Informed consent is one of the most important parts of medical care. Helping people to understand the risks, benefits, and any alternatives of a procedure before it takes place helps them take the drivers seat in their care. Here are 5 things to make sure your doctor or healthcare provider should be giving you consent for in labor.
Hi, I’m Hilary — The Pregnancy Nurse 👩⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺 I am an expert in helping you get the collaborative hospital birth you are hoping for.
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What Is Informed Consent
If you have followed me long, you know that I talk about it a LOT.
It’s your healthcare provider (should be the person ordering the procedure, but often it’s the nurse) telling you the risks and the benefits of something (and it CAN be ANYTHING) so you can decide if you want it done.
Why do some providers not get informed consent?
I think it comes down to time.
The reality is that the hospital is busy, and your healthcare team has a lot on their plate. Sometimes they just need to get it done, because they have 14 other things going on (this is horrible, but true).
The other thing is that 90% of people just say “sure”.
I always compare it to me being a bus driver, and I have to drive my regular route. Along the way I’m telling you other places in the city, but I have to just keep driving until you tell me to stop and go somewhere else.
I talk a bit about that in my podcast on saying no with my friend Mandy (that pink arrow below will help you listen to it):
I don’t want you thinking that most healthcare providers have any nefarious things to hurt you or do something wrong to you. The procedure they plan on doing makes perfect sense to them, so sometimes they charge ahead.
That is not OK, but I’m just sharing what I’ve seen at the bedside.
Ok, so let’s talk about some important ones:
Things Your Provider Should Get Consent For:
Remember, informed consent is telling you the risks, the benefits and any alternatives.
Providers really should be explaining things along the way — and while they may not tell you the risks and the benefits of a blood pressure check, I hope that my patients understand why I’m doing things — and that they can stop the “bus” at any time.
Yup, when we go to check you, you should understand the risks, benefits and alternatives (which with an exam, is just waiting).
What this can look like from a provider:
Hi Ms Brown, I would like to check your cervix. You’ve just shown-up to the hospital and I need to know what your cervix is, so we can decide if the hospital is the best place for you. If you come to early, it isn’t fun to have all our monitors and things on you for so long. Also, if you’re very progressed we especially want to alert your healthcare team for an impending deliveryYour Healthcare Provider
At that point, you can decide if that’s the best choice for you. You can also ask other questions like:
- Can we wait a few minutes, I just got into the bed and I could use some time to relax?
- How frequent will these exams be? I find them very uncomfortable (this also communicates to them that you’d like them to be infrequent).
- Are there risks to checking me right now (you’ll notice that she mostly went over the benefits above)?
You can also say “sure” and the procedure happens. Honestly, that’s mostly what happens.
The reality for this particular procedure (especially when you come in for admission) is that not much else can happen until we know what your cervix is and how quickly you are progressing. It’s an important one, but your provider also wants you to understand why it’s being done.
That being said, some hospitals check patients hourly to make sure they’re progressing, and that seems like a lot. Btw, this article is super helpful if you want more information on vaginal exams and what they mean. I also have a post on what to do if you find vaginal exams painful.
Now, as you can imagine it can be hard to ask this every time you go to do something with your patient. Often, after we explain the risks and the benefits initially and then we might say something like “is it OK if I check you now” — and it would be your responsibility to drive that bus and say yes or no, or ask questions if you have them.
Also, keep in mind that at any point in any procedure you can ask them to stop and they should do so.
Having an IV is a standard of care at most hospitals for laboring women. I have a whole post about IV fluids in labor (that’s on my sister site The Pregnancy Nurse).
That being said — a lot of people have a fear of needles, or don’t want to be tied down with an IV — so, informed consent can be important for this.
This is what it can look like:
Hi Mrs Brown, your doctor has ordered an IV during your labor. I’d like to place it so we can have access to your bloodstream in case you start to bleed or need medications. It sounds like you also want an epidural, and an IV is required for that. Is that OK if I put it in now?Your Healthcare Provider
Your response can include:
- Sure, I’d like that epidural soon, so please place it.
- Is there a possibility that we wait to get it in — I’d like to have more movement right now?
- I talked with my doctor about this, and we settled on just a saline lock — I’d prefer not to be hooked up to the IV fluids right now.
You can ask more about the risks and the benefits of the IV until you are comfortable in your choice.
I have a whole post about IV’s in labor you might find interesting:
Keep in mind that until you make up your mind for some of these things, we aren’t able to move foward. For instance, if you want an induction, you will need an IV placed before we can give the medication. It’s a standard of care that we have to follow to do medical interventions safely.
If you’re refusing the IV, you are basically refusing the induction.
ALSO, keep in mind that the earlier you discuss that you’d prefer to not have these things with your provider, the better. That way they know what you want and can help you aim for that when possible.
That’s why I love a birth plan — it helps get that conversation started:
Breaking Your Water
Sometimes providers will break your water without even mentioning it to you, so I think this one is really important.
Your informed consent might look like:
Hi Mrs Brown, I’m here to break your water. The reason I want to do it is to speed up your labor. I may or may not be able to do it once I check your cervix — but I wanted to ask before I start.Your provider
You’ll notice, that wasn’t a great informed consent. A PROPER informed consent should look like this:
Hi Mrs Brown, I’m wanting to break your water. I want you to understand about it before I do. The benefits to breaking your water is that we can hopefully speed your labor along so you can see your baby soon. The risks could be with the cord coming out, or a risk of infection as your baby will now be open to the bacterial of your vagina. Because your baby’s head is low enough I feel comfortable that we will mitigate any cord risks, and we will try to limit vaginal exams to limit infection. An alternative would be to wait a bit if you’d prefer. However, I am the only one allowed to break your water and I won’t be back until this afternoon.Your provider giving a proper informed consent.
You can tell that a proper informed consent is very different than the first one I shared, and obviously WAY different than “we broke your water” as they are checking your cervix.
Your provider’s informed consent will be somewhere along the spectrum of all those three options.
And again, if you would prefer your water not be broken, you can discuss that with your provider during your prenatal appointments. Then, if your labor stalls out and the team really feels like it will help move things along, you can discuss it more.
I am hoping you are understanding that there are lots of options in the hospital — not just one, and it’s up to you to decide!
Obviously, major surgery should have a very thorough informed consent. In fact, your provider is required to chart that they gave it to you. It should look something like this:
Hi Mrs Brown, we’ve been watching your baby for a while and the fetal monitor is showing us some very deep dips in the heart rate, which leads me to recommend a cesarean section. The benefits would be that your baby is out quickly, and doesn’t have to tolerate any more dips in the heart rate (or things getting worse). The risks would be infection, problems healing, and an increased risks with future pregnancies and labor. An alternative would be to wait, but my recommendation is that we have the cesarean section soon.Your Provider
Keep in mind, I very frequently see this as “You need to have a cesarean section, I think if we continue like this your baby could die.”
And obviously, all parents don’t want their baby to die, so they are quick to say OK to that type of consent.
And frankly, sometimes that type of consent is necessary. If you see that there are several nurses in the room doing things like messing with the IV, flipping you, checking your cervix (possibly without consent because things are happening very quickly) — you should realize that this is an emergency.
However, if it is just you and your provider with possibly one nurse in the room, who is likely charting — that isn’t an emergency and there is time to talk through the information you need to make your choice.
VERY frequently people feel pressured to make a choice right then, but you can always ask:
- Is my life at risk if I don’t make a choice right now?
- Is my baby’s life at risk if I don’t make a choice right now?
- Can I have some time to think over this big decision?
Now, the epidural is as bit different — as you are often asking for it. However, it is important that the epidural is given with informed consent.
It should look something like this:
Hi Mrs Brown, I’m Doctor White. It sounds like you have asked for an epidural, and it looks like you are in a good amount of pain so I will try to go through this quickly. The risks to an epidural include infection (and they name all the risks — and often this part ends in “you could die” and that is true, with all procedures you COULD die)… the benefit is that we would hope to get you about 80% pain free from about your bra line down to your knees. It may limit your movement, but the healthcare team can help you keep moving. An alternative with be IV pain medication or waiting on the placement. What would you prefer?Your anesthesiologist
Honestly, I see anesthesia doing this VERY often, and patients mostly saying “yes, whatever — just put it in“. Which is also fine.
Also, if you have questions about the epidural placement, you could ask to speak with an anesthesiologist early in your labor so you can know more about it (that is their job — although some resist coming to see patients until they request it).
Some people are put-off with that risk of possibly dying, but it is important that you understand the full risks of what you’re asking for. So, just understand that these are extremely rare risks.
We should all be grateful our car doesn’t give us informed consent every time we turn it on (or it would most definitely end in “you could die”).
Now, this is obviously not an exhaustive list — but, this will get you started, and give you an idea of what to expect.
It also gives you a way to sort of “grade” your providers in how much information they are giving you. If you want more information, say so. They may be holding back because a lot of patients don’t want the information. Many people get very OVERWHELMED by a full informed consent, so providers are always trying to balance what they think you want.
Ultimately, they aren’t mind readers, and neither are you — so be sure to just ask question. It is not a bother, and we all want you to be informed before making choices.
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