Wednesday, November 11, 2009

Informed Consent

Recently I missed a birth. I am a doula. I help guide women and their partners during pregnancy, labor and birth. I had been hired by a woman pregnant with her second child to insure that this time she would be informed of any procedures or options by the nurses and doctors during her birth so that she could make her own choices. This time, she wanted to be listened to and respected during the birth process.

But this birth, as often happens, had its own story to write. Her labor came so fast and furious there was barely time to get to one of our local hospitals before the baby zoomed into the world. I was left “doula-ing” via speaker phone as I raced down the road. I heard the baby’s first cry as I exited the freeway in Templeton five minutes from the hospital.

When I walked into their room, Mom and Dad were ecstatic as the doctor quietly finished sewing a minor tear and moved on to another woman in labor down the hall. The baby looked great. Mom looked great. Then I noticed she had an I.V. of medication running into her. I asked my mom what it was. She said it was her saline lock. I said no you are hooked up to an I.V. of medication. We looked at the nurse who calmly told us it was Pitocin and that it was standard protocol at the hospital for all moms. I was shocked. My mom looked shocked. Where was the informed consent?

When did it become OK to administer a drug to someone without getting their permission? This was not an emergency when fast action has to be taken. This patient wasn’t unconscious, delirious or out of her head. She was simply having a baby. Actually she had just had her baby. She was elated, alert and aware. She was completely capable of rationally saying yes or no to a medication given as a routine at a hospital.

The nurse became concerned and offered to unhook her from the drug, but half the bag was already in her system so my client chose to allow it to finish. Would she have said yes or no if asked, “Do you want us to give you medicine that can stop any excess bleeding that might occur?” We will never know because she was never granted that right.

In a study done in 1969 Hershey and Bushkoff came to the conclusion informed consent means, “the patient has the right to know the nature of, the risks and benefits of, and the alternatives to a proposed treatment or procedure.” The United States Court of Appeals ruled in Canterbury v. Spence in 1972 that it is a fundamental concept in American jurisprudence that “every human being of adult years and sound mind has a right to determine what shall be done with his own body.” This right has been supported both federally and on a state level. Further, the American College of Obstetricians and Gynecologists first publicly acknowledged the pregnant patient’s right to informed consent in 1974. This was followed by the International Childbirth Education Association publishing “The Pregnant Patient’s Bill of Rights” in 1975. So how can it be that 35 years later birthing women, such as my client, are routinely given medications or have procedures performed on them without even telling them it is happening let alone giving actual informed consent?

Jennifer Stover
Labor of Love Birth Education and Support

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