Informed Consent for Anesthesia

Regarding the role of the health care professional, the American Medical Association defines informed consent in the following way:

Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient’s authorization or agreement to undergo a specific medical intervention. In the communications process the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with [the] patient:

(1) The patient’s diagnosis, if known;

(2) The nature and purpose of a proposed treatment or procedure;

(3) The risks and benefits of a proposed treatment or procedure;

(4) Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);

(5) The risks and benefits of the alternative treatment or procedure; and

(6) The risks and benefits of not receiving or undergoing a treatment or procedure.

In turn, [the] patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention.

Do you feel like you have truly given your informed consent when it comes to procedures that were performed on you during pregnancy, labor, birth, or postpartum? Not just anesthesia, but for everything  — like an IV, being forced to stay in bed, or deprived of food and water, or having continuous fetal monitoring.

The above italicized portion was from Nursing Birth blog. Click here to read the rest of the very informative post, including an actual hospital informed consent form which you can read right now, instead of waiting until you are deep in labor.

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Bet she will!

What if you found out your doctor and nurses had a bet going on as to when you’d give birth, if you’ll end up with a C-section or episiotomy, etc.? Do you think that would have some bearing on the kind of care you receive? If your doctor thinks that all first-time moms and most subsequent moms need an episiotomy, what do you think your chances are of coming through childbirth uncut? If your doctor has you marked out for a C-section, do you really think he’ll try to ensure that you will have a vaginal birth, just because that is what you wish?

No, I don’t really think that doctors and nurses really have a betting pool on their patients (although, years ago, I did hear of a Las Vegas hospital or nursing home that had to fire some of its employees, after it was discovered they were betting on when their terminal patients would die), but does it really matter whether the doctor has money riding on it or not, if he has prejudged you as needing a C-section?

This is more than just a thought-provoking post. This post was inspired by numerous posts I’ve read recently that have come together in my mind in a new way. The main “other post” I read was by a woman who feels like she was railroaded into an unnecessarean. Of course, I only have her point of view to go on, and can’t ask her doctor’s opinion. While she has some legitimate beefs with the care she received, if her perspective is correct, she did fit several risk profiles (including being overweight and having diabetes and having a 9lb+ baby — although these in and of themselves do not require a C-section), and she may have been unaware of something that happened in labor from a clinical perspective, so it is also possible that her cesarean was indeed necessary and kept her baby safe. She does not think so, and is planning a home VBAC if she gets pregnant again, because of the care, or lack thereof, she received at the hospital.

But in reading her birth story, she relates that the doctor had strongly encouraged her to choose a C-section before she went into labor, and even said that she’d end up with a C-section anyway. It didn’t matter that she wanted a vaginal birth; it didn’t matter that she wanted to give birth without any medication at all. Her doctor grudgingly allowed her to go into labor (as if he really had a choice to force her into an elective C-section), but there was a thread running through her birth story of consistent undermining of her wishes and desires to have a vaginal birth. So while I was expecting the story to end more along the lines of, “so I ended up having a vaginal birth despite my doctor,” I was not too surprised to see the doctor keep pushing a C-section, and the woman finally consenting, without any indication of a real medical reason. (Although, again, she may have been unaware of something that had happened to indicate a C-section.) The actual diagnosis given was “failure to progress,” with the explanation being that she was too fat for the baby to descend into the pelvis, and the baby was also too big to descend lower into the pelvis and dilate the cervix. Of course, I would have just suggested that she be given more time, as long as the baby’s heartbeat was fine, but that suggestion would not have been taken well. You see, the doctor had determined that she ought to have a C-section before she even went into labor. So, the doctor was ultimately proven right. Or was he?

The fact that she ended up with a C-section does not necessarily indicate that the C-section was necessary to save either her or her baby’s life or health, any more than the fact that I give my kids peanut butter and jelly sandwiches for lunch when they ask for pizza is an indication that PB&Js are necessary for them. Reading her birth story indicated to me that the doctor had made his mind up to perform a C-section on her, and he had a “don’t bother confusing me with the facts” attitude. So, no, I don’t really trust that the doctor did what was medically indicated. Rather, I think he decided that she should have a C-section, and chose every opportunity he could to force-feed her a C-section, until she finally gave in and submitted to it. That is certainly the impression she has.

The other stories are mainly L&D nurses’ stories of patients they’ve taken care of — they advocated for them to have a vaginal birth and some succeeded, while others did not. Some of the stories make my blood boil, because the doctors just don’t care. Sometimes they are knife-happy; other times they are just selfish and want to go home and stay home, and not have to be called back out to catch the baby later; and sometimes they have just marked out a woman for a C-section, and jump at the earliest opportunity to coerce her into one by telling her that her body has failed. Hearing these stories from mothers who have gone through this experience, but may miss clinical reasons that truly indicated a C-section, so feel like their C-section was unnecessary, but are wrong, is one thing; hearing these stories from experienced L&D nurses who can unequivocally say, “I know her C-section was unnecessary,” is another.

So much depends on your care provider’s philosophy! Do not underestimate how important it is to choose your midwife or doctor and birth-place wisely!!

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Birth Survey is here!

Although I haven’t gotten anything official, the national results for The Birth Survey have finally been released! Woo-hoo!!! I checked it a couple of weeks ago, and I didn’t see any local hospitals — or any care providers outside of New York City — but today I checked, and it’s up! Yippee! Of course in my area (backwards as it is), there are only a few responses, but I hope to change that. I’ve got a stack of postcards and take some with me to the store, and when I see a pregnant woman or someone with a small child, I try to give him or her a postcard and explain what it is about. Yes, I gave a “Birth Survey” postcard to a man — how’s that for being unsexist? — he had an infant, so he was fair game, as far as I was concerned! 🙂

If you have had a baby in the past 3 years, please fill out the survey about your experiences — whether you loved or hated your doctor, midwife, nurse, anesthesiologist, etc., or just found him or her to be “okay”, other women in your area want to know about it! Think about it this way — if you had a real jerk for a doctor, don’t you wish somebody had told you he was a jerk before you ended up with him? Do someone else a favor, then, and tell them through the survey. Contrarily, if you had a great doctor (or other care provider), you can also do other women in your area a favor and tell them about your wonderful experience.

One of the good things about this survey is that it asks about so many things, and you can rate your care providers and place of care individually — in other words, if you had an awesome nurse but an awful hospital, you can reflect that in your ratings. Or if your nurse left something to be desired but your doctor was wonderful, you can say that. Also, if your doctor was great on prenatals but not so great during birth, you can say that. Or if he was ho-hum during prenatals but the best birth attendant you can think of, you can say it. Were you pushed into having unwanted drugs or other interventions? — say it! Did you ask for an epidural and had to wait a long time? — say it. Did your doctor tell you one thing during pregnancy and then totally change the rules during labor? — say it!

Ok, I’m so excited! But I’m going to stop now before I ramble on even more. Yee-ha! Go check it out, and if you haven’t yet filled it out, do it!! Your pregnant sisters now and in the future will thank you for it. Let your voice be heard!

VBAC Bibliography

April is Cesarean Awareness Month, and a lot of bloggers have been posting a lot of C-section related stuff (more so than usual), and here is a wealth of information on VBAC — nearly 100 links or other sources. Wow. Enjoy (or not as the case may be, since some of the links look sad just by the title).

The Upside-Down World of Birth

In putting a friend’s home movies on DVDs, I saw the videos of the births of two of her grandchildren. In both of these videos, the mother  is completely covered in sterile drapes except her “privates”. HER PRIVATES ARE MADE THE MOST PUBLIC!!! Does anyone else see what is wrong with this scenario? Her legs were invisible — they were draped up to her groin. Her abdomen was invisible, it was draped down to her pubic hair. The only part of her body (aside from her face and arms) that was visible was her perineum. Is that not just a perfect example of the “upside-down world of birth”? Women want darkness and warmth during labor, but the hospital is cold — and when she is pushing, a bright light is directed right at her perineum. All focus is on the doctor who “does” the delivery, rather than on the woman who pushes out her child. All focus is on the machines that tell what is going on inside the mother’s body, rather than on the woman who can also give out a load of information about what is going on inside her body… if they’ll just listen to her. Movement provides relief and helps to move the baby, but the machines and tubes require her to stay in one spot. Being vertical is preferable to being horizontal, but the hospital protocol is that she remain in bed. Labor and birth is a time of intimacy, but there can be half a dozen strangers in the room to witness the birth and provide assistance. And these examples are just the tip of the iceberg.

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The Amazing Placenta

Dr. Sarah Buckley had a very interesting article about the placenta, intertwined with the story of her son Jacob’s pregnancy and birth.

h/t to EnjoyBirth for the link!

And while I’m on the subject of placentas, click here to read more about the battle over placentas in Hawaii. Native Hawaiians are one of many groups who have traditions and ceremonies with the placenta, and Hawaii is the first state to specifically give parents the right to take the placenta home with them from the hospital, rather than (as the previous law stated) placentas being declared infectious waste.

High-Tech vs. High-Touch — Consumer Reports on Childbirth

In an article titled “Back to basics for safer childbirth,” and subtitled “Too many doctors and hospitals are overusing high-tech procedures,” Consumer Reports finds the same problems with modern birth practices for low-risk women that natural-birth advocates have been reporting for years: overuse of high-tech, often invasive measures, and underuse of high-touch, usually non-invasive measures.

Overuse of high-tech measures

  • Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005
  • Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests
  • Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization’s recommended national rate of 5 to 10 percent
  • Electronic fetal monitoring, unnecessarily adding to delivery costs
  • Rupturing membranes (“breaking the waters”), intending to hasten onset of labor
  • Episiotomy, which is often unnecessary

Underuse of high-touch, noninvasive measures

  • Prenatal vitamins
  • Use of midwife or family physician
  • Continuous presence of a companion for the mother during labor
  • Upright and side-lying positions during labor and delivery, which are associated with less severe pain than lying down on one’s back
  • Vaginal birth (VBAC) for most women who have had a previous Caesarean section
  • Early mother-baby skin-to-skin contact

They also have a link to a true-false quiz on maternity care (I scored 100%).

Now that Consumer Reports has jumped on the natural-birth bandwagon, maybe, just maybe, all those people who denigrate natural birth advocates will shut up. Hey, I can dream, can’t I? 🙂

My thanks to Empowering Birth for the link to the article!