“I’m wondering why your labor seems to start and stop. A vaginal exam might give me a clue about why. We can also just wait and see, your baby is doing just fine. What would you like to do?”
This is what respectful care and informed consent look like in labor. It looks like a respectful, informative conversation instead of a directive. I never saw exactly what informed consent looked like until I met a midwife. She explained to me exactly what my options were, what the risks and benefits of each option were, allowed me to freely choose, and supported me in my decision whether she agreed with it or not. I wasn’t used to that type of medical care. I was used to not just recommendations, but being told what to do with my body. We forget, these are our bodies, our babies, our births. In a situation of true informed consent, the choices are yours, and so is the responsibility of whatever consequences those choices may have. We often hear the details about the possible consequences of what may happen if we don’t accept the standard medical treatment. Are we always told the possible consequences of what may happen if we do accept the standard treatment?
Recently I was at the doctor, and I was told I had cysts on my ovaries. I was told I had one option. Birth control. I told them every time I have taken hormonal birth control, it is mere days before I feel 100%, dangerously depressed. I was told, “If you don’t take birth control, you will have to deal with the pain. I’m not trying to scare you into taking it, but if you don’t, your risk of ovarian cancer goes up.” What about increased risks of breast cancer from prolonged birth control use? What about the toll of dealing with daily depression? Those risks weren’t discussed. Informed consent does not involve scare tactics. It involves a presentation or referral to current research. Options are presented neutrally as the facts and the statistics can speak for themselves. The belief behind informed consent is that when given a presentation of facts and options, a client can make an educated decision based on their own priorities, even if it is not the choice the provider would make.
This is your body. You have the choices, whether they are presented as choices or not. I used to allow the dental assistant to torture me with flossing my teeth at each appointment. I realized one day, “Wait a second, I’m paying you, and I really don’t want anyone else jamming floss between my teeth.” The assistant looked taken aback when she grabbed the floss and I politely declined. She told me she would be gentle and that it was part of their treatment program. I ended up giving in and letting her, because I felt pushed. Why push? Was that one flossing going to change the entire trajectory of my dental health? Was it critical that I be flossed? I said I didn’t want it. So in the same way, what are we doing to mothers when we take their power in labor by pushing them? When we take their power as mothers in regards to their choices about their babies? It never feels good to feel pushed into something we don’t want and women are at their most vulnerable during labor and as new mothers. Our job is to protect them, inform them, and honor their choices.
During my time as doula, I have seen plenty of times what informed consent doesn’t look like: