by Brette McWhorter Sember
It's easy to feel as if you are on an assembly line during pregnancy. You go for the prescribed number of office visits, have the prescribed tests and listen to your health care provider explain birth procedures. When you get to the hospital or birth center you're on another assembly line. Wear this, we're putting in an IV, your partner needs to go here, get into this position and so on.
An expectant mother can feel like a specimen and not like a person with legal rights and individual preferences. Expectant mothers do have the right to control their medical care, to make choices based on information and to refuse care. Learning what your legal rights are will help you feel more in charge of your birth and help you insist on getting the information you need to make important decisions.
The most basic of rules about medical care is that the patient has the absolute right to be informed about the proposed treatment before agreeing to it; this is known as "informed consent."
Your care provider must explain the planned care in words that a non-medical person can understand and explain the risks involved as well as any alternatives. He or she must discuss medication with you and tell you about its risks and benefits, as well as its full name. Your provider must also share information about the effect of drugs or treatment on your baby. Care providers cannot hold back information because they believe it will scare you or make you uncomfortable. Once your provider has completely shared all of this information to you, you have the right to accept or refuse the treatment.
"Personally, if a patient is not interested in informed consent, I will not provide her with care," says Faris Ahmad, M.D., a physician with Wilshire Ob/Gyn Associates in Troy, Michigan. "She runs the risk of not fully understanding the procedure or care involved, any possible side effects, or any risks with the procedure. She will probably end up being dissatisfied with her care."
In practice, many care providers do not fully abide by the rules of informed consent. Rarely do they take the time to explain the benefits and risks of an IV, the full name and possible side effects of drugs administered during an epidural or explain all of the risks associated with c-section. It's often assumed that patients already have basic information about these treatments. If you need more information you should always speak up!
If you or your baby is in danger, your care provider is authorized to provide care without getting informed consent. For example, if you need an emergency c-section, your doctor is going to go ahead without spending the time to explain the all of the risks to you. Understanding the risks and benefits are more good reasons to do research on your own in advance -- just in case.
If you give birth at a hospital or birthing facility, you will be asked to sign a consent form. Read the form carefully. You can cross things off or add things to it. Usually these forms give consent for your health care provider and anyone under his or her supervision or direction to provide care for you. If you do not wish to have your baby delivered by anyone but your provider, you can cross this portion out and write in that you give permission only to your provider. Realize however that if your provider is with another patient, you have ruled out the possibility of someone else delivering your baby.
You have the right to refuse any treatment. Period. You can get up and walk out of a hospital or birth center at any time. Doing so may cause insurance problems though, since your carrier may not cover complications or care that results from you leaving against medical advice ("AMA") and your provider may decide not to continue on as your provider.
Ob/Gyn Ralph Dauterive, M.D., of the Ochsner Clinic Foundation in New Orleans, Louisiana, discusses any decision to refuse treatment with his patient, and advises her of the known risks, "Most OB patients really have little time and few options when it comes to therapy for an obstetrical problem. If a patient decides against a treatment option that I think is necessary, I document the chart with my recommendation and inform the patient of my action," he says. "Ultimately I would advise the patient to seek a second opinion or find another provider for her care." He adds that such a refusal is rare when "the doctor is competent and the relationship is based on trust and good judgment."
You have the right to know when you are being treated by a trainee (such as an intern in a hospital) and can refuse treatment by health care providers who are not fully trained and accredited. In most teaching hospitals, students routinely monitor procedures. You may choose not to be observed, but you have to speak up with your preferences.
Policies and Procedures
Hospitals and birth centers have set policies -- such as requiring you to wear a hospital gown or not permitting your partner to be with you during a spinal. You can refuse to agree to these, but the hospital or provider may refuse to treat you if you do not comply with their procedures.
Learn in advance what your care provider's and hospital's standard procedures are. If there are any you do not agree with, discuss this with your provider in advance. Most of your concerns can be worked around.
Listen to what treatment your care provider suggests, ask as many questions as possible and understand the procedure, risks and benefits before reaching a decision about whether or not to agree. Your care provider is often required to inform you of options even though he or she may not recommend them. Always ask your care provider what he or she is recommending in your situation. Don't be afraid to ask for a second opinion; you have the absolute right to request one at any time.
Changing Your Mind
You can always change your mind about what treatment you agree to. You can withdraw your consent to a treatment at any time, except when it is medically necessary to continue (for example, in the middle of a c-section you cannot withdraw your consent since it would endanger your life and that of your child). Additionally you can change your mind and agree to receive care that you originally declined. You also may also choose to switch providers at any time -- even during labor if you wish.
Can You Transfer to a New Ob/Gyn Late in Pregnancy? Here's what two moms said:
"I switched OBs at my 35 week appointment. I liked my other doctor; however, he always seemed so rushed and like [he thought] all my questions were stupid. Some of the nurses there were asking me why I was switching, but I just told them it was nothing personal against the other doctor. So, if there's anyone having second thoughts, it still isn't too late to switch!"
"If I hadn't switched at 32 weeks, my preterm labor and dilation would have continued to be ignored. It is so important to be with a doctor you trust. This is my third doctor this pregnancy, but I am so happy with my current doctor." - Crystal
Many women choose to create a birth plan in conjunction with their care providers. However, your birth plan is not a binding contract and your care provider is not required to follow it. It's best to think of your birth plan as a summation of your goals or as a guideline. "I am happy to discuss birth plans with my patients; it can help alleviate any concerns or apprehension they have about labor," says Dr. Ahmad. "However I caution them that, during labor and delivery, we cannot predict what the initial presentation or ensuing course will be like, and therefore, I let them know that there is nothing in a birth plan that cannot be changed, based on maternal status."
Choosing a Facility
You can choose to give birth at any facility you like, but be aware that your care provider will have a limited list of places he or she will go. You also have the right to choose to deliver your child at home, but again your care provider has the right not to attend (and your insurance may cover only certain facilities and providers). Discuss these options with your doctor or midwife in advance and find a provider who will go where you need him or her.
Your Rights After Birth
You have the right to insist that your baby remain in your hospital room with you ("rooming in"), but you might have to release the hospital from liability. You may also refuse to accept the hospital's feeding schedule for infants and feed your newborn on any schedule you prefer (such as "on demand"). You may refuse to allow some tests on your infant, but be aware that some are mandated by state law and cannot be refused (States commonly require tests for PKU, blindness and hearing problems. Check with your care provider for information on mandated tests in your state.) You have the right to leave the hospital with your baby at any time you choose.
You are truly in control of the medical care you receive -- it's your body after all! Don't be afraid to get the information you are entitled to and stick to the decisions that are right for you. Remember that presenting your questions and concerns in a respectful and non-threatening manner will lead your caregiver to respond in a thoughtful and helpful way.
For more information about maternal rights contact:
Maternity Center Association www.maternity.org or 212-777-5000
Alliance for the Improvement of Maternity Services www.aimsusa.org
Your state bar association (since laws vary in each state): check your local phone book
Treatments and Policies You May Choose to Opt Out of During Labor and Delivery:
- any labor or birth position
- your birth partner being sent out of the room
- epidurals or spinals
- pelvic exams
- forceps or vacuum extraction
- remaining in bed
- fetal monitors
- bottle feeding
- feeding schedules
- mandatory stays in the nursery
Note: This article is intended as general information only and is not intended to serve as legal advice or as a substitute for legal counsel.
Brette McWhorter Sember is the author of "Your Practical Pregnancy Planner: Everything You Need to Know About the Financial and Legal Aspects of Preparing for Your New Baby" (McGraw-Hill, 2005) and "Your Plus-Size Pregnancy: The Ultimate Guide for the Full-Figured Expectant Mom" (Barricade Books, 2005). She is the mother of two children. Her web sites are BretteSember.com and Your Plus Size Pregnancy.
Copyright © Brette Mcwhorter Sember. Permission to republish granted to Pregnancy.org, LLC.