By Anna Hurty, CD, CCBE, PES
I once had a couple in my childbirth class at Stanford. When discussing pros and cons of various types of technology, “Mark” said that he was planning to do whatever his doctor said, and, if anything didn’t work out the way they wanted it to, he would file a lawsuit. The class seemed shocked and his wife was embarrassed. I suspected that he didn’t want to know, was scared to know, or didn’t understand the value of knowing, the options that were available. He was choosing to leave all the responsibility to the care provider, while accepting none in return. I’m actually thankful that he made that comment, as it opened up a helpful conversation and spacious discussion about personal responsibility and opportunity, reflective study and informed choice. As the years have passed, I realize that there are many more “Marks” than I would have expected. So, the question is: Who “wants to know?” If you are one who does, I hope that today will be the beginning of your journey towards readiness. I hope that you find time to reflect, study and prepare to make your birth the very best it can be.
During the months of pregnancy and as we prepare for our labor and delivery, we are bombarded with information, advice and opinions. It seems that everyone, from the media, our caregivers, to our friends and families, has something to say ab
out what is best for us and for our babies. In addition to what can seem like a deluge of opinions and birth stories that may influence us one way or another, we face decisions about testing, type of provider, place of delivery, pain management, interventions to speed or “enhance” the birth process, and how to care for our newborn. As a doula and childbirth educator, I often emphasize the importance of “informed choice” when women and their families consider their options and make decisions and plans during pregnancy and for childbirth. But what does this term mean, and why does it matter? And how can we find the information we need to make the decisions that feel right for our own unique experience – for ourselves and our babies?
An informed choice is a carefully considered decision, based on accurate information, an understanding of the various options available, the risks and benefits of each option and their possible results. Making an informed choice implies thorough education and clarification of issues to allow us to confidently decide what to do – or not do – in our own best interest and in the interest of our unborn children. In California, patients are protected under CACI No. 532, an informed consent law that states that patients have the right to a full explanation of any procedure, medication, drug, test or other treatment that is being considered as part of their care. Our care providers therefore have a responsibility to provide clear information, but the responsibility does not rest with them alone. As we prepare for the birth of our babies, we too have a responsibility to learn about our options and consider our choices.
Becoming informed enough to make a choice or confidently “consent” or “refuse” takes time. It requires time to research on our own, time with our medical caregivers who can shed light on benefits and risks, time to tease out and understand research and statistics, as well as time to consider the physical, spiritual and philosophical values and goals that we hold dear. While it initially may seem daunting and stressful to fully explore and understand our options, the decisions we make are extremely important, as they may be birth- or life-altering in unforeseen ways. For example, there may be certain physical or psychological consequences to having or not having had a specific test, procedure or intervention. Being educated about our options allows us to take responsibility for our health and for the health of our babies.
So how can we prepare ourselves to confidently make such decisions? Our decision-making must be preceded by investigation and understanding of alternatives. This process is most useful when undertaken before we are in the throes of labor. That is, before we are in the somewhat delicate and necessarily vulnerable state when our bodies and minds are functioning in a primal physical and emotional state, rather than an analytical and intellectual one.
I believe that one of the most proactive ways to feel confident about our decision-making is by nurturing a solid, trusting relationship with our medical caregiver (midwife or obstetrician). Our caregivers should be open to our questions and concerns and be willing to explain their reasons for, and thoughts about, any tests, procedures or interventions they recommend – or do not recommend. They should offer this information in language that is clearly understood so that we may make our decisions voluntarily and without a sense of pressure. If we feel that our caregiver appreciates and respects our need to know, our values, goals and determination to be a full participant in decision-making during our pregnancy and birth, then we are off to a healthy start. If, on the other hand, our questions are met with condescension, or we feel “brushed off” and are left out of decision-making, our ability to trust may be threatened. With mutual trust and respect, there is a much greater chance that conflict of any sort can be avoided and confidence enhanced.
When considering a specific option, we can use the acronym BRAND to help us get the information we need to make the decision that feels best.
B – What are the Benefits of this test, procedure, intervention?
R – What are the Risks of this test, procedure, intervention?
A – What are the Alternatives to this test, procedure, intervention?
N – What if I do Nothing?
D – Based on the information gathered, we make a Decision.
We can gather this information by asking questions of our caregivers; talking to a doula, a childbirth educator, other mothers; reading up-to-date books and seeking other sources of reliable information. While the Internet is an incredible resource with a wealth of information, we must be aware that not all information is cross-checked for accuracy or based on actual research. There is a risk of being misinformed or getting caught up on a site that is more a forum for emotion than evidence. One exceptional online resource is the Cochrane Collaboration (cochrane.org), a research organization which reviews studies and provides summaries of current evidence-based health care practices. Seeking recommendations from the key resources mentioned above can lead to sources of high-quality information.
An in-depth understanding of pregnancy and childbirth options, which allows for knowledgeable informed consent (or refusal), should benefit all involved:
- Benefits to the provider include more positive patient evaluations, possibly a greater number of referrals, possibly improved communication with patients, and the satisfaction that comes with a happy client.
- Benefits to the mother include greater trust in birth and in herself, enhanced communication with her provider and support team (which decreases fear), as well as a greater sense of empowerment and self-esteem.
- Benefits to the baby include the mother’s enhanced sense of connection and confidence, which, I believe, will enhance her awareness and capabilities as a new mother.
It is often said that if we don’t know our options, we don’t have any. When we commit to being active and informed participants in making decisions during our pregnancy and in preparation for the birth of our babies, we increase the chance for a positive and satisfying birth experience. We expand the range of options available to us and ensure that we are engaged in and involved with the process that will bring our babies into the world. This deep dedication to the birth process provides a powerful beginning to what may be the most magical time in our lives.
Anna Hurty is a Certified Doula (CD), Certified Childbirth Educator (CCBE) and Placenta Encapsulation Specialist (PES) living in Oakland. www.birthgarden.com
