Informed consent before employing any medical treatment or intervention is a fundamental human right (16). This process that requires that:
- You understand the risks and benefits of the intervention or treatment.
- Information about the risks and benefits of other options, including not getting treatment is provided to you.
- Your right to ask questions and get them answered to your satisfaction has been supported.
- You have had time (if possible) to discuss the treatment or intervention with family or advisors.
- The information you have been given has enabled you to make a decision that you believe to be in your own best interest.
- You share your decision with your doctor or treatment team.
The only exception to this requirement is in the case of an emergency. This means you are unconscious or the doctor needs to act quickly to save your life. Under these circumstances, doctors cannot be held liable even if you would not have consented to the treatment. You can state your wishes in advance by writing an advanced health directive. However, the staff must know this directive exists. Please provide a copy to your providers if this applies to you.
What makes it a complex topic?
During pregnancy and birth, the involvement of another human being (your baby) makes the informed consent process more complex, but no less compulsory. As an individual, it is your right to have the decision-making power over your body and by extension the baby you are carrying.
However, doctors, midwives and others involved may not share your ideas or beliefs and may advocate for the rights of your baby over your own. This aspect of having a baby is a potential source of conflict. Some women feel pressured into accepting intervention without the benefit of balanced information.
In situations such as these emotions run high for most people involved. Mothers are worried about the health of their baby and partners are worried about the mother AND baby. Clinicians are juggling all of the above as well as making sure they have done everything possible to have the best outcome possible for all. Including themselves. It is no wonder that under all these pressures women often feel that they have lost control of their own birth.
Why is informed consent important?
Women are often left feeling disempowered, a situation contributing to negative feelings about their birthing experience. This may have a lasting effect during the postnatal period, increasing the risk of postnatal depression, and can potentially lead to Post Traumatic Stress Disorder (PTSD) (17-20).
In situations such as this, there are things we, as individuals, can change. We cannot control how your doctor is going to feel, or what information he may present you with, or the words they use to gain consent or justify their actions. We have no say in how your labour will naturally progress. Even the most healthy and well-prepared women find themselves in situations they could not anticipate. We can only control our part in the process and realise that the consent buck stops with us.
The best way that we, as women, can ensure that we protect our right to informed consent is to educate ourselves and use it. Continuity of care, whether it be your midwife, GP or obstetrician is one way you can communicate your needs with your caregiver. If you have support people, involve them in your education and decision-making process.
Why not put together a birth plan -that way if you can’t communicate during your labour for any reason, they are aware of your wishes and can advocate for you. Whatever way you choose to approach this, do everything you can to make sure you go into this life event armed with balanced and evidence-based information.
Tips for informed decision making:
- Know your rights. You have the right to decline any non-emergency intervention or treatment. You also have the right to withdraw consent at any time.
- Ask for time without medical staff present to discuss the situation with your support people.
- What are the statistics – what is the evidence around what they are saying? Is it reliable and recent?
- Make sure you go into any situation well informed. Do your research before the event, or ask your doctor the following questions:
B – benefits?
R – risks?
A – alternatives?
I – what do I want to do?
N – what happens if I do nothing?
(S) – second opinion
You can give an informed refusal, by stating ‘I do not consent.’
Clinicians cannot legally perform any intervention or procedure without your consent, other than in a real maternal emergency. If your baby is in dire need of help while you are pregnant or during the birthing process, they will assume that you will want to do anything you need to in order to get your baby the help they need. They may be correct, however just because they assume rightly doesn’t mean they have the right to assume. Some women, for whatever reason, choose to decline intervention. While we may not understand it as clinicians it is their right as an individual. We, as health care providers, must support their decision without judgement and protect their rights as a human being.
Dr Janelle McAlpine (PhD), Clinical Midwife
Photo by nito, used under license from Shutterstock.com