Advocating for yourself during birth: Why informed refusal is just as important as informed consent
What is informed consent?
In birth work spaces we often talk about the importance of informed consent. Informed consent is a principle in medical ethics and medical law that a patient should have sufficient information before making their own free decisions about their medical care. Interestingly there are several different definitions of informed consent depending on where you look.
Many birth workers also speak of free consent, which means that a person is able to give consent without being coerced one way or another.
These principles of free and informed consent rely on health care professionals who provide adequate provision of information and education to the birthing person regarding the nature, management implications, options and outcomes of various choices.
Why is informed consent important?
In order to make a balanced decision about what happens to your body, you need to understand the benefits, risks and alternatives to make the decision that is right for you. If you are only presented with the benefits, any decision you make cannot be informed as you don’t have the full picture, and vice versa.
What is active informed consent?
Active informed consent goes the extra step further so that the birthing person is not only presented with all of the information, but also able to do their own research and discuss the options with their birth team. Parents should actively participate in building their own document outlining what they want and do not want - this is often referred to as a birth plan. In addition to having it in writing, there is also the option of doing this verbally and recording it on video/audio for healthcare professionals. This allows parents to go into detail about why they are making certain decisions and how it relates to their personal values and beliefs.
How can I give free consent?
If you feel as though you are being coerced in any way into a medical procedure regardless of how trivial, it is important that you voice this to the medical professional. If you are unable to due to fear, anxiety or being in labour, try to indicate this to your birth team if they haven’t already realised so they can voice these concerns to the medical professionals. Let them know that you are unable to give free consent due to coercion so if the medical profession goes on to perform the procedure they are committing a criminal offense. Coercion from healthcare providers can come in many forms, including restricting a person’s choices without clear medical reasoning and being threatened with social services for refusing a medical intervention.
In reality many decisions about your care during birth come down to the personal judgement of the specific health care professionals who’s care you find yourself under, which will most likely be a general midwife who you wont meet until you go into active labour. This midwives judgement will be based on a combination of their personal beliefs about childbirth and the Trusts guidelines. The midwife who supports you during labour might have very different views and attitudes towards childbirth to yours. It’s important to know that you can ask for a different midwife or ask for a second opinion from another midwife.
What is informed refusal?
As a birthing person in the UK, you have the right to refuse any medical intervention offered, even to your own detriment. This means that you can say no even if it leads to you or the baby dying. If you refuse an intervention, healthcare professionals should explain to you the risks of doing so without inserting their own opinion, undermining your mental capacity or making any comments about the babys or your safety.
Why is informed refusal just as important?
During birth, it’s common for many of us, birthing people, partners and birth workers alike to get caught up in the mindset that health professionals know best, therefore we should put our trust in them when it comes to labour and birth. However when we look at the guidelines and NICE recommendations that UK hospitals base their perinatal protocols on, in some cases the evidence is from research that is outdated or lacking. Updating these protocols takes time and money that many hospitals don’t have.
Informed refusal allows birthing people to take the power back into their own hands. It expresses a simple boundary that lets health providers know that you know and trust your own body and have confidence in your decisions.
To be able to truly practice informed refusal, means to know all of your options and be able to question everything. Question what your midwife tells you, question what your doula tells you and ask yourself what feels right for you.
