Capacity to consent is essential in medical decision-making, and consent is always necessary during labor and birth. For pregnant women, it is therefore essential to clearly communicate their wishes when it comes to medical procedures.
In high-risk pregnancies, such as in those affected by hemolytic disease of the fetus and newborn (HDFN), where urgent decisions need to be made quickly and the pregnant woman may be incapable of answering, the responsibility will be either delegated to a partner or loved one or a medical professional.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (Rh) factor (Rh-positive or Rh-negative) during pregnancy.
What kind of medical decisions may need to be delegated?
Procedures administered during labor and birth without consent can be traumatizing for the pregnant woman. In particular, invasive procedures such as cesarean and episiotomies that are performed without informed consent can have a severely negative toll on the birth experience. Decisions may also need to be taken around other medical interventions such as pain control, anesthesia and urgent treatment of your baby following delivery.
Learn more about the HDFN care team
How is medical consent defined?
Consent is voluntary and given based on adequate information. It is ethical and also, in many countries, illegal not to have the consent of a woman when making decisions during labor or birth. Ideally it should be given in a written format, but verbal consent is also recognized. In many hospitals, patients are required to sign a maternal informed consent form.
Planning ahead for medical decision-making
During labor and delivery, the prevalence of consent incapacity is around 14%, often as a result of the effects of painkillers and the unpredictability of labor and birth. In high-risk pregnancies such as those affected by HDFN, it is important to designate a healthcare proxy who will take on the role of key decision-maker if you are unable to answer. This could be a spouse, partner, family member or friend with whom you have communicated your wishes beforehand.
Speak openly with your friends and family prior to labor and birth to ensure they are clear on your consent and lack of consent in regard to each potential medical intervention. Their responsibility is to represent you and not be influenced by their own opinions or wishes.
If no medical proxy is available, your medical team will be required to make decisions on your behalf. While they will always be made in your best interests and that of your baby, they might not be aligned with your personal choices. If possible, be sure to share your wishes with your medical team ahead of time.
