Informed Consent and Bodily Autonomy in Birth - Words from a Buffalo Birth Doula

I hear all the time that women have had birth experiences where they didn’t feel heard by their doctor. There are varying levels of trauma involved with not being heard or listened to while giving birth, and I have seen many of them first hand in my work as a doula. Because birth is such an intense experience both physically and emotionally, it is especially important that the birthing person feels safe, supported and in control. Of course there are many parts of birth that are out of the control of the woman in labor, such as how long her cervix will take to dilate, when her water will break, etc. This should not be used as an excuse to remove the woman as the sole decision maker for herself and her child. Doctors and midwives have extensive education that makes them experts at managing the medical part of the birthing process, however working with a doctor should be a partnership, not an authoritarian experience.

Every mom, doula, or doctor will say that a healthy baby and a healthy mother are the first priority. I certainly am not here to argue with that, however I do want to challenge people to expand their understanding of the concept of a healthy mother. I’ve been trained as a mental health practitioner so I work under the assumption that mental health is just as important as physical health and often forget that it’s not how everyone sees it.  Women undergo this amazing transformation when they become mothers and their mental health is impacted just as significantly as their physical health. The huge rush of hormones associated with childbirth as well as the intensity of the experience really make a huge impact on a mother’s emotional health. The biggest predictor for how a mother feels about her birth experience is how much control she had over decision-making and if she felt like she had control over her situation.

There IS room for a mother to be a part of her birth experience in a meaningful way. This means including her in decision-making that goes beyond explaining what is happening to her as it is happening. Good medical care isn’t mutually exclusive of a respectful and empowering birth experience. It seems as though there is this idea that we should accept when doctors do not respect a birthing women’s autonomy as an excuse for providing good medical care.

Informed consent is a crucial component of high quality medical care. Let’s break down the idea of meaningful informed consent. I think this is probably the easiest to do if we work backward. Let’s start with the minimum standard, which is just straight up consent.

Consent: to give approval : to agree

When you receive medical care, there is a minimum standard that doctors must receive consent before moving forward with any medical procedure.  This is why you have to sign so many papers when you are admitted to the hospital for birth. You should be verbally consenting to everything that you haven’t signed a form for. You should also be given the opportunity to consent or decline to things that the forms have covered. Everyone’s birth is so different and you do have a say in every decision made regarding the health and well-being of you and your baby. Things change. A birth might start one way and end another. Often routines happen in the hospital because it is the habit or routine of your particular doctor or nurse. This doesn’t mean it is hospital policy or evidence-based.  Also, you are also allowed to change your mind. You might say that you want an epidural, but if the sight of the needle frightens you when the anesthesiologist comes in, you can back out. Remember you can withdraw your consent.

Informed Consent: “have or show knowledge of a particular subject or situation.”

Let’s take this idea one step further. Now you know that consent means you have to agree to a procedure. The standard in medical care is that you should actually give informed consent. This means that your doctor, midwife, nurse, etc. should give you evidence-based information regarding the procedure to help you make an informed decision that you are confident in. With exception of true emergency situations, there should be room for discussion of the benefits and risks of a procedure, even if the procedure is seemingly simply like an antibiotic. If you are someone who likes a lot of information before you make a decision, then I suggest finding a provider who is not only receptive, but supportive of you being an active participant in your pregnancy, postpartum and birth.

I hope to write more in the future about patient’s rights during birth and other topics related to mental health. For now, check out my other bog posts including Empowered Hospital Birth Series Part 1: Advocating for Yourself.