Informed Consent

People in the medical profession are taught that patients must always give INFORMED consent. All too often, that is not done.
What exactly is informed consent? It is the patient giving their consent for a procedure, surgery, medication, whatever after they have and understand the pros and cons and have all their questions answered.
One prime example of this in the maternal child field is the AFP (alpha-fetal protein) test that is done between week 16-18 of pregnancy. It is a blood test that detects a protein in moms’s blood that can indicate a higher probability of the baby having a neural tube defect or Down’s Syndrome.
Unfortunately, there can be false positives with this test. Lets talk about what happens if the test comes back positive:
1. Mom gets a call from the doctors office
2. Mom is told the AFP is positive and baby may have a birth anomaly.
3. Mom is told that to find out for sure, she needs an amniocentesis.
4. From that moment on, mom will worry for the rest of the pregnancy and after. It will stay in her mind that her baby is not ok.
5. There are risks to an amniocentesis, though small.
6. Mom then has to wait for the result.
7. If the test shows the baby may have an anomaly, parents then have to decide if they want to continue the pregnancy.
8. As I said, even if the test comes back normal, the joy of the pregnancy is taken away, at least a bit.

Mamy people say that the test should be done so the parents can be prepared. As the parent of a mentally and physically disabled child – you can NEVER be prepared.

There are many moms who ask questions or do research and decide against this test. These parents have made the decision to have their baby – no matter what.

My point – informed consent is very important and the responsibility of the medical profession. And patients need to ask questions and get answers they understand.

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Tale of Three Breastfed Babies

I had 3 pregnancies, 3 children and 3 very different breast feeding experiences. 

First, a son, was born when I was 20 years old. I was a year out of nursing school and working at a pediatric office. I knew a few things about breast feeding, took an expectant parent class but breast feeding was not even mentioned in that class. I breast fed my son for the first time about 6 hours after his birth ( I had to lay flat for that long after a spinal anesthetic for a forcep assisted birth – the way births were done in 1975). The baby was given formula in the nursery and I received no help from the nurses. Once home, I attempted to breast feed often, but also gave formula (I did not know any better). At 3 weeks old, my baby became ill with a URI and ear infection. This illness went on for 3 weeks and breast feeding was difficult. At 6 weeks, I stopped breast feeding. 

Baby number 2, a girl, was born 3 years later. This birth was drug free. I kept the baby with me all during my hospital stay, she breast fed on a regular basis like a champ. I experienced 2 cases of mastitis during the first 3 months of my daughter’s life. I was told by my OB to stop breast feeding while on antibiotics and I followed these instructions. I was fortunate to get back to breast feeding after following this incorrect advice. My daughter stopped breast feeding at 9 months of age. She was given a sip of juice from a cup and liked that. She never had a bottle..
My third pregnancy was in 1982, another son. I knew this was my last pregnancy and I planned to do “everything right”. I would have another intervention free birth, breast feed immediately after birth, hold him all the time and so on. Unfortunately, Matthew was born with multiple physical anomalies. He was taken at birth to the nursery, I did not see him for hours. To shorten the story for now, Matthew had facial paralysis. He could not form suction to breast feed. He also had a soft cleft palate defect. I pumped breast milk for several days but could not keep up. I was taking care of 2 young children and traveling to the Children’s Hospital an hour away to visit Matthew. Matthew was fed formula through an NG tube, he could not suck.
I grieved breast feeding Matthew for a long time. Then I realized that there are several ways to feed a baby. Of course, breast feeding is best but that is not always possible, or the choice that is made.
Moral of this story – breast feeding is best but not the only way to feed a baby. A mom should make this decision after informing herself through discussion and research. Informed consent is so important in all areas of medicine. And I found in my career as an RN, that informed consent is often not applied.