When Doctors Don’t Listen: Informed Consent and Birth

When Doctors Don't Listen: Informed Consent and Birth

In August last year, a story emerged from the US about a woman named Kelly, who experienced a procedure during labour that she did not consent to.

Captured on video, Kelly is given an episiotomy – even though she questions the necessity of the procedure and asks for more time and despite clearly saying no. She was forced to endure a non-consented procedure that is not best practice or evidence based. You can read more about Kelly’s story here (trigger warning).

All over the world, women are repeatedly forced to undergo procedures and interventions during labour and birth that they would not necessarily agree to. Had they been given all of the information and been able to make an informed decision, their choice would have been ‘no’.

What is so shocking is how often women undergo such treatment unaware that a fundamental human right, that of giving informed consent, has been violated.

A study in Queensland revealed 26% of women receiving episiotomy were not consulted or informed before the procedure. A survey of over 1300 women showed that 96% of women wanted to take an active part in decision making. Yet it seems they are not.

What Is Informed Consent?

Informed consent is a process whereby your doctor/midwife (caregiver) is legally obliged to discuss the benefits and risks of any procedures or treatments with you. You as the ‘consumer’ have agency over the important decisions regarding what will and won’t be done to your body and your baby.

The information you should be given is:

  • A diagnosis and description of the situation
  • Recommended treatment or procedure
  • Risks and benefits of this course of action
  • Any alternatives available and the risks/benefits associated
  • The risks and benefits of refusing all treatment.

It is not considered to be informed consent if your caregiver has not covered these points yet follows through with a procedure without your consent, or has asked or demanded that you agree to a treatment before having all available information.

Why Is Informed Consent Important?

First and foremost, it is every woman’s right to have autonomy over her body and her baby at all times. The decisions you make about your birth options can have long lasting effects on the health and wellbeing of yourself, your baby and your family. Women who feel satisfied and in control of their birth experience are less likely to experience traumatic stress after birth. Ideally women should be valued as the key decision maker in their own care by all caregivers.

In Australia 97% of women give birth in hospital. Each hospital has their own particular policies around certain birth practices and women can feel that they must submit to whatever procedures are recommended or suggested. Most people are conditioned to accept that doctors or hospital staff are the ‘experts’ and do not feel comfortable questioning their authority to suggest or recommend procedures.

Arriving at hospital it is not uncommon to be shown to a birthing suite and be told a midwife will see how dilated you are and monitor the baby. A vaginal examination requires you to be on your back, which increases your pain levels. Admission electronic fetal monitoring requires you to be immobile and increases the use of continuous fetal monitoring during labour and the rate of caesarean section. While seemingly harmless procedures, they are often not offered as choices with the information about risks and benefits, and most women will comply, unaware they have not been given the option to decline.

Women can find themselves feeling bullied or coerced into agreeing to procedures they wish to avoid, such as induction or continuous fetal monitoring. They may be told if they don’t follow their doctor’s suggestion their baby’s life will be in danger. Consent is most often given, but it is not informed consent. Many parents in this vulnerable position either don’t know how to advocate for themselves or are under prepared to – practically, emotionally and psychologically.

How Do I Make An Informed Decision?

You can make a more informed decision by knowing the the following tips:

  • Know your rights. You do not have to agree to any non-emergency procedure without being given full information and you have the right to change your mind at any time.
  • Ask for time to make a decision without medical staff present. If people aren’t running around pushing emergency buttons then you have time to make an informed decision.
  • If your caregiver is pushing for a procedure and says there is an increased risk of poor outcomes if you do nothing, ask for the statistics. Evidence based practice means providing care that reflects the best research about safety and effectiveness of all tests, procedures and treatments.
  • Use your BRAIN to ask questions about proposed procedures so you can be fully informed before making any decisions:
    • B – what are the benefits?
    • R – what are the risks?
    • A – what are the alternatives?
    • I – what do I want to do?
    • N – what happens if I do nothing?
  • If at any time you are not satisfied with the information you have received you can ask for another opinion. Or you can give an informed refusal, by stating ‘I do not consent.’

What Happens If I Refuse?

You have the right to refuse any procedure or treatment and withdraw consent originally given, and your decision must be respected. It is your decision who you involve in your decision making process, whether that is your partner, doula or family and friends. If you decline the care or advice of your caregiver, you should not be abandoned because of your choice.

You may be asked to sign a refusal of treatment certificate acknowledging that you are taking responsibility for your decisions.

Tips For Getting Informed

  • Ensure you and your partner are as informed about birth as you can be. Independent birth educators can give you unbiased and evidence based information on your care options, as well as help you understand the birth process as a normal physiological event.
  • Write a clear and detailed birth plan. Your birth support team should be aware of your preferences during labour and birth so they can best support you.
  • Choose your caregiver and birth setting carefully. They should support your birth wishes and value your role in decision making.
  • Discuss your birth preferences with your caregiver during your pregnancy, rather than find out during labour that s/he does not support your choices.
  • Build your support team around your birth preferences. Experienced birth support people (doulas) can support you while you work through your options, although they cannot make decisions on your behalf.
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Sam McCulloch enjoyed talking so much about birth she decided to become a birth educator and doula, supporting parents in making informed choices about their birth experience. In her spare time she writes novels. She is mother to three beautiful little humans.

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