Informed Choice

A central and guiding principle of medical care is that you have the freedom to decide what happens to your own body. This right to autonomy means that a medical professional should seek your permission before undertaking any examination, investigation or providing any form of care or treatment. This is otherwise known as obtaining your consent. Consenting for medical treatment needs the input of both yourself and the medical professional and should be based on openness, trust and good communication.

What should the medical professional be discussing with me?

Consent for any treatment should be informed, meaning that you not only have to give permission for the treatment itself, but also that before having the treatment you should have a good understanding of the intended benefits, the possible risks involved and alternative treatment options.

Many decisions about medical care are not simple yes or no answers. Throughout pregnancy and the birth of your baby, there are choices to be made. In every situation where medical care is recommended, sufficient information must be given to you to allow you to decide what to do. As an example; one decision you may be encouraged to make is where you wish to have your baby. The options available to you may include a homebirth, birth centre or a labour ward in a hospital. When considering your preferred place of birth, your medical professionals should advise you of all of the reasonable options available to you in your particular circumstances, accounting for factors such as whether your birth is at high risk of complications or the range of pain relief available in each setting.  Your medical professionals may recommend a particular place of birth to you but ultimately it is your right as the patient to choose from the options provided to you.

When it comes to providing informed consent, the Supreme Court has stated that it is not simply the medical professional’s choice to decide what information a patient should be told; the patient has a right to know of all material risks before deciding whether or not to consent to the treatment proposed. Material risks are those risks which would be significant for a reasonable person undergoing that treatment or risks which the medical professional is aware would be particularly significant for you personally. The medical professional will need to look at your individual concerns as a patient and one size does not fit all.

As an example; a patient who has previously had a straightforward vaginal delivery may be less risk averse than a patient who has had a difficult vaginal delivery with their last baby. Your medical professionals should take material risks into account when giving you information about your options, and they should provide you with sufficient information to help you come to an informed choice.

To be able to make an informed decision about your own treatment, it’s important that you engage with the advice given by the medical professionals and ask any questions that you have. If there is anything that you do not understand or are unclear on, it’s important to raise this. With this in mind, the consent process should be a meaningful, clear and frank discussion between you and your medical professionals and if you have any particular worries or concerns about the treatment proposed, you should let your medical professionals know.

Informed Consent and Maternal Request for Caesarean Birth

If you have no medical indication for a caesarean birth and you request a caesarean birth, this is called a maternal request caesarean birth.

In this situation, a medical professional must discuss with you the overall benefits and risks of a caesarean birth compared to a vaginal birth. The medical professional must ensure that you have balanced and accurate information. This discussion will be personalised to you, and take into account your own particular circumstances, concerns, priorities and plans for future pregnancies.

If, after an informed discussion about the options for birth, you request a caesarean section, your choice should be respected and supported by your medical professionals. An individual doctor can say no to your request on the basis that they do not want to carry out a procedure that they believe could cause harm. However you should then be referred to a medical professional who is willing to perform the caesarean operation.

The caesarean birth should be offered within the obstetric unit of the hospital caring for you during your pregnancy.

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