Everything's Negotiable

Everything is negotiable... and the flip side? Nothing's truly mandatory.

Want to know the #1 thing that drives this doula absolutely nutty? The statement, "____ won't/will let me."


Well, let's see, IT'S YOUR BODY!

Sorry, was that offensive? What is offensive to me is the concept that our medical care providers have control over our health care and our bodies. That is simply not true! 
"Many women are not aware that they have the legal right to make their own decisions about caregivers, place of birth, medical procedures, treatments, drugs, or diagnostic tests for themselves and their babies. Childbearing women are encouraged to become informed about their legal rights to make the choices that best meet their needs." - Patient Rights at VBAC
Well, I am getting ahead of myself... so, what are these rights?
  • The consent of a competent woman's husband is never required for her treatment.
  • Women have a right to have another woman present during a physical examination.
  • Women can refuse to be examined or treated by anyone.
  • Women have a right to have the father of the child, or another advocate, present during childbirth and delivery.
  • Pregnant women have a right to refuse any medical treatment or drug, including a cesarean section, episiotomy, anesthesia, and pain medication.
  • A woman has a right to change her mind about any decision made before or during labor or childbirth.
  • A woman and her newborn have a right to remain in a hospital up to 48 hours after a vaginal birth and 96 hours after a cesarean section (your goal, however, should be to get mother and child out of the hospital as soon as it is safe for them to be discharged). - Legal Rights of Pregnant Women from ICAN
Remember that no one is responsible for your healthcare but you. As a parent and woman, you hold the ultimate responsibility for the choices that are made during pregnancy, labor, and postpartum, because you are the one who will be raising the child and have to live with the results of the care you have chosen for them and for your own body.
"American parents are becoming increasingly aware that well-intentioned health professionals do not always have scientific data to support common American obstetrical practices, and that many of these practices are carried out primarily because they are part of medical and hospital tradition." - The Pregnant Patient's Bill of Rights from AIM
With this knowledge, women should start making some of her birthing choices that will affect her birth time during pregnancy. The first step would be considering her options. And the next step is making sure that those options are in line with what she hopes for in birth, and then setting in place her advocates (aka birth team).

For some reason, even when women know what they want out of birth, they don't always choose places or people who will necessarily honor those choices. In those instances, whether it was a bait and switch situation, or mom simply stayed with a practice or place that she knew had policies in place that would not support her choices, it is important that she and her non-birth place-affiliated birth team knows what her rights are.

Every woman has the legal right to informed consent or refusal for every medical treatment that is offered. Even if they say it is policy, that you 'have to', or it is 'non-negotiable'. 

The American Medical Association supports this, “The patient has the right to make decisions regarding the health care that is recommended by his or her physician. Accordingly, patients may accept or refuse any recommended medical treatment.”

The ACOG even says that a woman may decline a physician’s advice or recommendation, even during treatment, based on “religious beliefs, personal preference, or comfort.” Women are entitled to “informed refusal.”

Your legal right to make your own choices for you and your babies health care mean that your treatment in your choice of birth place is your decision. Everything's negotiable, whether or not your medical care provider/place would like to acknowledge it.
  • What about when I sign that consent for treatment form at sign in? Even after you sign that form, you have the right to refuse any particular part of that treatment. Picture the cancer ridden person who is given the option of amputation or chemotherapy, even though the doctor believes one course of treatment will get better results. Every step of the journey is your right to refuse or accept.
  • What about if I already agreed to an IV, epidural, pitocin, cesarean, or nursery stay? At any time during your care, you can change your mind, decline treatment, or nullify any consent forms. 
  • What if they challenge me or threaten me? Then challenge them back and remind them of your rights. If it is really important to you, you have legal rights that they must honor. 

You don't have to go in for that scheduled induction. You don't have to agree to a repeat cesarean. You don't have to consent to continuous fetal monitoring, 'mandatory' nursery stay, or 'mandatory' newborn procedures... even bathing and eye erythromycin.

Be aware though, if you decide to decline any treatment recommended by your care provider, you may be asked to sign an AMA (Against Medical Advice) that states you acknowledge you are taking responsibility for your choices.

Before signing that form, though, you can get a second opinion, as you are always entitled to one. This second opinion may not agree with the first care providers opinion and may save you from having to sign the AMA.

For more information on the Rights of Childbearing Women, see here. Remember, your body, your baby, your right to refuse. 


Kathi said...

Thank you, Nicole. It is time for more birth workers to start speaking boldly about these kinds of injustices. The fact that an article needs to be written to advocate for women in this sense highlights the dire circumstances that envelope our paternalistic birthing system.

Ginger Bronson said...

I created and discussed my birth plan with my midwives but when it came time to utilize it, it was entirely disregarded by them. They also never asked for my consent before performing any procedures, and continued performing those procedures even after I asked them to stop, (a few of the nurses and an OB did this too). Is there any way to avoid that situation? And btw I spoke with a lawyer today and they said that my case was not worth pursuing, that they basically didn't do anything illegal.

Nicole D said...

Hi ginger. In all honesty, anything that you do not consent to but they perform anyway is considered assault/battery. That said, if it didn't cause you bodily harm, getting the court to uphold the law is the difficult part. If it is something like an episiotom, then you definitely have a stronger case and a better chance at winning.

The first step would be to file a formal complaint against your provider and the nurses with the hospital administration.

And then, something all women need to remember is that it is HOW you say no. Unfortunately, "no" is not enough anymore. I teach the women I work with to say " I do not consent to this procedure, and if you insist on performing it against my consent, its considered battery."

It sucks that that's how we have to do things nowadays. But it does get results.

I'm so sorry that you went through that. No woman should feel unsafe and threatened during her birthing time. :-(


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