If a midwife supports a client’s choices that are outside of her Plan of Care, she must be prepared to give evidence of informed consent. The midwife must also be able to document the process that led to the decision and show that the client was fully informed of the potential risks and benefits of proceeding with the new care plan. It is the responsibility of the midwife to provide evidence-based information, clinical expertise, and when appropriate, consultation or referral to other providers to aid the client in the decision making process.
Information provided should be free from the personal bias of the practitioner and should be presented without coercion or intimidation. When all reasonable options have been discussed, and the client understands the possible outcomes of each option, it is the client’s right to choose her course of care. Depending on legal limitations, it is the CPM’s right to continue care with the client, or to discontinue care and provide the client with resources toward choosing other caregivers. Midwives cannot and should not knowingly put a client at harm. Continuing care with a non-compliant client must be a decision that the midwife believes is in the best interest of her client. Documentation of informed consent in the client’s chart is the responsibility of the midwife. CPMs must obtain a client’s signature when the client’s care plan deviates from the Midwife’s Plan of Care.
Components of an Informed Consent/Informed Refusal if a client’s care plan deviates from the Midwife’s Plan of Care
- Explanation of treatments and procedures;
- Explanation of both the risks and expected benefits;
- Discussion of possible alternative procedures, including delaying or declining of testing or treatment, and their risks and benefits;
- Documentation of any initial refusal by the client of any action, procedure, test or screening recommended by the midwife based on her clinical opinion or required by practice guidelines, standard of care, or law, and follow up plan;
- Client and midwife signatures and date of signing for informed refusal of standard of care.