Most expecting parents want to be deeply involved in their pregnancy care, birth options, and postpartum care. They care about what is called in the medical world “informed consent”. In fact, based on a large-scale study from the ‘Journal of Perinatal Education’, 96% of surveyed pregnant women want to participate in the medical decision making. Yet, many mothers’ experience today is still the opposite: they often feel they “did not have any other options”, “did not know about their options”, or were told to follow doctor’s instructions without being informed sufficiently. So, let’s take a look what informed consent means, and what your options are to ensure you can make the decisions that are right for you and your baby:
The American College of Obstetricians and Gynecologists defines Informed consent as 1) the patient’s ability to understand and reason, paired with 2) adequate information and 3) freedom of choice.
This general approach does NOT change in pregnancy and labor – that means being pregnant or having contractions is not a reason for your medical team to assume you are not able to make decisions for yourself and your baby. Adequate information means you receive from your provider a comprehensive overview of benefits, risks, and alternatives. You always have the right to ask questions. You also always have the right to take time to reflect and think about your options. As a matter of fact, it is anchored in federal law today. Few situations in labor demand immediate action and, usually, there is at least a couple minutes to reflect and decide what you are most comfortable with (e.g., do I get the epidural, do I want Pitocin). Lastly, you do have the right (and freedom) to make the decision that’s right for you and your baby; it’s in your purview and even your partner cannot step in here. However, this one is the trickiest one.
Many doctors have clear views of what the next steps must be and are taken aback when they feel questioned. When I was pregnant with my first child, my water broke and I chose to wait instead of being induced (most labor starts on its own 24-48 hours after your water breaks). The medical team in the hospital could not have disagreed more, and I was questioned, coerced, and literally cornered in a small room for a couple of hours by a doctor and a midwife. I was neither given all information, nor did I have full freedom to choose from all options available. Let’s be very clear: This is the opposite of informed consent, and this happens ALL THE TIME! It may not be quite as obvious and forceful, but it more often comes in form of a friendly suggestion or offer from your doctor, such as a proposal for an early, non-medically necessary induction.
So how can you take charge of your medical decision making? Begin with these few steps:
- First and foremost, discuss options and scenarios with your care team early on. Preparation is really on your side for this one. Talk about things that your doctor or midwife does or does not do, how they approach challenges in pregnancy and labor. Assess how you feel about it – you also have the right to change your care team at any point if you don’t feel comfortable with their approach.
- Leverage Alimus and your Alimus doula to collect evidence-based data that helps you make informed decisions that you are comfortable with.
- Use the B.R.A.I.N. method before and during your birth: benefits, risks, alternatives, implications/intuition, and what if you do nothing
- When there is a decision to make, take time to reflect, unless it’s an urgent medical emergency – ask if it is. Sometime options are presented in a way that make you feel like you must decide immediately, but you may have those extra five minutes to consider and weigh your options.
If you want to learn more about Informed Consent, here are some resources: