What is Informed Consent?

Every woman who gives birth comes to a point of having to make decisions about that birth. It might be a seemingly simple decision: is it time to call the midwife, is it time to go to the hospital; or a very complex, difficult decisions: should we agree to an episiotomy, should we agree to a c-section. All of these decisions require information, and one of the ways patients in a hospital receive information is through informed consent.

The definition of informed consent is pretty straightforward. It has three main parts:

1) The patient must have the ability to give consent. Meaning, is she old enough, is she lucid enough, and does she understand.
2) Patients must be able to consent voluntarily. (They can’t be under duress.)
3) The patient must receive information. This means, according to the law, accurate information and full disclosure about their medical diagnosis and prognosis; the potential risks, benefits, and alternatives to the proposed treatment; and the risks and benefits of refusing treatment.
(The source of this list was Nursing2005, Volume 35, Number 3, pg. 24)

These seem straightforward, but as with anything connected with pregnancy, labor, and delivery, they are not. I came across this fascinating study in the British Medical Journal that talks about what happened in two hospitals when women were given an information pamphlet on ultrasounds. The study used “informed choice” as its definition, but informed choice and informed consent are synonymous. You can read the study at: http://bmj.bmjjournals.com/cgi/content/full/313/7067/1251/
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The gist of it is, the ultrasonographers thought the information pamphlets were biased and would cause too much anxiety in women. This is despite the data being based on findings of randomized controlled studies. There were to have been three hospitals in the study, but the ultrasonographers in the third hospital withdrew their support and refused to take part because: “Their objections focused on the credibility of the evidence reported in the leaflet (box 1); the likely effects on women's anxiety; reduced uptake of scans and disruption to the hospital's organisation; and reinforcement of ultrasonography's poor safety record as reported by some media (box 2).”

This study sums up many of the concerns about informed consent. Are women truly receiving “accurate information and full disclosure about their medical diagnosis and prognosis; the potential risks, benefits, and alternatives to the proposed treatment; and the risks and benefits of refusing treatment”? If you’ve ever had an epidural, were you told it could increase your chances of running a fever, which could lead to you and your newborn being treated like you have an infection, including a full sepsis work-up for the baby, including a spinal tap? Were you told that it would increase your odds of having a c-section? If you weren’t, than your rights of informed consent were not met.

In thinking specifically about VBAC (Vaginal Birth After Cesearean), when a hospital tells women they cannot even attempt a VBAC there, that is in direct violation of the second and third tenants of informed consent. There is no voluntary consent involved, and women who were given truly accurate information would know that VBAC is at least as safe as having a scheduled c-section.

Maybe you don’t care. Maybe you are okay with the doctor giving you just enough information to get you to agree to the procedure that your doctor truly feels is necessary. If that is the case, then you only need to say to your doctor, “I’ll do what you think is best.” The doctor might hem and haw, but she will give you an opinion eventually. Then just follow right down the golden path the doctor has laid out for you.

But for the rest of us, that isn’t acceptable. I choose to have a medical partner, not a surrogate parent. I want accurate, scientific data, then I will match and cross-reference that data with my values and experiences and judgements, then a decision will be made.