Informed consent during pregnancy and birth

Pregnancy can be uncharted territory for first time moms, or even moms who have had traumatic births. How is this going to go? What will happen at my appointments? There is a whole human being growing inside your body. But, the important part to remember is… That baby is growing inside YOUR body. People still need to ask permission to touch you. Every. Single. Time. They need to clearly explain procedures, tests, and treatments so that you may make an informed decision and give them a confident yes OR no answer.

Informed Consent

Informed consent is enthusiastic and ongoing.

And if any provider pulls the ‘dead baby’ card if you say no or request more time, you have every right to – and 100% should – turn them in to their governing board for review. That phrase should be removed from every provider’s vocabulary. Granted, I have participated in emergencies where that was a very real possibility. But it’s explained and addressed FIRST. I.e., your baby’s umbilical cord is prolapsed (has come out through the cervix before baby’s head) and we need to have a cesarean ASAP to save your baby. Having a provider suggest an induction for convenience then saying your baby might die if you don’t agree? Not so much. That is coercion.

Here is a description for a journal I found. It’s lengthy, but very detailed.

Informed consent should happen before someone touches your belly. Informed consent should happen before cervical exams. Informed consent should happen before medication is given to you either orally or in your i.v. (or any other route). Informed consent should happen anytime something is suggested to you – there is absolutely no part in your care where providers get to do what they want to your body without explanation.

B.R.A.I.N.

In response to a provider educating you on a possible intervention, procedure, or care plan, you can use this easy to remember pneumonic to process the information given.

For example, let’s say your provider is recommending breaking your bag of water (artificial rupture of membranes) in early labor “to help things progress”. Let’s walk through that together using B.R.A.I.N.

Benefits: What are the benefits of breaking my bag of water? It could speed up labor.

Risks: What are the risks of breaking my bag of water? It increases my risk of infection, it starts the “timer” for how long I can labor before a cesarean is recommended, it can make the contractions more painful related to removing that cushion of fluid inside my uterus.

Interventions: Are there any other interventions we could use to speed up my labor? Walking, the Miles Circuit, curb walking, nipple stimulation, medications, etc.

Intuition: What does my intuition say about breaking my bag of water?

Nothing: What happens if I choose to do nothing right now?

Pulling it together

I hope this was a helpful explanation for you! So often I believe we think that because we’re seeing a provider to manage our pregnancy, they have rights to our body they wouldn’t otherwise and that just isn’t true.

Respecting your body and your space goes for any healthcare worker. I remember once I told a patient “I’m just going to check your fundus for firmness” and her husband shot his arm out over his wife and said “she is the boss of her body” and that was such a huge conviction for me! I hadn’t even realized I stated what I was going to do that I completely forgot to ask for permission to touch her. I’m so grateful for her husband’s correction, and I always remember to ask permission before touching a patient. Just because I am assigned to their care team does not give me rights to touch or assess anyone without permission.

Consent covers your baby, as well. Members of the care team should always ask for permission to check on or touch your baby. If they don’t, remind them they need consent before moving forward.