Making Informed Health Care 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 health care 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 health care decisions in consultation with their caregivers.
As 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?
Your 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 my baby or me?
§ 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 my baby and me?
§ How do you feel about my getting a second opinion?
When you give birth in a hospital or birth center, you are asked to sign 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 and always required for a cesarean delivery.
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.
What do you need to know to give informed consent?
ü What is being recommended to you?
Is this a test, a medication or a procedure? Is this a one time event, or will it require several visits or administrations?
ü Why is this being recommended?
Is this something that is recommended to everyone, or is there a reason to believe it will be helpful in your situation?
ü What is this expected to do?
Is this going to relieve a problem, improve your health, manage discomfort or something else? In short, what should be different after you receive this.
ü What are the risks of this?
The list of risks will vary with every procedure and medication. Do not accept the answer, "There is no risk involved." Every procedure has a risk, many procedures have a very small risk and it is easy to see that the benefits outweigh the risks, but that doesn't mean there is no risk.
It is also important to remember that some risks are not "physical." There may be no physical risk to wearing a hospital gown, but many women report that it changed the way they felt. So there is an emotional risk involved in wearing a hospital gown.
ü What are the other options and their risks?
There is always another option, even if it is just to do nothing. Remember that the other options have risks too.
ü What will we do if this doesn't have its desired effect?
No procedure, medication or intervention (natural or medical) is 100% guaranteed to work. What will be the next step if you decide to go ahead, and it doesn't work. How will having used it change the other options available to you?
Great websites to check out...
http://www.pennysimkin.com/index.htm
Great book to read to become more informed:
The Thinking Woman's Guide to a Better Birth by Henci Goer
Adapted from The Rights of Patients:The Basic ACLU Guide to Patient Rights by George J. Annas . 1992. Totowa, New Jersey:Humana Press.
