Benefits - What are the benefits to this procedure? How might this help me, my baby, and my labor?
Risks - What are the risks of this procedure? How might this negatively affect me, my baby, and my labor?
Alternatives - Are there alternatives that we could try instead? What are all of my options?
Intuition - What is my gut telling me? Does this feel right?
Not Now or Nothing - Can I delay this procedure and take some time to think about it? What will happen if I choose to do nothing?
"Why would I want to refuse something that a medical professional is telling me I should do?"
Well, I'll tell you! There is no question that doctors strive to suggest treatments with your best interest at heart but that doesn't mean that things they suggest is always the right solution. Sometimes, recommendations from care providers are not based on scientific evidence or government standards of care (ACOG, WHO). Procedures like inductions or repeat cesareans are often times suggested out of convenience, fear, and a mentality of "that's how we've always done it."
Informed decision making may seem obvious for many people but this can be challenging for pregnant and laboring women who are experiencing intense emotions and pain. Fearing for the safety of our babies, we often comply without question. Doing this, we set ourselves up to be manipulated later on. It's imperative to remember that it's your right to question care provider's decisions. This way, you can be sure that you are receiving the care that best suits you and your needs.
So you might be saying, "Okay, so how do I know if I've gotten the information that I need to make informed decisions?" You can find excellent role play scripts online, where the laboring woman and her partner can practice asserting their rights. Let's practice!
You're at the hospital. Your contractions are changing and seem to be getting stronger. When you got to the hospital you were 5 centimeters dilated. Your baby looks good on the monitoring in triage, so you are assigned a room. When you get there, the nurse would like you to stay in bed on the monitors and not move around. You've asked to get up and get into the shower/tub because that is ALL you want to do but she has said that you should be in bed.
Using your BRAIN, let's see if we can give informed consent or informed refusal.
Typically, when a woman is admitted to the Labor and Delivery unit, they request that they get a 20 minutes of monitoring but given that your baby was healthy on the monitors in triage and you don't want to be in bed, the benefits for the nurse - he/she can keep you securely hooked up to the electronic fetal monitor, the blood pressure cuff, possibly an IV, and all the other gadgets being used to record your vitals. That way when they leave the room, they are able to keep track of your progress with the equipment. It is also likely that the nurse is used to women staying in bed and she has been told that the monitor is the best way to detect fetal stress.
R-isks: What are the risks associated with staying in bed? You already know that you are going to be extremely uncomfortable the entire time, especially if getting out of bed is all you want to do. Another risk is that staying in bed may make things more painful and can also slow your labor. Moving in response to labor contractions and changing positions makes use of gravity and changes the shape of your pelvis, helping baby make his/her way down. Having the freedom to move and to use pain relief/coping techniques like the shower gives you an increased sense of control and can lessen your anxiety.
A-lternatives: Are there alternatives to staying in bed? Can you get more information about why the nurse wants you to stay in bed? If it's to keep the baby on the monitor, you can request intermittent monitoring (roughly every hour or two), or maybe something portable, like a fetoscope or a telemetry unit. That way you have the freedom to move, walk the halls, or even get into the shower. If you have done your research, or if the nurse/doctor does theirs, you will know that routine continuous EFM provides no benefit for babies and increases the risk of cesarean for mothers.
I-ntuition: What is my Intuition saying? That's easy - I want to get out of this bed. I WANT TO MOVE!
N-othing: It's okay to need some time to think about it. You might choose to stay on the monitor for a bit and see if you can get comfortable. Or, if you've gathered all the information you can from your nurse and or doctor on the benefits, risks, and possible alternatives, you
just want a few minutes to talk to your partner and your doula about what you're thinking and feeling. There is no rush to decide.