Image by Michael Bentley
Most women give birth in the hospital. That’s the current trend in the U.S. and many women feel safer in the hospital, for one reason or another. Some women, those who are high-risk, may need to be in hospital in order to give birth safely. Regardless, the women who birth in hospitals face special issues with informed consent: do you have to ‘consent’ to every procedure? If so, how? If not, why not?
Many women are under the (unwitting) delusion that once you are in a hospital, that you must submit to whatever procedures they recommend. This is usually not true, but it also depends on the pre-admit forms that you sign. Typically, though, you have the right to refuse any treatment that you do not want. Remember that.
What is Informed Consent?
Informed consent is the idea that you must be fully aware of the risks and benefits of a procedure, as well as other options in your situation, before agreeing to undergo that procedure. A doctor should provide you with:
- A diagnosis or description of the situation, if possible
- His/her recommended procedure or treatment
- The full risks and benefits to this procedure or treatment
- Alternative treatment options — anything available, regardless of cost or insurance coverage
- The risks and benefits of alternative options
- The risks and benefits of refusing all treatment
If your doctor does not provide you with this full set of information, and treats you anyway, or bullies you into saying “yes” (which is ‘consent’ but not ‘informed consent’), s/he may be charged with battery or negligence, and may face a malpractice lawsuit. Pay attention to that last part: even if you say yes, the doctor may still face disciplinary action or legal charges if the consent was not informed.
Many women these days are bullied into accepting procedures that are not always medically necessary. Often times these procedures or medications are administered by the nursing staff, without any contact with a doctor. This is illegal.
The prescribing doctor must come in him or herself and explain to you the treatment that is recommended and obtain your informed consent.
Why This Matters
Women are simply being told what to do during birth, many times. When a woman arrives at the hospital, she is often told “We’re starting an IV now.” If her labor isn’t progressing fast enough according to the hospital’s time line, she may be told, “We’re starting Pitocin.” These statements are made, there is no question asked — “Our usual procedure is to start an IV line. Are you okay with that?” And there is no additional information on the risks and benefits provided. Women are simply told “This is what we do.”
Women often feel bullied and pressured into accepting treatments that are not medically necessary. Interventions in labor are often a cascade effect. A woman has an IV started and continuous fetal monitoring “because that’s what we do,” so she is confined to a bed for the most part. She struggles to cope with the pain when she has to remain still and on her back, so she opts for an epidural. This slows her labor, so the staff announces “We’re starting Pitocin.” Her labor still doesn’t progress, and she ends up with a medically unnecessary c-section. There are several different ways this situation can happen besides this example, but the trend is the same: the hospital staff begins their “normal procedures” and women, feeling that they have no choice but to submit, do so and end up with a very different birth than they had anticipated — and not due to any medical necessity.
You Do Have a Choice
Even when you sign the pre-admit forms, which gives the hospital permission to treat you, it does not remove the physician’s duty to provide informed consent for each procedure that s/he would like to perform. If a doctor feels a particular intervention is needed, then, barring an emergency, s/he should sit down and explain to you what is recommended and why.
If someone comes into your room and announces “We are doing this now,” you do not have to allow them to. Instead, you might say:
- Who has ordered this? Was it my doctor?
- Can I speak to the doctor who ordered this procedure?
- Is this procedure medically necessary at this time?
- What are the risks and benefits of this procedure?
- What are my alternatives?
- What are the risks and benefits to having no treatment at this time?
If you are not satisfied with the answers, you have the right to ask for a second opinion…or to simply say, “No, I do not consent to that.” Be clear. Don’t say “I don’t really want that,” or “I don’t like that idea.” Say, “I do not consent.”
Unfortunately, the staff may become upset with you. They may roll their eyes, sigh, or say, “I’ll have to call the doctor and see if he’ll allow that.” They may try to say, “We have to, it’s hospital policy.” But you never have to consent to a non-emergency procedure that you do not want. Do not let them lie to you or bully you.
A good doula and/or other support may come in handy here. When in labor, you’re not in a frame of mind to stand up for yourself and to argue with those around you. Your support people can fill this role for you. Make sure that your support people are aware before you enter the hospital what you will and will not consent to (given a non-emergency situation).
This is a phrase that a lot of doctors throw around when advocating for hospital births, c-sections, and other medical interventions. These situations and procedures are sometimes necessary, but not nearly as often as they are performed.
You have the right, as a patient, to ask for evidence-based practice. “You’ve been in labor for 8 hours now,” is not an evidence-based reason for starting Pitocin, if you and baby are tolerating labor well. That would be for convenience of the doctor and/or hospital staff, or because it is considered “procedure.” This is not good enough and you do not have to submit to something just because it is “procedure.”
Throughout this month, we’ll be talking about more issues you may face with informed consent: doulas, midwives, newborn procedures, and lots more. We’ll talk about how to handle it when someone does try to bully you or talk you into procedures without medical evidence. This entire month is dedicated to putting you, as a parent, in control of your birth.
What do you know about informed consent? Have you run into situations where you weren’t given true informed consent? How did you handle it?
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