Mamas on Bedrest: You May Refuse Treatment At Any Time

December 2nd, 2010

I have recently become a guest blogger for the Science and Sensibility blog from Lamaze International. My first blog appeared on November 30, 2010 and was an editorial of the research article, “Depressive Disorders During Pregnancy:  Prevalence and Risk Factors in a Large Urban Sample” published in the November 10th issue of Obstetrics and Gynecology. I have been pleased with the response, but a couple of comment got me thinking that I need to revisit the issue of Patient’s Rights and more specifically, a Pregnant Patient’s Rights.

The Alliance for the Improvement of Maternity Services has outlined the rights of pregnant patients in their document, The Pregnant Patient’s Bill of Rights. In a very thorough and easy to understand (albeit long) document, the Alliance has clearly outlined the difference between consent and informed consent as well as the specific rights of a pregnant patient regarding her medical care and that of her baby. I think  It should be required reading for all obstetrical patients. While there are numerous salient points in the document, I want to focus on one in particular,the right to decline treatment. Previously, the American Congress of Obstetricians and Gynecologists (ACOG) as well as the American Medical Association (AMA) believed that because a physician presented a treatment and procedure to a patient and a patient signed a form consenting to have the procedure, that meant that the patient had given informed consent for the treatment. But in 1974 with their Standards for Obstetric-Gynecologic Services publication, ACOG acknowledged that there is a big difference between giving consent and giving informed consent. Informed Consent means,

  • That a patient has actually been given information about the treatment
  • The Patient understands the treatment’s  efficacy
  • The Patient understands why the treatment is being proposed
  • The patient actually understands how the treatment works and the intended outcomes
  • The patient has been informed of all the potential risks and complications, the expected recovery and any long term potential complications
  • The patient has also been advised of any alternative treatments

What I want to emphasize is the fact that once a patient has all this information or even if they don’t have all this information, A PATIENT MAY REFUSE TREATMENT AT ANY TIME.

The article about which I did the editorial was a research study that sought to identify the prevalence of antenatal depressive disorders and to identify women who are at the greatest risk for developing the disorders. The article recommended that clinicians screen pregnant women at regular intervals during their pregnancy for depressive disorders.

Interestingly, two comments women expressed concern at the prospect of screening all pregnant women for depressive disorders. One woman’s concern is that women who are diagnosed with depression will risk having their children taken away from them. Another is concerned that women will be forced to take antidepressants.

I understand the readers’ concerns. We can all recount stories where people were recommended treatments and procedures that weren’t fully explained or understood and the patient suffered the consequences. Many of us are also aware of the Florida Court Case in which a pregnant woman was ordered on bed rest and ordered to submit to any and all procedures that her physician deemed necessary. (Samantha Burton v. The State of Florida) These situations have created a terse relationship between medical providers and patients, women in particular. But an adversarial relationship serves no one and women and their providers must be able to talk openly and honestly about the medical situation at hand and reach agreed upon solutions or it is women who stand to suffer the potential health consequences.

The best way for women to safeguard their health care is to take an active role.  I always tell my clients to choose their providers wisely. Find providers who are not only highly skilled but also keep up with the latest advancements within their discipline. Once they have found someone who is qualified as far as expertise, I advise them to choose a provider who they like and trust. While referrals are great, you can’t always rely on the recommendations of others. Your neighbor may love her OB, but you may find that your personality clashes with that OB. Everyone is different.  Find a provider who you feel puts your interest-medically and personally/emotionally-first.

Next, you as a patient have the responsibility to know what is going on.  This is a foreign concept to many women. Many women of my mom’s generation for example, feel that it’s the doctor’s job to tell them what is wrong, how to treat it and also how to feel. My mother rarely questions her doctor about anything. Even if something isn’t going well, she doesn’t want to call and “bother her doctor”. Many patients don’t want to upset their providers by questioning their instructions or disagreeing with a treatment plan-even if they don’t feel good about it. Speak up! Most times your provider has alternative options, but you won’t know if you don’t ask. A phone call is often a good way to get your fears and concerns addressed.

If  you are uncomfortable with something, get more information (get some literature to read or even a second or third opinion!). A really good idea, if possible, is to have someone go to with you to your office visits and take notes. Typically when we are ill or have a medical problem, we are not at our intellectual best to make decisions or to even hear all of our options. A companion can be more objective, can focus on the information being relayed and ask (or encourage you to ask) questions you may not have thought to ask.  They can remind you of important information later, when you are at home and more relaxed. They can also help you to remember instructions that will enhance your recovery.

Health care can be intimidating. It’s foreign territory for many people especially those who have never been ill or in the hospital, which is sometimes the case for a first time pregnant mama. For a woman who has never been ill, a complicated pregnancy can prove to be overwhelming. But keep in mind, Everyone involved is there to help YOU! YOU are the center of attention and all decisions and treatments should be guided and directed by what works best for YOU.  Clinicians are there to provide you with their best medical advice, what they believe to be the best thing for you at that moment as they know it. You don’t have to agree and if you feel really uncomfortable, you have the right to refuse the treatment.

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