It's easy to feel as if you are on an assembly line during pregnancy. You go for the prescribed number of office visits, have the prescribed tests, and listen to your health care provider explain birth procedures. When you get to the hospital or birth center you're on another assembly line. Wear this, we're putting in an IV, your partner needs to go here, get into this position ... and so on. An expectant mother can feel like a specimen and not like a person with legal rights and individual preferences.
Expectant mothers do have the right to control their medical care, to make choices based on information, and to refuse care. The following information will help you make important decisions during your labor and delivery.
The most basic of rule of medical care is that the patient has an absolute right to be informed about the proposed treatment before agreeing to it; this is known as "informed consent." Your care provider must explain the planned care in words that a non-medical person can understand and explain the risks involved as well as any alternatives. He or she must discuss medication with you and tell you about its risks and benefits, as well as its full name. Your provider must also share information about the effect of drugs or treatment on your baby.
Care providers cannot hold back information because they believe it will scare you or make you uncomfortable. Once your provider has completely shared all of this information with you, you have the right to accept or refuse the treatment.
"Personally, if a patient is not interested in informed consent, I will not provide her with care," says Dr. Faris Ahmad, MD, a physician with Wilshire OB-GYN Associates in Troy, Michigan. "She runs the risk of not fully understanding the procedure or care involved, any possible side effects, or any risks with the procedure. She will probably end up being dissatisfied with her care."
In practice, many care providers do not fully abide by the rules of informed consent. Rarely do they take the time to explain the benefits and risks of an IV, the full name and possible side effects of drugs administered during an epidural, or explain all of the risks associated with C-section. It's often assumed that patients already have basic information about these treatments. If you need more information you should always speak up!
If you or your baby is in danger, your care provider is authorized to treat without getting informed consent. For example, if you need an emergency C-section, your doctor is going to go ahead without spending the time to explain the all of the risks to you. Understanding the risks and benefits are more good reasons to do research on your own in advance—just in case.
If you give birth at a hospital or birthing facility, you will be asked to sign a consent form. Read the form carefully; you can cross things off or add things to it. Usually these forms give consent for your health care provider and anyone under his or her supervision or direction to provide care for you. If you do not wish to have your baby delivered by anyone but your provider, you can cross this portion out and write in that you give permission only to your provider. Realize however that if your provider is with another patient, you have ruled out the possibility of someone else delivering your baby.
You have the right to refuse any treatment. Period. You can get up and walk out of a hospital or birth center at any time. Doing so may cause insurance problems though, since your carrier may not cover complications or care that results from you leaving against medical advice ("AMA") and your provider may decide not to continue on as your provider.
Dr. Ralph Dauterive, MD, OB-GYN at Ochsner Clinic Foundation, New Orleans, Louisiana, discusses any decision to refuse treatment with his patients and advises them of the known risks. "Most OB patients really have little time and few options when it comes to therapy for an obstetrical problem. If a patient decides against a treatment option that I think is necessary, I document the chart with my recommendation and inform the patient of my action," he says. "Ultimately I would advise the patient to seek a second opinion or find another provider for her care." He adds that such a refusal is rare when "the doctor is competent and the relationship is based on trust and good judgment."
You have the right to know when you are being treated by a trainee (such as an intern in a hospital) and can refuse treatment by health care providers who are not fully trained and accredited. In most teaching hospitals, students routinely monitor procedures. You may choose not to be observed, but you have to speak up with your preferences.