The Power of Yes (and No): Mastering Informed Consent in Your Birth Journey
Consent.
It seems like a buzzword these days, and you’d think it would be common sense—especially in healthcare. Yet, far too often, consent is misunderstood or completely disregarded, even in something as personal and sacred as birth. You might assume that because you're in the care of a professional, your consent is automatically respected. Unfortunately, this isn't always the case. Many providers exhibit red flags when it comes to obtaining true consent—sometimes so subtly that you might not even realize it’s happening. I’ll share what these red flags look like and how to protect your autonomy during your birth journey, but first, let’s dive into what consent really means in the context of pregnancy and childbirth.
When it comes to pregnancy and birth, making informed choices is one of the most important factors in ensuring a positive experience for both you and your baby. While many providers and well-meaning friends might tell you that birth is unpredictable and that you shouldn’t plan too much, having a birth plan doesn’t mean you’re trying to control every aspect. In fact, having a plan ensures that your preferences and consent are clearly communicated, reducing the likelihood of unnecessary interventions, breaches of consent, or even trauma.
I want to share my own story to highlight how critical it is that consent be respected in birth. After the birth of my son, who had been diagnosed with gastroschisis before birth and would need to go directly to the NICU, I explicitly asked my provider to delay clamping and cutting his umbilical cord. I knew the importance of delayed cord clamping, especially for babies who may face medical challenges at birth, and I wanted to give my son every advantage in those critical first moments.
Despite my clear request, my provider clamped and cut his cord immediately after birth. It was a moment that made me feel powerless, as my wishes and my consent had been blatantly disregarded. This decision had serious consequences: my son ended up needing a blood transfusion in the NICU, something that might have been avoided had my request for delayed cord clamping been respected.
This experience reinforced for me how essential it is to not only understand your rights but also to advocate for them—even when you're in one of the most vulnerable moments of your life. It also showed me how providers can sometimes assume control over decisions that are not theirs to make, underscoring the importance of clear, firm consent in every part of your birth experience.
Consent in birth is more than just signing a form or agreeing to a procedure—it’s about understanding your options and making decisions that align with your values, even when things are unpredictable.
Let’s explore the different types of consent and how they play a crucial role in your birth experience.
Informed Consent
Informed consent means that you’re provided with clear, comprehensive information about any procedure, treatment, or intervention being recommended. This includes understanding the risks, benefits, and alternatives. Informed consent is more than just a checkbox—it’s about ensuring you have all the facts so you can make decisions that feel right for you and your baby.
Unfortunately, in many healthcare settings, true informed consent can be overshadowed by the power dynamics between patient and provider. It’s not uncommon for patients to feel pressured into decisions without having all the information, or worse, without feeling like they have a real choice. To ensure you’re truly informed, take the time to ask questions, request alternatives, and don’t hesitate to slow things down if you need more clarity. Informed choices are empowered choices.
Attuned Consent
Attuned consent goes beyond providing basic information. It’s a more compassionate and respectful approach, often facilitated by doulas and supportive birth teams. This type of consent takes into account not only what you say but also how you’re feeling and what your body language might be communicating.
Birth is a vulnerable time, and in the midst of contractions, pain, or exhaustion, it can be difficult to fully verbalize your thoughts or needs. An attuned provider or support person will pick up on these subtle cues, adjusting their approach based on your emotional and physical state. This deeper level of listening is vital in creating a supportive, respectful birth environment where you feel truly seen and heard.
Assumed Consent
Assumed consent is where things can get murky. It occurs when actions are taken based on assumptions rather than explicit verbal agreement. For example, many providers might assume that because you’ve entered a hospital or signed a general consent form, you’re automatically agreeing to any procedure they deem necessary. However, just being in a hospital or signing a consent form does not mean you’ve agreed to everything.
Assumed consent is dangerous because it bypasses your autonomy and can lead to situations where you’re subjected to procedures you didn’t fully agree to or understand. This can be a source of birth trauma and lead to feelings of violation or loss of control. Remember, you have the right to say “no” or to withdraw consent at any point in your birth journey, regardless of what forms you may have signed.
Consent and Birth Plans: Why Having a Plan Matters
Many providers advise against making a detailed birth plan, claiming that birth is too unpredictable to plan for. Ironically, these same providers may then offer an induction so you can “have more control.” The truth is, birth is unpredictable, and your baby will likely do what they want, but that’s precisely why a birth plan is so important.
Your birth plan serves as a roadmap for your providers, ensuring they know your preferences ahead of time so they don’t ask you life-changing questions when you’re deep in labor and focused on your baby. A clear birth plan can prevent unwanted interventions, touch, or procedures and create a safe environment where your consent is honored.
Advocating for Your Consent: Empowering Tools for Birth
As you navigate pregnancy and birth, knowing how to confidently express your choices is crucial. Here are some ways to advocate for yourself and ensure that your consent remains at the forefront:
Direct Communication: Be clear and firm when expressing your decisions. For example, "I've reconsidered and choose not to proceed with [procedure]."
Non-Verbal Signals: Establish a signal with your support team to discreetly indicate if you want to change your mind during labor.
Refer to Your Birth Plan: Discuss how your current decision aligns with or differs from your original plan.
Ask for Clarification: If you’re unsure, ask for more information to give yourself time to make a confident choice.
Request a Pause: If you feel pressured, don’t be afraid to ask for a moment to gather your thoughts or consult with your partner or doula. You can ask for a few moments to “pray” or privately discuss with your partner.
Red Flags in Consent: What to Watch For
Consent should never feel like an afterthought, and you should never feel coerced into a decision. If your provider tries to hand you a pamphlet instead of engaging in a discussion about your options, that’s a red flag. You deserve a conversation, not a leaflet. You shouldn’t be left to do all the research on your own or feel like you’re gathering information from scraps. Consent should be an active process, where your provider seeks to understand your concerns, answers your questions, and respects your decisions.
Here are some key red flag phrases that consent is being bypassed:
“I’m just going to…”
“Let’s do [procedure] now…”
“You don’t need to worry about that.”
“We always do this.”
“This won’t take long.”
“Do you want a healthy baby or not?”
“You signed the consent form, so we’ll proceed.”
“It’s easier if we just…”
“There’s no time to explain everything, let’s just get this done.”
“It’s really your only option.”
Additionally, fear tactics have no place in consent. If a provider resorts to asking, “Do you want your baby to die?” to coerce you into agreeing to a procedure, it’s time to reconsider your care. While birth does come with risks, very few situations are immediately life or death. Unless there’s a true emergency, you always have time to ask questions, weigh your options, and make informed choices. No one should manipulate your decisions by exploiting your love for your baby.
Remember, you can revoke consent at any time. Just because you said “yes” earlier doesn’t mean you can’t change your mind. Whether it’s mid-labor, mid-appointment, or even mid-procedure, your autonomy is your right. Don’t be afraid to trust your instincts and own your choices—your voice is essential in your birth journey.
Consent in birth is about more than just agreeing to a plan—it’s about ensuring that your rights, autonomy, and preferences are respected every step of the way. By understanding the types of consent and advocating for yourself, you can feel empowered and confident as you bring your baby into the world.
Now that we’ve explored the forms of consent, remember the red flags. If consent feels like an afterthought, if you’re handed a pamphlet instead of a conversation, or if fear is being used as a tool for compliance, it’s time to reassess your provider. Your consent is your power, and it’s crucial to have a birth experience where your autonomy and choices are honored every step of the way.
