def, that was a great post! thanks for your thoughtful and experienced views on this.
as a doula, i've been pretty amazed at how wide the interpretations can be for informed consent... i've seen anesthesiologists waltz in and begin a procedure with very minimal information to the client, and i've seen doctors who will give clients all the time they need to ask their questions (but not necessarily offer information without the questions), and i've seen nurses who will go out of their way to track down answers.
i saw a doc perform AROM on a second twin, about ten minutes after the first twin was born (quickly and without incident, and twin B was monitoring well... there was no rush here!). he didn't say peep to the mom, just started the procedure. i asked what the baby's station was, and he just glared at me and asked me if i wanted to stay in the room or not! watching him, i could tell he was rooting around pretty high. this kid was nowhere near 0 station! and of course, *I* knew that AROM with a high baby, with a mom on her back, is just asking for a prolapsed cord. if he had spoken to the mom about it at all, i would have told her this. but she never had a chance to consider it, he just did it. and of course, we had a cord wash down, next contraction we had nasty decels, and he called for a crash cesarean! but a nurse, bless her, leaned over and said, "if you can, push your baby out in the next contraction and he'll be OK." and that mom DID IT! from less than 0 station to birth in one push! it was like watching someone pick up a car or something. baby was fine, but it was a scary situation that was COMPLETELY unwarranted. it really made me mad, and when the mom figured it all out later, she was pretty peeved too. (she went on to have a beautiful home birth four years later).
i guess i was naiive when i thought this was a legal definition that all practitioners had to follow! but it's a lot fuzzier than i ever knew. one good thing is that it has taught me how to be a better advocate for my clients... how to form good questions to get the most information as possible (ie, not a yes-or-no question!), and how to negotiate for time so clients can truly think about the implications of their decisions (if time is not an issue).
i'd like to think i would have the balls to say to that doc now, "please tell the mom what you are doing, so she can give you her informed consent on the procedure." i wish i'd spoken out then!
(AROM=artificial rupture of membranes; station is the position of the baby's head in relation to the cervix... 0 is at the cervix, -3 is above, +3 is below)