ACDM Documentation for Domicilairy Midwifery Practice
Special Circumstances Informed Consent /
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Here are 3 "Special Circumstances" informed consent documents for home-based care and/or refusal of customary obstetrical protocols -- in particular, the decision by the family to decline hospital-based physician care in circumstances which normally indicate hospitalization as the "standard of care". In addition to VBAC pregnancies, a much short version of this document addresses macrosomia and a vertex twin pregnancy at term is included. In both mothers delivered NSVD at home without sequelae.

An important facet of the special consent process is to establish that the parents understood the difference between "standard" medical/midwifery advise based on evidence-based research or the authority of recognized medical experts and unproven or "experimental" medicine/midwifery which lacks currently the standard scientific "proof" of its efficacy or safety (especially lack of RCTs). It is not illegal for parents to choose an "experimental" model (for instance, when parents enroll a child with a malignant tumor in an experimental drug or surgical trial which includes not only the possible harmful effects of the unproven therapy but also the possibility of being assigned to the placebo arm of the study and thus untreated).

Neither is it negligence or malpractice for a caregiver to participate in experimentally-predicated medical/midwifery care forms. The key issue is the fully-informed consent/decline by the parents. It would be malpractice for the caregiver to "advise" or encourage the parents to opt for "unproven" therapies or to decline standard medical advise (especially to refuse prophylactic hospitalization in the presence of acknowledged risk factors) without telling the parents that these choices were unproven or otherwise "experimental". Then it is the parents who make the decision -- not the caregiver.

When it comes to refusal of standard medical care the courts do not give carte blanc to parents (or anyone else!). None-the-less, it is still a recognized legal principle that parents have the right to refuse "standard" care and decline medical advise, including choices which influence the outcome of pregnancy. A particularly good discussion of this can be found in Gabbe' 1991 obstetrical text book in the chapter on legal and ethical issues and also under the section dealing with refusal of laboring women to have the baby monitored (both EFM and auscultation).

The following special consent process is unique to each situation and should be tailored to that particular condition of pregnancy and the family's specific circumstances. You have permission to modify the text to create your own special circumstances consent form. Please cite this document by the GoodNews Network/ACDM in any publication ofthe work.



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