First, what is informed consent?


Informed consent is the permission you are able to give to undergo an intervention after a care provider guides you through an informed decision-making process. Ideally, your provider would explain your condition in a way you understand, share his or her professional recommendation for treatment, and then take the time to discuss with you the potential benefits, risks, and alternatives to his or her recommendation. Your provider should be open to your questions, doubts, and possibly declination without unduly persuasion or coercion.


Giving permission is not the same as giving informed consent.


Informed consent is important because you are the one who will live with the effects of your decision, whether positive or negative, accute or long-term. Because of this, you alone have the right and responsibility to make informed decisions about what happens to your body, and your provider must respect those decisions. (More on your patient rights and responsibilities in Point 2.)


As an X-ray student, I was taught that informed consent was a pillar of patient care, but as an X-Ray Tech, I was astonished by how many providers failed to guide their patients through an informed decision-making process and how many patients didn't know that they had any choices about everything that happened to their bodies.


Now, as a mother and a birth doula, I am passionate about informing other parents about their patient rights and options so they can make informed and confident decisions about their care.




Here are 12 tips for making informed and confident healthcare decisions for yourself and your baby:



1. CHOOSE A PROVIDER YOU TRUST

A provider can be a good provider without being the right provider for you. Choose a provider who you trust to uphold your priorities and your values. If possible, choose one who shares your values. Having a provider whose philosophies and values align with yours will spare you a lot of time and stress.


Ask yourself:

If you are incapacitated to make a decision (as can happen in the throes of labor) or in the rare event of a time-sensitive emergency, do you trust your provider to quickly make the decision that you would agree is best for you?


When you leave your appointments, do you feel heard, valued, respected, encouraged, and even excited for your next appointment? 


Here are some signs that the provider is not the right one for you:

  • You don't trust or agree with many of your provider's recommendations or philosophies
  • You keep having to decline interventions you don't want or fight for those you do
  • You feel anxious before your appointment
  • You leave your appointment feeling worse than when you arrived
  • Your blood pressure readings are higher during office visits than they are at home
  • You feel like you have to hide or justify your decisions (like what you eat or where your baby sleeps)
  • Your provider consistently uses persuasion or coercion techniques (See 3)
  • Your instinct tells you so


2. Know your rights and responsibilities

You may see these posted on a wall in the Emergency Department or included among your intake paperwork. Active labor is not the time to try to read and comprehend your rights as a patient.


Your patient rights include the right to refuse treatment, the right to know the names and positions of anyone involved in your care, and the right to receive all the information you need to give informed consent.


They are are pretty much the same throughout all states and hospitals across the United States, but I've linked state- and hospital-specific Patients' Bills of Rights so you can read for yourself, word-for-word, exactly what your rights are according to your intended birthing location.


New York State:

New York State Hospital Patients' Bill of Rights

UVM-CVPH Plattsburgh, New York Patients' Bill of Rights


Vermont:

Vermont Bill of Rights for Hospital Patients

UVM Burlington, Vermont Patient Bill of Rights


3. Learn to recognize the signs of coercion

The legal definition of coercion is “any scheme, plan, or pattern intended to cause a person to believe that failure to perform an act would result in serious harm.”


Some examples of coercion:

  • Using relative risk rather than actual risk (e.g. “The risk doubles...” rather than “The risk increases from 0.2% to 0.4%.”)
  • Speaking in absolutes or extremes (e.g " Your baby will die if…”)
  • Threatening to discontinue your care if you don't proceed with a recommended intervention
  • “If you love your baby, you will… “


Coercion can be aggressive and obvious, but even more insidious are the subtle techniques used to persuade or influence you. 


Some signs that your provider is trying to influence or persuade you:

  • Bringing in another provider to talk to you after you’ve declined an intervention
  • Withholding information or options from you (such as not telling you that you can monitor your blood glucose at home rather than drinking Glucola.)
  • Beginning sentences with “I’m going to…” prior to an intervention rather than, “Is it ok if I…”
  • Presenting one-sided information about an intervention (e.g. only the benefits or only the risks of accepting or declining an intervention)
  • Not giving you sufficient time to read documents before signing
  • Using credentials or years of experience in an effort to overrule you (e.g. “You're not a doctor… “)
  • Using “It's hospital policy" as a non-negotiable justification for an intervention or to deny you care (with the exception of hospital visitor policies)


These lists are nuanced and inexhaustive. If your provider uses any of these techniques, proceed with caution. If your provider uses most of all of these techniques, it may be time to consider looking for a new provider.


What is the problem with a provider trying to influence my decision? Isn't that what they're there for?


The issue is that you can't give informed consent without being informed [on the potential risks, benefits, or alternatives to an intervention]. You should have all the information you need to feel fully informed and confident in your decision (See 2). 


Intentionally trying to influence or persuade you is not the same as making a professional recommendation. A professional recommendation should involve objectively presenting all your options, providing uncensored information about their risks, benefits, and alternatives, and answering any of your questions without shaming or threatening you. This approach respects your right to receive all the information you need to give informed consent.


4. Remember that your provider is human

Your provider is not infallible and can not possibly know everything. He or she is is making his or her best educated recommendations based on training, life experiences, personal values, and professional experiences. Other factors that may influence your provider's recommendations for you are liability, finances, workload, hospital policy, personal preferences, and even the time of day. Kindly consider your provider's recommendations but know that he or she cannot predict the future.


5. Know the choice is always yours, even if you don’t feel like it.

Your provider does not have authority over you or your baby. Your provider’s job is to use his or her professional training and experience to guide you through an informed decision-making process and to serve you. His or her role in your decision-making process should be that of a trusted consultant - your equal, not your superior.

It is not your job to be a "good patient." It is your job to make informed and confident decisions for yourself and your baby and to build a care team who supports those.

6. Know that you are the expert on your body and your baby

You live in your body 24/7, constantly collecting and processing data about how your body and mind are working or feeling. You have a greater ability to recognize patterns in your symptoms than anyone else ever could, and that data is worth serious consideration when attempting to make diagnoses and healthcare decisions.


7. Remember that no one loves your baby more than you do

That automatically makes you the best person to make decisions for your baby, regardless of your education, values, or life experiences that inform your decisions.


8. Remember that only you are the one who has to live with the effects of your decisions. 

No one on your care team will have to live with the effects of your decisions the way that you will. At the end of the day, your providers go home. Many of them, you will likely only see a few more times in your life, if ever.


9. Have someone you trust with you

During pregnancy, childbirth, and postpartum, your brain is occupied and likely tired. You may have a limited capacity to remember your questions or their answers or to remember all of these tips for making informed decisions. Whether in an outpatient office or in a delivery room, a trusted loved one or doula can help you remember and process information with consideration for your personality, priorities, and values.


10. Take your time

It's rare that a healthcare decision is a matter of life or death and must be made immediately, and it's hard to make an informed and confident decision when you're put on the spot. If you're unsure about the best decision or are not feeling safe discussing your options with that particular provider, let your provider know that you'd like to take some time to make the decision.


Some examples of how to communicate your need for more time:

“I'd like more time to consider my options; I'll let you know my decision at my next appointment.”

“I need some time to discuss this with my husband privately.”


11. Write down questions before your appointments

Take time before each appointment to discuss with your partner any questions or concerns you have about your symptoms or any recommended interventions. Yes, write them down.


12. Use your BRAIN

BRAIN stands for Benefits, Risks, Alternatives, Intuition, Nothing. The acronym is meant to help you remember what kinds of questions to ask when trying to make an informed decision.

 

  • What are the potential benefits of this intervention? 
  • What are the risks of this intervention?
  • What are the alternatives to this intervention (and the potential benefits and risks of those)? 
  • What is my intuition telling me to do or to avoid?
  • What might happen if I do nothing right now?