Informed Consent Goes Both Ways: Responsibilities of Care Providers

“Consent is only meaningful when we are informed.”  -Edward Snowden.

Information has a dual aspect to it for both the care provider and for the birthing family.  What does being informed look like for those serving families? 

1) The Responsibility to Recognize Embodied Consent

Care providers are informed as part of “informed consent” by truly looking for the signs of embodied consent, not just the words.  But also there is the responsibility of the provider to see the “no”and name it rather than pressing forward towards coercion.  The provider is the one being “informed” as well.  It is their responsibility in this process to know what it looks like for someone to truly give or deny consent.  They are also watching, listening, and tracking.  The issue is that this takes time and attention, and without this being a priority, this time may not be created.

I’m talking about the responsibility to hear a true “yes” whether it comes from overwhelm and devastation or even from relief or from embracing what is being offered.  What is that tipping point where the body is saying “no” and the words are “yes?”  When is it acceptable to move forward even in the face of a disembodied “yes.”  When is it unacceptable?  These are the questions that need to be part of the informed consent discussion.  What is consent without consent?

Acknowledgement can be made over the complexity of these moments.  Naming that incongruence and slowing down the pacing deeply matters. This is a place where we may not be able to head off trauma completely, but it is also the crux of autonomy and the meaning behind consent. 

Sometimes with consent thereby be an edge of grief and acceptance, but there is also a time that we can see the signs that someone isn’t “giving” consent and that it is being thrust upon them even when there are options around them.

Without emergency, we find the time to stop, because we can.  In childbirth, the bigger decisions are going to be remembered by the person for their lifetime.  Even if they don’t speak up and say, “Actually, I don’t want to do this,”  them being witnessed can change how someone integrates these decisions and processes them long term.  This is the moment that can be transformative for we are truly listening and allowing informed consent to be a collective understanding of responsibility.  Slowing down for a person in the midst of birthing themselves as a parent and birthing their baby may not prevent grief or trauma from physical overwhelm, but it just might be the key to meeting that in a different way than if it had been thrust upon them without consent.

2) The Responsibility to Provide Information (or refer to someone who can).

It is also the providers responsibility to know what the ethical options or decisions are for a particular situation or it is not  truly “informed.”  As they inform the parents, they have also taken responsibility to understand that information even if it means sending them to another provider to give them the care offered (or true informed consent) that they cannot.

Information is a two way street when it comes to consent.  We are providing information so that someone can make a decision.  If safe choices are purposefully left out, then it is coercion.  Coercion is not consent.

As care providers gathering the keys to consent and looking beyond a “yes” or a “no,” the complexity begins to appear especially in a health care system that may not be “informed” in and of itself.  For how we see, hear, and feel the person in front of us is not just witnessing, but we may be in co-creation with a profound part of their being.  Consent is only meaningful if we are open to being informed.