Pregnant Patient’s Bill of Rights AndPregnant Patient’s ResponsibilitiesDanger Signs of Pregnancy
The International Childbirth Education Association (ICEA) is an interdisciplinary, volunteer organization representing groups and individuals who share a genuine interest in the goals of family-centered maternity care and education for the childbearing year.
ICEA constantly seeks to expand awareness of the rights and responsibilities of pregnant women and expectant parents. Most pregnant women are not aware of their rights or of the obstetrician’s legal obligation to obtain their informed consent to treatment. The American College of Obstetricians and Gynecologists has made a commendable effort to clearly set forth the pregnant patient’s right of informed consent in the following excerpts from pages 66 and 67 of its Standards for Obstetric-Gynecologic Services.
“It is important to note the distinction between “consent” and “informed consent”. Many physicians, because they do not realize there is a difference, believe they are free from liability if the patient consents to treatment. This is not true. The physician may still be liable if the patient’s consent was not informed. In addition, the usual consent obtained by a hospital does not in any way release the physician from his legal duty of obtaining an informed consent from his patient.
Most courts consider that the patient is “informed” if the following information is given:
- The process contemplated by the physician as treatment, including whether the treatment is new or unusual.
- The risks and hazards of the treatment.
- The chances for recovery after treatment.
- The necessity of the treatment.
- The feasibility of alternative methods of treatment.
One point on which courts do agree is that the explanations must be given in such a way that the patient understands them. A physician cannot claim as a defense that he explained the procedure to the patent when he knew the patient did not understand. The physician has a duty to act with due care under the circumstances; this means he must be sure the patient understands what she is told.
“It should be emphasized that the following reasons are not sufficient to justify failure to inform:
- That the patient may prefer not to be told the unpleasant possibilities regarding the treatment.
- That full disclosure might suggest infinite dangers to a patient with an active imagination, thereby causing her to refuse treatment.
- That the patient, on learning the risks involved, might rationally decline treatment. The right to decline is the specific fundamental right protected by the informed consent doctrine.”
Following ICEA sets forth the Pregnant Patient’s Bill of Rights along with the Pregnant Patient’s Responsibilities.
The Pregnant Patient’s Bill of Rights
American parents are becoming increasingly aware that well-intentioned health professionals do not always have scientific data to support common American obstetrical practices and that many of these practices are carried out primarily because they are part of medical and hospital tradition. In the last forty years many artificial practices have been introduced which have changed childbirth from a physiological event to a very complicated medical procedure in which all kinds of drugs are used and procedures carried out, sometimes unnecessarily, and many of them potentially damaging for the baby and even for the mother. A growing body of research makes it alarmingly clear that every aspect of traditional American hospital care during labor and delivery must now be questioned as to its possible effect on the future well-being of both the obstetric patient and her unborn child.
One in every 35 children born in the United States today will eventually be diagnosed as retarded; in 75% of these cases there is no familial or genetic predisposing factor. One in ever 10 to 17 children has been found to have some for of brain dysfunction or learning disability requiring special treatment. Such statistics are not confined to the lower socioeconomic group but cut across all segments of American society.
New concerns are being raised by childbearing women because no one knows what degree of oxygen depletion, head compression, or traction by forceps the unborn or newborn infant can tolerate before that child sustains permanent brain damage or dysfunction. The recent findings regarding the cancer-related drug diethylstilbestrol have alerted the public to the fact that neither the approval of a drug by the U.S. Food and Drug Administration nor the fact that a drug or medication is safe for the mother or her unborn child. In fact, the American Academy of Pediatrics’ Committee on Drugs has recently stated that there is no drug, whether prescription or over-the-counter remedy, which has been proven safe for the unborn child.
The Pregnant Patient has the right to participate in decisions involving her well-being and that of her unborn child, unless there is a clear cut medical emergency that prevents her participation. In addition to the rights set forth in the American Hospital Association’s “Patient’s Bill of Rights” (which has also been adopted by the New York City Department of Health), the Pregnant Patient, because she represents TWO patients rather than one, should be recognized as having the additional rights listed below.
- The Pregnant Patient has the right, prior to the administration of any drug, or procedure, to be informed by the health professional caring for her of any potential direct or indirect effects, risks or hazards to herself or her unborn or newborn infant which may result from the use of a drug or procedure prescribed for or administered to her during pregnancy, labor, birth or lactation.
- The Pregnant Patient has the right, prior to the proposed therapy, to be informed, not only of the benefits, risks and hazards of the proposed therapy but also of know alternative therapy, such as available childbirth education classes which could help prepare the Pregnant Patient physically and mentally to cope with the discomfort of stress of pregnancy and the experience of childbirth, thereby reducing or eliminating her need for drugs and obstetric intervention. She should be offered such information early in her pregnancy in order that she may make a reasoned decision.
- The Pregnant Patient has the right, prior to the administration of any drug, to be informed by the health professional who is prescribing or administering the drug to her that any drug which she receives during pregnancy, labor and birth, no matter how or when the drug is taken or administered, may adversely affect her unborn baby, directly or indirectly, and that there is no drug or chemical which has been proven safe for the unborn child.
- The Pregnant Patient has the right, if Cesarean birth is anticipated, to be informed prior to the administration of any drug, and preferably prior to her hospitalization, that minimizing her and, in turn, her baby’s intake of nonessential pre-operative medicine will benefit her baby.
- The Pregnant Patient has the right, prior to the administration of a drug or procedure, to be informed of the areas of uncertainty if there is NO properly controlled follow-up research which has established the safety of the drug or procedure with regard to its direct and/or indirect effects on the physiological, mental and neurological development of the child exposed, via the mother, to the drug or procedure during pregnancy, labor, birth or lactation-(this would apply to virtually all drugs and the vast majority of obstetric procedures).
- The Pregnant Patient has the right, prior to the administration of any drug, to be informed of the brand name and generic name of the drug in order that she may advise the health professional of any past adverse reaction to the drug.
- The Pregnant Patient has the right, to determine for herself, without pressure from her attendant, whether she will accept the risks inherent in the proposed therapy or refuse a drug or procedure.
- The Pregnant Patient has the right, to know the name and qualifications of the individual administering a medication or procedure to her during labor or birth.
- The Pregnant Patient has the right, to be informed, prior to the administration of any procedure, whether that procedure is being administered to her for her or her baby’s benefit (medically indicated) or as an elective procedure (for convenience, teaching purposes or research).
- The Pregnant Patient has the right, to be accompanied during the stress of labor and birth by someone she cares for, and to whom she look for emotional comfort and encouragement.
- The Pregnant Patient has the right, after appropriate medical consultation to choose a position for labor and for birth, which is least stressful to her baby and to herself.
- The Obstetric Patient has the right, to have her baby cared for at her bedside if her baby is normal. And to feed her baby according to her baby’s needs rather than according to the hospital regimen.
- The Obstetric Patient has the right, to be informed in writing of the name of the person who actually delivered her baby and the professional qualifications of that person. This information should also be on the birth certificate.
- The Obstetric Patient has the right, to be informed if there is any known or indicated aspect of her or her baby’s care or condition which may cause her or her baby later difficulty or problems.
- The Obstetric Patient has the right, to have her and her baby’s hospital medical records complete, accurate and legible and to have their records, including Nurses’ Notes, retained by the hospital until the child reaches at least the age of majority, or, alternatively, to have the records offered to her before they are destroyed.
- The Obstetric Patient both during and after her hospital stay, has the right to have access to her complete hospital medical records, including Nurses’ Notes, and to receive a copy upon payment of a reasonable fee and without incurring the expense of retaining an attorney.
It is the obstetric patient and her baby, not the health professional, who must sustain any trauma or injury resulting from the use of a drug or obstetric procedure. The observation of the rights listed above will not only permit the obstetric patient to participate in the decisions involving her and her baby’s heath care, but will help to protect the health professional and the hospital against litigation arising from resentment or misunderstanding on the part of the mother.
Prepared by Doris Haire, ICEA President 1970-72, ICEA Consultant 1982-83.
The Pregnant Patient’s Responsibilities
In addition to understand her rights the Pregnant Patient should also understand that she too has certain responsibilities. The Pregnant Patient’s responsibilities include the following:
- The Pregnant Patient is responsible for learning about the physical and psychological process of labor birth and postpartum recovery. The better informed expectant parents are the better they will be able to participate in decisions concerning the planning of their care.
- The Pregnant Patient is responsible for learning what comprises good prenatal and intranatal care and for making an effort to obtain the best care possible.
- Expectant Parents are responsible for knowing about those hospital policies and regulations which will affect their birth and postpartum experience.
- The Pregnant Patient is responsible for arranging for a companion or support person (husband, mother, sister, friend, etc.) who will share in her plans for birth and who will accompany her during labor and birth experience.
- The Pregnant Patient is responsible for making her preferences known clearly to the health professionals involved in her case in a courteous and cooperative manner and for making mutually agreed-upon arrangements regarding maternity care alternatives with her physician and hospital in advance of labor.
- Expectant Parents are responsible for listening to their chosen physician or midwife with an open mind just as they expect him or her to listen openly to them.
- Once they have agreed to a course of health care expectant parents are responsible, to the best of their ability for seeing that the program is carried out in consultation with others with whom they have made the agreement.
- The Pregnant Patient is responsible for obtaining information in advance regarding the approximate cost of her obstetric and hospital care.
- The Pregnant Patient who intends to change her physician or hospital is responsible for notifying all concerned, well in advance of the birth if possible and for informing both of her reasons for changing.
- In all their interactions with medical and nursing personnel, the expectant parents should behave towards those caring for them with the same respect and consideration they themselves would like.
- During the mother’s hospital stay, the mother is responsible for learning about her and her baby’s continuing care after discharge from the hospital.
- After birth the parents should put into writing constructive comments and feelings of satisfaction and/or dissatisfaction with the care (nursing, medical and personal) they received. Good service to families in the future will be facilitated by those parents who take the time and responsibility to write letters expressing their feelings about the maternity care they received.
All the previous statements assume a normal birth and postpartum experience. Expectant parents should realize if complications develop in their case, there will be an increased need to trust the expertise of the physician and hospital staff they have chosen. However, if problems occur, the childbearing woman still retains her responsibility for making informed decisions about her care or treatment and that of her baby. If she is incapable of assuming that responsibility because of her physical condition, her previously authorized companion or support person should assume responsibility for making informed decisions on her behalf.
Prepared by Member of ICEA
Published by International Childbirth Education Association, Inc.
P.O.Box 20048, Minneapolis, Minnesota 55420 U.S.A.
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