I recently read an article on twilight sleep, an archaic practice of the 20th Century in labour and childbirth, in which women were restrained and drugged during the process. This came into practice at the end of the 19th century with the discovery of more modern anaesthetic drugs. This was a very dark age for obstetrics as women were subjected to this practice routinely and without consent. This barbaric practice was abandoned somewhere in the 1960s along because women were demanding autonomy and a more natural approach to childbirth in an age where unethical medical practices were being questioned.
Now almost 60 years later, we have different challenges in the modern age that threaten the birthing mother’s autonomy during the process of pregnancy and childbirth. Common place practices with routine interventions like unnecessary inductions and elective caesarian sections, misinformation, intimidation and bullying of parents into making certain decisions by the very healthcare professionals they entrust their care to, even when it goes against evidence based practice and ethical standards. But this “us and them” is a very dangerous agenda to drive.
So, what is the deal with autonomy and consent?
- Autonomy: is the ability to self-govern.
- Consent: is giving permission for something to happen or an agreement to do something. Informed consent means you were provided with accurate and evidence based information and based your decision on the information provided. This includes discussing the risks, benefits and alternatives available. In obstetrics it is the ability and right of the patient (according to the charter of patient rights and responsibilities) to make decisions about their obstetric care, without their care provider influencing their decisions.
This is currently a hot topic in the medical industry. It is the responsibility of all healthcare professionals to educate patients on evidence based medical practices and to provide them with their available choices. This process can have medico-legal implications for both the health care provider and the patient. Once a patient has made a decision, it should be respected and supported especially if it does not threaten the health and safety of the person (or baby in the case of pregnancy). A dire lifesaving situation is a different matter altogether. As women, midwives, family members and interested parties, we should be advocating for ethical and evidence based practices in a safe and non-judgmental environment.
But autonomy is a double edged sword. Where there are rights, there are always responsibilities. Patients are encouraged to do their own research during the pregnancy in preparation for the birth. Ask the burning questions you have during consultations and attend a local childbirth education class. This will help you to adequately prepare for the birth.
Below are some great resources for evidence practices and information:
- Guidelines for Maternity Care in South Africa 2015 – (downloadable pdf)
- Evidence based birth (www.evidencebasedbirth.com)
- Cochrane Review (https://www.cochrane.org/)
- American College of Obstetrics and Gynaecology – ACOG (https://m.acog.org/)
- Royal College of Obstetrics and Gynaecology – RCOG (https://www.rcog.org.uk/)
By Sr Victoria Black of Protea Nursing Services
Follow me on Facebook: @proteanurse or send an email to firstname.lastname@example.org.