- Is your doctor listening to you?
- Is she really answering your questions?
- Is he giving you all the information you need?
- Is your birthing facility telling you what you are “allowed” and “not allowed” to do?
- Are you feeling like an object instead of an active participant?
- Do you feel like you are being “steered” in a certain direction?
- Do you feel like you can say, “No” and be respected and not shamed?
A patient has the right to voluntarily consent to or refuse any medical treatment, procedure, or intervention.
The patient should be given up-to-date, evidence-based information, that includes the benefits and risks of each intervention, as well as the medical reason behind them. They should also be given the actual risk, as opposed to relative risk, of continuing without the intervention. The patient should be provided with alternatives and should have the freedom to choose options that may not be offered or recommended. The doctor should be a facilitator of this decision-making process, and all decisions should be made without coercion, pressure or fear-tactics.
This is informed decision-making!
The medical world was founded, and largely still functions, under a paternalistic model. This is a model in which the doctor has complete and unquestioned authority over the patient’s care and treatment. This has led to a problematic and systemic imbalance in power, and biases based on gender and race.
We now have federal regulations that protect a patient’s rights to autonomy, and the right to consent to or refuse treatment. There have been many organizations, such as ACOG, AMA, and WHO that have provided access to information to help patients make decisions about their maternity care, but often, what patients want and what doctors offer, differs. Sometimes doctors underestimate the patient’s desire to be involved in her care. Studies show that women of childbearing age want more information and participation in decision-making than any other age group.
It’s also important to remember that being pregnant is not a medical condition but physiologically normal. You’re not sick and don’t need to be cured!
We know that informed decision-making improves birth outcomes. Studies show that when women are fully included in informed decision-making, this has positive effects on the child’s health and well-being, often with long-term benefits.
What does informed decision-making look like?
During your pregnancy: Choose a provider and birthing facility that uses up-to-date, evidence-based information. Choose a provider that sees your values, beliefs and preferences as important factors in your care. Ask questions that help you understand the way your choices fit (or don’t fit) with the practice protocols. Watch for blog posts coming soon about questions to ask you provider and what to look for on a hospital tour.
If at any time you feel pressured, manipulated or coerced, this is a red flag that this might not be a provider who will respect your role in deciding your health care and the care of your baby.
Write up a birth plan with your doula. Go over all the interventions and learn about the benefits and risks. Get information on how each intervention is connected – often one intervention will lead to another. Take this plan to your doctor appointment and go over the details.
During labor: If an intervention is suggested, ask for the medical reason behind it, ask for the benefits and risks. Then ask for alternatives. Also ask for the statistics if you decide to continue without the intervention – sometimes the risk of doing something is greater than the risk of waiting. After you have all the information you need, ask for time alone to discuss with your partner and doula.
Informed consent looks like this: “Are you okay with me checking your cervix to assess what’s happening?” NOT this: “After you put this gown on, I’m going to check your cervix.”
Remember that the person with the most legal power in the room is YOU, the birthing person.
A note on the role that a doula plays in informed decision-making: a doula’s main role is to support you in having the birth experience that you want. A doula is there to get you up-to-date, evidence-based information, and to walk through the decision-making process with you. She is an objective person on the birth team who can help you slow things down, so you can focus on the details and find your voice. She will be there, quietly supporting you, without judgment, with her presence and a hand on your shoulder as you speak up for what you want – whether that is consenting to or refusing an intervention.
A doula is like a trusted friend who knows a lot about birth and is a calming presence in an unpredictable situation.