Many women don't realize just how many choices/decisions they need to make in pregnancy, birth and parenthood. A lot of these choices they might not even know they have! Did you know that it's your right to decline any and all routine tests/interventions in pregnancy and birth? Yes!! You get to decide what's best for you (and your baby), but how do you know whats best? What questions do you ask? How do you gather the evidence to make informed decisions?
Understanding how something is communicated and how this impacts the decision making process is a critical piece of the puzzle for informed choice.
Here are a few examples;
Example # 1
"If you don't do this procedure, you're choosing to put your baby at risk"
This is an example of medical coercion, which may include providing insufficient/partial information to obtain consent, emotional scare tactics or gaslighting.
Instead....
"The risk of infant death increases if we don't go ahead with [ said procedure/intervention]. The actual risk increases from 1 in 1000 to 3 in 1000. The risks of this procedure are [abc]. If you choose not to do the procedure, your other options are [abc].
This statement takes out coercion and ensures that someone understands the actual risk and their options so they can make an informed decision.
Example #2:
"The risk doubles..."
This is broad statistic that doesn't tell someone the actual risk
Instead...
"The risk increases from 2% to 4%
OR
"The chances that everything could be OK are 98% compared to 96% without going ahead the procedure"
If someone heard the original statement, it might come across as very alarming. Double the risk?!? Yet, when they understand what the actual numbers are, or the reframing of everything being OK, it allows for confident decision making.
Someone might still think the risk of 4% is too high and choose to go ahead with the procedure, but they are making that an informed choice with all of the information.
Example #3:
"You are considered high risk being over the age of 39"
This is a broad statistic/label that doesn't tell someone the actual risk
OR
"Certain genetic conditions are more common in pregnancies for advanced maternal age (AMA). The risk of having a stillbirth at ages 35-39 is 0.61% compared to 0.47% for those ages 18-34. I will give you a handout on AMA, just so you have an idea of what some of the risk factors are."
Understanding why something is considered 'high risk' or why it is labeled 'risky' is important in informed decision making. Just driving your car on a rainy day or flying in an airplane is 'risky' but most of us still do it.
In order to form a firm foundation for informed and empowered decision making, it's helpful to understand your values and priorities when it comes to birth.
Download this helpful guide in clarifying your values:
Ask yourself;
What do I believe about birth and the importance/impact of the birth experience?
How much information do I need when making a decision? How much time do I need when making a decision?
Do I want to make decisions, or do I trust my partner or care provider to make these decisions for me?
Gathering information in order to make a decision can feel scary. Below is a list of questions you can ask a care provider when needing to make an informed decision (think 'BRAIN')
(B) Benefits- What are the benefits of this intervention/procedure?
(R) Risk- What are the risks of this intervention/procedure?
(A) Alternatives- What are my alternatives? How do they compare?
(I) Intuition- What is my intuition telling me? What feels right?
(N) Nothing- What if we choose to do nothing or just wait?
Maternity care is not a one size fits all approach. We all come with our history, values, potential trauma, and varying clinical situations which greatly impact the choices we make.
This is why informed decision making is so important! Five people in a similar situation might choose very different paths, based on their own risk assessment. Being informed opens doors to confident decision making.
Check out the book 'Whats right for me' By Sara Wickham as another fantastic resource on decision making.