True Informed Consent

As a homebirth midwife, I’ve come to rely on the practicality of true informed consent as the basis for the care I offer to birthing families.

 I’ve found over they years that it’s so rare for most people to ever be exposed to the concept of true informed consent, that most have no idea what it even means.  In fact, I believe our world as a whole is experiencing a crisis around consent.  Lack of consent is a violation of each of our inherent and unalienable boundaries.  These violations have been coming to light on the world stage more and more often recently, so I have hope for the direction we are heading- and for the potential changes this kind of transparency exposes.

 We still have a long way to go to reach consensual practices within our larger community, as well as in the health care community.  Has anyone reading this ever gone into a doctor’s visit and left without all of your questions sufficiently answered?  Without a clue how common the side effects listed really are?  Unsure of whether their practitioner heard your concerns at all?  Having been badgered for refusing the treatment or medication proposed by your doctor?  Having been touched or examined without being asked?

 

So what is informed consent? 

Lets start by breaking it down.  I’ve done a bit of alchemy with a few different definitions I found from Internet dictionaries to find the following:

 The definition of INFORMED:

“Possessing, or displaying, or based upon reliable information.  Knowledgeable or educated.”

 So to paraphrase; informed means having ALL the relevant knowledge, education, and facts.

 

The definition of CONSENT: 

“Acceptance or approval of what is planned or done by another.  To permit or comply.”

 

Medical Dictionary Online states that Informed Consent means: 2. consent to medical procedures/treatment given by a patient after the potential risks, hazards, and benefits of the treatment have been explained.

 

In practical terms in our current health care system Informed Consent documents are considered the paperwork that practitioners have their patients/clients sign after discussing an option/procedure/test/treatment etc. to prove that the patient is indeed informed of the risks.  This form allays the practitioner of responsibility for consequences that come about from said treatment.  In our high liability and insurance-led healthcare system it’s no wonder that this paperwork is the gold standard for practice.  And indeed it is one of the necessary components to informed consent.

 

What is sorely lacking in the common presentation of IC, in my opinion, is a full overview of ALL possible risks that include all available statistics and studies- both absolute and in the practitioners own lifetime of practice.  Try going in to a hospital pregnant and asking your Obstetrician what the hospitals rate of C-sections is?  What their own personal rate is? Are we talking 3%, (the 20 year average for the birth center The Farm)? 10%? 30% (The US current national average?), 45%?  This information makes a huge difference for someone seeking to avoid unnecessary interventions in their pregnancy and birth experience.   There are some practitioners and some facilities that have come a long way in addressing concerns and questions like these in the past 10-20 years- but chances are you’ll be treated like an ungrateful, indigent, and unwelcome nuisance if you begin to ask questions like these in a setting like that.  And how can a pregnant person determine the actual risks of birthing with a specific practice if basic statistical information such as this is not made readily available?  If the person asking is often made to feel that they have no right to do so?  This system is not as much based on true IC as it is on CYA liability. And this is bad for everyone.

 In my own homebirth practice I take the meaning and the practicality of informed consent to a deepening level, way beyond the signing of a piece of paper.  This I call TRUE INFORMED CONSENT(TIC):

  •  TIC is completely free of any coercion or hidden agendas on the part of the practitioner.  The client/patient should be aware of the practitioner’s true and complete reasoning for proposing the intervention, including whether it’s based in liability/protocol/personal experience etc.

  •  TIC allows the client/patient the open option to decline or refuse whatever is being proposed without any backlash, belittling, or condescension on the part of the practitioner(s).

  •  TIC respects the clients/patients right to decline any proposal. Period.

  •  TIC honors each person’s inherent wisdom in navigating their choices for their own bodies, babies, and families. 

  • TIC recognizes autonomy as an inherent right of all people.

  • TIC respects the right of the client/patient to make their decision based on any form of intelligence they choose- be it intuition, emotion intelligence, rational thought, spiritual/religious beliefs, or any other.

  • TIC answers all of your questions to the best of the practitioner’s ability.  The practitioner identifies which information is unknown to the them and follows up with the client once the available information is garnered.

  • TIC is dynamic; it requires a practitioner to listen to the concerns of the client/patient and present the information relevant to those concerns

 

I feel honored each and every time, to experience the full wisdom and power of a birthing family standing in their own autonomy and choice- and I delight in offering them the widest and most accurate scope of knowledge and experience I have available for them.  I find that families often choose to decline quite a few of the options presented to them- when those options aren’t packaged as requirements, and that being a practitioner who offers true choice builds trust and rapport between birthing families and myself.  Ultimately this trust allows them to focus on their true work: bringing our next beings to the planet- and not on the stress created by a liability and intervention-based birthing system.  And offering TIC is better for me as well, I can release the need to be liability-oriented within my practice and focus instead on the unique desires and needs of each family I work with.  What a blessings this is!

 

True informed consent is essential to safe-guarding the passage of our emerging generation through their transition into life (for babies) and their transition into parenthood (for families!)  And WE have the ability to shift the trend by demanding TIC.  If our current practitioners won’t offer it we can let them know we’ll be finding new care, and why.  I’ve seen this begin a shift in the hospitals near my midwifery practice here in Boulder, CO.  The demand and education and autonomy of the people here have forced the healthcare providers to meet them at least in the middle. 

 

Here’s to bodily autonomy, true informed consent, and TRUE freedom!