Consent in labor, and the people who help you ask
How to get a real explanation of a procedure in labor, not just a reassuring one, and how to set up the people and paperwork that help when you’re too tired or frightened to ask twice.
Key points
- ACOG, the professional organization for OB-GYNs, says informed consent means “adequate, accurate, and understandable information” and a voluntary choice, and that a patient can refuse treatment during labor and delivery. Ask: “What are you recommending, why now and what are the alternatives?”
- In a Cochrane review (a summary of the research) of 26 trials and 15,858 women, continuous support in labor was linked to a 25% lower chance of cesarean and a 31% lower chance of negative feelings about the birth. Decide before labor who stays with you the whole time.
- A fetal scalp electrode, a small wire used to monitor the baby’s heart rate internally, can only be placed after the waters have broken. It is not suitable for everyone, including some pregnancies affected by infection or bleeding risks. Ask before labor whether internal monitoring might be recommended for you and why.
Why I want this settled before labor
I think the advice in the birth-preparation videos I’ve been saving is excellent. I also feel sad about how much of it I need as a Black woman preparing to give birth again. When I save a video about asking questions in labor, I’m thinking about how to understand my care. I’m also thinking about what happens if my first question is brushed aside, or if I’m too unwell to ask it again.
The sadness is in how much of the preparation begins to feel like preparing to be disbelieved.
Three saved videos shaped what I want in place:
Practicing the conversations. One post encourages women to use the months before delivery to practice labor scenarios, including conversations they feel nervous about. I want to rehearse an uncomfortable question before I’m exhausted or in pain, and I want my support person to practice too. [1]
“A little clip on the baby’s head.” Another is about the language used to describe a fetal scalp electrode. A reassuring description isn’t the same as a useful explanation. I may agree to it. Understanding it is what lets me agree with confidence. [2]
“Why did you even come here?” A third shows those words on screen, attributed to a nurse. [3] Coming to a hospital should leave room for questions. Wanting an explanation doesn’t mean I’ve decided against a recommendation.
What informed consent means
ACOG says the patient should get “adequate, accurate, and understandable information” and be “free to ask questions and to make an intentional and voluntary choice.” It also says a patient “has the right to refuse treatment, including during pregnancy, labor, and delivery.” [4]
Pregnancy doesn’t change that. In ACOG’s words, pregnancy does not “lessen or limit the requirement to obtain informed consent.” [5]
Urgency does not cancel the rights of a patient who can make decisions. Labor can change quickly, and there may be less time to talk. I want my team to tell me how urgent a decision is. A narrow exception applies when life-saving treatment is needed, the patient cannot give consent and an appropriate directive or decision-maker is unavailable. That is worth discussing before labor, too.
One example: the fetal scalp electrode
- What it is: a small, spiral-shaped wire placed just beneath the baby’s scalp to monitor the heart rate from inside. [6]
- Why it’s used: when the team is struggling to track the baby’s heartbeat from outside.
- What it requires: your waters have to have broken. If they haven’t, breaking them would be an additional procedure to discuss first.
- The risks listed: bruising or irritation to the baby’s scalp and infection. HIV needs specific discussion: current U.S. guidance says fetal scalp electrodes should be avoided when viral suppression is achieved and should not be used when it is not. Other circumstances can also make internal monitoring unsuitable.
- The tradeoff, in one hospital leaflet’s words: “The need for more accurate monitoring has to be balanced against the more invasive nature of this type of monitoring.”
The questions I keep ready
- What are you recommending, and why now?
- What does it involve?
- What are the important benefits and risks for me and my baby?
- Are there reasonable alternatives, including waiting?
- How urgent is the decision?
If I need more time, I’ll say: “I’m not saying no. I need to understand this first.”
The team in the room
Before a procedure, I want to know who will perform it, what their role is and who supervises them. A resident is a physician in training; that alone doesn’t make their care unsafe. I’d still rather ask these questions before I’m in pain. One reel I saved, shared as a nurse’s account of advocating for a patient, left me with that thought: what can I put in place while I can still think clearly? I don’t take every claim in a repost as fact. [7, 8]
What my support person does
I want the person beside me to know more than my preferences. Their job:
- Remind me of the question I wanted answered.
- Write down what we’re told, at the bedside or on speakerphone.
- Ask what a word means when neither of us knows.
- Have a backup, someone who can join important conversations by phone if they can’t be there.
I wrote a script for my husband. It includes: “What has changed since the last check?” and “She isn’t saying no. She needs to understand this first.” Then he writes down the time, who spoke, what they recommended and why. Give the person beside you the questions you want help asking.
That support matters to me. So does remembering that a woman without someone beside her deserves the same attention and explanation. Respectful care can’t depend on having an advocate at the bedside.
My first child was born by cesarean, after an induction that didn’t progress. These are things I did myself in that pregnancy, from before the birth to the weeks at home:
- Before delivery, I asked for a plastic surgery appointment for after my cesarean, because of my history of keloids (thick, raised scars). It was already on the calendar when my incision opened in the weeks after the birth.
- During the induction, I found a doula partway through, when I realized I needed more support in the room.
- When the Pitocin (the drug used to bring on contractions) hurt too much, I asked them to turn it down.
- When I wasn’t ready for a cesarean, I asked, more than once, whether I could labor longer.
- At home after discharge, when the hospital’s emergency line and my discharge papers gave me two different blood pressure numbers for when to call, I kept calling until I had one answer in writing.
The one-page summary I bring
- My medications and allergies.
- Relevant history, in a few lines.
- My most important questions, easy to find.
Before I go home
I want a discharge plan I understand: which medications, what follow-up, which symptoms need urgent attention and whom to contact. Hospitals’ own discharge guidance recommends including a support person the patient chooses. [9]
Room for faith, and a plan
Hospitals are places where souls are coming through. Birth and death happen in the same buildings, with hope, fear, grief and prayer side by side. My faith belongs in how I think about those places. I want room for prayer and for a plan.
I’ll keep preparing because I want to understand my care. But when I look back on this birth, I hope what I remember most is how well I was cared for, rather than how carefully I had to ask.
Take this back
To discuss with your care team:
- Before labor, can we talk through how you explain recommendations and how you involve my support person?
- If you might recommend internal monitoring, an induction method or a cesarean, can we go through it now?
- How will you tell me how urgent a decision is?
To discuss with the people in your life: Will you practice the hard conversations with me before labor? If I lose track, will you remind me of my question, write down the answer and ask what a word means?
Next in the series: “My Birth Story”
Sources
These notes draw on the captions and on-screen text of four saved reels. The full spoken videos and the encounters they describe weren’t independently verified. The people in them aren’t named here; the linked pages may identify the creators.
- Reel: practicing labor scenarios and difficult conversations. The post also promotes a paid program; no course was reviewed or endorsed.
- Reel: the language used to describe a fetal scalp electrode
- Reel: a patient’s hospital experience. Only the on-screen words attributed to a nurse are used here.
- ACOG Committee Opinion 819: Informed Consent and Shared Decision Making in Obstetrics and Gynecology, 2021
- ACOG: Ob-Gyns Address Refusal of Medically Recommended Treatment During Pregnancy, 2016
- East Kent Hospitals (NHS): Monitoring your baby’s heartbeat in labour; MedicineNet: What is a scalp electrode?
- Reel: hospital advocacy, shared as a nurse’s account. The individual incident wasn’t independently verified.
- American Society of Anesthesiologists: Statement on the Anesthesia Care Team
- AHRQ: IDEAL Discharge Planning
- Bohren et al., Continuous support for women during childbirth, Cochrane, 2017
