Why Consent when you can Decide? Guest blog post by Catherine Bell

 Consent is on everyone's lips.  From media discussion about 'enthusiastic consent' in sexual encounters to medical requirements for 'informed consent', it seems pretty clear there is a problem with 'consent'.  If consent was what mattered, we would not need to prefix it with a qualifier.  

​Consent is about freeing someone of liability.  To seek consent is to clearly express a desire for a
particular action or outcome.  The person seeking consent has the power position.  They are placing
someone in a position where it is known they are expected to consent. To not consent is to ‘refuse’ or
‘decline’.  To not consent can be met with repeated asking – coercion – until consent is relented.  It can
also be met with increasing pressure and threats.  In some situations consenting to ‘step one’ is treated as consent to any subsequent steps.

In medicine, it is a legal requirement to obtain ‘Informed consent’.  The legal role of the person seeking
consent is to provide full disclosure of the procedure…and any subsequent ones that may arise.  In
maternity care, this consent is often sort at the critical moment, under intense stress and pressure.  The ‘informed’ component means “I told you what I was legally required to” not “you know all you need to know to decide what is right for you”.  It does not mean all options were understood or available.

When it comes to pregnancy and birth, it is possible avoid this situation.  This means considering various possibilities in advance, and taking the time to look at the risks and benefits of different options and make an informed decision about the direction to go.  So if ‘consent’ is requested it can be given as actual informed consent, or confidently declined knowing that the decision is valid and based on understanding.

Reflecting on that, replace ‘consent’ with ‘decision’ and the implied yes is removed.  The person seeking consent may still recommend, assume or prefer a particular outcome, but when framed as a decision the other possible outcomes become visible.  With ‘consent’, only one outcome is spotlighted.   This simple shift in language may just be the key to helping reduce birth trauma.

Above image by Rawpixel on Unsplash.com.

Catherine Bell is The Birth Cartographer. She runs bellabirth.org, which provides information, support and mentoring to those wanting to be Informed, Prepared and Confident.
​Her book The Birth Map gives insight into the maternity system, provides the questions you need to ask to make informed decisions, and takes you beyond the birth into realistic parenting.
www.bellabirth.org