Informed consent, informed consent, informed consent!!! It’s a major slogan of birth activists everywhere. Even most hospitals are getting in on it and including bits in their policies about making sure care providers obtain the informed consent of the woman before performing procedures on her. But just what is informed consent? What does it mean? How common is it? And are we all banging on about the right thing?
I’m going to go with no, we aren’t all banging on about the right thing. And it boils down to this: The term “Informed consent” implies that the client will actually consent. Once they are informed. It doesn’t leave room for the woman to decline the procedure. I would much prefer to hear everyone banging on about “Informed decision making”. Instead of seeking informed consent, care providers should be asking women to make an informed decision. This leaves room for women to decide to do something other than consent.
But let’s step back for a second and look at just what informed consent is. Wikipedia tells me that
“An informed consent can be said to have been given based upon a clear appreciation and understanding of the facts, implications, and consequences of an action.”
This makes me wonder: just how many women are being asked to give informed consent to maternity care procedures? I know that I was very rarely asked to give informed consent.
I was sent off for the 12 week nuchal translucency scan without being told that if it came back as “high” risk I would be recommended to have an amniocentesis. I was never told I could decline the GTT. I was never advised that anti-d is a blood product and that there are risks associated with receiving it. I wasn’t told that by having a “routine” sizing scan I could end up being called up to the hospital “urgently” to have CTG monitoring done because of “low fluid” (nor was I told what “low fluid” is).
When getting me to consent to an induction the doctor simply told me that if I went home my baby and I would likely die – scaring a woman into consent is NOT obtaining informed consent. I would suggest that consent gained by such unethical means is not any type of consent. So I was not encouraged to give “informed” consent at all.
So how do we become informed and just what constitutes an informed decision?
I hear a lot of women say “Oh the doctor suggested XYZ and I agreed with them so I made an informed decision to do it”.
Simply agreeing with your doctor isn’t making an informed decision. And, sadly, I also often hear these same women tell me that “Oh I didn’t know ABC could happen as a result of XYZ”, thus proving that the decision was not a fully informed one. Knowing that you could say no if you wanted, but deciding to say yes isn’t making an informed decision.
It’s important to know that you can say no. But if the doctor says “I’d like to break your waters. You can say no if you don’t want me to” and you then say yes this isn’t an informed decision. An informed decision requires you to have knowledge of the risks, benefits and alternatives to a course of action. It involves research. It involves getting in touch with your intuition and having a good think about what is truly best for you.
Informed decision making is a process and it takes time. If you have done some birth planning and prior research you may already have a huge amount of knowledge and be able to make an informed decision relatively quickly – but it still requires some time to apply that knowledge to the current situation.
I would also wonder if you can be said to be truly informed if you have only been given advice from one source – ie: your doctor / midwife / hospital. Particularly if that source has a vested interest in getting you to choose a particular course of action (such as if they wish you to be following a particular policy). Is it truly “informed” consent if your doctor gives you some information and then asks you to consent, on the spot, without doing any additional research.
As a university student I would be marked down on any assignment that was submitted with less than 10 sources listed. And I think that the birth of my baby is rather a bit more important than a 2000 word essay. In order for a decision to be fully informed you NEED to consult different sources. And they need to be sources that both do and do not support your hypothesis. Various sources you might consult include: midwives, Obs, research articles, blogs, your own family and friends You can learn a LOT from someone who disagrees with you – and these are often the most important (and challenging) learnings to achieve.
And what happens after you become informed? What if you now decide that you don’t actually want to give informed consent? That you would prefer to give informed refusal? This is where things get a little tricky. You see…no-one expects you to say no. And if you do they assume that it’s just because you’re not informed enough. Because once you are informed you’ll consent, right? This is where the terminology comes in. If care providers are focused on asking women to make informed decisions the way is open for that decision to be consent, refusal or somewhere in between.
So stop asking women to give informed consent. Stop asking care providers to ask for informed consent. And start asking everyone to look a little more at making an informed decision. The world can always use more thinkers!
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