them is an important foundation to set before you give birth.