Posts Tagged ‘informed consent’

VBAC: You’re The Number One Stakeholder

Tuesday, April 19th, 2016

Add headingIn 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?

No.

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?

They can’t.

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:

VBAC Facts
International Cesarean Awareness Network
Science & Sensibility: Too bad we can’t just ban accreta…

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.

Thank you!

Grace & Peace,
Tiff Miller, CCCE, Student Midwife

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Passenger or Driver: The Importance of Informed Consent.

Monday, June 15th, 2015

PASSENGERYes, it almost sounds like a Dr. Seuss-ism – “Would you rather be a passenger or a driver?” Most of us would rather be the driver, I would venture.

In every other aspect of our lives, we exercise informed consent. We want to be involved, in control, and overseeing every detail. Take for example the research we do in buying our next car, cell phone, or home. Think about how much we invest in knowing our stuff, so we can avoid the sales pitch and just get exactly what we want because we desire to make a responsible informed decision.

Yet, when it comes to our health care–prenatal care in particular–we often content ourselves with being a passenger. We readily abdicate responsibility for our health by laying down our questions and concerns to take the word of a stranger. We leave our right to informed consent in the waiting room.

Why is that?

“But, they’ve gone to medical school for a million years! What do I know?” Of course, their expertise is invaluable. Their advice is often sound. While they have an intimate knowledge of the human body and its various pathologies, they do not have an intimate knowledge of your body in particular. Its quirks and signals that are all too familiar to you.

What many fail to realize is that, no matter which role we choose to play in our health care, the consequences of any and all decisions are carried by the patient. By you and me. For the physician, it is out of sight, out of mind, not because they are inhumane, but because they are human.

When it comes to prenatal care in particular, we see a unique dilemma, because the health care we receive has more to do with a physiologic process, rather than pathology or disease. This isn’t a broken femur, a tumor, or a chronic illness. It is not even a parasite, in spite of the tongue-in-cheek proclamations of many. It is something our bodies do naturally, without a lot of help. It is a process more in need of general oversight, rather than active management.

Pregnant or not, it is imperative to understand that the practitioner is hired for his or her advice. It is up to the patient to decide what to do with it. We have many options.

1. Follow the advice without question.
2. Question the advice, decide what to do.

  • What are the benefits?
  • What are the risks?
  • What are my alternatives?
  • How does this advice apply to my personal case?
  • What happens next if it doesn’t work?

3. Get a second opinion.
4. Discard the advice in favor of an alternative outside traditional medicine.
5. And more…

Medical decisions are rarely black and white.

The key is to remember who it is that carries the weight of the risks. It is ultimately the patient. There are many factors that play into the reasoning behind your doctor’s recommendations–not all of which are health-related. (That’s another post for another day, however.)

In the end, all you have to do is decide which set of risks you are most willing to live with. That is true informed consent.

Only the driver can decide that. Not the passenger.

In which seat will you choose to sit?

Thanks for reading.

Our best to you,
Desirre & Tiffany

“Elective” Cesarean – If you had one…..

Friday, February 5th, 2010

There is much in the news and in community talk how women are signing up for cesareans electively. I am very intrigued by this assumption and believe there is much misinformation regarding the topic out in the public for consumption. I am seeking to shed some more light on this topic.

Though this is not a scientific survey, I believe your experiences can help others in understanding why women are making this choice, as well as, potentially aiding other women in informed decision making.

If you have had or are planning an “elective” cesarean, I appreciate you answering this informal survey.  Answers can be submitted via confidential email to desirre@prepforbirth.com. By responding you are agreeing to allow me to use the information anonymously in a future blog, writing or other educational medium.

  1. Was your “elective cesarean for a medical reason?  If so, what?
  2. Was your “elective” cesarean for a non-medical reason?  If so, what?
  3. How were you given informed consent?
  4. What information were you given in the cesarean consent for benefits, risks, consequences, and alternative for you and your baby?
  5. Were any words such as: Easier, safer, painless, no big deal, not risky, saves vagina or less pain used to describe potential experience?
  6. Were you told your cesarean was necessary and found out later it was coded as elective?
  7. Did you ever feel pressured or led by care provider to choose cesarean?
  8. After your cesarean, did you feel you were consented fully enough prior to the surgery?
  9. Did the cesarean “do” or live up to what you were told for you and your baby?  How so?  How not?
  10. Would you make the same choice again or would you “go for” a VBAC?
  11. What country do you reside?

Thank you very much for answering these questions. I am so grateful for input on this subject.

If you would like any information shared and attributed to you as a quote,  please indicate in your email to me.  As stated above, otherwise your identity will be kept completely anonymous and confidential.