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Epidurals and informed consent


Forum: Natural Childbirth

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  #1  
January 14th, 2009, 12:28 PM
kristen121's Avatar Mega Super Mommy
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Hi ladies. I'm not a regular poster here, but I've been thinking about this ever since my DD was born and was wondering if anyone had any thoughts about it. I went into labor hoping to have a natural child birth. However, I was in labor for 4 days and by the end I was so tired and delirous from the pain that I decided to get an epi. FWIW, no one pressured me to get one. In fact, my nurse tried to talk me out of it. Anyway, my experience got me thinking about informed consent. Of course they gave me the required literature on the risks and benefits of epidurals and I signed a consent form, but I probably would have signed anything at that point! (And I usually won't sign my name to anything without reading it first) And I was in no kind of mood to read through the information they gave me. I don't remember anyone talking to me about the possible risks, although I knew them from my own research and schooling. I really wouldn't call my consent "informed consent" it was more like consent out of desperation. I'm sure many women sign consent forms for epis with very little or no knowledge of the possible risks. Thoughts?
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  #2  
January 14th, 2009, 01:31 PM
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When I was given an epidural with my first, I was not told the risks, they just gave me the form to sign. I think thier idea of "informed consent" is "It's up to you to read this form even though you are not really in a mindset to, and decide if you agree to it". But like you, most women don't even care at that point, they would sign anything!

Would it make a difference though? I'm not sure, how many women would change thier mind if they were told the risks over reading them at that point? The way the hospital presents them is very different from how they could be. The hospital wont' tell you that an epidural can slow down labor and lead to more interventions and possibly a c-section. I think if more women were told that, they may think twice about it.
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  #3  
January 14th, 2009, 01:42 PM
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My hospital has you sign the form around 30 weeks or so. They give it to you in a packet with literature about making a birth plan, etc. It had one line that said something like "side effects can be numbness, migraines, and/or death". They did not go over it with me or anything. They had me sign it even though I went natural, they want it ready in your file I guess just in case.
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  #4  
January 14th, 2009, 01:55 PM
Husher's Avatar B & E complete me.
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I have often wondered this myself. I don't see how it's really an informed consent if one party is under duress (and you could say being desperate for pain relief is a form of duress, IMO) when they sign it. I believe my old OB gave me a packet before my EDD with information on the risks as well but they also had me sign a form at the hospital and made me meet with an anesthesiologist just in case I changed my mind. I agree though that a lot of women probably would still get the epidural if they were told of the risks in that moment because it's just so hard to think clearly in a time like that.
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  #5  
January 14th, 2009, 01:57 PM
snlemon's Avatar Platinum Supermommy
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You bring up a good point...at least I would imagine. I went into L&D two weekends ago for pre-term labor and a stomach flu...anyways...I signed whatever they handed to me and normally I read everything over. I just didn't care at all. If they had told me to stand on my head I would have done it. lol.

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  #6  
January 14th, 2009, 02:14 PM
DoulaMama's Avatar Platinum Supermommy
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very little in the medical field is really informed consent. It's so sad, but that is the way it is. But doctors (and especially insurance) feel like the form protects them, even thought it doesn't. You can still sue, and the lawyers will argue over wether it was consent. consent under durress (like the DR saying if you don't consent to a section your baby will die, evne though that isn't the case), or informed consent.

That is one of the biggest reasons I feel like in most locals (depending on the birth climate) if you want to be really informed you need a personal advocate (doula), and to have private time from the hospital staff and their agendas (whether obvious or hidden) to make your decision.
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  #7  
January 14th, 2009, 02:52 PM
mgm78's Avatar Zoe's mom Meredith
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I am a HUGE pusher of patient education, NO MATTER WHAT it is about. I am very forward with a lot of my patients and really make them research things and educate themselves, and I am huge with getting second and third opinions.

Cheryl brought up a doula, i was going to say a health care proxy, someone who will make that decision for you, or assist you in making it. I do not think a spouse would be a good choice, cause no spouse wants to see their SO suffer and most will cave in and say, yes, drug her up in the heat of the moment!!! LOL.

Luckily, being (god willingly) in a birth center, there is not the risk of epidurals.

I also think people do not want to educate themselves on them. I will say a friend went to a birthing class at her hospital and they said the c-section rate was very high with women who chose epidurals and it scared her. She still got one though, which she later regretted. She did not need a csection, luckily, but only because her dr left and the ob that delivered her daughter was patient. She flat out told her her dr would have cut her open.
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  #8  
January 14th, 2009, 07:35 PM
soImarriedAnerd's Avatar Platinum Supermommy
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I am mixed on this topic, I don't think its informed consent to hand someone a form in pain and think they read it and understand it. However, its not like an epidural is a out of the blue intervention, I think if a woman REALLY wants to know she will have looked it up in the 10 months she was pregnant! I think its lazy to not look at your NORMAL options and see what the risks/benefits are before hand...labor isn't a surprise event for 99% of people. So if they didn't look it up...well its kind of their own fault at that point. However I do like that some providers offices are going over this stuff in office PRIOR to being in labor....now if they would just talk more in detail and not so general I would be happy--but thats asking alot! LOL
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  #9  
January 15th, 2009, 05:49 AM
snlemon's Avatar Platinum Supermommy
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Quote:
I am mixed on this topic, I don't think its informed consent to hand someone a form in pain and think they read it and understand it. However, its not like an epidural is a out of the blue intervention, I think if a woman REALLY wants to know she will have looked it up in the 10 months she was pregnant! I think its lazy to not look at your NORMAL options and see what the risks/benefits are before hand...labor isn't a surprise event for 99% of people. So if they didn't look it up...well its kind of their own fault at that point. However I do like that some providers offices are going over this stuff in office PRIOR to being in labor....now if they would just talk more in detail and not so general I would be happy--but thats asking alot! LOL[/b]
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  #10  
January 15th, 2009, 06:14 AM
NutMeg76's Avatar Platinum Supermommy
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Ah, informed consent. I think it is a joke when dealing with the birth process in general.

Giving someone a paper to read and sign is not informed consent in my opinion. Even when a person is NOT in pain, it is still iffy. How many people take hte time to read it, and how many trust their doctors and figure it is okay, so they sign it. How many people UNDERSTAND what they are reading? How many are to embarassed to admit they don't understand.

I do agree though that you have a lot of time during pregnancy to figure things out and research, but it comes back to trust. The patients trust the doctor. They don't question them because hte doctor has a degree and the doctor has the patients 'best interest' in mind. Until someone is burned by the medical profession they will just take the form and sign it.
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  #11  
January 15th, 2009, 06:43 AM
PixieQueen's Avatar Hi-Tech Hippie
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Quote:
Giving someone a paper to read and sign is not informed consent in my opinion. Even when a person is NOT in pain, it is still iffy. How many people take hte time to read it, and how many trust their doctors and figure it is okay, so they sign it. How many people UNDERSTAND what they are reading? How many are to embarassed to admit they don't understand.[/b]
You know, I consider myself a fairly intelligent and well-read individual, but legalese is a whole other language! It usually takes me a couple read-throughs to figure it out. And about the remembering or understanding while you are in labor? Ha! I actually had a pretty easy labor and still couldn't properly remember the name of the Assistant MW. She is now fully certified and my MW, but I didn't know who she was until I had talked to her for a bit. And I am usually really good wtih names!
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  #12  
January 15th, 2009, 07:35 AM
mgm78's Avatar Zoe's mom Meredith
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If they have you sign it before your childbirth, is it not a requirement to sign it to be a patient there? Which means, you have to sign off on consent prior to your childbirth, which means they can do whatever when you are there in labor, right? Correct me if i am wrong about the process.
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  #13  
January 15th, 2009, 07:48 AM
shannaj's Avatar Mega Super Mommy
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Location: Ontario, Canada
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Quote:
I am mixed on this topic, I don't think its informed consent to hand someone a form in pain and think they read it and understand it. However, its not like an epidural is a out of the blue intervention, I think if a woman REALLY wants to know she will have looked it up in the 10 months she was pregnant! I think its lazy to not look at your NORMAL options and see what the risks/benefits are before hand...labor isn't a surprise event for 99% of people. So if they didn't look it up...well its kind of their own fault at that point. However I do like that some providers offices are going over this stuff in office PRIOR to being in labor....now if they would just talk more in detail and not so general I would be happy--but thats asking alot! LOL[/b]
DITTO!!! I wish more women were as keen as we are to research our options. It should be something more doctors and nurses push.
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