Informed Consent for the Midwife

As a midwife, I face the enormous and important task of educating women and families on pregnancy, birth and the early days of parenting. 
 
Because a woman’s care is often fragmented and she may see a different midwife or care provider at every appointment, it is very difficult to ensure we are providing all the information and knowledge that a mother is deserved so she can make informed decisions throughout her care. ​

A study in 2010, ‘Queensland Centre for Mothers and Babies: Having a Baby in Queensland', states that in their study of over 3500 women, 70% of women who had an epidural felt uninformed or did not provide consent to the procedure. They also stated 26% of women had not been informed or consented to their episiotomies. As midwives, how can we better ensure women are involved in their care and informed appropriately? 
 
I have worked in several models of care, and in my experience, the model of care that can provide the most thorough and informative education, and therefore true informed consent from women, is that of a model where there is continuity such as a midwifery group practice or through a private midwife (look out for our radio podcast all about Privately Practising Midwives in August). 
 
When we work in a model of care where there is not continuity, as midwives, we must really make sure that the women we see receive all the information they need and are actively involved in their care. We must know that the decisions they make are based on INFORMED consent. We have a responsibility and duty of care to keep women and babies safe, and they have a right to be respected and not coerced in their decisions.
 
Sometimes women make an informed decision that goes against routine or recommended care- they may decline a routine blood test or ultrasound, or decline administration of antibiotics for GBS. We must make sure we find out why she declines, as a woman declining electronic fetal monitoring in labour, may not be opposed to monitoring, but she may be concerned about mobility in labour. We can better understand her needs by asking questions and respecting her right to make her own decisions. 

Top photo by Brandi Redd on Unsplash.

Author
Danie Smallwood, Midwife and PBB Media Contributor

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