tag:blogger.com,1999:blog-346749784229772317.post6025382230467832369..comments2022-03-09T03:58:19.101-05:00Comments on Safer Midwifery for Michigan: InfluenceMWShttp://www.blogger.com/profile/04125751490256911705noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-346749784229772317.post-7415509990668836462013-03-14T15:34:04.730-04:002013-03-14T15:34:04.730-04:00I agree that informed consent is rather poorly don...I agree that informed consent is rather poorly done - among many providers and under many different circumstances - and not just around childbirth. <br /><br />My "informed choice" statement may not have come out the way I intended. Those are very purposeful quotation marks, and they are meant to convey that informed choice is not actually what occurred, but some form of persuasion or false-reassurance. A woman's right to making a informed choice is often the reason used to justify poor outcomes in an OOH setting. "But what about a woman's right to informed choice and consent?" "Women have the right to autonomy and to make their own decisions." <br /><br />Yes. Yes they do. The most important point is that they deserve the right to factual information - you and I agree on this - and I have witnessed "informed choices" made by women in OOH settings based on anything but a thorough examination of existing data and evidence and the risks of their decisions. (To be fair, I've witnessed this in hospital settings, too, this blog is about OOH midwifery - so we try to keep the discussion focused).<br /><br />Midwifery will not have a leg to stand on if they continue to accept/promote risky births OOH. The data will not support these risky births as safe options for women in an OOH setting. But too many of these 'variations of normal' are sold as safe options. Because anecdotally - it usually all works out just fine.<br /><br />As far as birth stories go, I have to disagree that they do not influence others' perception of risk. Many people see the positive results of harrowing birth stories and are reassured that these risky situations are or can be safe. This is true not only for mothers, but midwives as well.excpmstudenthttps://www.blogger.com/profile/09160963666740106359noreply@blogger.comtag:blogger.com,1999:blog-346749784229772317.post-51499155202122194402013-03-14T11:29:41.035-04:002013-03-14T11:29:41.035-04:00I think it's really important to not minimize ...I think it's really important to not minimize the importance of informed choice (consent or refusal -- see third to last paragraph of post). EVERY care provider must provide and document TRUE informed choice -- not "here's this paperwork we need you to sign about this intervention" or "here's this waiver I need you to sign releasing me from liability based on your choices about your birth" choice. Neither of these is actual informed choice (I do research with human subjects, so I have quite a bit of knowledge regarding what IS and what is NOT informed consent/refusal). When we say that promoting informed choice isn't what's best for mothers and babies, I think we're treading on dangerous ground. If we don't advocate for informed choice (in every birth context), it seems like we're saying that someone else who's "more informed" because of their experience/background/knowledge should be given authority to make decisions for pregnant women based on what's in their best interests and the best interests of their baby. We're asking women to give up their autonomy (and responsibility!) just because they're pregnant. That's not okay.<br /><br />I understand that the author feels that telling positive homebirth stories when risk factors were present makes women say to themselves "Well, she had risk factor X and her homebirth went fine, so that means mine will too" but I think that gives women a lot less credit than we deserve. I think most women realize that just because Sally had a positive outcome with risk factor X doesn't mean that Julie will have the same positive outcome with risk factor X. Data/evidence needs to guide the decision-making process, not anecdotes. This data/evidence -- as much as possible -- should be a part of the informed choice procedure both in and out of hospitals.katerowbothttps://www.blogger.com/profile/04795157168947405680noreply@blogger.comtag:blogger.com,1999:blog-346749784229772317.post-22777293928647213292013-03-14T10:00:35.796-04:002013-03-14T10:00:35.796-04:00This is very compelling. Thank you for posting thi...This is very compelling. Thank you for posting this.LauraThttps://www.blogger.com/profile/15986846093055282121noreply@blogger.com