Nothing can be more empowering than standing up for your wishes and needs. But much too often, women in labor are unaware of their rights as patients, and their birth experience could be sabotaged because of it. When I read Marsden Wagner’s Born in the USA, I became particularly interested in the political aspects of fixing the maternity care system in our country. One of the most powerful things a woman can do is arm herself with information, and knowing her rights as a patient is the first step.
The right to informed consent and the right to refuse treatment are protected in the Constitution by the First and Fourteenth Amendments, the right to privacy and self-determination. They are also protected by federal law through the Emergency Medical Treatment and Active Labor Act (EMTALA) and the Patient Self-Determination Act. The American Medical Association (AMA) an the American College of Obstetricians and Gynecologists (ACOG) also cover both these rights in their ethical guidelines.
So what does “informed consent” and “self-determination” really mean? And how does it apply to labor and birth?
- The right to exercise self determination and autonomy in all medical decisions, including the decision to refuse treatment. This is especially important for situations where hospital policy requires you to birth a particular way, or prevents you from having the type of birth you want. Mandatory c-sections for breech and twin births, as well as bans on Vaginal Birth after Cesarean (VBAC), are just two examples of how hospital policy limits the patient’s choice regarding her health and the health of her baby. Such policies are not protected by law, and you have every right as a patient to refuse treatment, no matter the consequences of that choice.
- The right to bodily integrity. Any non-consensual touch or procedure in a medical setting constitutes battery and should not be tolerated. This includes non-consensual Artificial Rupture of Membranes (AROM) and episiotomies, both of which should only be done with the woman’s knowledge and consent. A woman’s who experiences birth trauma is more likely to suffer from Postpartum Depression (PPD) or even Post-Traumatic Stress Disorder (PTSD), and is more likely to have difficulty breastfeeding. These experiences can be so traumatic that a growing number of women are classifying it as “birth rape.” If you feel you were violated in any way during your birth, please report it — that’s what the legal system is intended for.
- The right to be provided with the necessary information on which to base medical decisions. This includes getting a diagnosis, recommended treatments and alternatives, the risks, benefits, and side effects of proposed treatments, realistic expectations of outcomes, a second opinion, and any financial or research interests a physician has in proposing certain treatments (I find that last one particularly interesting). Clearly, it may be difficult to get all of the above information while in labor. I know I certainly couldn’t have sat through it! It is important to discuss these issues with your doctor before you go into labor, not during. Make like a boy scout and be prepared.
- The right to be informed of any potentially life-threatening consequences of a proposed treatment, even if experiencing such such an outcome is unlikely. C-section is a major procedure for which the consequences and risks are often downplayed or left out, especially if it is a repeat surgery. Other interventions, such as induction/augmentation and epidurals also have risks which are rarely discussed in depth.
- The right to make medical decisions free from coercion or undue influence from physicians. Many women are talked out of VBACs because of the risks only to undergo an (at least) equally risky repeat C-section. Women are also “talked into” more minor procedures like epidurals, augmentation, and induction when doctors talk about the “risks” (like hypersomia and shoulder dystocia). This right is especially poignant during labor, when a woman is experiencing the effects of lots of hormones, stress, and exhaustion, as she could be more suggestible at that time.
- The right to revoke consent to treatment at any time, either verbally or in writing. I have read many stories where a woman stated to her care provider, “I don’t want an episiotomy,” or “I don’t want a C-section,” only to have her wishes dismissed. While these procedures are sometimes necessary, a women does have the right to take the risk and not have one. Even if you’ve already consented, you have the right to “backsies,” and legally a care provider must respect your choice, even if they disagree with it. A care provider’s purpose is to advise and serve, not make decisions regarding your health.
Another helpful bit of information — a doctor can only terminate care after reasonable notice, and after providing necessary care. Many people, including physicians, believe that if a doctor disagrees with a patient’s choice, they can simply discharge you on the spot, but that’s not true. When you are in labor, discharging you against your wishes is considered patient abandonment.
Also, you are NOT required by law to sign a hospital’s consent form, and you also have the right to make any changes regarding specific treatments (get a copy of whatever you sign upfront, especially if you made changes). If your wish to refuse a specific treatment is documented, and you receive that treatment anyway, the hospital and doctor can be held liable, just like they can if they violate a Do Not Resuscitate (DNR) order. If a patient refuses a C-section upfront, and she receives one anyway, the doctor and hospital can be subject to battery charges, regardless of whether or not she or the baby were harmed.
Know your rights BEFORE you go into labor. Make your care provider(s) know that you are aware of your rights — by empowering yourself in this way, you are setting yourself up for a more respectful birth experience.
If you feel like your care provider was negligent or abusive of your rights, speak up! In recent years, the courts have repeatedly upheld the rights of pregnant women to refuse procedures, even C-sections. It is dangerous for this vigilante medicine to be practiced, where the doctor thinks he cares more about the baby than the mother, which is exactly what coercion and blatant disregard for a patient’s wishes imply.
What you can do if your rights are violated:
- File a complaint with the chief compliance officer of the hospital.
- File a complaint with the state medical board.
- Don’t be afraid to press charges if you feel it is justified.
This is a heavy subject, and it is very unfortunate that our maternity care system is in a condition where laboring women must concern themselves with such matters. Take this information and use it to your advantage. Flex your legal muscles, and see how powerful you become.
I am a wife and stay-at-home mother to one darling little girl, with a degree in Psychology and a background working with children ages 2-11. I have worked in a preschool setting as well as a private nanny. Children have and will always be one of my greatest passions, and I take great joy in seeing happy and healthy children.
In March of 2011, I gave birth to a beautiful baby girl (Sweet Pea), in my home and without any sort of labor augmentation or pain management. I credit my self-education, the support of a wonderful husband and midwife, and just a little bit of luck to my great experience. After an early pregnancy loss and fertility issues, I didn’t go into pregnancy with a lot of confidence in my body, but birth changed all that. I had a truly transformative experience, and it is now my sworn duty to guide other women toward their own metamorphoses.
Too many women in our culture are deprived of a positive birth experience by a malfunctioning medical system. Choices in birth are disappearing left and right, and new technologies fail to improve the outcomes for mothers and babies. The more I learn about our maternal care system, the more I am convinced that it is time for women to stand up and take back what is rightfully theirs — their births.
And it isn’t just in the delivery room where women are being manipulated — mothers are bombarded left and right with “advice” about raising their children. But how much of this advice is supported with evidence to be the healthiest choice for your child? Sadly, not much of it. I have explored some of the alternatives to “normal” feeding, sleeping, and discipline, three of the most volatile decisions facing today’s parents. I have had great success exploring these “variations on normal,” and believe others will as well.
I invite you to join me.