Birth on Your Terms: The Crusade for Informed Consent

When it comes to healthcare, especially something as intimate and life-changing as childbirth, informed consent isn’t just a formality; it’s your right to take the reins of your own journey. This issue isn’t about doctors or midwives making decisions for you; it’s about empowering you to make choices that resonate with your body, beliefs, and life. But let’s be honest, this ideal doesn’t always align with reality.

Just the other day, I was chatting with another midwife about a client who wanted to have a vaginal breech birth. She had done her homework, understood the risks, and was ready to go through with it. Yet, she hit a wall because she couldn’t find a provider who would support her in this choice. This conversation hit me hard because of her frustration and because it reflects a broader issue in our healthcare system. How did we end up where choice – the essence of informed consent – often feels out of reach?

In this article, we will dive deep into what informed consent truly means in the context of childbirth. We’ll explore why it’s not just a legal checkbox but a fundamental part of respecting a woman’s autonomy. I’ll share stories from the front lines, including my own experiences with breech births, to illustrate the challenges and victories of informed consent. We’ll look at how our medical system sometimes fails to uphold this right, discuss the legal and ethical dimensions, and, most importantly, provide practical steps you can take to ensure your voice is heard in your healthcare journey.

So, buckle up as we navigate the complexities of informed consent, empowerment, and the fight for choice in childbirth. Whether planning your birth or advocating for someone else, this article is designed to arm you with knowledge, inspire action, and maybe even spark a little revolution in how we approach childbirth care. Let’s begin this journey towards a future where every woman can confidently say, “This birth is mine to choose.”

The Reality of Informed Consent

Informed consent in the realm of childbirth isn’t just about signing a piece of paper before procedures begin; it’s about ensuring you’re fully engaged in the decision-making process for your health and your baby’s. Being informed means you are given a full, honest rundown of what’s ahead, translating the medical jargon into terms that resonate with real life. It’s about understanding the implications for you, your body, and your baby, not just in the moment but for your life moving forward.

Imagine sitting down with your healthcare provider where you’re not just a patient but a partner in planning your birth. This level of communication is what informed consent should look like:

• Positive example: “Let’s talk about your options for pain management during labor. We have epidurals, which can be very effective but can also slow down labor, or we can discuss non-medical options like water birth, massage, and breathing techniques. Each has benefits and considerations, so let’s find what fits best for you.”
• Positive example: “I see you’re considering a home birth. Here’s what you need to know about the safety, the support we can provide, and when we might need to transfer to a hospital. It’s your choice, but let’s ensure you have all the information to make it.”

Now, contrast that with experiences where informed consent falls short:

• Negative example: “We need to do a C-section; it’s the safest option for breech babies.” Here, the provider isn’t offering a dialogue but deciding for the patient without exploring other possibilities or explaining why other options might not be advisable.
• Negative example: “You don’t have a choice if you want your baby to be safe,” said without discussing the risks of the proposed intervention or alternatives, essentially removing the woman’s autonomy from the equation.

In an ideal world, every woman would sit down with her provider, thoroughly go through all the possibilities – from birth positions to interventions to what might happen if things don’t go as planned – and make a choice that feels right for her. But let’s be real; this doesn’t always happen. Sometimes, it feels like the system is more about ticking boxes than truly empowering women with knowledge.

This lack of proper informed consent can manifest in various ways:

• Providers might rush through explanations, leaving women feeling overwhelmed and uninformed.
• There might be an overemphasis on the risks of less conventional choices without balancing this with potential benefits or discussing options to mitigate these risks.
• The conversation might focus solely on the hospital’s protocols rather than tailoring care to individual needs and desires.

This article isn’t just about pointing out where the system falters; it’s about understanding what informed consent should look, feel, and be like. It’s about advocating for a healthcare experience where you’re not just a recipient of care but an active participant. When done correctly, informed consent is empowering and respectful, leading to decisions that are truly your own and not dictated by the ease of the procedure or the comfort of the provider.

Vaginal Breech Births – A Case Study

Let’s delve into this client’s story momentarily because it’s not just her story but a reflection of many women’s experiences. She was not just ready but also educated, having done her due diligence on what a vaginal breech birth entails. She knew there could be complications, but she also knew that with the proper care, these weren’t insurmountable.

Having extensive training in managing vaginal breech births, I’ve successfully overseen several in my homebirth practice. My approach has always been to empower women with choices when they’re informed and when we’re well-prepared for any scenario. In one memorable case, we had to transfer a mother to the hospital due to some postpartum bleeding – a move made out of an abundance of caution. It wasn’t an emergency; both mom and baby were okay, and this was simply to ensure she could receive blood products if necessary. This cautious approach is part of our practice protocol, focusing on the safety of the mother and baby.

However, what happened next was not just disheartening but a stark reminder of our uphill battle. The doctor on duty pulled me aside, his tone scolding, accusing me of being unsafe for performing a vaginal breech delivery. He didn’t consider the full context, the preparation, or the successful outcome. But I knew, based on my training and the results we achieved, that I wasn’t unsafe. He was wrong in his assessment and understanding of what informed consent and choice in childbirth should look like. The challenging part for me is if he reported me to the Board of Nursing, I would have to spend thousands of dollars and many hours defending myself to keep my license. This hostile situation is the risk I take with every birth, defending women’s right to informed consent and providing trained, loving care to support their decisions. Unfortunately, this is the reality we live in today.

This incident isn’t just a personal anecdote; it underscores a broader issue in our healthcare system. It shows how far we still have to go in changing perceptions and practices around informed consent, especially when it comes to choices that deviate from the norm, like vaginal breech births. It’s a call to action for all of us – providers, patients, and advocates – to push for a healthcare environment where women’s choices are respected, where they’re not just heard but truly listened to, and where the safety of the mother and baby is the priority, not just the method of delivery.

The Broken System

Our healthcare system sometimes feels like it’s designed more to protect doctors and hospitals than to serve women. This isn’t just a feeling; it’s often reflected in practices prioritizing institutional caution over patient autonomy. There’s an overarching fear of litigation that can make providers hesitant to explore or support less conventional birth choices. This fear can overshadow the trust and partnership between a woman and her healthcare provider.

Moreover, there’s a heavy reliance on outdated guidelines that do not reflect current research or advancements in medical practice. For instance, the approach to breech births has evolved, with research showing that, under certain conditions, vaginal breech births can be as safe as cesarean sections. Yet, many providers stick to the old “C-section for breech” rule, not because it’s necessarily the best choice for every woman, but because of old ideas and training on these births.

The lack of training in newer, less invasive techniques further exacerbates this issue. Many obstetricians or midwives might not have been trained in or feel comfortable managing a vaginal breech birth. This lack of training leads to a cycle where the only option presented often involves the least risk to the provider – not the one that might be best for the mother or baby.

Here are some examples that illustrate how the system can feel broken:

• Pressure for C-sections: I’ve witnessed countless scenarios where women, fully informed and desiring a vaginal birth, are subtly or overtly nudged towards cesarean sections. Phrases like “It’s safer for the baby” or “You’re not making progress” are used without fully exploring natural progression or alternative interventions, often driven by time constraints or institutional policies rather than the woman’s health.
• Dismissal of Birth Plans: Women come into their birthing experience with plans, only to find these plans overlooked or dismissed when it’s time to deliver, often in condescending ways. These plans can include preferences for movement during labor, delayed cord clamping, or even refusing certain interventions unless necessary.
• Lack of Time for Informed Consent: The labor process can be hectic, but there should always be time for informed consent. Too often, rush decisions are made, with women feeling they have no choice but to agree to procedures they’re not entirely sure about due to the urgency portrayed by their care team.
• Ignoring Patient’s History or Wishes: In cases where a woman has a history of successful natural births or has expressed a strong desire for a particular type of birth, these experiences or wishes are sometimes disregarded. This disregard can happen when new providers come on shift or if there’s a change in care team dynamics, leading to a disconnect in care that feels more like a conveyor belt than personalized healthcare.

It’s disheartening because childbirth should be about empowerment, not about stripping away autonomy. The system’s current state can make women feel like they’re going through the motions of giving birth rather than actively participating in one of the most significant events of their lives. I am not saying that all providers or hospitals operate this way, but these practices are common enough to warrant serious conversation and reform.

The path to fixing this broken system involves rethinking how we train medical professionals, revising outdated guidelines, and truly embracing the concept of informed consent. It means fostering an environment where women aren’t just patients but partners in their care, where their choices are respected, and where tailored birth experiences meet their needs, not the convenience of the system.

Empowerment Through Information

Here’s where the real magic happens – when women are informed, they’re not just empowered; they become architects of their own birthing experience. Expectant moms must dive deep into learning about their bodies, the birthing process, and all the possible scenarios that might unfold. But this isn’t just about passively absorbing information; it’s about actively engaging with your healthcare provider, asking the tough questions, and ensuring you understand the answers in a way that makes sense to you.

Empowerment through information looks like this:

• Education Beyond Books: It starts with reading, sure, but extends to attending childbirth classes, workshops, or even informal gatherings where women share their experiences. This education can demystify the process, making it less scary and more of a shared journey.
• Engagement with Providers: Asking questions isn’t just your right; it’s part of your empowerment. Questions like, “What are the risks and benefits of this procedure?” or “What are my alternatives?” can open up essential dialogues for informed consent.
• Understanding Outcomes: Knowing what different scenarios might look like – from natural birth to interventions – helps mentally prepare for the birth. For example, understanding that pitocin might speed up labor but can also lead to stronger and often less productive contractions gives you the power to weigh whether this intervention aligns with your birth plan.
• Role of Technology: Using apps or websites that track labor stages, provide educational content, or connect you with communities of other expectant mothers can be incredibly empowering. They offer information at your fingertips, helping you feel more in control.

As midwives, our role isn’t just to be present at birth; we’re educators, guides, and advocates. At my practice Holistic Heritage Homebirth, we take this commitment to another level:

• Educational Sessions: We often conduct one-on-one or group sessions to go over everything from the anatomy of childbirth to the emotional aspects of becoming a parent. We tailor these sessions to answer the questions women might not feel comfortable asking in a more formal medical setting.
• Supporting Informed Decisions: If a woman is considering an epidural, for instance, we’ll discuss not just how it works but also its effects on labor progression, potential side effects, and how it might change the birth experience. We do not provide this information to sway her decision but to ensure it’s informed.
• Advocacy During Labor: Often, a mother is overwhelmed or in pain; in these cases, we stand by her side and ensure her wishes are honored. For example, suppose she had planned for intermittent fetal monitoring but is being pushed for continuous monitoring. In that case, we’ll advocate for her original plan unless there’s a compelling medical reason to change.
• Continuous Support in Transfers: One aspect that sets my practice (Holistic Heritage Homebirth) apart from other birth centers and homebirth midwives in our area (Houston TX) is our policy on hospital transfers. If a mother ends up needing to transfer to the hospital to give birth, which only happens to about 2% of our clients, we go with them. We stay with them at the hospital until their baby is born and everyone is stabilized. We do this because we’ve formed a deep bond with the client and family, understanding that this continuity of care can be crucial in the sometimes intimidating hospital environment. We act as their advocates, ensuring their birth plans and wishes are respected as much as possible, even in a new setting.
• Postpartum Education: Our education doesn’t stop at birth. We discuss recovery, breastfeeding, newborn care, and how to navigate the new realities of motherhood, ensuring women continue to feel empowered in their new roles.

By ensuring women aren’t just passengers but navigators of their childbirth journey, we’re changing individual experiences and challenging the broader narrative around childbirth. This shift from passive to active participation in healthcare decisions can lead to more personalized care, fewer unnecessary interventions, and ultimately, births where women feel respected, heard, and in control.

Empowerment through information is about turning knowledge into confidence, transforming fear into excitement, and ensuring every woman has the tools to make the best decisions for herself and her baby.

Real Stories, Real Impact

I could share countless stories from my years as a midwife, each painting a vivid picture of the spectrum of childbirth experiences. These stories aren’t just anecdotes; they’re the heart of why informed consent matters (obviously, to protect their privacy, these are not their real names):

• The Coerced C-section: There was a woman, let’s call her Sarah, who came to me after an experience that left her feeling betrayed by her own body. She had wanted a VBAC (Vaginal Birth After Cesarean), but she met with resistance at every turn. Despite her preparation and clear wishes, her OBGYN repeatedly told her that a C-section was “safer,” with little explanation or discussion of alternatives. The decision was made for her under the guise of emergency, stripping away her autonomy. She left the hospital feeling defeated, her confidence shattered, her birth overshadowed by a sense of loss over the experience she yearned for. When I met her, she was coming to us to try for a VBAC again. I am happy to say she was able to birth her baby vaginally and unmedicated at home with absolutely no issues.
• Empowering Births: On the flip side, I witness the joy and empowerment when they take the reins of their birth experience, like Maria, who had her heart set on a water birth after a traumatic first delivery. She educated herself and developed a birth plan that met her needs. We discussed each step when challenges arose, ensuring she was still in control. The result was an empowering birth where she felt in tune with her body, ending with her baby being born in a birth pool in her bedroom with her husband and other children present. Surrounded by love and choice. Her eyes sparkled with the pride of accomplishment, a stark contrast to the fear and helplessness she felt during her first birth.
• The Breech Birth: Then there’s the story I mentioned earlier, where a vaginal breech birth was not only planned but executed with care. The mother, Annie, was all about informed consent. She knew the risks and prepared for all outcomes. When we had to transfer due to postpartum bleeding, it was a decision made together, not in panic but with caution. Despite the doctor’s reprimand at the hospital, the outcome was successful – both mother and baby were safe and healthy. This experience underscored the importance of informed consent, as it allowed Annie to feel in control, even when the plan changed. These moments, where the system tries to pull back autonomy, fuel our drive to advocate harder for change.
• The Homebirth Triumph: Another story is of Lisa, who, after two hospital births that left her feeling like just another case, chose a homebirth with us. She was initially skeptical, having heard the horror stories from her nurse sister-in-law. But through education and trust-building, she navigated her pregnancy with a sense of empowerment. When labor came, she felt supported in every way she had hoped, and despite slow labor, we avoided unnecessary interventions. Lisa gave birth in her home, surrounded by the comfort of her environment, her choices respected, turning her childbirth into a celebration of her strength and knowledge.

These real stories have a real impact. They show us the stark difference between a birth dictated by fear, protocol, or convenience and one where informed consent is the guiding light. Each narrative is a testament to how crucial it is for women to be educated, supported, and respected in their childbirth choices.

They remind us that there are human experiences filled with emotions, hopes, and life-altering moments behind every statistic, guideline, or medical debate. These stories push us to keep advocating, educating, and challenging the system to do better by every woman who embarks on the journey of bringing life into this world.

Ethical Considerations

Ethically, the principle of informed consent is very clear:

• Autonomy is Paramount: Ethically, respect for a patient’s autonomy is one of the four pillars of medical ethics (alongside beneficence, non-maleficence, and justice). This means healthcare providers have an ethical duty to ensure patients can make decisions free from coercion and are fully informed of the implications.
• Ethical Dilemmas: Yet ethical dilemmas often arise during childbirth. For example, when a provider believes a C-section is necessary for the safety of the mother or baby, but the mother disagrees, navigating this situation can be complex. The ethical question then becomes balancing the mother’s autonomy with the duty to protect life.
• Impact on Providers: There’s also an ethical dimension to the provider’s responsibility. The fear of litigation can push providers to err on the side of caution, potentially leading to over-treatment or unnecessary procedures. This dilemma can create an ethical concern as it might not align with the patient’s wishes or best interests.
• The Role of Advocacy: Ethically, there’s a strong case for advocacy groups and legal precedents to push for better practices. This advocacy involves educating healthcare professionals and patients about rights and responsibilities fostering an environment where informed consent is an ideal and standard practice.

When you’re in labor, the last thing you want is to be thinking about a courtroom battle. Yet, these legal and ethical considerations are crucial because they set the stage for how care should be delivered. They remind us that childbirth isn’t just a medical event but a deeply personal one where legal rights and ethical principles should guide every step.

The gap between the law, ethics, and real-world practice underscores the need for ongoing education, policy reform, and, perhaps most importantly, a cultural shift within healthcare towards truly patient-centered care. This level of care is about ensuring that every woman can navigate her birth experience with dignity, respect, and the full spectrum of her rights intact, without the shadow of legal contention looming over what should be one of life’s most joyous moments.

Moving Forward

Here are the top five actionable steps to ensure informed consent becomes a cornerstone of maternity care:

1. Legislative Advocacy:
   • Action: Write to your local representatives to advocate for policies that protect informed consent in childbirth.
   • Resource: Use templates or guidance from organizations like the National Women’s Law Center (nwlc.org) to craft your message.
2. Support Evidence-Based Education:
   • Action: Engage with or support organizations that promote evidence-based childbirth education.
   • Resource: Follow and contribute to Evidence Based Birth (evidencebasedbirth.com) for up-to-date, research-driven information on childbirth practices.
3. Promote Provider Training in Non-Traditional Births:
   • Action: Advocate for or donate to groups that train providers in less conventional birth scenarios like breech births.
   • Resource: Breech Without Borders (breechwithoutborders.org) offers training and resources for healthcare providers to support vaginal breech births.
4. Join or Form Support Groups:
   • Action: Connect with or start local or online support groups where women can share experiences and information about informed consent.
   • Resource: Look into community platforms like Meetup or online forums for childbirth education and support.
5. Share and Learn from Stories:
   • Action: Share your birth story or learn from others’ experiences to foster a community of informed choice.
   • Resource: Platforms like SHEis.com can be a space to share these stories, or explore podcasts like “The Birthful Podcast” for a broader range of narratives.

By focusing on these key actions, we can collectively work towards a future where informed consent in childbirth is respected, understood, and practiced, ensuring that every woman’s voice is heard and honored in her birthing journey.

Conclusion

Informed consent in childbirth is about more than just paperwork; it’s about ensuring you’re the captain of your own ship, navigating one of the most significant events of your life with confidence, knowledge, and respect. Here are practical steps to empower yourself:

• Educate Yourself: Use resources like Evidence Based Birth (evidencebasedbirth.com) for up-to-date information. Attend childbirth education classes, read books, and don’t hesitate to ask questions. Knowledge is your ally in making informed choices.
• Choose Your Provider Wisely: Look for doctors or midwives who respect your autonomy and support your choices. Organizations like the American College of Nurse-Midwives (ACNM) (midwife.org) can help you find providers who align with your birth philosophy. Consider if they are open to non-traditional methods, like those supported by Breech Without Borders (breechwithoutborders.org).
• Have an Advocate: Whether it’s your partner, a friend, or a doula, or your midwife, having someone who understands your wishes can be crucial. They can speak up for you when you’re in labor, ensuring your voice is heard.
• Document Your Wishes: A birth plan might not be legally binding, but it’s a powerful statement of your intentions. It helps communicate your desires to your care team, setting the tone for your birth experience.
• Stay Informed During Labor: Even in the throes of labor, you can still make informed decisions. Keep open lines of communication with your care providers, and ask for explanations when they suggest interventions. Make them explain it until it makes sense to you!

My experience with that breech birth and the subsequent hospital interaction only solidified my commitment to this cause. Let’s work together – providers, advocates, and women – to make informed consent a principle and practice. Let’s strive for a system where every woman feels empowered, heard, and supported in bringing new life into the world.

Remember, your voice, your choice, your body, your baby.

— Stay Strong, Jaelin —

Additional Reading

• Pushed: The Painful Truth About Childbirth and Modern Maternity Care by Jennifer Block
• Ina May’s Guide to Childbirth by Ina May Gaskin
• Informed Decision Making in Maternity Care – PubMed
• Childbirth Is Not a Medical Emergency: Maternal Right to Informed Consent throughout Labor and Delivery – PubMed

Note: Full disclosure: SHEis Online earns a small (very small) commission on any links in the article that take you to Amazon.

About the Author

Jaelin Stickels, CNM, WHNP, is a deeply passionate and highly skilled Certified Nurse Midwife, Women’s Health Nurse Practitioner, and the owner of Holistic Heritage Homebirth in Houston, Texas.  With over a decade of experience, Jaelin has had the privilege of helping several hundred women welcome their babies into the world. In addition to her advanced practice licensure training, she has additional advanced training in twin and breech births, making her one of only a few with these skills in her area.  Jaelin approaches every birth with expertise, compassion, and a deep respect for the birthing process. Jaelin is finishing her doctorate and looking forward to being Dr. Jaelin in early 2025.

Jaelin’s journey into midwifery began with a profound love for supporting women through the incredible experience of pregnancy, labor, and postpartum. Since 2010, she has been dedicated to walking alongside families during these transformative moments, offering guidance, support, and care tailored to each individual’s unique needs. She is a big believer in informed consent and ensures clients are given the best evidence-based information to make the best decisions for themselves and their families.

Married to her high school sweetheart Ted (aka Chef Ted) since 1984, Jaelin is the proud mother of three grown children and the delighted grandmother of one amazing granddaughter. When she’s not assisting in births, Jaelin finds joy in going to the movies with her husband, quilting, and cherishing time with her family. Known by the other midwives in her practice (Holistic Heritage Homebirth) affectionately as the “Birth Hog,” she brings an unmatched dedication and enthusiasm to her work—no one loves birth quite like she does.

Read Jaelin’s Bio Page

Find out more about Jaelin’s Homebirth Practice (Holistic Heritage Homebirth) in Houston, TX