It's your choice!

*This blog post was originally published 9 October 2011*

In my classes, my sole focus is to educate women about their choices for birth. Many of the things I talk about, one would not hear in a conventional hospital class. This is because, unfortunately, the hospital system is not set up to empower women but to control risks. In an effort to streamline care and minimise liability, a crucial element has been omitted from their system – supporting mothers to make truly informed decisions.

There is a significant difference between informed consent and informed choice, the former being what is most often practiced in pre- and post-natal care. Informed consent is where the caregiver provides information on a particular procedure which they are recommending. The intention is to provide all the risks and benefits of the procedure so that the “patient” (i.e. expectant mother) can give consent. Due to time constraints (or simply convenience) however, the information is often not thoroughly explained and is usually presented in such a way so as to “convince” the woman that the procedure is necessary and the risks acceptable. The focus is on obtaining consent rather than exploring options. In fact, the woman may not be aware that options even exist!

This contrasts greatly with informed choice, which involves full disclosure of all options (including options that the caregiver may not personally recommend) and an open exploration of the risks and benefits of each. By “open”, I mean that:

• different perspectives are discussed (i.e. differing views within the “birthing community” )
• genuine discussion is facilitated (no coercion or judgement)
• valid information is shared (where possible, sources and studies should be cited)
• information is presented in an unbiased manner (or bias should be disclosed)
• where time allows, women are encouraged to do further research at home before making a decision
• ‘Waiting’ or ‘doing nothing’ are also valid options to discuss.

The focus is on mothers making decisions based upon high quality information which they can then consider in reference to their own feelings and values. The “right” choice will be different for everyone and it is the woman who determines what is right for her and her baby. This decision-making process is far superior to the informed consent model.

There are a few key principles related to making informed (birth) choices:

1. There are risks and benefits to EVERY test and procedure.
2. You can accept or decline ANY test or procedure.
3. There are vastly different views amongst birth experts (i.e. doctors, midwives, researchers etc.) as to what tests and procedures are necessary or safe and in what instances they should be used.
4. Be aware that statistics and studies can sometimes be misused or misrepresented. For example,
   • a risk may “double” (i.e. it has increased by 200%) given a particular set of circumstances, which sounds quite alarming, but if the risk was 0.1% in the first place it has only doubled to 0.2% which may be acceptable to you.
   • Some studies are inadequately designed or controlled and therefore produce inaccurate results. Sometimes professionals mistakenly continue to cite these studies to justify certain procedures. (Check commentaries/critiques of studies to get the full picture).
5. Make choices that feel right for you. Your intuition is just as valuable as an expert’s opinion (perhaps more so!).
6. Finally, take ownership of your decision. When talking about your decisions, rather than saying “my doctor/midwife said I had to do x”, say “I/we chose to do x”. You do not “have” to do anything – there is always a choice. Let your words reflect the active role you have played in the decision-making process.

Information on specific issues can be sourced from books, brochures, websites, documentaries and birth professionals (including doctors, midwives, birth educators and doulas). However, getting informed takes time and effort and some people prefer to just go with the flow. That also, is your choice.

In a broader context, informed choice is about living consciously and taking responsibility for your health. This can extend to such topics as vaccination, food, clean water, disease, and sustainable living (just to name a few!). There is a multiplicity of options out there in all facets of modern living. Seek out alternate views, get informed and make decisions that are true to you and your own set of values.

[Note: In this article I have referred to the mother/woman as the decision-maker. This does not diminish the important role that the father/partner has in supporting the mother, however ultimately the choice belongs to her as these choices affect her body. Moreover, only she can claim an intuitive connection with the baby that can guide her decisions.]