Okay.. before I begin.. do I have your permission to get a bit fiery around this topic? If so, please buckle in and come along for the ride, as this is a topic that continually rocks me to my core!
As a birth and postpartum doula, I am dedicated to educating women and partners about the need for informed consent as a basic and fundamental human right, particularly around pregnancy and birth.
Consent as a generalised topic is surprisingly broad, and much more than just a simple ‘yes’.
However ‘Consent’ by definition, according to the Collins Dictionary (online), is merely “to agree (to do something); to willingly engage in…[something]; or to give permission, .. or approval [for something to happen]. (www.collinsdictionary.com/dictionary/english/consent)
Consent can be given verbally and can be written; it can also be implied – which essentially means, you’re showing signs that you consent to something happening for example, you arrive at the hospital for an antenatal appointment, where the midwife says she just needs to check your blood pressure, so you roll up your sleeve and put your arm out for her to do so. A blood pressure check is minimally invasive, and therefore very low-risk, however there are far more significant interventions that happen in the lead up to, during and after birth, that carry more risk, and therefore require a lot more information sharing and a thorough understanding on the part of the woman, in order for her to make an educated decision. In fact, informed consent doesn’t start when a woman is birthing, no, it starts as soon as she finds out she’s pregnant! It’s also noteworthy to mention that just because you consent to something in your birth plan or during birth, doesn’t mean it’s set in stone – you can change your mind at any time!
Birthing women shouldn’t be THINKING during labour, they should be sinking deep into themselves, not worried about the outside world and what’s happening around her; that’s imperative for keeping things moving! (I’ll write all about that another day!) They should be investing their time (and money) into a reputable evidence-based and woman-centred antenatal education program that thoroughly goes into detail about all the different interventions that may be suggested during pregnancy, labour, birth and early postpartum, as well as how birth works and how to cope during labour etc. (Again, I’ll talk about this another day!).
Obstetricians, Midwives and any other healthcare provider present in the pregnancy and birth journey, should not just be saying things like “hey I’m just gunna do a vaginal exam to see how far along you are okay?” or “I’m just going to do a little cut to help baby along as she/he seems to be a bit stressed”. Although I know for a fact it happens day in, day out in the hospital system. It’s just not good enough, and countless women are suffering at the hands of such treatment. Of course a mother is going to consent without much of a thought for her own wellbeing, when she’s feeling vulnerable and exposed with her legs up in stirrups and she’s being told her baby is stressed. These practitioners actually have a legal, ethical and professional obligation to provide all the relevant information including risks, benefits and alternatives, so that the pregnant woman is able to make a well-informed decision and give informed consent or informed refusal, based on their own unique circumstances. It would be remiss of me to omit the fact that sometimes baby’s do really need to be born quicker than desired, however the woman should still be given some more information than what is currently being given in such situations.
There’s a very important document that I want ALL birthing women to be made aware of so I’ll link it here for you! Please print it out, familiarise yourself with it and take it to your birth.
The document is a position statement on Maternal Decision-Making, by the Australian Medical Association (AMA) [the peak professional body for doctors in Australia]. The document can be found here. It contains 10 key points, that are woman-focused, pertaining to consent and decision making in the birth space. Two of the key points are as follows:
5. “Doctors play an important role in supporting pregnant women to make fully informed health care decisions by providing advice on the risks and benefits to both the woman and the fetus of lifestyle and medical treatment options. Doctors should provide women with opportunities to ask questions and express concerns over the advice given. In many cases, these discussions may also involve the pregnant woman’s partner, other family member, or support person.”
9. “The doctor must respect the woman’s informed decision, even if not consistent with Drs advice, and continue to provide patient support. In the event that the doctor cannot in good faith continue to care for the patient, the have a duty to make timely arrangements for that patient’s ongoing care”
As I’ve recently been learning from Vicki Hobbs, from the Doula Training Academy, when a woman is presented with all the relevant information that is delivered with transparency, respect and trust, then can give informed consent or informed refusal.
What happens more commonly, is that mis-information is delivered in a manipulating, coercive and bullying manner, which only leads to what’s dubbed as informed compliance; so essentially women are left feeling like that’s their only choice and that by doing the opposite of what the practitioner is advising, they’re going to end up with XYZ happening. As disgusting as it is to hear, you would also be surprised to know how often the ‘dead baby’ card is pulled on women who try to refuse certain interventions.
Now I know I’m not painting a great picture of the hospital system.. to be fair it really isn’t great, however It’s still possible to have a beautiful hospital birth; I’ll get into that another day! (You may like to check out my own birth story here!)
So, to end this long ranty (but hopefully helpful) blog post, I’ll just say that knowledge really is power; if you want to walk away from your birth, feeling like you had a beautiful and positive experience, then it isn’t enough just to wing it and hope for the best!
You need to:
- Invest in decent antenatal education
- Know your rights
- Get your partner on the same page, or find a support person who can be!
- Work with a birth worker to create a thorough birth plan (or birth preferences list) that details what you will and will not be okay with during labour and delivery.