Female Reproductive Health & Informed Consent
What exactly does it mean and how does it impact women's bodies?
In order to understand Informed Consent, it is important to examine the history of the Hippocratic Oath, or the historical process of swearing in a medical provider.
The Hippocratic Oath comes from the Ancient Greek physician Hippocrates who established ethical guidelines for practicing medicine. This oath, or promise, is made by medical professionals as they finish training and enter into medical practice.
The main principles of the Oath are to:
Respect and support the teachers of medicine
Share medical knowledge
Use their knowledge of medicine (and diet) to help patients
Avoid harming patients, including "deadly medicine" even if requested to do so
Not provide a remedy that may cause an abortion
Seek help from other physicians if necessary
Avoid “mischief”, injustice, and sexual relations with patients
Keep patient information confidential
While most of these principles are still widely practiced today, the Oath itself is not commonly used to swear in physicians. In fact, many physicians that graduate from medical school utilize an alternate pledge, or… none at all.
Although there are people among the medical community who do not fully agree with the Hippocratic Oath, Informed Consent is without a doubt considered to be the most essential principle of medical law and bioethics.
According to the Code of Medical Ethics, “the process of informed consent occurs when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention. In seeking a patient’s informed consent (or the consent of the patient’s surrogate if the patient lacks decision-making capacity or declines to participate in making decisions), physicians should:
Assess the patient’s ability to understand relevant medical information and the implications of treatment alternatives and to make an independent, voluntary decision.
Present relevant information accurately and sensitively, in keeping with the patient’s preferences for receiving medical information. The physician should include information about:
the diagnosis (when known);
the nature and purpose of recommended interventions;
the burdens, risks, and expected benefits of all options, including forgoing treatment.
Document the informed consent conversation and the patient’s (or surrogate’s) decision in the medical record in some manner. When the patient/surrogate has provided specific written consent, the consent form should be included in the record.”
The Code of Medical Ethics has one exception when it comes to obtaining informed consent from a patient and that has to do with medical emergencies.
It reads, “In emergencies, when a decision must be made urgently, the patient is not able to participate in decision making, and the patient’s surrogate is not available, physicians may initiate treatment without prior informed consent. In such situations, the physician should inform the patient/surrogate at the earliest opportunity and obtain consent for ongoing treatment in keeping with these guidelines.”
Now let’s talk about how this relates to healthy pregnant people. How can someone in active labor give informed consent when her body and baby are requiring her undivided attention?
The answer is - it depends.
As someone who has attended 200 + births within hospitals, birthing centers and home, I can tell you with certainty that the birthing woman must first and foremost feel safe. And in order for her to feel safe, she needs to trust her care team. And in order to trust her care team, she needs to be educated and empowered in her decision making.
This is why having an experienced doula or birth support person present can make a world of difference in terms of birth outcomes.
This is also why *no one* should be left alone in a medical setting to make decisions about their health, especially when they are physically and emotionally vulnerable.
*Housekeeping*
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If you have any questions, you can reach out to hello@keelysemler.com.
And if you prefer listening rather than reading, I totally get it. You can listen to MOTHERLANDS - a podcast that traverses the current landscape of fertility, pregnancy, childbirth, and postpartum by bridging the two distinct worlds of traditional allopathic medicine and holistic health practices.