What is Informed vs. Implied Consent?

 Consent is an all-around important topic around birth, especially when you consider up to 40% of women will experience birth trauma. In the medical field, it is called informed consent when your Ob doctor or midwife discusses the benefits, risks, and alternatives for interventions prior to initiating recommendations or performing a procedure. You as the patient can then make an evidence-informed decision on how to proceed. Medical professionals have an ethical and legal obligation to provide informed consent to their patients. 

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Let’s use induction of labor for an example: * Not an exhaustive list

Possible Benefits: 

  • Decreased risk of developing a pregnancy-related complication
  • Decreased risk of stillbirth 
  • Can be planned around your schedule
  • Birth can end certain pregnancy-related conditions
  • Availability of a specialized medical team
  • Your doctor or midwife is the one on call 

Possible Risks:  

  • Induction may be unsuccessful 
  • Increased risk for additional interventions 
  • Increased risk of postpartum hemorrhage
  • Increased risk of fetal intolerance of labor  
  • Increased risk of uterine rupture (rare)
  • Increased risk of the medicalization of the birth process 

Alternatives: 

  • Waiting for spontaneous labor 
  • Membrane sweep 
  • Nipple stimulation 
  • Castor oil
  • Consume dates 
  • Cesarean birth  

   Each example has risks, benefits, and alternatives associated with it. Keep in mind every situation is different. For example, the risks vs. benefits of induction will be different for a woman who has preeclampsia vs. someone with an uncomplicated pregnancy. 

    An example of implied consent is when the doctor or midwife states “ We’re going to start Pitocin and your body language implies you are okay with the intervention. When you may have a knowledge deficit of the pros/cons, feel too intimated to ask questions, or don’t realize you can decline. This is different than when your Ob discusses all the options with you and waits for your response before moving ahead. 

   When it comes to making decisions consider the B.R.A.I.N acronym. *Unknown  original source

Benefits: What are the possible benefits of this intervention? 

Risk: What are some of the possible risks of this intervention? 

Alternatives: What other options are there to consider?

Intuition: What does your intuition lead you towards? 

Nothing: Do nothing, wait, or ask for time to think about it and discuss it alone

  Your doctor or midwife is an expert in pregnancy and birth, and they are not an expert in what is best for you. The only expert about your body is you.  Be proactive, do lots of research, take prenatal education classes, consider hiring a doula to help support you, and ask lots of questions at your prenatal appointments, and during the birth process.  Feeling that you had informed consent and were an active participant is an important part of satisfaction with your birth experience. 

Pro Tip: At each prenatal visit ask what to expect at the next appointment. That way you have the opportunity to research things ahead of time and aren’t surprised.  

Click this link to find local Mama Coach prenatal classes. Mama Coaches offer private and group prenatal classes in person and virtually. Private classes can be tailored to your specific needs. Classes are evidenced based and taught by registered nurses.

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