July 09, 2003

"Informed consent" and "informed choice"

I've written before about the way that prenatal classes are often used (sometimes unwittingly) to set women up for routine procedures carried out by hospital staff during labour. This is one area where educators need to have a very clear concept of their role and the impact/potential of their work if they are to be effective, especially in ensuring that women make informed choices about the care they receive.

It is important to be clear about the difference between "informed choice" and "informed consent". "Informed choice" suggests that various options are under consideration and a decision will be made about which one to adopt in a given situation. "Informed consent" means being asked, having been given the pros and cons, if a specific action or option is acceptable.

In maternity care, choosing a birth place would be an example of "informed choice" where expectant parents canvass the various hospital and home birth service available and decide where they wish to have their baby. An example of "informed consent" would occur when a midwife, having explained the advantages and disadvantages of the procedure, asks a labouring woman if she consents to her membranes being ruptured.

These are important distinctions to get across in classes to parents. Obtaining consent does not mean making sure that parents are told what is going to happen to them. It does not mean explaining a procedure and then asking if it is now alright to go ahead with it.

I believe that both "informed choice" and "informed consent" are myths in our present maternity care system. Parents are rarely aware of all the choices available (and sometimes inconvenient options are deliberately withheld), making informed choice impossible. In addition, requests for permission to proceed with a treatment or intervention are often couched in friendly terms or dressed up with a smile in such a way that refusal is made difficult. Sometimes these requests will be made of women under extreme duress or in situations where rational thinking is impossible ( established labour, for example), making a mockery of the whole concept of informed consent and leaving caregivers in a vulnerable legal position.

Childbirth educators have a vital role in reducing the amount of coercion going on in our maternity hospitals. They are the people who can take the necessary time to explain options and explore alternatives, have the necessary information at their fingertips and make sure that parents understand the information being presented.

Demonstrating a clear understanding the difference and importance of these terms is a vital first step in offering quality prenatal education and should be a prerequisite for all those presenting education programs for parents. Without this, educators could easily be accused of colluding with the establishment to maintain the current coercive practices that many women encounter when they give birth to their babies.

Posted by andrea at July 09, 2003 04:52 PM

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