Informed consent: natural childbirth advocates take a page from the anti-choice playbook

The latest mantra among “natural” childbirth advocates is informed consent. Advocates sigh and proclaim that they fully support women making the choice for interventions in childbirth, but fret that these same women cannot possibly provide a “truly informed” consent since they haven’t been appropriately informed.

Penny Simkin has produced a classic of this genre, Weighing the Pros and Cons of Epidural. Evidently there’s only one “pro”, relief of pain, and a long list of “cons,” nineteen in all. The list is a hodgepodge of minor “risks” (itching, shivering from cold liquid) and made up “risks” (feeling “detached,” decreased infant responsiveness). Presumably, Ms. Simkin believes that this long list of “cons” is required in order for a woman to give informed consent.

Simkin piously concludes:

The childbirth educator’s duty is to inform, not to talk women into or out of using an epidural. Many women will choose an epidural, when well informed of benefits, risks and alternatives; others will choose to avoid it if their labor allows.

Ms. Simkin and many other “natural” childbirth advocates are well aware that millions of women each year choose epidural for pain relief in labor, yet they are confident that women would make a different choice if they were fully informed.

Why does that sound familiar? Oh, I remember. That’s the same argument that the anti-choice forces make about abortion.

The anti-choice forces make the same pious argument in regard to abortion. Anti-choice advocates are well aware that more than a million women each year choose abortion, yet they are confident that women would make a different choice if they were fully informed.

According to the National Pro-Life Alliance:

Women’s “right to know” (informed consent) laws deal with this obvious conflict of interest by guaranteeing women receive critical information on the risks of abortion, such as infection, hemorrhage, danger to subsequent pregnancies, breast cancer, infertility, psychological consequences, and other dangers.

A Women’s Right to Know Act ensures that women are fully informed about adoption agencies, pregnancy care centers, medical assistance benefits, and the liability of the father to provide support.

It’s hardly surprising to find that their list of “cons” also contains a hodgepodge of “risks,” some utterly fabricated. The National Pro-Life Alliance has thoughtfully considered many, many things that women ought to know before choosing abortion:

* Thorough and accurate description of the nature of the proposed procedure.

* All physical and psychological risks involved in the abortion procedure versus carrying the pregnancy to term.

* A conflict of interest disclaimer disclosing what percentage of the clinic’s gross income is from abortion, as well as how much money the clinic stands to lose should she decide not to abort.

* Availability of adoption alternatives and financial help from the adoptive parents for prenatal care, childbirth, and neonatal care expenses.

* Medical assistance benefits that may be available for prenatal care, childbirth and neonatal care.

* Names and contact information for organizations that are willing to assist with the costs involved in carrying the pregnancy to term.

* Information on the liability of the father for child support…

At the time of each clinic consultation, a Women’s Right to Know law would also require that the mother be given relevant information about her unborn child and how the child would be affected by an abortion. This information would include:

* A sonogram of the unborn child.

* Probable gestational age of her unborn child, including provision of color photos of fetal development at 4-week increments.

* Description of the development of the child’s nerve endings and the child’s ability to feel pain at each stage of development.

* Relevant information on the potential survival of a child at its stage of development and the requirement of the doctor to take measures to save the life of the child should it be born alive.

Should we take the anti-choice forces at their word? Are they really interested in making sure women are informed about risks? The Guttmacher Institute, a pro-choice organization that provides information on reproductive health, doesn’t think so. In fact, they believe that anti-choice forces are really interested in “misinformed” consent:

Under the banner of informed consent, a majority of states have enacted abortion counseling laws requiring physicians to provide specified information to women seeking abortions. Many of these laws require the state health department to develop detailed written materials that must be distributed to women prior to the procedure.

An analysis of these state-developed materials demonstrates that they do not always measure up to the gold standard of informed consent. Particularly with regard to certain hot-button issues, the information presented is either out-of-date, biased or both. In some cases, the state goes so far as to include information that is patently inaccurate or incomplete, lending credence to the charge that states’ abortion counseling mandates are sometimes intended less to inform women about the abortion procedure than to discourage them from seeking abortions altogether. (my emphasis)

Anti-choice advocates do not hide their opposition to abortion, but they have learned that the majority of women do not share that opposition. They recognize that a frontal assault on abortion is doomed to failure. They have settled instead on undermining a woman’s right to choose by misinforming her about the “risks” and placing obstacles in her path under the guise of “informed consent.”

“Natural” childbirth advocates have enthusiastically followed the playbook of anti-choice activists. They recognize that the majority of women do not share their philosophical objection to pain relief in labor. They have acknowledged that a frontal assault on epidurals is doomed to failure. They have settled instead on undermining a women’s right to choose pain relief in labor by misinforming her of the “risks” and placing obstacles in her path under the guise of “informed consent.”

Such tactics are not merely disingenuous, they are unethical in regard to abortion, and they are unethical in regard to pain relief in labor.

  • I am a natural childbirth advocate. And I am pro-vaccine, very much in the scientifically literate camp, and pro-choice about abortion. Actually, I am pro-choice for YOU about abortion, even if I have always known I would never personally have one myself (unless my life was in jeopardy). I personally don’t care if someone wants to have their baby at a hospital or a birth center or at home. I had my first baby in a hospital and had an epidural and you know what happened? It wore off on the right side, repeatedly. I suffered nearly all the known side effects except death. Yes, I have permanent damage from that epidural. All the side effects, except infection at site and death. And, afterward, I found out that, by some studies, 30% of lumbar epidurals fail. No one told me that risk. That was not in my prenatal books. The OB never told that to me. I also found out, from chatting online, that most women have no clue how often epidurals fail. All we hear about is the glorious stories of pain-free birth, not the stories of epidurals failing while you are tearing 4 degrees and your tailbone is breaking.

    Don’t you think women deserve to know that sometimes epidurals fail? That is all Penny is talking about. And there is nothing wrong with being informed about the RISKS associated with epidurals.

    So, for the second baby, I chose to deliver her without any pain relief whatsoever. I could stand, move, was not shivering, bp did not drop, I did not need O2, breast milk came in immediately, I did no suffer further nerve damage, and I knew what I was doing. Yes, it hurt like a beyotch. It was better than what happened the first time.

    Your constant stereotyping of people who question medical interventions during birth does not contribute to an increase in healthy babies. No one is reading your blog and deciding to have an epidural.

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