Last month I "attended" a webinar entitled Informed Consent and Refusal in Maternity Care given by the Coalition for Improving Maternity Services. I always felt that there was something wrong about a care provider walking into a hospital room declaring, "it is time for your IV," and there is. Informed consent is not a declaration, it is a process of information dissemination (see below). Informed consent means giving the mom space to make an informed refusal (how many of us have attended births where mom's attempts to refuse an intervention have swiftly been pushed aside). The best part is that we all benefit when informed consent and refusal is respected, mothers, babies, AND providers. Please read the below handout prepared by the webinar presenters and pass this information along to your friends. Pregnant moms need to know that they are the decision makers. Healthcare providers can be sued for failure to obtain sufficiently informed consent (examples below).
Care providers should provide diagnosis, prognosis, and alternatives, including choice of no treatment.
Without true informed consent and refusal, empowered birthing is not possible. A big thank you to the Coalition for Improving Maternity Services for creating the below handout!
Informed Consent & Refusal in Maternity Care
Session Presenters: Tabaré Depaep, Esq.,Holly Goldberg, BA, PhD-c, Cordelia Hanna-Cheruiyot, MPH, CHES, CCE, CBA
The research supporting this educational activity is published in The Journal of Perinatal Education, Volume 18, Number 1, 2009, pp. 32-40.
What is informed consent and refusal?
Informed consent is a process of information dissemination. It involves providing the patient with sufficient, evidence-based information so she can make a decision that reflects self-determination, autonomy, and control.
It is a process of information exchange.
It is based upon involving patients in the decision making process.
Every pregnant woman has the right to make informed decisions about the care for herself and her fetus. Examples of judicial interventions that support patient rights:
Schloendorff v. Society of New York Hospitals, 1914.
Health care provider held liable for failure to get patient’s consent to surgery.
Salgo versus Leland Stanford Jr. University Board of Trustees, 1957.
Health care provider held liable for withholding information necessary for making an informed decision.
The essential components of informed consent and refusal
Numerous national and international professional associations promote patients’ rights to informed consent and refusal, including the American College of Physicians, American Medical Association, and March of Dimes, among others. The American College of Obstetricians and Gynecologists’ (ACOG) publication Ethics in Obstetrics (2004) included the ACOG Committee on Ethics’ statement on Informed Consent (PDF). This document details the following essential components of informed consent and refusal.
o Provider gives diagnosis, prognosis, and alternatives, including choice of no treatment.
o Provider is aware of and understands the patient’s situation/possibilities;
o Provider uses language that is understood by the patient;
o Patient’s consent is given freely, intentionally, and voluntarily.
Freedom of Choice
o Patient is free of coercion/free from outside pressures;
o Patient chooses among options and has the right to choose other than what is
o Patient gives provider the right to perform action.
The benefits of informed patient decision making:
Benefits for Providers:
Better patient/provider relationships
Enhanced trust in providers
Higher patient evaluation of providers
Increased patient recommendations of provider to others
Benefits for Patients:
Improved quality of life and physical and social functioning
Enhanced emotional well-being, increased sense of empowerment and self-esteem
Increased adherence to treatment plan and improved clinical outcomes
Shorter recovery periods
Benefits for Childbearing Women:
Lower levels of fear
Less depressive and post-traumatic stress symptoms after birth
More positive feelings toward newborn
About the Coalition for Improving Maternity Services (CIMS)
CIMS is a coalition of individuals and national organizations with concern for the care and well-being of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-, baby-, and family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs. CIMS is a not-for-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3). CIMS abides by the WHO-UNICEF “International Code of Marketing of Breast-milk Substitutes.”
CIMS Evidence Basis for the Ten Steps of Mother-Friendly Care (PDF), The Journal of
Perinatal Education, Winter 2007
The Six Care Practices that Support Normal Birth, Lamaze International
Listening to Mothers Surveys and Reports, Childbirth Connection
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© 2009 Coalition for Improving Maternity Services (CIMS). Permission granted to freely reproduce with attribution.