Many decisions arise during pregnancy, birth, and postpartum. And the decision-making doesn’t end there, but naturally extends well into parenting. Birthing individuals and families select among choices about where to give birth, who shall be present at the birth, who provides primary care, which tests and procedures to accept or refuse and when…just to name a few. Making informed decisions during this tender time enhances your confidence as a parent and positively impacts your long-term self-esteem, in addition to fostering the best experience for you and your family.
What is informed decision-making?
Informed decision-making is a process in which you are made aware of all the essential information surrounding an option and you are given an appropriate amount of time to make the decision. It also means that your decision is respected and that you will not be pressured to change it.
Once you are fully informed about a procedure, test, or other process, and you choose to accept it, you have given your informed consent.
Your care provider cannot legally give you medical treatment in either of the following cases:
- You’re insufficiently informed about the treatment (and therefore cannot give your informed consent).
- After becoming sufficiently informed about the treatment you refuse it (informed refusal).
Concerned about what might happen if you say NO? It can, of course, feel uncomfortable to choose a path that seems to deviate from the common one. And generally speaking, most of us like to avoid confrontation. However, when it comes to birthing and parenting, you have the final responsibility for the well-being of yourself and your baby/babies. Remember: “The right of refusal (to say ‘no’) is strongly upheld by human rights laws, U.S. courts, and ethical standards for healthcare professionals” (Pascucci).
How can I get more information?
The BRAN model for decision-making helps parents-to-be remember what information to seek out. The formula goes like this:
- Benefits – Learn the specific benefits of the test or procedure as relevant to your specific experience and circumstances. How likely is the test or procedure to succeed or to otherwise achieve the desired result?
- Risks – While your care provider will likely discuss the major risks of a test or procedure with you, you may need to dig deeper to uncover all of the risks associated with various procedures. Learn the possible risks or side effects for you and your baby/babies and how they are handled. Know which additional procedures or precautions may become necessary to ensure safety.
- Alternatives – What other options and routes are available? Can you delay the procedure or opt out completely? Reach out to parents you know (or seek out parent support groups) who have made alternative decisions and ask about their experience. Though subjective, these accounts may give you an indication of what you need to look further into. When in doubt, ask a midwife. Why? Because “midwives are the experts in normal birth, and they usually have excellent skills in exploring alternatives and facilitating decision-making” (Buckley 40). You can also consult with alternative healthcare practitioners in your community such as naturopaths, chiropractors, and Traditional Chinese Medicine (TCM) practitioners.
- Nothing – What if we do nothing? This is almost always a valid option, though this may make your care providers uncomfortable. As with seeking out alternatives, you can consult with midwives, other practitioners, and other parents who have chosen this route. Choosing to do nothing can give you more space to explore your options. Ask if your decision can be changed at a later date.
Use the BRAN acronym as a guide when seeking out information from care providers, peers, reputable resources, and other healthcare practitioners. The list of consulted resources at the end of this article is a great place to start for guidance on options in pregnancy, birth, and parenting.
What if my care provider and I do not agree?
Hopefully you and your care provider are able to respectfully discuss the situation and through good communication, come to an agreement. Respectful discussion and good communication create the foundation for shared decision-making. In shared decision-making, care providers and patients/clients work together to make the best choices for treatment and care plans based on “clinical evidence that balances risks and expected outcomes with patient preferences and values” (Shared Decision Making). This is a more collaborative approach to healthcare.
If you are unable to resolve the disagreement via healthy communication, you may choose to switch care providers. Women in the U.S. and Canada are legally allowed to do so. Additionally, caregivers can opt to discontinue care so long as the pregnant individual has other care options.
What about the baby’s consent?
A discussion of informed consent would not be complete without defining the baby’s consent. In Neonatal Resuscitation (NRP) workshops with Karen Strange, she emphasizes keeping the baby informed, even while in the womb. Always let the baby know what is about to happen before it happens. Talk to your baby and let her know what is going on.
Mothers can do this by always telling the baby what they are feeling or experiencing, or what is about to happen. Care providers can help, too. Even something simple like “Okay Baby, we’re going to take Mom’s blood pressure now” lets the baby know that something new is coming and that her environment may change because of it. The baby is literally immersed in the mother’s thoughts and feelings: they are her environment. Anything that happens to the mother impacts the baby/babies.
Talking to the baby, keeping her informed, is the best we can do to maintain the baby’s consent during pregnancy and birth. Talking with the baby/babies now will set the foundation for secure attachment in the newborn and infant stages, paving the way for a strong parent-child bond.