Tuesday, July 18, 2006

Making Informed Decisions

Making Informed Decisions
Nicette Jukelevics, MA, ICCE

In pregnancy and childbirth, by communicating openly with your caregiver, together you can make decisions that best meet your needs. You should know that every woman has the right to fully participate in all decisions regarding her own healthcare and that of her unborn child.
This legal doctrine is called the right to informed consent. The World Health Organization, the European Parliament, the American Hospital Association and many other organizations support and endorse the right of women to make their own healthcare decisions in consultation with their caregivers.

In fact, the American Colleges of Obstetricians and Gynecologists (ACOG) supports a woman's right to make healthcare decisions for herself and her unborn child. Physicians must disclose to their patients information about the risks and benefits of any recommended treatment, test, or procedure so that women can make an informed decision.

When a physician has clearly explained the benefits and risks, a woman has the right to choose among the options available to her or refuse them altogether. ACOG states that patients may decline a physician's advice or recommendation, even during treatment, based on "religious beliefs, personal preference, or comfort." Patients are entitled to an "informed refusal."
Labor and BirthAs a mother-to-be, you have the responsibility of obtaining early prenatal care, living a healthy lifestyle, and finding out as much as you can about the process of labor and birth.

You have the right to ask:

Can you explain this to me?
Where can I get more information?
Can you write this down? Draw me a picture?
I want to think about this before I make a decision.
I don't feel comfortable with this recommendation.
Is there any else I can do or try?

Tests and ProceduresYour caregiver will give you information and advice. You will probably feel better about making decisions regarding tests, procedures, or treatments if you ask your caregiver a few questions:

How is this helpful to me or my baby?
Are there any risks involved?
Can you recommend a safe alternative?
How will this affect my labor? My baby?
Do I have time to think about this and give you my answer later?
If I choose not to go ahead with this recommendation, what would the consequences be for me and my baby?
How do you feel about my getting a second opinion?

Consenting to Treatment
When you give birth in a hospital or birth center, you are asked to sign a consent to treatment form. Your signature gives permission to the staff to care for you and your baby. Usually this form includes common procedures such as: vaginal exams, fetal monitoring, use of IVs, pain medication, breaking the bag of water, use of forceps or vacuum extractor.

You do not have to agree to everything on the form. You can delete from or add statements to the form. A separate consent is sometimes required for an epidural or for a cesarean section.
You can change your mind at any time by making your wishes known to your caregivers. If you choose not to agree with a treatment or procedure you may be asked to sign a waiver of liability acknowledging that you are taking responsibility for your decisions.

You also have the right to have a copy of your medical records. You may be able to obtain them directly, or they may need to be sent to the caregiver of your choice, depending on the regulations of the community in which you live.

Caregivers may disagree about what is best for pregnancy and childbirth. By becoming actively involved in your care, you are likely to be more satisfied with your decisions.

Adapted from The Rights of Patients: The Basic ACLU Guide to Patient Rights by George J. Annas. Southern Illinois University Press; 3rd edition (January 1, 2004).
ACOG June 2000. Informed Refusal. Committee Opinion, Number 237.

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