Wednesday, July 1, 2015

Informed Consent in Maternity Care

Informed consent is the process where a healthcare provider discusses any procedure before it happens with a patient.  This includes discussing all the risks, benefits, and alternatives with the patient.  Informed consent is not only a discussion, but also typically involves some paperwork.  Some of this paperwork is signed during the pre-registration process, and even more is signed while you are in labor depending on the procedures that are being suggested for intervention or augmentation. 

So what’s the big deal about informed consent in maternity care? Not all providers are equal when it comes to the informed consent discussion.  We’ve even seen some providers who are absolutely horrible at it, even performing procedures without ever getting consent.  This has recently come to a BIG discussion in the birth community, with the case of a California woman who clearly did not consent to episiotomy while her provider proceeded to cut her. This woman is now suing her doctor for assault and battery in a landmark case!

Here are some great links for informed consent in maternity care:
1.      Research paper on informed consent & access to evidence-based research
2.      North American Registry of Midwives statement oninformed consent
4.      Use of the word ALLOWED when it comes to informed consent
5.      What the American Congress of Obstetrics & Gynecology has to say about informed consent

We always encourage our clients to do research about the procedures that might be suggested to them during pregnancy and birth.  We also encourage clients to be prepared for the informed consent conversations that will inevitably come up during the course of their care. The best way that you can approach conversations with your provider is by remembering the acronym B.R.A.I.N.


Ask these questions:
What are the benefits of this procedure?
What are the risks?
Are there any alternatives?
What is my intuition saying?
What happens if we do nothing?

As your doulas, we can also help you by talking about the research that we have done. We regularly try to keep up with the maternal medicine research that is constantly evolving, and we can tell you what we’ve found.  What we can’t do, is have the conversation with your provider for you or make the decision for you.

We want to help you make the best decisions for your care.  We want to make sure that the most recent evidence-based research is being used in your care as well.  We want you to have the best birth experience ever, but as doulas it is not our place to make decisions for you.  You have to be an active participant in your care, and being an informed consumer is one step along that path.  Providers have an ethical responsibility to utilize good informed consent procedures, but you also need to be a good healthcare consumer.  Being a good consumer means asking questions and making sure 

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