#METOO : Consent and Childbirth.

“It's time for a vaginal check.”

“I would like to break your water”

“Let's schedule your induction.”

What do these three phrases have in common? These are all things you might hear from the medical staff during your pregnancy or birth, but all three are missing something of critical importance. CONSENT! These three phrases are worded in such a way that consent is not asked for at all, in fact all three imply that consent has already been given. I've unfortunately been the victim of, and witnessed medical staff talk to women in a way that implies that consent has already been given, when proper informed consent was never actually given at all. What is most shocking to me is how often women undergo treatment, unaware that their fundamental right to informed consent has been violated.

So what is informed consent? 
Informed consent is not an abstract idea but it is a legal precedent that has been clearly defined. By law, “A care provider must not provide health care without an adult's consent”. Informed consent practices require your health practitioner to provide the following:

• Explain proposed treatment including:
  
  • The condition for which health care is proposed
    
  • The nature of the proposed health care
    
  • The risks and benefits of the proposed health care
    
  • Alternative courses of health care and the likely consequences of no treatment.
    
• Patient must have the opportunity to ask questions and receive answers about the proposed health care.
  
• Patient can give or refuse consent to proposed health care.
  
• A healthcare provider must stop or withdraw treatment if consent is later withdrawn by patient.
  

Although consent can be implied by cooperation, such as moving your arm for an IV, cooperation should not be confused with consent. Except for under very specific circumstances, no one is allowed to give or revoke consent on your behalf. Many people believe that when birthing in a hospital, signing consent documents waives your right to informed consent. This is incorrect. If there is a medical emergency and you are unable to speak, only then is your medical provider authorized to treat without getting informed consent.

Now lets take a second look at the three phrases that I started this post with. When these statements are made to a woman, it gives her the impression that there is no option, no permission to say no. I've noticed that medical staff choose these words very intentionally, and carefully in order to maintain cooperation within their patients. It's important for birthing women to be aware of this and watch out for it.

Why is informed consent important?
First and foremost, the idea of informed consent is rooted in the dignity and respect of the patient. Informed consent recognizes the basic human right to have autonomy over your own body, as well as parental rights to the healthcare of your children. Birth is an occasion you will remember for the rest of your life, and each pregnancy only has one opportunity to make this memory a good or a bad one. The decisions made during birth will have a lasting effect, not only on the mothers memories but also on the life and well being of herself, her baby, and her entire family.

With the Women's March taking place just a few days ago, and the #metoo movement still trending on social media, sexual abuse is being talked about much more frequently than ever before. One out of every six women is a victim of sexual abuse, and this abuse has lasting effects. For these women, feeling out of control or unable to say no can be a huge trigger. Yet, many do not understand how this can carry over into the birthing space. Lets think about this.. You have a woman, often being cared for by nurses and doctors they have just met, and those medical professionals are not freely giving them the option to say no. Sometimes this happens even when the interventions proposed are involving the most intimate areas of women's bodies, such as vaginal exams. When you think it through, it is easy to imagine how horrific this could make an abuse survivor feel.

I don't believe doctors or nurses do this on purpose. I'm sure things like cervical checks just become routine, and they are unaware of how their actions can make victims feel. However, we need to consider how our words (intentional or not) could affect women, especially victims, during childbearing and birth. Our words matter. Consent matters.

How do I acquire informed consent?
The first step for acquiring informed consent during birth starts when choosing a medical provider and a birthing location. Make sure your birth team knows how important it is to you to play a leading role in your healthcare decisions. Understanding informed consent gives you a leg up in receiving the care and birth you want. Make it a priority to choose a health practitioner who also values your role in making decisions. Secondly, taking a birth class may help you to better prepare for the procedures and interventions that may be proposed during birth. Most birth classes will cover the basic benefits, risks, and alternatives for commonly suggested interventions. Thirdly, it is important that you are ready to ask the right questions when an intervention is proposed. Remember the acronym BRAIN
B- Benefits- What are the benefits to this procedure?
R- Risks- What are the risks to this procedure?
A- Alternatives- What are the alternatives to this procedure?
I- Instinct – What is my instincts telling me?
N- Nothing- What would happen if I do nothing or revisit this procedure at a later time?

By taking a minute to ask the nurse or doctor these questions you are taking the ability to gain informed consent back into your own hands. Another tip I always suggest to parents is to ask for a moment to discuss the procedure in private after they have asked the necessary questions.


For those parents hiring a doula, you should be aware that a doula should never speak on your behalf. However, they can help you to obtain informed consent by reminding you to use the BRAIN acronym, informing you of risks, benefits, and alternatives, and empowering you to speak up about your thoughts and feelings on procedures being proposed. Doula's are a great way to ensure you receive proper informed consent about your birthing choices.

Informed consent is a cornerstone of good medical care. It builds trust between patients and physicians, it empowers parents, and it is a legal right to all. However, oftentimes it's importance is ignored. It's time for mothers and parents everywhere to share their experiences (good and bad), and to take informed consent into their own hands. As consumers, we can influence the degree of consent by the questions we ask, the research we do, and by the voices we have. Hiring your medical staff wisely, educating yourself, asking the right questions, and surrounding yourself with support will help to ensure you are given proper informed consent during pregnancy, birth, and parenting.