Decision Making in Labor

How to Get Informed Consent

Woman in labor in hospital bed
Cultura RM/Charles Gullung/Collection Mix: Subjects/Getty Images

Sometimes, labor and birth don't follow the path we predict they will. When or if your labor takes a turn down an unexpected path, don't worry! Just use your BRAIN. This simple, easy-to-remember tool will help you make solid, informed decisions about your options even in the most complicated situations!

Benefits: what are the benefits of this procedure? How will it benefit me as a laboring woman, and how will it benefit my baby?

Are the benefits mostly cosmetic or convenience-based, or are they truly likely to improve my health/the baby's health? Are the potential benefits greater than the potential risks?

Risks: What are the risks of this procedure? It's important to be thorough here. No procedure is risk-free. If you are handed a form to sign, be sure to read the fine print: many procedures performed during the birth process have risks that women are not verbally informed about. Don't let your provider's reassuring tone prevent you from hearing what he or she is actually saying.

Alternatives: There is often a choice to be made about obstetric procedures, e.g., forceps or vacuum extraction? External version or gravity-based positioning? Many of these choices are made based on the provider's experience and habit rather than any clinical necessity. If there is more than one option for a birthing procedure, you deserve to know about it.

A choice with only one option is not really a choice, let alone an informed one.

Instinct: This is the big one. What does your instinct tell you? Even if you are not typically a person who regularly follows your instincts, pregnancy and birth is the time to give yourself the benefit of the doubt. Oftentimes we are aware of delicate physiological changes that medical equipment cannot pick up.

Many a mother has reported to her practitioner because something "just didn't feel right," and discovered that she is 8 cm dilated, or persisted in her instinct that something was wrong until the problem was discovered and remedied. Always remember: your practitioner would rather be called for a false alarm than because something dangerous went unreported.

Nothing: What happens if we do nothing? Most often, in labor and birth, this will take the guise of time. Can we wait? Do we have time to let physiology do its work before we intervene in the process? Once again, sometimes medical decisions are made not because they are necessarily the best choice, but the most convenient. Everyone wants a shorter labor, right? Probably not if it's riskier. Any time a procedure is proposed that will change the natural course of your labor, find out what could happen if you refuse or delay it.

Even though every labor and every birth is different, we can face them both with confidence and bravery with the proper preparation.

This BRAIN tool is a powerful step in that direction, and will help you make informed decisions during your labor and birth – no matter what path they take!

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