Informed Consent in a Hospital Setting

Consent is often discussed in sexual circumstances, but the term "informed consent" when it comes to pregnancy, labor, and birth is often misconstrued and misunderstood. So what exactly does "informed consent" actually mean? 

Let’s break this down simply: according to Webster’s dictionary, informed means "having  information: based on possession of information." Consent is defined as "to agree to do or  allow something: to give permission for something to happen or be done." Therefore, informed consent means to agree to an action based on all the available information. Seems logical,  right? Well, this is where it gets sticky. 

Unfortunately, birth, as we know it today, is based on cultural norms rather than evidence, which you can read more about from Dr. Rachel Reed here. Meaning, there are common practices in birth that occur not because it is the best choice for birthing person and baby, but because it’s what is seen as normal. These normal practices can have negative effects on the birthing person and baby, but they are disregarded for various reasons. 

With that in mind, obstetricians do not always do what is the safest choice based on evidence,  instead they put money and time at the top of the priority list and do not ask for true informed consent, thus taking control of the birth out of the birthing person’s hands. In a hospital setting,  a care provider may believe they’re asking for informed consent, but fall short. This often looks  like "I’m going to do a cervical check now, okay?" Instead, what should happen is a  conversation, something more along the lines of: 

Obstetrician or Nurse: Hello, is it okay if I reach my hand into your vagina to take a cervical check with my two fingers? It may feel uncomfortable. The reason I would like to do this is to mark your dilation and effacement progress on the chart. Cervical dilation does not predict how soon the baby will come. If your water has broken, there is a higher chance of infection for both you and baby with every cervical check done. With this information, is it okay for me to perform a cervical check? 

Notice that the care provider greeted the person, explained what they do during the procedure,  how it may feel, reasons why they want to perform the exam, and the risks if performed. It’s probable that the birthing person would like to think about their answer given all the information they now have. Here’s the thing, doctors don’t feel they have the time or resources 

to go through this every single time they want to do a cervical exam or any other procedure.  Note that in a hospital setting, cervical exams are typically often offered every 3-4 hours because obstetricians want the cervix to dilate one centimeter every hour, this is called the  Friedman’s Curve. Doctors are often overworked and hospitals are understaffed, thus wanting birth to go as quickly as possible so they can move on to the next birthing person.  Obstetricians are under extreme stress from the hospital system and have insurance companies pushing particular methods in the name of "safety" and money. This leads to unnecessary interventions, poor communication, and lack of informed consent, all of which then can manifest into physical and mental trauma for both parents and baby. 

I wish there were an easy and simple solution to this problem. The injustices in the hospital birthing system are woven together in such a tight web, one string cannot be cut without disrupting everything else. To which I say, let’s cut it all down and start anew because this process is not benefiting the people who are most important during birth. 

For more information on informed consent and how it looks under a legal lens, check out Human Rights in Childbirth.