Technically, in any area of medicine, no matter how big or small a procedure may be, a provider is supposed to obtain your informed consent – except in the case of an absolute dire emergency, or when a patient is non-responsive. Obstetrics does not get a pass from this little requirement, contrary to modern customs. This means that your provider should OFFER certain information about any proposed procedure (as opposed to only telling you after you have grilled them for 3-hours, good cop/bad cop style).
Unfortunately, in regards to birth, full benefit/risk information is very rarely freely offered in a real practice setting. So the only other alternative is for you to know what questions to ask.
I teach the easy-to-remember acronym BRAINS. As in “Use your BRAINS“
- B – Benefits – What are the benefits of doing this procedure? What are we trying to achieve? Why?
- R – Risks – What are the risks of doing this? What other accompanying interventions will come with this? What are the side effects?
- A – Alternatives – What are my other options? What are the benefits and risks of those?
- I – Intuition – What is your intuition telling you? Does this make sense? If no, research independently and ask more questions, or ask for a second, independent opinion.
- N – Nothing – What if we do nothing? What if we wait a while?
- S – ‘Scuse Me – As in, please give us a moment to discuss and decide. Unless it is an absolute emergency (which it rarely is), you should be able to take a few minutes to discuss and decide alone. You can image that it’s harder to make an honest decision if the doctor’s staring right at you, waiting for an answer.
Use your BRAINS.
How would this play out in real life, you may ask?
Nurse: “The doctor has ordered a little Pit to speed up your labor.”
You: [B - Benefits] “Why does he feel we need to speed up the labor? What would be the benefit of speeding it up?”
Nurse: “He just feels like it’s going too slowly, and your water has been broken for a while now.”
You: [R - Risks] “What are the risks of Pitocin?”
Nurse: “None.”
(Mandi: This is a lie. If anyone ever tells you there are no risks to doing something, call them on their BS. There are drawbacks to everything. Sometimes the benefits outweigh the drawbacks, so just because there is a drawback doesn’t mean you should automatically refuse. But you deserve [and have the legal right] to know the risks.)
You: [R - Risks - Seriously, I would like to know the risks.] “I have read that it can increase the odds of fetal distress, and can make labor much more painful, increasing the odds of an epidural.”
Nurse: “Oh, that. Yeah, most Pitocin moms get the epidural.”
You: [R... still! This is an important category!] “Since I would be more likely to get the epidural, what are the risks of that?”
Nurse: “Drop in blood pressure, increased chance of fetal malpositioning due to limited range of maternal motion, shaking, and increased chance of cesarean due to fetal distress/aforementioned malpositioning and inability to effectively push due to loss of muscle control.”
(Mandi: The nurse is never going to tell you this. But I could really turn this into a 12-hour string of [R] questions. So for the sake of my sanity, the nurse is just going to very clearly come out and tell you the risks. This is why it’s important to take a comprehensive childbirth class so you are already somewhat familiar with the risks of different interventions.)
You: [A - Alternatives] “What are the alternatives? I’ve heard walking is fabulous at speeding up labor if time is truly a concern.”
Nurse: “Walk? What is this walking of which you speak? We’ve never had a patient walk here. I would have to call a board meeting to see if that’s a possibility.”
You: [I - Intuition] “That sounds ridiculous. Women have been walking during labor since the dawn of time. My intuition is telling me it’s fine to walk. But I would love to get a second opinion on that.”
Nurse: “I’ll see what I can do about that.”
You: [N - Nothing] “Seeing as this isn’t an urgent situation, would there be any risk to NOT starting the Pitocin right now?”
Nurse: “Um, no, I guess there wouldn’t be any risk.”
You: [S - 'Scuse Me]: “Okay. Thank you so much for your help. We’d like to have a few minutes alone before deciding how to proceed.”
Easy -peasy? Not exactly, especially not in the midst of labor. But I can darn-well guarantee you it’s better than getting steamrolled into unnecessary interventions. And again, I’d like to clarify that sometimes these questions help you to conclude that an intervention IS the safest, smartest option for your particular birth. But every woman deserves to have this information so SHE can make the decision that is best for her and her baby.
Use your BRAINS.
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Love it, Mandi! I’m totally adding the “S” to my list – LOL!
Wonderful tool!! I am sooo using this for my birth!! As an RN, I love to see my colleagues challenged. It really helps us grow! All nurses should KNOW that it is best to ask questions and most will not be offended! Informed consent is not a formality…it is a patient RIGHT and a provider’s RESPONSIBILITY! Thanks Mandi!
Thank you, Heidi! It’s so wonderful to hear this viewpoint from an RN! Unfortunately, a few RNs on a birth group which shall remain anonymous apparently were offended by this post and had the link to it that I posted removed. 95% of RNs I have encountered have been amazing, wonderful women. I guess these were the 5%?