Patient rights during birth and informed consent

Patient rights, particularly the rights of a birthing person, have recently come to the forefront of conversations for many groups working with pregnant mothers and families. This past year, during the International Day for the Elimination of Violence Against Women, there was a lot of discussion surrounding obstetric violence and the negative impact that birth trauma can have on generations of women. After years of being a hushed subject, women all over Italy and the world are speaking out about their experiences of violence and mistreatment in the delivery room.

Obstetric violence is a difficult and often controversial topic particularly because it occurs during a time of great joy for new parents. Like most violence that is difficult to discuss mainstream, it is committed by a trusted authority, someone in whom a great deal of faith has been placed. Like many instances of institutionalized violence, it is not always recognized as violence by the perpetrators or the witnesses because it is so commonplace that it is normalized. Many justifications are made, such as “this is how it has always been done” or “that’s how I was taught” which allow for complacency where there should be change. Now though, a growing body of research, testimony and jurisprudence has recognized and defined obstetric violence and mothers, the most common victim, are speaking out like never before.

Obstetric violence is defined as mistreatment during the perinatal and postnatal stages, categorized by physical or verbal violence but also by a refusal to provide full information and involve patients in the decision-making process. For decades we followed a medicalized approach to birth, where women were not seen as the centre figure in the experience but as another element to be managed. Globally we are now shifting to a more patient-centred approach and Italy is taking steps to catch up. Advocates for respectful maternity care are working hard to get domestic legal recognition for protections of birthing individuals. The long-held belief that as long as the baby is delivered safely means that nothing else matters is changing to recognize that the impacts of a traumatic birth for parents holds negative consequences for the family but also society as a whole.

Informed Consent

Informed consent is a legal concept which gives the patient the right to be fully informed about the risks, benefits and alternatives to any medical procedure proposed. This does not mean having a patient sign a waiver but means having an actual discussion with the patient and providing an explanation. The right to refuse medical treatment is included in the Italian constitution as a legal right. The only exceptions for not obtaining informed consent are cases of emergency where the patient is incapacitated or legal incapacitation. A physiological birth is not considered an emergency though long-standing practice is to make decisions without fully informing or conversing with the birthing individual. The push for respectful maternity means that birth, and the decisions surrounding any medical interventions, involve a conversation between doctors and patients, with respect for the decisions taken by parents, even if not parents choose an option that differs from the preferences of the doctor.

Creating Change

Creating change around birth will not come exclusively through legal means. A cultural shift is needed and both parents and medical professionals have to expect better outcomes for birth. Parents who are looking for a positive birth experience need to inform themselves, but they also need to find a care provider who is able to respond to each question they have with respect. Within the medical community, we need to move away from a “doctor knows best” attitude to one that is patient focused. As a culture, we need to value maternal health much more than we currently do.

Why does respectful birth matter?

Birth trauma, that is trauma caused by mistreatment while pregnant or giving birth, has impacts for parents and society. Studies show that women who suffer abuse while giving birth are more likely to suffer post-partum depression, are more likely to have only one child and show a general reluctancy to seek medical attention for other illnesses. These outcomes impact society as a whole.

What can be done?

We need to support families by providing them with information during pregnancy about what a respectful birth experience entails and what their rights are. At the same time, we need to work with health providers and hospitals to explain obstetric violence and its impacts. Only by coming together as a community can we create a sustainable and non-litigious change for the benefit of everyone.