Do You Know What You are Signing? Elective Cesarean
Below is a copy and pasted version of a real elective cesarean consent form provided by an L&D nurse on her blog. Often times women sign these when they schedule their cesarean but they sign them without reading it or if they do read it they do not understand exactly what they are reading. Yes, they may see the words on the page but they do not realize that the risks outlined on that page are so very real. I have made some additional notes within the content of the form. My notes are in italics.
Consent for Elective Cesarean Section
A cesarean section (c-section) is the surgical delivery of a baby through an incision in the abdomen and uterus. An incision is made on the abdomen just above the pubic area. The second incision is made in the wall of the uterus. The physician can then open the amniotic sac and remove the baby. The patient may feel tugging, pulling, and pressure. The physician detaches and removes the placenta; incisions in the uterus and abdomen are then closed.
I authorize and direct _______________________________, M.D. with associates or assistants of his/her choice, to perform an elective cesarean section on _______________________________.
(Print Patient Name)
_____ I have informed the doctor of all my known allergies.
_____ The details of the procedure have been explained to me in terms I understand.
_____ Alternative methods and their benefits and disadvantages have been explained to me. How many times are the benefits of VBAC explained? Does the patient understand that with a successful VBAC the risk of uterine rupture (which is initially 0.05%) decreases and that the risk of rupture (before labor and during) increases with each cesarean?
_____ I understand and accept the possible risks and complications of a cesarean section, which include but are not limited to:
* Pain or discomfort
* Wound infection; and/or infection of the bladder or uterus. Bladder infections are very common after cesareans because of the catheter. It is not uncommon to be re-catheterized after cesarean because of the inability to urinate independently. This increases the risk of bladder infection immensely. Obviously the uterus is at risk for infection as it has been cut open.
* Blood clots in my legs or lungs You are four times more likely to develop a clot after a cesarean than a vaginal birth. This may not seem like a big deal to most people but as a person with a hereditary blood clotting disorder and a mother with chronic DVT, and a sister who had a hysterectomy at 23 years old because of a blood clot in her ovary, I can tell you first hand that this is real and it is serious.
* Injury to the baby Babies born by c section 50% more likely to have lower APGAR scores than those born vaginally. About 2% of babies born via cesarean are cut by the scalpel. After my own cesarean my OB told me about a friend that she went to school with that cut a baby on her face so badly that she required plastic surgery. What a nice welcome to the world.
* Decreased bowel function (ileus)
* Injury to the urinary tract of GI tract I have ready many stories of the bladder being cut by the scalpel. If you are not aware, the bladder sits on the uterus and is connected by a layer of tissue that must be separated so that the bladder can be moved out of the way and the uterine incision made.
* Increased blood loss (2x that of a vaginal delivery)
* Risk of additional surgeries
* Post surgical adhesions causing pain/complications with future surgeries Adhesions make subsequent cesareans more difficult and longer to perform. They do not interfere with vaginal deliveries.
* Increased risk of temporary breathing problems with the baby that could result in prolonged hospitalization We were in the hospital six days total as a result of this very thing.
_____ I understand and accept the less common complications, including the risk of death or serious disability that exists with any surgical procedure.
_____ I understand in a future pregnancy that I have an increased risk of complications including, but not limited to: These aspects of cesarean are so very important and so often omitted from the discussion. Risks are increased with every cesarean.
* Placenta previa, where the placenta covers the cervix.
* Placenta accreta, where the placenta grows into the muscle of the uterus.
* This may lead to a hysterectomy and excessive blood loss at the time of the cesarean section.
* An increased risk of uterine rupture (with or without labor) and that this risk increases with each subsequent cesarean section. Uterine rupture can lead to the death of the baby or myself.
_____ I have been informed of what to expect post-operatively, including but not limited to:
* Estimated recovery time, anticipated activity level, and the possibility of additional procedures.
_____ The doctor has answered all of my questions regarding this procedure.
_____ I am aware and accept that no guarantees about the results of the procedure have been made.
I certify that I have read and understand the above and that all blanks were filled in prior to my signature.
________________________________ Patient Signature/Date
________________________________ Witness Signature/Date
I certify that I have explained the nature, purpose, benefits, and alternatives to the proposed treatment and the risks and consequences of not proceeding, have offered to answer any questions and have fully answered all such questions. I believe that the patient fully understands what I have explained.
________copy given to patient ________copy placed in office chart
What is not included on the consent form is the psychological effects on both mom and baby when a cesarean is done. The interference with the normal hormonal processes that both the mom and baby go through do have an affect on bonding and breastfeeding. I have talked to some people who say that they had no bonding issues at all and that breastfeeding was easily established after a c section and that is wonderful. However, MANY times this is not the case. Many mothers and babies do have problems. The rate of postpartum depression is higher as well.
Because the c section rate in the US is so high (31% for 2008) many people just assume that it’s routine and simple and safe. So many women are not taking time to fully understand the consequences of a c section. There are medical reasons for them but that is the small minority. Most c sections are unnecessary. Most primary c sections should have never happened to begin with. The data is there, these are not my opinions. I believe that if women were truly informed and educated on the risks and benefits involved in current obstetrical practices that they would take a more active role in their births. For this to happen, we have to start questioning procedures and asking the questions. We have to have a level of awareness and believe in our bodies abilities to birth.
ICAN’s (International Cesarean Awareness Network) Patient Choice Cesarean Position Statement says:
“The International Cesarean Awareness Network opposes the use of cesarean section where there is no medical need. Birth is a normal, physiological process. Cesarean section is major abdominal surgery which exposes the mother to all the risks of major surgery, including a higher maternal mortality rate, infection, hemorrhage, complications of anesthesia, damage to internal organs, scar tissue, increased incidence of secondary infertility, longer recovery periods, increase in clinical postpartum depression, and complications in maternal-infant bonding and breastfeeding, as well as risks to the infant of respiratory distress, prematurity and injuries from the surgery.
All physicians take an oath to “Do no harm”. This means choosing the path of least risk to patients. Medically unnecessary elective cesareans increase risk to birthing women. It is unethical and inappropriate for obstetricians to perform unnecessary surgery on a healthy woman with a normal pregnancy.”
Food for thought…