Informed Consent

As a midwife I`ve often been concerned about the subject of informed consent, what it means to me as a midwife and what it means to the woman in my care. I`ve often wondered what is meant by informed consent and actually what that means to the woman.

Role of the Midwife
The NZCOM consensus statement ratified at National Committee in May 1996 is very clear on the role and responsibility of the midwife in getting informed consent and what is to be documented. It also discusses obtaining written consent where either person in the midwifery partnership requests it. I am left to reflect on how often I have within my practice formed a partnership based on trust and how often I trust the women when I don`t obtain that written consent. The documentation part of midwifery practice I find can begin to fall down when a midwife is tired and stressed. it can be the case that there is every good intention to record throughly what is discussed at a visit only to find that one appointment has run into another and someone else is waiting to be seen so you have every good intention of writing it down but before you know it you`ve got home cooked tea, sat down, relaxed and then ended up asleep in bed.

More than one professional perspective
The consensus statement also discusses that where there is more than one opnion on how care can proceed then the midwife has a responsibility to inform the woman that another perspective on care exisits and give her information on how to access that perspective. It is then presumed that the woman can request that opnion or she can request not to.
The dilemma can exist then when she has two perspectives which one does she choose to follow?

Dr House perspective
I am fascinated how House views informed consent in the 3rd episode of the 3rd season. It is often viewed that House has his 3 doctors to represent different aspects of morality on the subject in the hopes of keeping him on the straight and narrow and failing miserably.

Parentscentre
In my teaching of antenatal class for Parentscentre, informed consent forms part of the cornerstone in the class. The organisation which was set up in the 1950`s decided to offer antenatal classes on the basis of giving clear, unbiased information so that women could leave the classes able to make their own choices. During the first session I often spend some time discussing what the class believe informed choice is and how the think they may be in control of their maternity experience. I often use the analogy of getting married. When women are organising their weddings they pour through heaps of bridal magazines choosing the right dress, they visit dressmakers, florists, venues, the ask friends what happened at their weddings and they gain as much information as possible before making the plans for their own wedding. It is rare, although there is always someone in the class who has done this, that they just hand over control to their mothers and mother-in-laws and say just give me the date and I`ll just turn up.
I often end up saying having a baby is a similar experience, you cannot just hand over control to someone else and have them give you their impression of what the birth should be like.

Childbirth Educator v LMC
At the end of class I am often approached by the women under my care as a LMC and they always express the concern that they want to follow my advice as much as possible. I often do explain that my CBE hat and LMC hat are slightly different and in any given situation I would endeavour to give them the benefit of my professional experience but that it is my duty to ensure that they feel in control of their own decisions. I often end up using another analogy for these people and say that if I wanted a professional newspaper article written I would approach a journalist for advice and at that point I could take it work in partnership and have a brilliant article or ignore the advice go it alone and have just an ok article.

Here`s hoping that this hasn`t just been and insane ramble and that this all makes sense!