This meme has been floating around social media and at first annoyed me but it’s gone viral and now it enrages me.
Enrages me?! Yep for reals. I am going to break it down for you and tell you why. The first option ‘I’m going to check your cervix’. This obviously allows no room for a labouring woman to consent. It is a statement and the care provider is assuming the outcome is going to sticking their fingers into a woman’s vagina to guesstimate how fare along she is.
The second option ‘I’m going to check your cervix when you’re ready.’ This at least allows a woman to decide when said fingers are stuck into her vagina but no option to decline. So no opportunity to give consent here either.
‘Are you comfortable with me checking you cervix when you’re ready?’. This does allow a woman to consent but not informed consent.
So what is informed consent? Let’s look at this assuming our Mama being asked these questions has NO KNOWLEDGE whatsoever of the hospital procedures in labour. First of all the procedure needs to be explained. The first step in informed consent is making sure a patient know what the procedure is. So starting off with ‘I would like to check how dilated your cervix is. To do this I will put 1 - 4 fingers into your vagina, reach up to your cervix and open them up to estimate your dilation in centimetres.’
Great so now we understand what is being suggested but we need to know why. So following on from above care providers should next explain why they think a procedure a necessary. ‘Checking your cervix tells me how far progressed you are in labour now but it cannot tell me how quickly you will deliver you baby.’.
Knowing how and why is great but a Mama also needs to know the benefits and risks of a procedure. ‘If you are progressing well it can be a real boost to your confidence and help you to continue to labour as is. If you are not progressing well you may feel disheartened and ask for medication that was not part of your birth plan. Also it helps the hospital track your labour to a timeline. If you aren’t following a specific timeline we will recommend augmenation or surgery to ‘help’ you along’. OKay that is a lot of information but we NEED to know it. You can see that benefits here weigh heavily in favour of the hospital and not the labouring Mama. This is worth considering before you consent to any procedure.
We nearly have enough information to make a decision but we are probably going to have ask a couple of questions now. First of all let’s find out ‘Is there an alternative’. There is no specific alternative for the procedure I am breaking down here but an answer might be like ‘Nothing will tell me as accurately how far dilated you are but based on your demeanor, purple line or uterus position after a surge I could estimate approximately how far dilated you are.’ Interesting all those options are far less invasive… Just one more question ‘What if I decline?’. The answer ‘I won’t stick my fingers in your vagina’.
Now all you need is some time to think about your decision and you and your care provider have worked together to get informed consent. It takes a conversation to get informed consent. If you only get a sentence you cannot give informed consent. Ask for more information! If you are in labour it is perfectly okay to allow your birth partner to do the talking, and ask these questions for you while you listen in. You will still have the final say but there is no need to interrupt a labouring Mama to have this conversation. The important thing here is that both of you understand what informed consent is and are confident in asking questions until you get enough answers to make a decision. Which means share this blog with your birth partner. Know it is okay to ask questions or even for a second opinion. Only when your mind is one hundred at ease will you be able to make a decision you are comfortable with. It is up to our care providers to do this for us but if they don’t let them know you are so curious about all the options.
Try this meme on for size. This one I created on my own is the START of the conversation on informed consent. After you get this bite sized piece of information then you can ask questions and come to a decision on your care.