This is a topic I am very passionate about. As doulas, we should always reflect on what I call the ‘birth impact’.
Pregnancy and birth tips from Sydney doula, Danae Cappelletto.
I believe the largest positive “Birth Impact” doulas can contribute is sharing evidence-based information. This can empower the mother to ask questions and make a space in her birth for herself. This may otherwise have been unavailable to her without the confidence that comes with understanding and knowledge.
Informed Consent can be defined as: “Voluntary permission granted in full knowledge of the facts, benefits, risks, alternative management options and possible consequences.”
What is informed consent in a maternity context?
In a maternity context, informed consent is given by a pregnant / labouring / birthing mother to a Midwife / OB / Clinician for treatment, when there is sufficient information and understanding to make an appropriate decision about the care, for her and for her baby.
The clarity of options, choices and decisions available to mothers and their care is often clouded by:
- insurance policies in the birthing environment
- the recommended policies in that environment
- the agenda and personal opinion / recommendation of the care provider, and
- maybe the agenda of her partner or support team.
The following components are essential to the decision-making process:
- the explanation of information needed to make the decision
- the understanding of the medical information
- the ability to make the decision, and
- the voluntary decision to receive a procedure / treatment.
Supporting women through informed consent
The opportunity to support women through informed consent comes up during the journey into motherhood over and over again. It is an unfortunate reality of our current maternity care system that this process can be overlooked by care providers. Doulas need to fully appreciate what impact that has on a woman’s sense of bodily autonomy, ownership of the experience, sense of control, emotional wellbeing and therefore transformation into motherhood and beyond.
The danger of lack of informed consent can play out in numerous ways including and not limited to:
- when a clinician performs a procedure that may be considered common policy, or assumed as low risk or well-intentioned, or without first gaining permission
- when a care provider manipulates a discussion to encourage a decision that suits their preferred method of practice
- when a woman has a compromised ability to make her decision due to possible lack of understanding, experiencing labour, experiencing extreme stress related to the condition of her baby, limitations of time and unfamiliar environments and faces.
“The right to informed consent is a fundamental healthcare right grounded, like the right of refusal, in the right of every human being to autonomy and authority over their own body. When a doctor or other healthcare provider recommends an intervention or treatment, they have a legal obligation to inform the patient of the risks and benefits of the full range of options available to that patient” – Bashi Hazard, Human Rights in Childbirth
In 2013, the AMA (Australian Medical Association) released a statement regarding Maternal Decision Making. This statement acknowledges that “most pregnant women strive to achieve the best possible health outcomes for both themselves and their unborn babies” and that “the doctor must respect the woman’s informed decision, even if it is not consistent with the doctor’s advice and continue to provide patient support”.
So how do Doulas add value by helping to create the opportunity for informed consent?
We direct mothers to scientific and evidence research studies, blogs and articles relevant to the decision the mother has at hand – not just at birth, but for all the decisions during pregnancy, at the birth and in the postpartum. We can assist in the understanding of information. We provide physical and emotional support, help our clients explore and consider all their options, and support them unconditionally in their choices. We help women to understand that they can consent or decline a recommendation, and they can change their mind anytime too.
In a labouring and birthing environment we help women make decisions using the BRAIN-S acronym – Benefits / Risks / Alternatives / Intuition / Nothing – and Space.
In a time-limited potentially high-stress situation, there is always opportunity to ask a woman “Do you understand what is happening? Do you consent to this procedure?”, giving her a voice.
- invites women back into the process, it gives them the opportunity to feel a sense of control, opens up confidence, bodily autonomy, emotional space and physical options in an environment where they may have felt limited and powerless.
- equalises the playing field and with the right support can empower women and parents to have the best possible experience.
- can change negative birth culture and transform the way women receive care and perceive their birth experiences, no matter what path the birth takes.
- helps expecting parents to look back and say “I understand why that decision was necessary” which in turn reduces trauma and helps create more positive birth outcomes.
As a doula I want you to reflect on your birthing experience and think “That’s the best birth I could have had. I understood all my options and choices, and, my preferences and choices were respected.” That is how women and couples come out the other side emotionally well.
Danae is a Sydney birth doula and pregnancy support specialist. She works with families to provide guidance, information, emotional and physical support during pregnancy and birth.
If you have any questions about birth and pregancy support and her doula services, don’t hesitate to contact Danae directly.