Making Tough Decisions Without All the Facts: How Inadequate Informed Consent Puts Childbearing Families at Risk

For further information, contact Melissa Maimann at Essential Birth Consulting. Making Tough Decisions Without All the Facts: How Inadequate Informed Consent Puts Childbearing Families at Risk WASHINGTON (March 10, 2009)

Imagine you are a woman in labor and your doctor tells you that electronic fetal monitoring is necessary to record your baby's heartbeat. Without any further information about the monitoring or its risks, you are given a consent form to sign. Believing the doctor is doing what is best for you and your baby, you sign. By neglecting to tell you that electronic fetal monitoring can result in labor complications and increases the need for cesarean surgery, your doctor has not held up his or her end of the informed consent process.

This shocking scenario plays out nationwide thousands of times a day across a range of procedures. The purpose of informed consent is to ensure that before a health professional or researcher does something to a patient's body, the patient must understand what is being done and give his or her voluntary consent. But in all aspects of medical care, informed consent can fall short of the mark. In the instance of childbirth, women and their partners may be asked to make decisions without being well-informed of the risks and potential outcomes that can affect moms and babies. .... A recent article published ... reveals how sub-par information provided by health care providers undermines the purpose of informed consent. This results in parents having incomplete information when making decisions with potentially grave implications, such as whether or not to use medication or submit to obstetrical procedures during childbirth. [Inadequate informed consent is] a major barrier to women benefiting from evidence-based maternity care.

- I have seen this many many times in hospital settings in this country. Most women do not give truly informed consent because their care providers only tell women what care providers want them to know. I believe most women would not sign up to the vast array of interventions offered on the "menu" if they really knew the risks, benefits, potential complications resulting from the intervention, and the lack of research that has been done (especially in the case of fetal monitoring) prior to the introduction of the intervention on a wide scale.

Why does it matter? It matters how babies are born. It matters for women and it matters for babies. Intervention in birth that is not what you signed up for, can lead to postnatal depression, birth trauma, being labelled "high risk" in your future pregnancies and births, complications in your current birth and future births, not bonding with your baby, breastfeeding problems, and the list goes on.

All women birthing in hospital, planning "natural" births - whatever that means to each woman - needs support in labour. Australia's caesarean rate is over 31%. Many NSW hospitals have caesarean rates of over 40%. Most women have a "high risk" label of some sort. If you want a successful natural vaginal birth, you need good support. The best support will come from a private / independent midwife.

Melissa Maimann, Essential Birth Consulting.