There are so many important decisions to make before, during, and after pregnancy. Many people find themselves feeling overwhelmed and even ill-prepared for making choices about treatment options, caregiver selection, and birth preferences. Lack of education or fear of questioning providers can leave expectant mothers and families feeling helpless and out-of-control, often resulting in dissatisfaction in their overall birth experiences. Many look back and wish they had known the options available to them, had asked more questions, or been more assertive; this likely would have led to a different decision and, ultimately, a different outcome. Even if the end results had been the same, perhaps their feelings about it after-the-fact would have been more positive.
Many of the decisions surrounding the time of birth have to do with medical interventions, such as induction of labor, augmentation of labor, or cesarean delivery. This post does not purport to suggest that these medical interventions are never necessary, but rather that they are often over-utilized (see my previous post, "The Rights of Childbearing Women" and the discussion of cesarean rates, for example). Providing patients with more education regarding expectant management versus induction, VBAC (vaginal birth after cesarean), natural labor induction methods, and non-medical options for reestablishing an active pattern in a stalled labor can lead to more favorable outcomes for mom and baby, as well as a more positive experience overall.
One way to accomplish this goal is through educating expectant mothers and their families about their rights when it comes to these decisions. Knowing that they can, and should, ask questions about any proposed test, treatment, or procedure will allow them to make a choice to either consent to or refuse an option from an informed, educated, and empowered place. Below, I have described the important elements of informed decision making for childbirth, but these same elements are universal to all healthcare and should be utilized whenever a treatment decision arises.
Informed Decision-Making: agreeing to or refusing a test, treatment, or procedure after becoming fully-informed about it by asking the following four questions:
What are the benefits of the proposed test, treatment, or procedure?
What are the possible risks or side-effects to myself and/or my baby?
What are the alternatives to the proposed option? What are the risks and benefits of the alternatives?
What will the next step in my care be if I consent to this option? What will the next step be if I choose to refuse it?
Informed Consent: agreeing to the proposed test, treatment, or procedure after becoming sufficiently apprised of it.
Informed Refusal: declining the proposed test, treatment, or procedure after being sufficiently apprised of it.
Shared Decision-Making: a collaborative approach to making an informed decision (either consent or refusal). You and your caregiver discuss medical risks and benefits of an option, any available alternatives, questions or concerns you may have, and your preferences and priorities regarding your care. Shared decision-making enhances trust and mutual understanding between you and your caregiver, and results in you feeling more empowered and in control of your care.
Lastly, the scenario may arise where a mother and her care provider cannot seem to agree on a course of treatment. In the event that a disagreement cannot be solved through dialogue facilitated by the questions described above, then it is the mother's legal right to seek an alternative care provider, one who she feels has a practice model that better aligns with her care preferences. Alternatively, the care provider can also refer the mother to alternative care as long as it is available. Incorporating a birth doula into the care team also provides additional support and encouragement when faced with decisions surrounding pregnancy and birth. While the doula cannot provide medical information or recommendations, they can assist with formulating questions as well as with developing a clear and concise birth plan to outline pregnancy, labor, and birth wishes.