Informed Consent and
Women in Labor
ROSALIND EKMAN LADD
Recent changes in attitudes and practices concerning childbirth--from a hospital-based, physician-directed model to a woman-centered, less medicalized model--have been inspired in large part by the recent move of Western women to take control of this and many other aspects of their lives. They also reflect the more general trend in medicine away from a form of paternalism where physicians make decisions for their patients and toward informed consent in virtually every aspect of the doctor- patient relationship.
Although women are given many choices about the use of various reproductive technologies and are required to give legal consent through often elaborate contractual arrangements and disclaimers (e.g., in the instance of in vitro fertilization), one of the last holdouts of the power of the physician to make unilateral decisions for others is in relation to the woman in labor. Typically, women entering hospitals for childbirth are asked to sign blanket consent forms providing the physician with the power to perform any procedures he or she deems necessary. This consent effectively removes any obligation on the part of the physician to obtain further specific agreement for such procedures as induction of labor, fetal monitoring, or cesarean section. This circumvention of informed consent reflects a number of assumptions about women in labor and childbirth that are usually false and often involve unwarranted general-