Feeds:
Posts
Comments

Posts Tagged ‘informed consent’

I used the title “vaccination question” because I don’t consider it a debate. We don’t debate with people outside our family about where we’re going on vacation, whether the kids should go to school or homeschool, or what to have for dinner, even when we receive suggestions, insight, and/or helpful information from others. We take in the information, discuss it, research it more sometimes, and make the choices we feel are right for our family.

We think every family has this right. And I don’t like the notion that some doctors don’t like to discuss all information available about vaccines (and what information is not available) because they are afraid parents won’t make the decision the doctor wants them to make. A big part of my skepticism is that information about risks wasn’t discussed in mainstream medicine until Autism questions forced it into the open. And even if Autism is not caused by vaccines, there are other risks that I was never warned about before vaccinating my older daughter as an infant.

No one said anything about risk – until I met a woman with a vaccine-injured child. She talked about it- you can imagine she talked about it a lot. And I discovered I had a lot of questions that I didn’t know to ask when we first chose to vaccinate. We stopped any vaccination for our oldest after 12 months, declining MMR and Chickenpox at the 12 month visit. (Our younger child has had none.)

Then I started to research online. What I found was that some diseases do pose a serious risk to some children/people- that it’s hard to define who will be affected most seriously. That wasn’t really surprising. And I read about the serious risks of vaccines for some people- and that it’s equally difficult to determine which people will have a serious reaction. I also found that other parents were upset and nervous about vaccinating; about not vaccinating; about the risks to their children from vaccines, from disease, from un-vaccinated children.

As parents we can only make decisions based on the information available. We simply don’t know what we don’t know. My reasons for currently not vaccinating are many. Among them is the idea that I believe the potential risk of damage by vaccines (not just immediate, but long-term health consequences) is greater than the risk of my children suffering long-term damage from illnesses vaccines were created to prevent.

Are there consequences I haven’t considered? Possibly. I’m willing to listen if you have a story to tell me or information to offer. I know I don’t know everything there is to possibly know about vaccines. So if you’ve got something to share, please do.

Incidentally, we were exposed to chicken-pox last week and are waiting for the arrival of spots. Each day, I check the kids and nothing yet. I’ve picked up a homeopathic remedy to use if/when the spots appear and I’m expecting that we’ll go stir crazy in the house before long. (But we may also get some needed organization and laundry done along the way to crazy.)

I’ve still got a lot of questions about vaccination. So on Monday (at 1pm ET) I’m interviewing Barbara Loe Fisher from the National Vaccine Information Center. You can access the show here. You can also call in with questions during the live show, but if you want to simply provide your opinion, I respectfully request you do so here, so that we can have as many questions answered as possible during the hour-long show.

Advertisements

Read Full Post »

I was thinking about Rev. Dr. Martin Luther King Jr and his most famous speech- how one man articulated the dream of so many. It wasn’t his dream alone and he didn’t want it only for himself. The dream was so big & amazing and became possible only because so many were willing to speak out, be present and stand strong together for a common goal- real freedom & equality for all people regardless of their color.

My dream doesn’t make headlines. No one is marching – yet.

I have a dream that women (and men) might see more clearly that how women are treated during labor matters. That honoring the wisdom of the body, allowing labor to wind its way to birth, holding a sacred space for birth, and keeping intervention to a minimum matters- for both mother and baby (and for generations to come.)

I have a dream that women won’t have to struggle for informed consent and refusal and that the courts stop ordering medical management of pregnancy, labor and birth against any woman’s decisions. I dream that women have the resources they need to be educated about their body and the community support they need to remember their innate strength, and to find confidence from the experience of birth.

I dream that the hostility and judgment of women by women ends; that women unify to leverage their majority to create real solutions that support women and validate and honor individual choice.

I dream that women might not have to choose between caring for their children at home and earning a living apart from their families- that working together solutions can be found that allow babies to accompany their mothers if they choose to engage in professional work.

I dream women will no longer need to act like men to belong in the world. I dream that being feminine and female is honored- that the role of mother and nurture-giver is respected as valuable work; that women and men will each be respected for their differences- in perspective, in approach to problem-solving, in simply be-ing.

I dream that all women have the opportunity to understand and embrace conscious conception, bonding before birth, gentle pregnancy, and trusting birth; that women have empowered choices for labor; that they are recognized as the experts of their bodies.

I dream that my daughters grow up valuing their femaleness; and that being female is synonymous with wisdom and respect – and the right to bodily integrity.

What are you dreaming?

Read Full Post »

I’m going to get a bit political today. If you’re not into that, skip this post. There is so much going on about healthcare reform in the media and I can’t help but notice there isn’t much mention of improving the sorry state of pregnancy-related care and maternal/fetal outcomes. No one is talking about the continued restriction of valid childbirth options for women with a history of c-section. Yes, I’m talking about VBAC.

VBAC, short for vaginal birth after cesarean, is a valid healthcare option for pregnant women in low risk categories. According to Childbirth Connection.org:

If you do not have a clear and compelling need for a cesarean in the present pregnancy, having a VBAC rather than a repeat c-section is likely to be:

  • safer for you in this pregnancy
  • far safer for you and your babies in any future pregnancies”

Most OB’s and hospitals that refuse to support VBAC do so citing concerns about uterine rupture. And while this is a possibility, educating women about risks and benefits is vital to informed consent of patients. To be vital, informed consent requires patients (in this case women) the option of informed refusal. It is the right of every person to make healthcare decisions personally. Each pregnant woman, therefore, should also have the same right to choose what she will and will not accept as part of her individualized care. She can choose to accept or refuse induction, epidural, ultrasound, fetal monitoring, IV. She has the right to change her mind, even during labor.

Let’s look at the risks associated with uterine rupture during VBAC (from this article at ChildbirthConnection.org):

“What is the added likelihood that the scar will give way (uterine rupture) during a VBAC labor?
Best research suggests that an extra 27 women experience a ruptured uterus in every 10,000 VBAC labors, compared with planned c-section deliveries. Thus, nearly 400 women would need to experience surgical birth to prevent one instance of uterine rupture during VBAC labors. While the scar giving way usually requires an urgent cesarean, loss of the baby is much less common (see next paragraph).
Added likelihood for a woman with a known low-transverse (horizontal) scar: MODERATE for scar rupture compared with planned repeat c-section.”

“What is the added likelihood that the baby will die as a result of the scar giving way (uterine rupture) during a VBAC labor?

Best research suggests that about 1.4 extra babies die due to problems with the scar in every 10,000 VBAC labors, compared with planned c-section deliveries. Thus, over 7,000 women would need to experience risks of surgical birth to prevent the death of 1 baby from scar problems during VBAC.
Added likelihood for a woman with a known low-transverse (horizontal) scar: LOW for death of the baby around the time of birth compared with repeat c-section.”

To fully understand the risks associated with VBAC and make an informed decision women must also comprehend the risks to mother and baby for repeat cesarean birth. (From this article at ChildbirthConnection.org)

“Extra risks associated with cesarean section: Current research suggests that cesarean section has the following disadvantages in comparison with vaginal birth:

Physical problems in mothers: Compared with vaginal birth, cesarean section increases a woman’s risk for a number of physical problems. These range from less common but potentially life-threatening problems, including hemorrhage (severe bleeding), blood clots, and bowel obstruction, to much more common concerns such as longer-lasting and more severe pain and infection. Even after recovery from surgery, scarring and adhesion tissue increase risk for ongoing pelvic pain and for twisted bowel.

Hospitalization of mothers: If a woman has a cesarean, she is more likely to stay in the hospital longer and is at greater risk of being re-hospitalized.

Emotional well-being of mothers: A woman who has a cesarean section may be at greater risk for poorer overall mental health and some emotional problems. She is also more likely to rate her birth experience poorer than a woman who has had a vaginal birth. {Note: This risk is reduced somewhat for planned cesarean birth.}

Early contact with, feelings toward babies: A woman who has a cesarean usually has less early contact with her baby and is more likely to have initial negative feelings about her baby.

Breastfeeding: Recovery from surgery poses challenges for getting breastfeeding under way, and a baby who was born by cesarean is less likely to be breastfed and get the benefits of breastfeeding.

Health of babies: Babies born by cesarean are more likely to:

  • be cut during the surgery (usually minor)
  • have breathing difficulties around the time of birth
  • experience asthma in childhood and in adulthood.

Future reproductive problems for mothers: A cesarean section in this pregnancy puts a woman at risk for future reproductive problems in comparison with a woman who has a vaginal birth. These problems may involve serious complications and medical emergencies. The likelihood of experiencing some of these conditions goes up sharply as the number of previous cesareans increases. These problems include:

  • ectopic pregnancy: pregnancies that develop outside her uterus or within the scar
  • reduced fertility, due to either less ability to become pregnant again or less desire to do so
  • placenta previa: the placenta attaches near or over the opening to her cervix
  • placenta accreta: the placenta grows through the lining of the uterus and into or through the muscle of the uterus
  • placental abruption: the placenta detaches from the uterus before the baby is born
  • rupture of the uterus: the uterine scar gives way during pregnancy or labor.

Concerns about babies in future pregnancies: A cesarean section in this pregnancy can affect the babies of future pregnancies. Studies have found that they are more likely to:

  • be born too early (preterm)
  • weigh less than they should (low birthweight)
  • have a physical abnormality or injury to their brain or spinal cord
  • die before or shortly after the birth”

When women are fully informed of the risks associated with repeat cesarean and VBAC, they should each have the opportunity to choose which risks they are willing to take. When a doctor refuses to “allow” his patients to attempt VBAC, s/he is taking away a fundamental right of women to determine the direction of their healthcare.

According to ACOG’s Committee Opinion #321 from November 2005, respecting patient’s autonomous decision making is a fundamental ethical obligation:

“Requiring informed consent is an expression of respect for the patient as a person; it particularly respects a patient’s moral right to bodily integrity, to self-determination regarding sexuality and reproductive capacities, and to the support of the patient’s freedom within caring relationships.”

“The ethical requirement for informed consent need not conflict with physicians’ overall ethical obligation to a principle of beneficence; that is, every effort should be made to incorporate a commitment to informed consent within a commitment to provide medical benefit to patients and thus respect them as whole and embodied persons.”

“[Even if] a woman’s autonomous decision [seems] not to promote beneficence-based obligations (of the woman or the physician) to the fetus, … the obstetrician must respect the patient’s autonomy, continue to care for the pregnant woman, and not intervene against the atient’s wishes, regardless of the consequences.“(emphasis mine)

“The obstetrician must keep in mind that medical knowledge has limitations and medical judgment is fallible” and should therefore take great care “to present a balanced evaluation of the expected outcomes for both [the woman and the fetus].”

So how can it be true that women have the right to make autonomous choices regarding their healthcare, including care during pregnancy and childbirth, yet doctors choose to ignore and even ban valid healthcare options for these same women?

This is about women’s rights. A woman doesn’t stop having the right to bodily integrity because she is pregnant. She maintains the right to independent thinking, personal preference, and choice throughout the 40+ weeks gestation. Choosing to bring a child into the world doesn’t limit my right to individualized care or informed consent. In fact, choosing to bring a life through my body has made me more focused on what is appropriate and acceptable risk to me and my baby- and this is a very personal choice.

I should always have the final say about what is ok and not ok for my body, and any baby residing within it. And that’s what I teach my girls.

Who does your body belong to?

Read Full Post »