• Abigail Mehrmann

How having a doula can protect your right to informed consent

Earlier this week, I came across this great post on Birth Monopoly about birth and the language of care--namely, that pregnant and laboring women are often told which things they are and aren't "allowed" to choose for themselves as part of the medical care they receive. As the article astutely points out, telling a mentally competent woman that she is incapable or otherwise not permitted to make decisions about her treatment is a violation of informed consent, "a legal, ethical standard which requires the provider to convey all of the information around a suggested procedure or course of treatment, and the person receiving the procedure or treatments gets to decide whether or not to take that advice."

We can make all sorts of assumptions about why this is and what it represents--why pregnant and laboring women are often treated as incompetent by their providers, why cesarean births in the United States make up more than 30% of all births when world health experts say the rate should be no higher than 10-15%, why the maternal death rate in this country is actually rising instead of falling, as it has in other developed countries. But for the pregnant or laboring woman, the more immediate question is, how can I reclaim my bodily agency in an obstetric setting?

Here is where a doula can help. One of the primary roles of a doula is to help laboring women ensure that their mental capacity and care choices are honored. Ideally, your doula will work with you to facilitate communication between you and your provider, ensuring that you have all the necessary information before you make any important decisions. There are proven benefits to this kind of support, not the least of which is a higher rate of maternal satisfaction with the birth experience.

I believe strongly in the power of partnership in an obstetric setting. At the end of the day, you and all the members of your care team want the same thing: a healthy mother and a healthy baby. But one crucial and too-often overlooked aspect of maternal health is respect for the mother's psychological needs, including the need to have her wishes validated and her choices respected. A care relationship that does not honor this is not a true partnership. In cases such as these, labor support can be critical.

Under the standards set forth by DONA, the organization under which I am currently certifying, I do not speak to care providers on behalf of the clients I serve. To do so would defeat the purpose of my work, as it would further the mistaken impression that you are incapable of making these decisions for yourself (and possibly get me kicked out of the delivery room). Instead, my advocacy consists of empowering you to find your voice and speak for yourself.

As your doula, I will..

  • Provide you with up-to-date information on evidence-based practices. While I do not provide second opinions in the manner of a qualified medical professional, I will make an effort to answer your questions to the best of my ability, backing up my answers with solid evidence and connecting you with resources for your own use. Nobody should ever expect you to make a major health decision without first informing you of the potential pros and cons. This especially applies in the case of blanket hospital policies! You are always entitled to an explanation, and you always have the right to refuse any treatment or intervention that you do not want.

  • Support you when you are faced with difficult care decisions during labor, including reminding you of previously discussed preferences or birth plans. My only agenda is to help you have a positive birth experience, whatever that means to you. I will not impose my personal opinions onto your decision-making process, trusting that you are able to synthesize the relevant information and make your own choices.

  • Remind you of your right to informed consent, especially if you feel rushed or pressured into making a decision without having access to the pertinent information and without adequate time to consider. Depending on the situation, I may ask you if you have any further questions for your provider; in a case where you feel rushed, I may ask you if you would like a little more time to make your choice--this is almost always possible except in the case of a true emergency.

Whether this is your first birth or your fifth, being aware of your rights as a recipient of medical care can go a long way towards facilitating a positive labor experience. In addition to hiring a doula, I strongly recommend taking the time to read up on childbirth (or, better yet, take a childbirth class), make a birth plan, and thoroughly consider the care that you would like to receive during labor. These lists of questions to ask your provider and questions to ask your doula are a great place to start. Finally, this detailed set of ethical guidelines from the American College of Obstetricians and Gynecologists explains the nuances of informed consent as it should be practiced in an obstetric hospital setting.

Bottom line: birth doesn't always go according to plan, but your bodily agency should always be respected. In a time and place of great vulnerability, advance preparation and support will help empower you to make that a reality.

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