Informed Consent

Pregnancy Podcast – Q&A: Informed Consent

Why this episode?
I was not intending to feature the amazing Pregnancy Podcast again quite so soon but when I found this episode I knew I had to.

I cannot emphasise enough how important, vital even, informed consent is to having a birth experience which you view as both positive and empowering.

With that being said, let’s get right into this fantastic episode.

The episode
In the Q&A episodes (which tend to be a bit shorter) Vanessa reads out a listener question and then answers it using scientific research and evidence-based resources.

This particular listener does not feel that her care provider is answering any of her questions or obtaining informed consent before carrying out various procedures.

So, what is informed consent?
The American Medical Association outlines informed consent as follows-

”The process of informed consent occurs when communication between a patient and a physician results in the patient’s authorisation or agreement to undergo a specific medical intervention.”

When seeking a patient’s informed consent physicians should –

”Include information about the diagnosis, the nature and purpose of recommended interventions, the burdens, risks and expected benefits of all options.”

Vanessa delves into more detail from both the AMA and ACOG in the episode and also mentions that in a true medical emergency informed consent may well go out the window, at least until the situation is more stable.

Informed Consent & Informed Refusal
The North American Registry of Midwives outlines the components of both informed consent and informed refusal –

1. An explanation of the treatments and procedures
2. An explanation of the risks and benefits
3. A discussion of alternative procedures including delaying or declining testing or treatment
4. Documentation of any initial refusal by the patient and any specific recommendation by the midwife
5. That there needs be signatures on the consent form.

So, what does this all mean in practice?
Vanessa sees true informed consent as the patient or client having a full understanding of the procedure, including all of the potential risks and benefits and that they are given the choice of opting in or out of the specific treatment or intervention.

I love that Vanessa points out that of course, you can opt-out of absolutely anything; ultrasounds, blood glucose or Group B  Strep tests, but some tests and procedures will be such standard practice for your care provider that it may simply not occur to them to obtain true informed consent.

In short, it may not appear that you have a choice.

But you do. Always.

To wrap up
Ensuring you have all the information before making a decision or giving consent is such an integral part of a positive and empowering birth experience.

As a doula, I always talk to my clients about asking questions based on the BRAIN tool.

Your first question can always be –

”Am I or my baby at risk?”

If the answer is no then there is no rush to make a decision and you can begin gathering information so that any decision you do make is an informed one.

Benefits.
Risks.
Alternatives (and the benefits and risks of those).
Intuition (what is your gut telling you?)  
Nothing (do nothing for now – wait)

Even after you have gathered all of the information you need you can still ask for time to think about everything – and come up with more questions if necessary – before making YOUR decision.

And, to be very clear, this is not about you versus your care provider.

This is not about being an annoying or ”difficult patient”.

Your care provider should be someone that you trust and who is on board with the birth experience you are planning for.

They should also be someone with whom you can have open conversations and whose advice you value.

BUT, you and your partner are the ones who must, ultimately, make the decision that is best for you and your baby.

Do you feel that your care provider obtained informed consent during your pregnancy and birth?

How would you have wanted things to be different?

How did being asked for informed consent make you feel about your pregnancy and birth experience?

I’d love to hear from you.

Until next time!