Consent is a very topical subject and one with a lot of confusion as we live in a society that does not completely understand or respect consent where it matters most – when it comes to our bodies. In the past year and a half we have seen the awareness of the MeToo movement take the world by storm. There is now language and consciousness around sexual violence and how that shows up in various forms in our lives. Women around the world have felt the courage and support to speak their truth and tell their stories. When our boundaries have been transgressed and our bodies have been violated it can gravely impact our lives overall and particularly our pregnancies and birth experiences.

Pregnant survivors need the support of trauma informed birth workers to help them navigate potentially triggering scenarios along the birth continuum. From cervical exams to aggressive touching or language use, the patient doctor/midwife relationship is one that needs to be grounded in safety and informed consent. Countless women enter into birth settings where they feel dominated and they lack the information to make informed decisions, choices that will impact their birth outcomes and in some cases, their lives.

When women are are coerced into making decisions without informed consent, they aren’t really making a choice at all. The work of the Tarana Burke, founder of the MeToo Movement, puts a spotlight on the spaces where we lack accountability when it comes to consent- in the hospitals. While informed consent is your legal right, it isn’t always practiced the way it should be in medical spaces. Let’s break down what informed consent really means and how you can advocate for yourself or clients.

INFORMED CONSENT: the legal doctrine requires that medical doctors provide a patient with all relevant information about a proposed procedure or treatment prior to obtaining the consent of the patient to carry out the procedure or treatment. The following are your legal rights in terms of giving or refusing consent to health care procedures:

1. The right to give consent or refuse consent on any grounds, including moral or religious grounds, even if the refusal will result in death;
2. The right to select a particular form of medically appropriate health care on any grounds, including moral or religious grounds;
3. The right to revoke consent;
4. The right to expect that a decision to give, refuse, or revoke consent will be respected; and
5. The right to be involved to the greatest degree possible in all case planning and decision making

Four items of information must be provided to have informed consent:

1. Nature of procedure – what is actually be proposed
2. Risks
3. Benefits
4. Availability of an alternative treatment (including no treatment) and the risks and benefits thereof

Make sure that before any decision has been made that you have asked and been given all four items of information. Then you can choose whether or not to consent.

Important Points on Consent

• Although consent can be implied by cooperation movements such as opening your legs for a cervical exam, cooperation should not be confused with consent. If you have not been provided with information about a health care treatment, behavior cannot be assumed to imply consent.
• Except for under very specific circumstances, no one is allowed to give or revoke consent on your behalf. This includes the partner, family members, doula or health care provider. 
• Ask for numbers. If midwife / doctor explains, for example, that a treatment increases your risk of a poor birth outcome, ask by how much. 40%? 10%? 1%? 0.05%?
• Whenever possible, ALWAYS take time to reflect on your options before making a decision, even if it’s just for a moment or two. Ask to be left alone to discuss and weigh the options. Never make a decision without time to discuss and process what was discussed.
• The birth team (partner and doula) can help advocate and ask questions about proposed treatments so you have as much information as you’d need to make an informed choice about your care.
• Discuss a safety plan with your birth team.
  • What would make me feel most safe?
  • What are the barriers to safety?
  • What are my triggers? 

If you are a survivor who could benefit from extra support during the pregnancy and labor experience, please consider hiring a doula who is trained in trauma informed support and working with a counselor like those at The Seleni Institute. Everyone who is carrying trauma should have the option of support during the pregnancy and postpartum period.