Informed choice

(This article is also available in an audio format)

The buzz word in maternity care circles is informed choice! But how often are women exhorted to make an informed decision? How many times do these words appear in policy documents and procedure manuals within a health care institution? The reality is that this concept, of parents making truly considered decisions about their care, is a mirage! Do you want to fall in to the category of a mirage or will you truly make informed decisions about your birth?

Lamaze’s philosophy states that birth is normal, natural and healthy. The experience of birth profoundly affects women and their families. Women’s inner wisdom guides them through birth. Women’s confidence and ability to give birth is either enhanced or diminished by the core provider and place of birth. Women have their right to give

birth free from medical interventions. Birth can safely take place at home, birth centres and hospital. Childbirth education empowers women to make informed choice in health care, assume responsibility for their health and to trust their inner wisdom.

Too many times parents lack the information they need, are asked to make a decision under duress, or are presented with options in such a way that they are gently led to make decisions that fit comfortably with the caregiver’s protocols, rather than the parents expressed needs or desires.

In the past – father’s weren’t allowed into the labour ward, perineal shaving and enemas were routine procedures on entering hospital during labour, moms had to wear a hospital gown to labour in, baby’s had to stay in the nursery and not room-in with mom. These days all the above should be routine options for moms and dads.

These innovations stemmed from consumer pressure from parents who had obtained the vital facts and details from a childbirth educator or other source outside the system of direct care.

Informed choice is not a level playing field on which women can state their wishes, and if necessary, have recourse to rights to enforce these wishes. Choices are limited first and foremost by doctors and hospitals. Typical examples are

  • restrictions on the number of people the woman can have with her in labour,
  • restrictions on eating and drinking in labour,
  • unavailability of birth balls, showers and baths in labour wards
  • Not routine skin-to-skin for all babies at birth
  • Top-up feeds to all babies

Other constraints may restrict women’s access to choices that are unavailable eg. A woman’s choice of care provider and place of birth are determined by medical aids, geographical distance from alternatives to the traditional hospital, the availability of midwives, birth units or home births. Choice is further limited by the withholding of information or providing information to women that is consistent with restrictive hospital rules and obstetricians protocols rather than with evidence-based information.

The framing of information shapes choice profoundly. The “gentle steering” of midwives coaxing women to choices that the midwife is comfortable with. Subtle blackmail is another strategy used to influence choice. “If it were me …, I would do …”. Women are coerced, steered, or manipulated to choose what others want and expect them to choose.

Attend childbirth education classes but first check that you will be given all the facts, all the alternatives, so you will be able to make truly informed decisions based on the knowledge of alternatives!

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