What is Informed Consent?

And how does a doula advocate for you?

 When you choose to give birth within the system (through a public or private hospital or one of the homebirth programs), you must be aware that Obstetricians and Midwives will treat you according to the policies of their hospital and state. In South Australia, these are the Perinatal Practice Guidelines, and you can find a link to them at the end of this blog. 


The government website states that "The statewide guidelines do not address all the elements of clinical practice and assume that clinicians are responsible for discussing care with consumers in an environment that is culturally appropriate to ensure informed decision-making and individualised care for pregnant women, mothers and their babies. 


The emphasis on specific terms is mine. Because although the health departments mention this in their documents, women rarely receive wholly culturally appropriate, individualised care with a real opportunity for informed decision-making.  


Let me share some examples. 


Is it culturally appropriate care to tell a woman she can not have her placenta straight away for burial because part of a policy says that the hospital must stick it in a fridge for seven days, along with every other placenta born there that week? No. 


Is it individualised care for a midwife to tell a woman that the last person she saw with higher blood pressure was induced straight away, so that is what she will need to do also? No. 


Has the opportunity for informed decision making been given when a midwife performs a stretch and sweep while doing a cervical exam without asking the woman first? Just because the midwife wanted to "razz things up a bit" No. 


Is a decision free from coercion when the unit manager storms into a woman's birth space without introduction, demanding to know why the labouring woman isn't consenting to a suggested course of action? No. 


Is it individualised care for a midwife to tell a woman that she will not attend her birth if she doesn't consent to cervical checks, despite knowing the woman has a history of sexual abuse? No. 


Has a woman given legally valid consent to have continuous monitoring if the OB only tells her that if she refuses, her baby could suffocate and they won't know about it until it is too late? No. 


These aren't made-up scenarios. 


My clients have disappointingly experienced them all and I have witnessed the majority of them. 


So as your doula, what do I do in these types of situations? How do I advocate for you? It's a question I often get asked.


I know that these are all stressful situations which can interrupt the labour process, so my first action is to remind my client that she isn't alone in this - reassuring her with a touch, eye contact or even a smile to help her settle her nervous system as much as possible. 


Depending on the situation and timing of the event, I might also do any of the following:

• Check in with how she (and her partner) feels about the given information or what happened.

 

• Remind them that they have the final say about how to proceed

 

• Spend a lot of time prenatally with my clients to make sure they are clear about how they want to feel and be treated during their child's birth. Everyone has varying levels of comfort with the responsibility for decision making.  Everyone has different life-experiences and values that affect how they make decisions.  Everyone has different priorities for their birth.

 

• Support them to go through a decision making process. This may look like helping my clients formulate questions for the doctor or midwife to ensure they understand the proposed actions and their options. Reminding my clients of their original birth goals and seeing how they can be supported to achieve these still. Getting the clinician to explain medical terms or asking my clients if they would like time in private to talk together about what they want to do - with or without my presence. Often it is enough for me to demonstrate these behaviors with my clients to remind the health professional that they should be doing the same.

 

• I might give my client & partner a distinct look so they know that my doula "bullshit-o-metre" has picked up on something they're being told which isn't realistic or may not be the whole story. We talk about this in prenatals, and it serves as a great reminder for the partner to step up and do an excellent job of advocating for their choices, like we've prepared for beforehand.

 

• Sometimes I will communicate my client's choice to the midwife or doctor once they have made a decision, other times the client or partner will do it themselves. I think it's important to note here that there is a big difference between informing a clinician of a person's choice once they've been through the decision making process and making decisions for the client or telling them what you would do in the same situation. A good doula will never do the latter.

 

• Provide my clients with resources for further learning and understanding.

 

• Validate that what has just happened wasn't okay and see if they would like to request a different care provider or put in a complaint when they are ready.

 

• Let my clients know what I see happening in the room if it's against their birth plan. Perhaps I've noticed that a student midwife is in the room when they didn't want students or that the obstetrician is getting out the equipment for a forceps delivery or episiotomy when I know my client didn't want those things.

 

• Ensure my clients understand what real, informed consent looks like from a legal perspective and how that can be used in their birthing space.

If you would like to learn more about what informed consent and refusal looks like, you can download the free handout below.  Click on the picture to get your pdf and print it out.  Hey, you could even take it with you to your appointments if your health professional needs a little reminder =)
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Click on the image to get your free download of Informed Consent for Birth in South Australia

​Further Reading

1. SA Perinatal Practice Guidelines 
2. What is my role as your doula?
3. When your birth doesn't go to plan.

Author

Kelly Harper is a birth and postnatal doula in Adelaide, trained in trauma-informed practice. She is passionate about ensuring her clients understand their rights and how they can use them to get their best birth possible.  Please contact Kelly if you are interested in working together towards transforming your birth experience.

Book a birth options session with Kelly