Informed Consent

If you know me, you know that my motto in labor is: Informed Consent Is The Only Consent.

Unfortunately, I've seen enough hospital "informed consent" documents to know that what they give you as "informed consent" is usually less informative than any consent requires.

These documents usually pose normal, unmedicated, vaginal delivery as risky and potentially harmful while putting "options" such as vacuum delivery, use of forceps, episiotomy, and cesarean section as the "safer" alternative.

I have a current client who just received her informed consent form from her hospital and could not believe that they wanted her to go ahead and sign away her consent for vacuum, forceps, episiotomy, and emergency c-section, in order to have a normal birth. She was not given the option to revoke consent to any of these procedures and was told that the form is "standard and required."

She was told that they are "conservative" with episiotomies and will "communicate" during delivery. What?! No, your provider should not be strong-arming you into procedures that are convenient for them, but you are not comfortable with. This form should have detailed the risks of each "alternative" option and not just list the risks for a vaginal delivery for it to be truly informed consent.

Additionally, your provider should NEVER begin doing a procedure without asking first and receiving consent. This is when a doula is SO important. Your doula will notice that the doctor is planning to perform an episiotomy, and knowing that you may have discussed in your prenatal visits with her that an episiotomy is not part of your birth plan, will ask you if that is something you want done now that you are in labor. She will then empower you to refuse the procedure. A doula cannot speak for you, but she can make the space for you to speak.

For example, Labor and Delivery

nurses may come in, trying to push a Pitocin drip, which you don't want but you are in the middle of a contraction and can't think while they are trying to get an answer right away. Your doula will hold that space and say, "my client is currently in the middle of a contraction, she previously mentioned that she did not want Pitocin, but I'd like to let her make this choice when she comes out of her contraction. Could you let us know the side effects and risks of beginning Pitocin right now?" Then, when you come out of the contraction and can process the question with all of the proper information (informed consent or informed refusal), your doula can say, "[Client], knowing all of the information, do you want to begin Pitocin?"

Remember, your doula is there to offer unbiased, non-judgmental support of your choices, but to also provide complete education so that you can truly be completely informed about your options so that you can make the choices that are right for you.

If you have questions about any procedure, consent form, or information that your care provider is giving you, do not hesitate to discuss with your doula. It's a good idea to write down your questions & any info you get during your prenatal appointments with your care provider and then to call your doula that same day. Informed consent is only consent when all the information is available and given sufficient time to process.