Informed vs Implied Consent in Childbirth

​Informed Consent - "accurate, adequate and relevant information must be provided truthfully in a form (using non-scientific terms) and language that the patient can understand."1 
Implied Consent - Consent assumed based on circumstances or a person's actions. For example: a care provider automatically assumes they can exam you if you are in a gown on their exam table. 

Most care providers set out with ethically decent intentions regarding the care of their patients. I think that problems arise when consent is assumed and not asked. Probably the number one example of this is regarding cervical exams. 
Scenario 1) Care Provider walks into the laboring woman's room " How's it going in here, it's about time for a check, go ahead and lay back."
Scenario 2) Care provider walks into the laboring woman's room. Pausing to see if she's having a contraction or not, they wait until she is ready and listening. "Hey, how are the contractions feeling? It seems like we've been doing the same thing for a while now. I'm thinking it might be beneficial to do a cervical exam, if you're ok with that. The risks, like we discussed earlier, are that your water is broken and any exam will increase your risk of infection. The benefit of having an exam would be to see if the baby is malpositioned, and then we could try some different positions to get them into a better place to progress labor. Baby's and your health both look steady, so you also have the option to just keep doing what you're doing. I can step out if you need a minute to discuss your options with your partner and doula. Do you have any questions?" 

You don't have to be a doula to see the difference. In the first scenario, the woman is not asked for her consent to be examined. The care provider likely assumes that since she is their patient, and possibly has consented to an exam before, that they have consent for the remainder of the birth. AKA Implied Consent.

In the second scenario, the care provider makes sure the woman is focused on her words. Women in labor often get a little spacy, and unfocused, especially during contractions. The care provider truly informs the patient the risks and benefit of what she is requesting, with the option to still do nothing. She respects the relationships between the laboring women and her support team, the patient's body and her capacity to make her own decisions about her care. AKA Informed Consent. 

There is so much more that goes into the ramifications of Implied vs Informed Consent. Mainly a woman's right to her own body, even when she's carrying a fetus. 

“The freedom to accept or refuse recommended medical treatment has legal as well as ethical foundations. . . . In the obstetric setting, recognize that a competent pregnant woman is the appropriate decision maker for the fetus that she is carrying” (ACOG Committee on Ethics Committee Opinion No. 390 Ethical Decision Making in Obstetrics and Gynecology; Dec 2007, reaffirmed 2013).

This includes the right to decline interventions, exams, treatment, monitoring, medications, and even surgery. It is illegal to threaten a woman about calling CPS, as sometimes happens, if she does not comply with the care provider's request. It equates very closely with a First Degree Sexual Offense, that the woman must allow something to happen to her body for fear of something happening to her baby. 

To advocate for your own Informed Consent always use your 
   Benefits 
   Risks
   Alternatives
   Intuition
   Nothing
   Second Opinion 

When deciding about your options in childbirth, remember to always use your BRAINS. Have your care provider, nurse, or doula, go over these points with you to make a truly informed decision.  B - what are the benefits of the item being proposed, conversely what are the R - risks to myself, to my baby, to the rest of this labor, to future pregnancies. Are there any A - alternatives, such as waiting, position changes, natural augmentation? What does your I - intuition tell you, trust your body knows how to give birth. N - what if you simply wait and do nothing? S - lastly, if you don't agree with the proposed care, ask for someone else's opinion. There is no one right way to manage a labor and birth, it is organic, and changes.

Trauma in childbirth doesn't always come from the act of an exam, an intervention, or a cesarean. There are many women who reflect positively on their very medicalized labor that ended in a cesarean birth. Trauma can occur when a woman feels like she was not heard, like she had no choice, and like she was violated. The easiest way to help mitigate these feelings is to make sure she has truly informed consent. That she is supported in making the decisions regarding the care of her own body and baby; and she is ultimately respected in the decision she makes. Empowered women are more satisfied with their birth experience. Some might still feel sorrow and loss over the detours from their original birth plan, and that is completely normal and ok! Grief is healthy in its own way, trauma is not. 

Whether your birth went "perfectly" or detoured tremendously, avoid feeling traumatized by empowering yourself with informed consent.