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There once was a dentist, honest and bold
Who felt their story was best told
As The trouble with consent,
Despite good intent,
Means uncertainty in how things unfold


This is a story about tooth extraction.  It tells a tale of a woman’s visit to a dentist, and the dentist’s need to obtain ‘informed consent’.  This story highlights the absurdity that is ‘informed consent’.
This story could just as easy be an anesthetist seeking informed consent before administering an epidural.  Many women primed to receive an epidural are in a not listening, just-get-on-with-it state of mind.  This is not the time to discuss it.  The discussion needs to take place before the procedure is being set up…before the need arises.  In the case of the tooth, the ‘informed consent’ should be sort BEFORE the appointment is even made.  The making of the appointment is a step towards consent.  There is already an assumed consent that comes with entering the birthing ward, just as there is with sitting in the dental chair.  In that moment, whilst the procedure is being set up, it is patronising and painstakingly frustrating to pause to seek ‘informed consent’.  If the person you are seeking consent from is mentally distracted (ie by pain) or has already accepted the necessity of the procedure (ie the only alternative is more pain, further complications or even death), then ‘informed consent’ is neither respectful or logical.  A decision has been made.  The information regarding risk, benefit and alternative should have happened before the appointment was made.

Unfortunately, when we are in the moment, informed consent takes on a new meaning.  It is not about making a decision, but taking a last minute chance to re-evaluate.  In such times, we need to be really tuned in to our intuition AND empowered to withdrawn consent, should that be our determination.  This is especially true if the last minute is also the first minute.

When it comes to dental procedures, there is usually plenty of time before the last minute.

And despite what many say, there is also plenty of time during pregnancy to consider various scenarios, so that any last minutes are not also the first minute.  Leaving any ‘decisions’ to the last minute can be incredibly stressful for all involved.  As the dentist in our story describes – the care provider is very aware of the fraught nature of informed consent.

When it comes to birth, this process is called ‘Informed Birth Preparation’ or Birth Cartography.  The process leads to the creation of a Birth Map.  This is not unlike an Advanced Care Directive.  It facilitates communication between the care provider and the client, and provides clear direction to the support person, reducing stress for all.  Birth might be unpredictable, but that does make it unplanable.

labour could be spontaneous, induced or avoided
http://www.bellabirth.org The home of Informed Birth Preparation

The commentary was originally publish here

Catherine Bellbirth cartographer

Purchase the rather awesome, game changing book, 

The Birth Map: boldly going where no birth plan has gone before.

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