In response to the discussion of breast surgery where the mother was assured verbally that cutting ducts would not affect breastfeeding: 

Mothers should always take paper and pen along. Usually they are not needed, because communication is clear and complete. But if the provider makes statements that the mother is not sure about, the mother can amiably write them down on the paper. "I want to be sure that I have understood what you are saying, so I am writing it down. Is that exactly what you said?"  Often the mere sight of someone writing down the words makes a professional restate something very carefully.  Then the mother should write that revised version down, not be cowed or hurried into giving up on the writing.  When the caregiver agrees to what is written, "Yes, that's it" -- then the mother has a choice.  
1) Move the paper toward the caregiver, offer the pen, and say pleasantly, "Would you please just sign this, so we are both clear about your statement?"  At this point, many providers will refuse to sign.  They clearly are not so very sure of the information they were offering, after all, and the dialogue needs to continue.
Alternatively, the mother can 2) write the time, date and name of the provider herself, saying "I'm making sure that I remember when I heard this, and exactly what it was that you told me."  

Anger and resistance to this process could be expected from the few remaining providers who retainn an internalised image of the "good female patient" being quiet, unquestioning, unable to decide about complex situations, not in any need of evidence beyond the most basic generalized material. These are the same providers who hit the roof if they find her reading her own medical records -- as if they owned her charts rather than the mother.  Unfortunately, they may be the very ones who really need a stimulus to providing attentive and respectful care.

Luckily, they ARE few. Most providers are more than happy to explain, to discuss all the informed consent issues, to have a mother write down anything she wants to write down, to give her the charts to read, and to sign off on what she and they have discussed.  These are the medical care providers that we all so much value and respect -- and literally owe our lives to, often enough.  It is in their interest to ensure that all of their colleagues are conscientious in applying the same principles of informed consent -- and in this, the "good pen-and-paper female patient" is their vital ally. 

My own experience with this process or amiable assertiveness originated in Kenya, where informed consent was rudimentary.  It was developed further through being told by my HMO in Massachusetts that as a post-menopausal woman, I must take Estrogen Replacement Therapy -- that it was their practice and they provided it free of charge to 3000 women every year, so I need not ask for evidence of its long term effects.  Just writing down what was said and asking for a signature to it produced a far more informative and respectful two-way dialogue.   

Perhaps the work of breastfeeding counsellors, lactation consultants, and birth educators includes giving women ways to counter any dismissive attitudes from a minority of health care providers.  Amiable assertiveness is part of any woman's essential tool kit for survival, and a mother will need it to defend herchildren as well. 

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