Getting Informed Consent

Source: NY Times

I'm extremely concerned with the lack of information given to parents before they are subjected to hospital protocols & procedures. In fact, this is one of the biggest reasons I became a doula. Informed consent is NOT just signing your name on a piece of paper. While that may be "consent," it isn't informed consent. The key? Patient education. As a doula, I do not make decisions for parents. I support their decisions. However, part of my job is to make sure that they feel confident in their choice because it will affect their overall birth experience.

Before consenting to any procedure or intervention, I encourage parents to ask the following questions.

1. What is the diagnosis?
2. Why is this a problem?
3. What are the risks to the proposed solution?
4. How will this change my care?
5. What are the alternatives?

The above questions help the parents to understand why a recommendation is being made as well as the risks and benefits of said procedure. However, I believe that question #3 is the most crucial. In childbirth, every intervention ultimately leads to something else. For example, even an epidural will lead to continuous monitoring, a catheter, and bed confinement. An epidural will also limit your position options for pushing. While these aren't necessarily risks, they do change how you have been cared for up until this point and would have been cared for if an epidural had not been chosen. (side note: I am not against epidurals. This is just one example of how a cascade of interventions can get started.)

Assuming there is no pending emergency, I would recommend the parents request some time to discuss this information. As a doula, I am available to answer questions or request clarification from the staff. If a decision is required right away, I would suggest the parents make a choice based on their first instinct. The options are always the same.

• Yes
• No
• Wait

It is extremely important that a mother knows she can say 'no.' She is delivering this baby. She is the parent. She gets to choose. Waiting is also a very acceptable answer. (side note: 'Wait' may quite possibly be my favorite answer. Sometimes things just need a tincture of time and they will resolve on their own. Not always. But sometimes.)

To further clarify what informed consent looks like from a medical perspective, the American Medical Association defines IC as follows

Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.

In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:

• The patient's diagnosis, if known;
• The nature and purpose of a proposed treatment or procedure;
• The risks and benefits of a proposed treatment or procedure;
• Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
• The risks and benefits of the alternative treatment or procedure; and
• The risks and benefits of not receiving or undergoing a treatment or procedure.

In turn, your patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention.

This communications process, or a variation thereof, is both an ethical obligation and a legal requirement spelled out in statutes and case law in all 50 states.

Parents, please make sure you are asking these questions before consenting (verbally or in writing) to any hospital procedure. It is your right to know!