Informed Consent in New Zealand
Initial audience responses at 2 Auckland screenings of the new documentary ‘Freedom For Birth’ , were thankfulness that the maternity system in New Zealand unlike Hungary, the USA and many other nations, offers a full range of birth options; a choice of Lead Maternity Carer and support of midwifery autonomy. Or does it?
NZ Care Contrary to NZ Law.
However during the film, some audience members’ heads were nodding in acknowledgement of accounts about fear-mongering and other coercive means to gain women’s consent such as when a health professional stood over an exhausted woman and said a cesarean section was the means to end her turmoil ‘now rather than later’. After the film several women spoke of being separated from their babies for observation ‘just in case’ or the baby going to another hospital where it was given formula with-out the mother’s consent, here in Aotearoa! But none of these incidents are consistent with the New Zealand legal requirements of the Health and Disabilities Commission’s (HDC) Code Of Consumer Rights which all hospitals need to meet to maintain their Ministry Of Health (MOH) funding. According to the HDC Consumer Rights include;
Right 1: the right to be treated with respect
Right 2: the right to freedom from discrimination, coercion, harassment, and exploitation
Right 3: the right to dignity and independence
Right 4: the right to services of an appropriate standard
Right 5: the right to effective communication
Right 6: the right to be fully informed
Right 7: the right to make an informed choice and give informed consent.
A guide to determining what is adequate information to support an informed decision is to check if the information given answers the following BRAINS questions about the treatment (or test) being offered;
1) What are the Benefits of the treatment.
2) What are the Risks of the treatment.
3) What are the Alternatives to the test.
4) What does my Intuition say about the treatment (ie How do you feel about it?).
5) What if I/we do Nothing?
6) What are the Subsequent actions (consequences) of the test.
Too many New Zealand women, recount tales of not being told the risks of a procedure as part of their consent process. Such tales are often told when they learn about the possible connections between risks and subsequent events, sometimes months or years after their experience. Many procedures have happened so often in hospitals that they become an accepted or needed event or ritual, one of many myths and misinformation about birth which are thought of or expected as necessary by many in the community.
For example women have been told, and many practitioners still believe as they were taught, that rupturing the membranes in labour speeds up a labour. International evidence rejected this assumption in 2009, catching up with the knowledge and respect many home birth midwives have long had for the membranes and their physiological protection of both mother and baby. Similarly, many doctor dramas talk of how a cesarean delivery has saved a baby from strangulation by their cords in the womb, but this is not consistent with anatomy and physiology. Labour progress and birth means the placenta moves down with the baby who also usually does not breathe until after they are out of the womb and receiving oxygen as long as the cord pulsates. However anatomical alternatives do not appear to inform treatment options for many labour emergencies such as foetal distress or ‘failure to progress” both of which can be eased when a woman is off the bed!
Thus some NZ maternity consumer groups have created information resources such as brochures to address deficiencies in MOH information sources, explaining for example the known risks to healthy women and babies of common labour options or ‘treatments’ such as induction, epidurals and caesarean sections, and explaining possibilities of water birth and leaving baby’s cord to stop pulsating . Lack of information on the impact of ‘place of birth’ is one reason why most (84% in 2007) healthy NZ women birth in secondary and tertiary where evidence says they are least likely to have an intervention and complication free outcome.
NZ Care Contrary to International Best Evidence.
Obstetric hospitals are also where all the doctors, most New Zealand midwives and those from elsewhere have learnt about labour, birth and how they should practice. Thus today there are many NZ midwives who are not comfortable to look after labouring women at home or in primary or birth centre, regardless of the increasing evidence that home is as safe, or safer for healthy women as they have fewer complications following home birth. As well only supporting labour and birth care in hospitals is contrary to the profession’s statement, endorsed by maternity consumer groups which says: “Women who are experiencing normal pregnancies should be offered the option and encouraged to give birth in primary maternity facilities or at home. The evidence clearly demonstrates that women who receive effective antenatal care and are assessed to be at low risk for complications, will give birth to healthy babies and need fewer interventions if they are supported to give birth in a primary maternity unit or at home.”
Today more than ever ‘Women need midwives’; midwives who promote, protect and support natural childbirth. Similarly ‘midwives need women’ to demand that women-centred birthing units are created and home birth is effectively promoted so student midwives are grounded in powerful, loving, natural birth.
Both midwives and women need evidence based information to be a feature of MOH maternity information, policy and funding directives as outlined in the Maternity Manifesto rather than women and midwives having to demand evidence-based care options or to protest inappropriate policies such as DHB closure of primary birthing facilities. Reputable evidence also needs to inform reporting about maternity care in NZ, not sensationalist media stories.
In New Zealand today, as ever “Midwives Need Women, Women Need Midwives” as birth is a (Human) rights as well as health issue!