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Informed Consent and REFUSAL

Posted Jul 13 2009 10:37pm

Last month I "attended" a webinar entitled Informed Consent and Refusal in Maternity Care given by the Coalition for Improving Maternity Services.  I always felt that there was something wrong about a care provider walking into a hospital room declaring, "it is time for your IV," and there is.   Informed consent is not a declaration, it is a process of information dissemination (see below).  Informed consent means giving the mom space to make an informed refusal (how many of us have attended births where mom's attempts to refuse an intervention have swiftly been pushed aside).  The best part is that we all benefit when informed consent and refusal is respected, mothers, babies, AND providers.  Please read the below handout prepared by the webinar presenters and pass this information along to your friends.  Pregnant moms need to know that they are the decision makers.  Healthcare providers can be sued for failure to obtain sufficiently informed consent (examples below).   Care providers should provide  diagnosis, prognosis, and alternatives, including choice of no treatmentWithout true informed consent and refusal, empowered birthing is not possible.  A big thank you to the Coalition for Improving Maternity Services for creating the below handout!


Informed Consent & Refusal in Maternity Care 

 

Session Presenters: Tabaré Depaep, Esq., Holly Goldberg, BA, PhD-c, Cordelia Hanna-Cheruiyot, MPH, CHES, CCE, CBA 

  

The research supporting this educational activity is published inThe Journal of Perinatal Education

Volume 18, Number 1, 2009, pp. 32-40.  

 

What is informed consent and refusal? 

Informed consent is a process of information dissemination.  It involves providing the patient with 

sufficient, evidence-based information so she can make a decision that reflects self-determination, 

autonomy, and control.  

 It is a process of information exchange. 

  It is based upon involving patients in the decision making process.  

 

Every pregnant woman has the right to make informed decisions about the care for herself and 

her fetus.  Examples of judicial interventions that support patient rights: 

 Schloendorff v. Society of New York Hospitals, 1914. 

Health care provider held liable for failure to get patient’s consent to surgery.  

 Salgo versus Leland Stanford Jr. University Board of Trustees, 1957. 

Health care provider held liable for withholding information necessary for making an informed 

decision.  

 

The essential components of informed consent and refusal 

Numerous national and international professional associations promote patients’ rights to informed 

consent and refusal, including the American College of Physicians, American Medical Association, and 

March of Dimes, among others.  The American College of Obstetricians and Gynecologists’ (ACOG) 

publication Ethics in Obstetrics (2004) included the ACOG Committee on Ethics’ statement on 

Informed Consent (PDF).  This document details the following essential components of informed 

consent and refusal. 


 Adequate Information 

o Provider gives diagnosis, prognosis, and alternatives, including choice of no treatment. 

 Comprehension 

o Provider is aware of and understands the patient’s situation/possibilities; 

o Provider uses language that is understood by the patient; 

o Patient’s consent is given freely, intentionally, and voluntarily. 

 Freedom of Choice 

o Patient is free of coercion/free from outside pressures;  

o Patient chooses among options and has the right to choose other than what is 

recommended; 

o Patient gives provider the right to perform action. 

 

The benefits of informed patient decision making: 

 

Benefits for Providers: 

 Better patient/provider relationships 

 Enhanced trust in providers 

 Higher patient evaluation of providers 

 Increased patient recommendations of provider to others 

 

Benefits for Patients: 

 Improved quality of life and physical and social functioning 

Enhanced emotional well-being, increased sense of empowerment and self-esteem 

 Increased satisfaction 

 Increased adherence to treatment plan and improved clinical outcomes 

Shorter recovery periods 

 

Benefits for Childbearing Women: 

 Lower levels of fear 

 Less depressive and post-traumatic stress symptoms after birth 

More positive feelings toward newborn 

 


About the Coalition for Improving Maternity Services (CIMS) 

CIMS is a coalition of individuals and national organizations with concern for the care and well-being of 

mothers, babies, and families.  Our mission is to promote a wellness model of maternity care that will 

improve birth outcomes and substantially reduce costs.  This evidence-based mother-, baby-, and 

family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, 

diagnosis, and treatment programs.  CIMS is a not-for-profit organization recognized as tax-exempt 

under Internal Revenue Code section 501(c)(3).  CIMS abides by the WHO-UNICEF “International 

Code of Marketing of Breast-milk Substitutes.” 




 

The Mother-Friendly Childbirth Initiative 

CIMS Evidence Basis for the Ten Steps of Mother-Friendly Care(PDF),The Journal of 

Perinatal Education, Winter 2007 

 

Additional Links 

 

 The Six Care Practices that Support Normal Birth, Lamaze International 

 Listening to MothersSurveys and Reports, Childbirth Connection 

 

References Related to Informed Consent and Refusal 

1. Cahill, J. (1998). Patient participation – A review of the literature. Journal of Clinical Nursing, 7(2), 

119–128. 

2. Christiaens, W., & Bracke, P. (2007). Assessment of social psychological determinants of 

satisfaction with childbirth in a cross-national perspective. BMC Pregnancy and Childbirth, 7, 26. 

3. Declercq, E. R., Sakala, C., Corry, M. P., & Applebaum, S. (2006). Listening to mothers II: Report 

of the second national U.S. survey of women’s childbearing experiences. New York: Childbirth 

Connection. 

Coalition for Improving Maternity Services (CIMS) Webinar Handout June 2009 

Informed Consent & Refusal in Maternity Care  Page 3 

 

 

4. Elwyn, G., Edwards, A., Gwyn, R., & Grol, R. (1999). Towards a feasible model for shared decision 

making: Focus group study with general practice registrars. British Medical Journal, 319(7212), 

753–756. 

5. Goodman, P., Mackey, M. C., & Tavakoli, A. S. (2004). Factors related to childbirth satisfaction. 

Journal of Advanced Nursing, 46(2), 212–219. 

6. Green, J. M., & Baston, H. A. (2003). Feeling in control during labor: Concepts, correlates, and 

consequences. Birth: Issues in Perinatal Care, 30(4), 235–247. 

7. Green, J. M., Coupland, V. A., & Kitzinger, J. V. (1990). Expectations, experiences, and 

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Coalition for Improving Maternity Services (CIMS) Webinar Handout June 2009 

Informed Consent & Refusal in Maternity Care  Page 4 

 

 

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© 2009 Coalition for Improving Maternity Services (CIMS).  Permission granted to freely reproduce 

with attribution. 

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