In this line of work, informed consent and refusal is paramount. There is not one factor more ethically important than accurate fully informed consent. Without it, a care provider is practicing unethically, and patients are deciding blindly. Without it, it is far too easy for doctors, hospitals, and insurance companies to steamroll patients in their desire to protect the so-called “greater good.” The greater good argument is just a nicer way of saying “The end justifies the means.” An argument most people dismiss as childish at best and despotic at worst.
Nowhere is this more true than in making medical decisions. No government has the right or the jurisdiction to decide ahead of time what would be in anyone’s best interests to choose one course of action over another. The only exception to this is when one’s decision would interfere directly with the safety or life of another human being. Very few medical decisions will directly result in putting another human in mortal danger. Even smoking isn’t guaranteed to produce cancer in every individual. Rather, there are risk factors linked to smoking that make it far more likely. Yet, we don’t ban smoking entirely! We understand that each individual has a right to do with their lungs what they like.
“Unless we put medical freedom into the Constitution, the time will come
when medicine will organize into an undercover dictatorship to restrict
the art of healing to one class of Men and deny equal privileges to
others; the Constitution of the Republic should make a Special
privilege for medical freedoms as well as religious freedom.”
~Benjamin Rush (one of our Founding Fathers)
Why does this change when it involves a uterus? Medical institutions seem to have the mindset that women give up their rights when they cross the threshold of the labor & delivery room. Up for discussion in Colorado are the midwifery regulations. Up until last week, everything was going smoothly, and midwives were going to be given some reasonable freedoms to better care for the women who choose home birth. At the last minute, ACOG tacked on an amendment to HB-1360 to remove the option for midwives to care for women desiring a VBAC at home. It passed the House, and is now on the Senate floor this week.
Rewinding a bit back to decisions that interfere directly with the safety or life of another human being. Doesn’t VBAC do that very thing?
It does not.
Most medical decisions fall on a spectrum. They are not black and white, right or wrong. There are degrees of risk. And those degrees vary among different women. They even vary among different pregnancies in the same woman! How on earth can there be any government regulation that allows for every possible variation in these risks? How can any government regulation account for every arbitrary circumstance? Every irregularity?
And they should not.
Who then, is best equipped to balance the risks of VBAC against the risks of a repeat cesarean? The woman who is pregnant is the number one stakeholder. Period. End of story.
“But what about the baby?” Yes. What about the baby, indeed. That baby has a mother more intimately connected to him than anyone else. There is no one more fit to make decisions in regards to the risks baby may incur during any given birth than his or her fully and accurately informed mother. Not the doctor. Not the hospital. Not the insurance company. And certainly not the government.
That’s my story, and I’m sticking to it.
Please — do your homework. Educate yourself. Speak up! Start here:
Want to do something about it? Visit the Colorado Midwives Association Facebook page, and follow their posts. They are posting updates regularly. They are sharing specifics like who to call, and what to say. Easy peasy.
When it comes to VBAC consent: You are the number one stakeholder.
Grace & Peace,
Tiff Miller, CCCE, Student Midwife
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