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Partnering with Patients and Families during Childbirth

Confirming Knowledge for Informed Consent

Simpson, Kathleen Rice, PhD, RNC, CNS-BC, FAAN

MCN: The American Journal of Maternal/Child Nursing: May/June 2019 - Volume 44 - Issue 3 - p 180
doi: 10.1097/NMC.0000000000000527
ONGOING COLUMNS: Perinatal Patient Safety
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There are many opportunities during hospitalization for childbirth to offer information to the woman and her family about various options and choices for clinical care and treatment. Women should be provided information at their appropriate literacy level and language to make decisions about their care in partnership with the health care team. While events of labor and births may seem routine to clinicians, they are usually not for patients. Therefore, shared decision-making approaches and patient consent are essential throughout the childbirth hospitalization.

Kathleen Rice Simpson is a Perinatal Clinical Nurse Specialist in St. Louis, MO, and the Editor-in-Chief of MCN. Dr. Simpson can be reached via e-mail at krsimpson@prodigy.net

The author declares no conflicts of interest.

When a woman presents in labor, often she goes along with directions from nurses, midwives, and physicians during the childbirth process, trusting that they know best (Sakala, Declercq, Turon, & Corry, 2018; Simpson, Newman, & Chirino, 2010). Some women have a birth plan, but most do not. In a recent study (N = 14,630 births), only 12% of women had a birth plan and less than one-third had attended prepared childbirth classes (Afshar et al., 2017). Women often seek childbirth information on-line, but not all sites offer accurate data (English, Alden, Zomorodi, Travers, & Ross, 2018; Sakala et al.).

During childbirth hospitalization, many clinical events involve choice (see table). The list is not all-inclusive. Most allow ample time for detailed conversation and patient consent. Information should be provided at the appropriate literacy level and language. Interpreter services should be used as needed. Women should be treated as true partners in their care. They have the most vested interest in what is happening to them and they know their own bodies and preferences best. Shared decision making involves communication between clinicians and patients to make healthcare decisions that are consistent with key patient preferences (National Quality Forum [NQF], 2018). Information should be evidence-based, unbiased, and individualized, and include potential benefits and risks (NQF). Nurses are ideally positioned as part of the healthcare team to facilitate shared decision making during childbirth.

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References

Afshar Y., Wang E. T., Mei J., Esakoff T. F., Pisarska M. D., Gregory K. D. (2017). Childbirth education class and birth plans are associated with a vaginal delivery. Birth, 44(1), 29–34. doi:10.1111/birt.12263
English C. L., Alden K. R., Zomorodi M., Travers D., Ross M. S. (2018). Evaluation of content on commonly used web sites about induction of labor and pain management during labor. MCN. The American Journal of Maternal Child Nursing, 43(5), 271–277. doi:10.1097/NMC.0000000000000455
National Quality Forum. (2018). National quality partners playbook: Shared decision making in healthcare. Washington, DC: Author.
Sakala C., Declercq E. R., Turon J. M., Corry M. P. (2018). Listening to mothers in California: A population-based survey of women's childbearing experiences. Washington, DC: National Partnership for Women & Families.
Simpson K. R., Newman G., Chirino O. R. (2010). Patient education to reduce elective labor inductions. MCN. The American Journal of Maternal Child Nursing, 3 5(4), 188–194. doi:10.1097/NMC.0b013e3181d9c6d6
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