Risk management
Informed Consent
Informed choice is a foundational aspect of midwifery care.
The informed consent process ensures that clients receive clear, comprehensive information about their care options and are empowered to make voluntary, informed decisions. For midwives and birth centers, well-documented informed consent also plays a critical role in risk management, demonstrating that clients understood the risks, benefits, and alternatives to their care.
This page provides guidance on developing and revising informed consent forms, includes required elements for midwifery care in Washington State, and offers templates and FAQs to support best practices.
Why Informed Consent Forms Matter for Risk Management
Clear, thorough, and well-documented informed consent:
- Establishes trust and transparency in the midwifery-client relationship.
- Provides legal and professional protection by showing that the client was informed and agreed to (or declined) the proposed care.
- Reduces the likelihood of misunderstandings or disputes about care decisions.
- Serves as an essential part of the medical record and can be critical in the event of a complaint, claim, or lawsuit.
Required Informed Consent Forms in Washington State
Washington State law and regulations require that licensed midwives and birth centers obtain and document informed consent for specific procedures and clinical circumstances. There are additional consent forms that are a good idea for all practices to have. Below is a summary of the core informed consent forms required by law, as well as others that are recommended by the JUA.
For Licensed Midwives
As required by RCW 18.50 and WAC 246-834
Must have these consent forms:
- Consent for Care
- Authorization to Disclose Protected Health Information
Good idea to have these consent forms:
- Administration of Vaccine
- Electronic Communications
- Emergency Transport to a Hospital
- Gestational Diabetes Testing
- Group B Strep Testing/Treatment
- HIV Testing
- Neonatal Eye Ointment Administration (required if client is planning a birth center birth)
- Newborn CCHD Screening
- Newborn Metabolic Screening (required if client is planning a birth center birth)
- Post-dates Fetal Surveillance
- Prenatal Genetic Screening
- RhoGAM Administration (required if client is planning a birth center birth)
- Student Participation in Midwifery Care
- Use of Images and Testimonials
- Vitamin K Administration (required if client is planning a birth center birth)
For Licensed Birth Centers
As required by RCW 18.46 and WAC 246-329
Must have these consent forms:
- Birth Center Services, Eligibility, Risks, Limitations, and Newborn Protocols (WAC 246-329-120)
- Rapid HIV Testing (WAC 246-329-120)
How to Develop or Revise an Informed Consent Form
1
Use clear, plain language that is accessible to a lay audience. Aim for a 6th-9th grade reading level. (There are lots of readability checkers online.)
2
Include required elements (RCW 7.70.060):
- A description of the procedure, test, or plan of care
- What to expect with or without the procedure/test
- Alternatives, including the choice to decline
- Benefits, risks, and potential complications of the procedure/test and each of the alternatives, including doing nothing
OR - A statement that the client elects not to be informed about this issue
3
Encourage dialogue during the consent process so that the form supplements, not replaces, an informed discussion.
- DO use open-ended questions, such as “What questions do you have?” or “How does this option feel to you?”
- DON’T use language that implies judgment or nudges clients toward a particular choice.
4
Include space for client questions and signatures, and for the midwife to document the discussion and confirmation of understanding.
5
Review and update forms periodically, especially when clinical guidelines or regulatory requirements change.
Templates and Examples
The sample documents, templates, and guidance provided by the Washington JUA are intended for informational and educational purposes only. They do not constitute legal advice, clinical directives, or regulatory requirements. Each midwifery practice is responsible for reviewing and adapting these materials in accordance with current Washington State laws, professional standards, and the specific needs of their practice. The Washington JUA assumes no responsibility for how these resources are used or interpreted.
Templates
Examples
Frequently Asked Questions
Do I need a separate informed consent form for each procedure or situation?
Yes. While some general consents cover routine care, Washington State requires specific consents for situations like out-of-hospital birth. It’s best practice to tailor each consent form to the unique decision being made.
Can I use digital forms for informed consent?
Yes, as long as electronic signatures are legally valid under state and federal law. Make sure your digital system allows you to store and retrieve signed forms securely.
What happens if a client refuses to sign a consent form?
Document the discussion thoroughly, including the information provided, the client’s response, and any refusal to sign. In some cases, it may be necessary to reassess the appropriateness of continuing care without written documentation.
How often should informed consent forms be reviewed or updated?
Review forms at least annually, or sooner if there are changes to regulations, scope of practice, or clinical protocols. Keeping forms current is essential to ensure legal and ethical adequacy.
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