Consent means to give approval for what is done to you, the patient, by another person, the provider. In form, consent implies education and clarification so both parties have a good understanding of the procedure, its risks and benefits and any alternatives for meeting the same need. The patient is the one who either gives or refuses their consent for any given procedure. Giving one's consent requires education on the part of the patient. Everyone must take responsibility for his or her own well being, especially in today's health care market. All too often, hospital informed consents are signed in labor when women are in no condition, mentally or physically, to understand what they are signing. At our birth center, the informed consent papers were included in the family handbook, which every family received on admission. At the early pregnancy class when most patients were still in the first trimester of pregnancy, the nurse midwife would spend about 30 to 60 minutes reviewing the consent forms. Patients were encouraged to study the forms at home and discuss any questions with a nurse midwife on subsequent prenatal visits where they would eventually sign the form. Patients should never be intimidated or afraid to ask questions. Too often, I have seen patients sign consent without really investigating whether a certain procedure was necessary or learning if there were any alternatives from what was being suggested. Remember that medical opinion and standards of care are constantly evolving. What is involved today and considered to be essential treatment may be outdated tomorrow. Case in point is newborn jaundice. Only a few years ago, every newborn with a bilirubin level of 12 or greater was given phototherapy and mothers were encouraged to stop nursing. Today we know that full term newborns can handle newborn jaundice at much higher levels without therapy or interruption of the nursing process.
The informed consent in a birthing center is different from any informed consent that I've ever seen developed. First, it explains in detail what the birth center is capable of doing and what it is not capable of doing; the kind of situations it can handle and the kind of situations that will need hospitalization. It has a glossary that explains all the words that you might not understand; it's like a little dictionary. It has a list of responsibilities, the things that are your responsibility in your care during pregnancy, birth and after the birth, and the things that are the responsibility of your caregiver, your doctor or your midwife.
If there is anything you don't agree with in your informed consent, you have the right to change it. You simply do this by underlining the section that you want to change, making your change and then initialing it along with the initials of the care giver, indicating they have agreed to that change. You have to inform your caregiver of any changes you make in your informed consent, so that she/he can understand the change and agree to it. For example, you may say under no circumstances will I go to the hospital. The informed consent will say that if there is a problem, you are going to be transferred to the hospital where they have all of the equipment to care for problems. Your caregiver is not going to initial that. She/he has the right to take you to the hospital to give you the best care for your problem. So you do have the option of changing what is written in your informed consent if your caregiver is also in agreement with the change. Once you have signed an informed consent, you have agreed to it and it becomes a legal document.
The International Childbirth Education Association (ICEA) carries a wallet size card by Penny Simkin "Questions to Ask When a Treatment or Procedure is Recommended." For information on ordering please contact ICEA Bookmarks at 800-624-4934.