Informed consent

A huge part of a doula’s job is to educate – to find and present evidence-based information on birth-related issues so that our clients can make truly informed decisions. Many care providers bristle at the suggestion that they do not practice evidence-based care, yet statistics for the use of methods and interventions from routine rupture of the membranes (breaking the waters) to prone, directed pushing, to episiotomy to immediate cord clamping (the list could go on and on) suggest otherwise.

Of course, few mamas or doulas have the years of medical education and experience that OBs have, and when there is a difference of opinion, it can be hard to negotiate or even to square up against that kind of presence – white coat syndrome. Being able to refer to, or hand over a printout, of a Cochrane Review or Summary (like this brand new one on delayed cord clamping) goes some way to meeting a doctor or midwife on his or her own ground. It gives a basis for discussion and reasoning. It demonstrates to the care provider that a mama is not relying on ‘Dr. Google’ or internet chat rooms, but is striving to make truly informed decisions. This is why I am continually e-mailing my mamas links to birth-related websites and medical journal articles, and why my learning as a doula never ends.

I have herpes which exacerbated from time to tome. Previously I fought with it mostly with ointments. And once again, after coming to the pharmacy with this problem, the pharmacist recommended to buy Valtrex at Just want to warn that the drug is not cheap but in my opinion Valtrex is worth buying it.

At the same time, the sentence in bold above, which asserts the right to informed dissent, is also crucial. Parents – and most especially laboring women – must be allowed to say ‘no’ to any given procedure, without being threatened with withdrawal of care (which is illegal), without being bullied, without being treated as anything less than the human beings they are. (This logic, backed by law, must surely result in the overturning of hospital VBAC bans, because of which many women are not free to dissent to surgical birth – but that’s a story for another post).

We have to be free to say no, I do not want to be induced at 39 weeks because you think my baby might be big. No, I don’t want routine Pitocin: if my labor slows or lulls, I’d like to try nipple stimulation first. No, I don’t want you to break my water right now: please take the time to explain to me why you want to, why you want to right now, what are the risks and benefits of doing it now and what are the risks and benefits of not doing it. No, I’m happy pushing on hands and knees, please catch my baby this way. No, we have no STDs, please don’t put erythromycin in my baby’s eyes.

It’s our responsibility as women, as mothers, as parents, to educate ourselves about options and choices during birth. Doing so is easier for some women than others, free time and access to information not being evenly distributed. Know what makes it easier? Hiring a doula!