Informed Decisions in Pregnancy and Birth

Informed Decisions In Pregnancy And Birth

Birth Unlimited and the team at Birthing Magazine support the rights of the pregnant and birthing woman to make informed choices about her own care. Navigating the many interactions with your healthcare professional during the prenatal and birthing period can be a challenge if you are not sure of your own rights.

The number of decisions that need to be considered during pregnancy can be overwhelming. The standard maternity care protocol includes a long list of recommended screenings, ultrasounds and monitoring of the mother and baby. As the time for birth approaches, even more decisions have to be considered: where to give birth, whether or not to induce labour, which pain coping methods to use. Each of these interventions can have an impact on the pregnancy and birth. While your care provider may be used to the routines of caring for many pregnant women, each individual pregnancy is a unique experience for the mother and baby.

Each woman deserves to have her questions, concerns and decisions respected.

What is Informed Consent?

Informed Consent: noun

An autonomous decision made by a person after having been provided with the relevant facts and risks of a medical intervention. This includes the option to accept, delay or decline any test, procedure or drug.

Informed Decisions in Pregnancy and Birth

The concept of informed consent is integral to many health care professions but what does that really mean for a pregnant woman? All of the medical professionals with whom a woman comes into contact during her pregnancy and birth from physicians, midwives, nurses to medical sonographers, are bound by their ethical, legal and professional requirements to obtain consent for procedures.

In Canada, each person has the legal right to determine what happens to their own body. This means that no medical professional can bully or coerce a patient into making a decision. This also means that a patient has the right to ask for more information until they feel confident that they have the information necessary to make a decision. In a non-emergency situation where a patient is deemed capable, their decisions must be respected according to professional requirements.

Relationships

From the time a woman begins considering conception, her interactions with health care professionals can have an impact on her pregnancy and birth. Choosing a care provider who is open to building a trusting relationship can help lay the foundation for dialogue around the many decisions to be made during the course of care.

When seeking a care provider ask questions about their model of care:

Will you see the same physician or midwife over the course of the pregnancy and during birth?

Do appointments include time for discussions and questions?

Will you have the opportunity to build a relationship with each of the care providers that will be responsible for your care?

Are the policies of the clinic in line with your personal goals for your pregnancy and birth?

Including a partner or trusted friend in appointments with your healthcare provider can help you to remember information that was discussed. Take notes and ask for further resources. Talking through your options can help you decide if certain tests, procedures and/or interventions are aligned with your goals for the pregnancy and birth. Consider working with a doula, a labour support professional, who can offer information and support for your decisions during birth.

Ask Questions

  • When a test, procedure or intervention is suggested, ask your care provider about it:
  • Is this a standard recommendation?
  • What are the risks to me or my baby if we accept this recommended treatment? Or if we refuse it?
  • How will this test result or intervention benefit me and my baby?
  • Is there medical evidence to support this recommendation?
  • What could happen if I decline?

While your care provider can answer many of your questions, you can also do your own research. In non-emergency situations take as much time as you need to consider your options, whether that’s an hour or until the next appointment. There are many resources available in print or online that explain the risks and benefits of medical tests and interventions. Talking through your options with a partner or friend can help you gain clarity around your decisions.

Confidence and Courage

Working within a health care system that uses routines and policies to care for as many patients as possible can often lead professionals to influence women towards the choices that are more convenient for the practitioner. Asking questions of a medical professional can be a courageous act. Making a decision that aligns with your personal values but may be outside the realm of standard practice may be seen as an inconvenience, but remember that it is your right to do so. You are an advocate for yourself, as well as your baby.

Informing oneself about the routine tests and interventions offered during pregnancy and birth is imperative to making informed decisions. Remember that it is your legal right to decide which interventions to accept or decline.

Trust your body, trust your baby, trust birth. B

Statements on Informed Consent from Different Professions:

“Mutual trust and respect are critical to the success of a relationship that requires joint decision making at every level. Moral integrity, truthfulness and adequate information enable all participants to judge together the best course of action in varied situations.”

Midwives Association of North America

“The patient must always be given the opportunity to ask questions about the risks involved in the proposed treatment.”

Canadian Medical Association

“Nurses ensure that nursing care is provided with the person’s informed consent. Nurses recognize and support a capable person’s right to refuse or withdraw consent for care or treatment at any time.”

Canadian Nurses Association

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About the Author

Nicole Allarie

Nicole Allarie (Senior Birthing Magazine Contributor, Author, Pregnancy and Birth Interventions: Part 3—Informed Decisions in Pregnancy and Birth) is a regular Birthing Magazine contributor and a mother to two children, both caught by midwives. She is an advocate for the midwifery model of care and women’s informed choice in childbirth.

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