Informed Consent.

Another term used frequently in our health system but often consent in the antenatal or birthing room isn’t as informed as it probably should be. I recall being 41 weeks pregnant with my first baby sitting in the Ob’s office as he informed me that being “overdue”increased the risk that my baby would be stillborn…therefore an induction was needed. But that’s where the “inform”-ation stopped.

Here’s what I wasn’t told;

Inform-ation
Informed Consent. Do you know what you are agreeing to?
  • Its actually really normal, particularly for first time mums to be “overdue”. In fact the normal gestation time for babies can be as long (some say longer) as 42 weeks
  • “Due dates” are also calculated on a 28 day cycle…yep I’ve never had one of those in my life. Mine are typically 35 days meaning I wasn’t overdue at all and would be quite well within the “normal limits” for some time yet
  • What “increased risk” of fetal death actually was. Evidence now says that the risk only rises after 42 weeks to 1/1000 and only 1% of women in Australia are still pregnant at that time. This also needs to be weighed against all the potential risks of the induction itself…
  • And there are many in fact.
These include;
  • Over stimulation of the uterus caused by prostaglandins that ripen the cervix. This can lead to fetal distress
  • Contractions that peak and get stronger faster than in natural labour
  • Increased stress on the baby as the uterus cannot relax between contractions
  • Increased need for epidural to counter the pain of the strong contractions. This can potentially prolong the first 2 stages of labour.
  • Increased risk of an instrumental birth (vacuum or forceps….or both)
  • Increased risk of Caesarean
  • Inducing a “near term” baby. This means baby’s age is actually 35-37 weeks but it can happen if “due dates” have not been calculated correctly. There can be developmental and medical risks for a near term baby
  • Medical risks of synthetic oxytocin; postnatal haemorrhage, fetal distress, water intoxication.Risks to the bub can include shoulder dystocia, brain damage, jaundice, neonatal haemorrhage, death.
  • Induction has also been linked to increased depression and reduced breastfeeding postnatally and even to greater incidence of cerebral palsy in babies.
With induction you also miss out on
  • The ability to move around freely. You will be connected to a monitor due to the stress on the uterus and baby. You will also be connected to an intravenous line. This can also cause discomfort.
  • Endorphins…natures pain relievers. Synthetic Oxytocin does not cross the blood-brain barrier. The brain therefore does not release the Endorphines needed to remedy the pain caused by unnaturally strong contractions.
  • The surge of Catecholamines. This gives mum the alertness and final burst of energy needed to birth the baby.

This information is crucial to any woman being presented with this option, but particularly in situations where there is no medical reason for intervening.  Reasons such as being “overdue”, having a “big baby” or the risk that the placenta is “dying” are simply not supported by credible evidence. *I need to say I am not against inductions when they are medically necessary or wanted by a woman. My point is that women need to have all the information to make a decision that is right for them*

Where does that leave us with informed consent? Maybe some health professionals cannot be trusted to present their patients with all the information needed to make an informed choice. It means that we, as women, mothers and consumers of this health system must seek out and demand this information.

Crucial Steps to Informed Consent

  1. Do the research. Educate yourself as much as you can on birth, options, interventions, choices etc. Take course. Hire a doula. Do whatever it takes to get educated.
  2. Ask your caregiver questions. Have questions ready for antenatal appointments especially as your “due date” gets closer. Get specific, know what you think should happen. Be prepared to challenge your caregiver and say no.
  3. Write a birth plan. This will be your greatest asset when you are in labour (see my article on “The most essential item to take into your birth”).
  4. Importantly you should use your BRAINS – you can get this resource for free by accessing my Free Empowered Mama Resource Hub.  Ensure that all these can be answered before an intervention is performed. Unless your life or your baby’s life is in immediate danger there is still time to be fully informed.

Informed consent is vital. When women report being traumatised during birth it’s their feelings of “not being heard”, “not knowing what was going on”, or “not having a voice” that contributed to that trauma. It is a health professionals responsibility to provide adequate information for women to make a decision. BUT it our responsibility to ensure that we probe for more and we challenge if and when it doesn’t feel right.

Have you been in a situation where you haven’t felt fully informed?

Don’t forget to download my free resource Use your BRAINS to assist you in ensuring you have all the info needed to make an informed decision.

References

Lothian, J. A. (2006). Saying “No” to Induction. The Journal of Perinatal Education, 15(2), 43–45. http://doi.org/10.1624/105812406X107816

Gu, V. et al. (2006) Intrapartum Synthetic Oxytocin and Its Effects on Maternal Well-Being at 2 Months Postpartum. Birth. Mar;43(1), 28-35. https://www.ncbi.nlm.nih.gov/pubmed/26554749

Dekker RL (2016). Labour induction for late-term or post-term pregnancy. Women Birth. Aug;29(4):394-8. doi: 10.1016/j.wombi.2016.01.007. Epub 2016 Feb 12. https://www.ncbi.nlm.nih.gov/pubmed/26879103

https://midwifethinking.com/2016/07/13/induction-of-labour-balancing-risks/

https://www.healthdirect.gov.au/informed-consent