Informed consent

Alison Cole

I challenge every health care provider to provide the informed consent of two marginalized, but essential, areas of women's health care: abortion and midwifery.

I haven’t been to the dentist since I had my wisdom teeth removed,
about five years ago.  I was 24.  I got to the office where I had been
referred by my regular dentist for the surgery.  I was given forms to
read and sign.  Then I was taken back to a reclining chair where I had
a few words with the dentist who would be doing the operation.  I
remember he called me "little girl."  Then, before I realized what was
happening, someone took my arm and injected me with drugs, and the next
thing I knew, I was groggily awake with the lower half of my face
swollen and numb. 

This was the most major medical procedure
I had ever had, and I was very nervous going in to it, but no one ever
told me what to expect, what they were going to do to my body, what
medicines I would be given, how I would feel afterwords.  I ended up
getting an infection, and having to return to the office, were I was
seen by a different dentist who packed the holes in my gums with
clove-soaked something that made me feel ill for days.  The whole
experience was disempowering, and as I said, I haven’t been back to a
dentist since. 

At the time, I was a paramedical worker at a fabulous private women’s health clinic,
where I still work today, though in a different role.  I spent my days
there reviewing surgical informed consent forms with women seeking
abortions.  I would meticulously go through the steps of the procedure,
unless a woman didn’t want to hear what was going to happen, but either
way I would review every possible complication of the procedure, give
the woman statistics on how often those complications were likely to
happen, and give her a chance to ask any questions she had about the
procedure.  When I went to get my wisdom teeth out, I expected
something similar, and was shocked that it was nowhere to be found. 
How can anyone claim that I was provided with informed consent at that
dentist’s office?  I knew I was getting my wisdom teeth out.  That was

Soon after the wisdom teeth experience, I began working
as a doula, supporting women and families during hospital births. 
There, I saw moms hooked up to external fetal monitor (EFM) belts as a
matter of course.  No one at the hospital mentioned to my clients that
the monitors had never been shown to improve birth outcomes.  No one
mentioned that the monitors had been shown to increase cesarean section
rates.  No mom was ever given an informed consent form to sign
authorizing the hospital to perform continuous EFM, or presented with
the option of refusing the EFM all together. 

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Medicine pays
lip service to informed consent, but ultimately our culture expects us
to cede our power to our doctors.  They are the experts, we are told,
they know best.  This is a problem in which we, as patients, are
complicit.  We need to get educated about our bodies and our health
care, demand that our care providers give us complete information about
our options, and make our own choices about how to promote our health. 
Ultimately, WE are our own primary care providers, as our behavior has a
24/7 impact on our health, while we may only see our doctors once or
twice a year.  One of the beauties of midwifery care is that it recognizes and promotes this vision of heath-care as client-centered. 

challenge every health care provider to provide the informed consent of
two marginalized, but essential, areas of women’s health care: abortion
and midwifery.

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