Oregon homebirth midwives don’t want to obtain informed consent

Isn’t every patient entitled to give informed consent for medical care, with the provider explaining risks and benefits of each available option? Oregon homebirth midwives don’t think so.

New state regulations enacted earlier this year mandated informed consent:

Beginning on June 1, 2011, each LDM [licensed direct entry midwife] must provide risk information as published on the agency’s website www.Oregon.gov/OHLA, and obtain informed consent for the following circumstances:

(a) Out-of-hospital birth;
(b) Vaginal birth after cesarean (VBAC);
(c) Breech;
(d) Multiple gestations; and
(e) Pregnancy exceeding 42 weeks gestation.

It’s now November, yet Oregon homebirth midwives are NOT obtaining informed consent in these high risk situations. That’s a remarkable turn of events for two reasons.

First, it is notable because a specific regulation was required to address the fact that Oregon homebirth midwives were not fulfilling their ethical obligation. Every healthcare provider is ethically and legally required to provide accurate information about the risks of any medical care. Oregon homebirth midwives SHOULD HAVE been providing information about the increased rate of perinatal death at homebirth, and the further increase in risk posed by VBAC, breech, twins, and postdates pregnancy. Oregon homebirth midwives flagrantly disregarded this obligation and Oregon officials felt compelled to make informed consent mandatory for license maintenance.

Second, it is remarkable that Oregon homebirth midwives have still not begun obtaining consent for these high risk situations, arguing repeatedly that they need “more time” to create consent forms. Homebirth midwives petitioned for and were granted an extension until October 15, and as the date drew near, they petitioned to postpone the requirement for informed consent until January 1, 2012. That request was formalized on 9/26/11. A little over a week later, having postponed compliance with the requirement for 6 months, Oregon homebirth midwives petitioned to postpone a further 6 months.

The idea that they needed any extension at all is bizarre. The increased risks posed by VBAC, breech, twins and postdates pregnancy are well known and have been quantified for years. For example, obstetricians have been obtaining informed consent for VBAC for at least 20 years. The Board of Direct Entry Midwifery could easily assemble and print the information in one day.

Moreover, the requirement for informed consent does not depend on provider convenience. Can you imagine a doctor arguing that he didn’t obtain informed consent for gall bladder surgery because he hadn’t had time to prepare a consent form? Can you imagine an oncologist arguing that he didn’t obtain informed consent for a patient to refuse chemotherapy in favor of herbs because he didn’t have time to prepare an consent form? Of course not.

Can you imagine a doctor insisting that he needn’t obtain informed consent for gall bladder surgery for any patient in the next year because that’s now long he would need to prepare a consent form? Can you imagine an oncologist arguing that he needn’t obtain informed consent for any patient in the next year to refuse chemotherapy in favor of herbs because he didn’t have time to prepare an consent form? Of course not.

Yet that’s precisely what Oregon homebirth midwives are arguing:

Amend OAR 338-025-0120 to extend the implementation date for risk information packets by requiring that each LDM provide risk information as published on the agency’s website regarding out-of-hospital birth, malpresentation birth (breech), multiple gestations (twins), vaginal birth after cesarean (VBAC), and births exceeding 42 weeks gestation (post-dates) beginning June 1, 2012.

There is no plausible reason to take a year to amend a consent form, especially since the information has been known for decades and can be accessed in moments on Google. So why are Oregon homebirth midwives arguing for repeated extensions to the informed consent requirement?

It’s simple. They don’t want to obtain informed consent.

If Oregon homebirth midwives are are required to provide patients with accurate information about the real risks of homebirth, and particularly about the increased risk of high risk homebirth, they will have many fewer clients.

The state of Oregon should refuse to grant any further extensions. Informed consent is a requirement for all healthcare providers and there should be no exception for Oregon homebirth midwives.

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