On Informed Consent and Refusal
I can’t tell you how many women I’ve met who are dissatisfied with their birth experience at some level and, even years later, still have regrets. Sometimes it’s because they didn’t understand what was being done to them. Sometimes it’s because they felt pressured by their health care provider to do something they didn’t want. Sometimes it’s because they had an outcome that, they learned later, probably could have been prevented if they had avoided a certain intervention.
I also know many women who trust their doctors implicitly, and while I never want undermine my client’s health care provider, I realize that the health care system is pretty dysfunctional and doctors are, unfortunately, motivated by many factors in addition to their patient’s well-being… but that’s a can of worms I don’t want to open right now. My point is, many women expect to walk into the hospital, have their doctor tell them what to do, and be happy with the results, and it very often doesn’t work that way. You have to understand the process of labor and the many medical interventions that may and probably will be suggested to you at some point.
If you don’t know your options, you don’t have any. Many wonderful alternatives to standard medical interventions aren’t popular with most doctors because they may take longer, bring in less money, or be less convenient for staff. And even though some procedures have been proven useless or even harmful, many doctors continue to recommend them routinely.
Did you know that your Health Care Provider must inform you of the following prior to performing a procedure?
- The nature of the procedure and how it is done
- Whether the procedure is new or experimental
- Why they recommend it for you (is it universally recommended, and why?)
- How it will affect you, your baby, and your labor
- The benefits associated with the procedure
- The risks associated with the procedure
- Any alternatives that are available (a doula may suggest many helpful alternatives)
- What you can expect your recovery to be like
- If it’s possible to delay the procedure
It is your legal right to get answers to every single one of these questions. It is your legal right to refuse any intervention (unless it’s an emergency, in which case doctors may do anything necessary to save you and your baby’s life). That’s why education is so important before you get the L&D Ward.
When facing a decision during labor, the BRAINED acronym is a great way to make sure you are giving informed consent- or refusal- to whatever intervention your doc is suggesting.
Benefits. Why is this good for me, my baby, and the progress of my labor?
Risks. What are the risks associated with this? What other interventions are likely to go along with it?
Alternatives. What are my other options? Is this a routine procedure, something that is universally suggested?
Intuition. Don’t underestimate the power of you gut. What do your instincts say?
Nothing. What if I do nothing? What if we delay this intervention?
Emergency. If this is an emergency and there’s literally no time for an in-depth discussion, try to talk with the staff as they work.
Discuss. Your Health Care Provider is legally required to give you and your support system (partner, doula, friend, or whoever you want) time to discuss the intervention privately. You don’t have to make a decision right then and there.
If I could get one message across to women, it’s that you are under absolutely no obligation to consent to an intervention you aren’t comfortable with or don’t understand unless it’s a true life-and-death emergency. I think many women feel as if they are inconveniencing and annoying their doc or have a fear of being “that” patient, but you have a right to get all the information necessary to make an educated choice.
Get educated before your birth. Make sure you have a strong support system, like a doula, who will help you understand your options so you can self-advocate. Remember BRAINED if your health care provider is recommending an intervention you aren’t sure about.