Consent: A Progression of Decision-Making in Birth

In this episode, I tackle the hot topic of consent in the birth space.

TRANSCRIPT:

Before we jump into the content on today's episode, I wanted to encourage you to head on over to www.birthwords.com, check out the new website and all the features there. You'll notice a few things. There's a Classes tab, where you can sign up for one-on-one video consults. And I'd love to meet with you that way, either for expectant families or birth professionals. Stay tuned, in a while those will turn into full fledged online courses, but for now, you can have the one-on-one if you sign up there. You can also check out the Shop tab which has birth affirmations cards that you can choose from the ones that speak to you or customize your own and order from there. And, if you use the promo code podcast for either of those purchases, you can get 15% off, so head on over to www.birthwords.com. Come and check it out.

Hi, welcome to today's episode about informed consent. This is a big phrase in the birth world. I know doulas who have T-shirts that say “informed consent is my jam.” And it's important and people are passionate about it, because it doesn't always happen the way that it should. I've talked a little bit about this topic previously. I'm thinking about my conversation with Rebecca Dekker that was aired on October 28. Go back and check that one out if you haven't. We talked a little bit about informed consent or informed choice in that episode. And it's a really important topic that we'll continue to touch on and dig into in upcoming episodes. Today I want to talk about this progression from no consent, to consent, to informed consent, to informed choice.

So, no consent, unfortunately happens in the birth space more than people would like to admit. Occasionally it makes headlines, but most of the time it doesn't. And most of the time, this looks like things like the nurse saying: “Okay, the doctor wants me to turn up your Pitocin," so she turns it up, not waiting for any sort of consent, not waiting for a verbal “Yes, that's okay.” So, I'm thinking of when you fly in an airplane, if you're seated in an exit row, they tell you the roles and responsibilities of being seated in that row and what you would need to be able to help with in the event of an emergency and the plane will not take off until each person and an exit row has given a verbal “Yes.”

And sometimes, in the birth space, that verbal “Yes,” is not waited for and it can have traumatic, long-lasting effects. I'm thinking of unconsented episiotomies--have a huge effect. And, just other things that are done during the birth process that don't recognize and honor a woman as a life-giving agent, engaged in a praiseworthy work, right? Somebody who's bringing new life into the world, who has carried this life within her own body for nine months, and is now emerging, and is now inviting that baby to be born, the birthgiver is playing a critical role in the ongoing drama of life. And, acting for her, acting upon her, without her consent is completely counter to the truth of the work that she is doing, and the beauty of it.

So let's talk about consent, then. We talked about no consent, let's talk about consent: "compliance in or approval of what is done or proposed by another." That's Merriam Webster, there: "compliance in or approval of what is done or proposed by another.” So still here, that agent, the actor is the care provider. Saying: “Hey, I'm going to do this,” but it does in this case, wait for that “yes. That's okay. You can proceed with that."

Still, with the power in the hands of the care provider, with the nurse or doctor or midwife being the one proposing or doing a course of action, and then leaving the role of the birth giver to be simply to consent, again, I argue does not honor the beautiful, life-giving, life changing work that she's doing in bringing that baby into the world. And of course, people will argue, and I will not disagree, that in some emergency situations, this is appropriate for the care provider to be the one really proposing the course of action. And, then we'll go into the next step of informing as much as possible, as much as emergency allows, and then moving forward with it.

In some cases, that's appropriate.

But in most cases, as I talked about in episode one and episode three, birth is typically emergence, not emergency, and sometimes we act as if it's the other way around. So, let's take another step forward into informed consent. Google says that informed consent is “permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits.” So, with this model, who is granting the permission? The patient. It's a step up in that the pat...