The language "I do not consent" sounds harsh but in fact, is the only statement that has clear legal power so I encourage you to use it for things that you feel strongly about. If someone does something to you after you state that you do not consent to it, legally they have committed Medical Assault and Battery on you. Hospitals are well aware of this, but they assume you are not.
In the Event of a Cesarean Delivery
We understand that there are times when a cesarean delivery is in the best interests of the mother and infant. We also understand that cesarean delivery as a surgical procedure is common and even routine in most maternity centers. However, we would ask that the staff respect that this individual surgery is a unique and never to be repeated event in the life of our family. For us, it is neither common nor routine, but rather is an event that will have effects lasting a lifetime. We have already experienced the cesarean delivery of our sons and because of that, have certain requests and requirements to be taken into account.
Obviously, true emergent situations must be dealt with in the safest and most expedient manner, we do not want any undo risk to mother or infant. However, many of the routine procedures are just that - routine and so we do have preferences when there are no urgent medical issues to dictate procedure.
Gretchen Humphries is sensitive to penicillin but not to cephalosporin and has no other known medication sensitivities.
Gretchen Humphries is a licenced Doctor of Veterinary Medicine and is familiar with the practice and procedures associated with anesthesia and surgery, including regional anesthesia and obstetrical surgery.
I do not consent to having my support staff removed from my presence during any of the prep procedures, including placement of an epidural catheter, assuming no medical emergency exists.
I do not consent to placement of a Foley urinary catheter until after regional anesthesia is in place, unless it has been discussed with me in advance.
I do not consent to any pre, peri or postoperative medication without prior verbal consent from myself or my spouse if I am incapacitated. I wish to discuss the complete anesthesia protocol with the anesthesiologist prior to any medication administration. I desire post-operative analgesia to be administered via epidural, before any use of systemic analgesics, sedatives or tranquilizers. I have used this protocol in the past and was pleased with the results.
My preference is for regional anesthesia, with an attempt at adequate epidural anesthesia being made before resorting to spinal anesthesia. If the situation warrents rapid anesthesia, my preference is for spinal anesthesia before general anesthesia. Any anesthesia will be administered by a certified anesthesiologist -- I do not consent to acting as a teaching aid or demonstration for any student, intern or resident in training.
I do not consent to having my arms strapped down unless I am physically unable to control them. I am familiar with surgical fields and understand the necessity of maintaining a sterile surgical field.
I do not consent to having my spouse absent from the operating room, even if a general anesthetic is used -- it is important that the birth of our child be witnessed by a family member, even if I am not in need of support at that time. My preference is that both of my support people be present in the OR at all times, and photographs of the delivery be taken for my personal use later.
I would like to have the drape dropped at the time of birth, or a mirror provided for my viewing.
Please make every effort to use a subcuticular closure of my skin incision as opposed to staples or external sutures.
Unless there are specific and emergent conditions that require immediate care, I do not consent to the removal of my infant from the OR. S/He may be suctioned and swaddled and then passed to my spouse, who will hold him/her throughout the remainder of the surgery, next to me. If I am physically capable of holding my child, I will do so, if not, my spouse will hold our child next to me.
Our child will then accompany me to recovery where breast feeding will be initiated as soon as is possible.
If my spouse does leave the OR for any reason, I would like to have our second support person to stay with me in the OR for the duration of the surgery and then accompany me to recovery.
I do not consent to the administration of any post-operative pain medications without prior discussion and consent, unless I am incapacitated.
Please do not dispose of the placenta until we have decided whether we wish to dispose of it ourselves. We may only wish to view it but we reserve the right to determine its disposition at the time of the birth.
If it is necessary, because of specific and urgent medical concerns to take our child from my presence, my spouse will accompany our child where ever s/he is taken. We do not consent to being both seperated from our child at any time, under any circumstances without prior consent.
We do not consent to prophylactic eye medications, Vit. K injections and any other non-emergent, "routine" neonatal procedures until after a time in recovery. We feel that the first hour or two of life is a very important one and all of these procedures can be delayed until after that period of time.
We do not consent to administration of the Hepatitis B vaccine. All vaccinations will be handled by our Family Practicioner at a later date.
We do not consent to the PKU test until the third day after birth. We believe that this will reduce the likelihood of an inadequate sample, making it less likely a retest will be needed.
We do not consent to routine infant care in any place other than the room where I am recovering or residing. We want complete rooming in to be assumed, unless we specify otherwise. Any evaluation of our child can take place in my room, in my presence.
We do not consent to any artificial npple or supplement use in our child. If there are medical concerns about glucose status or nutritional status, these will be discussed with us before any action is taken. I plan to exclusively breast feed and was successful in this with our twins.
I do not consent to a hysterectomy unless consent has been given at the time of surgery by myself, or by my spouse if I am incapacitated.
I do not consent to the administration of blood products unless consent is given at the time of the procedure, by myself or my spouse if I am incapacitated.
Revised June 30, 2006
Revised June 30, 2006