choice
noun
an act of choosing between two or more possibilities.
the right or ability to choose.
a range of possibilities from which one or more may be chosen.
If you type 'Choice in maternity services' in your web browser, you'll find this page from NHS England. It's a good one to know about, as if the care you're receiving is not reflective of what the NHS is committing to deliver - and is by law required to deliver - you can use it to remind your care providers that you should always receive all the pros and cons of all the existing options before having to make any decisions.
"The NHS wants everyone using maternity services to receive safe, personalised care. This means that care is centred around the unique needs and circumstances of each individual using maternity services and their baby. It also means that they have had genuine choice about the care they receive, informed by impartial information."
Source: NHS England
By definition, you should always be given options when you're being asked to make a choice in your pregnancy or during the birth - it's rarely as simple as yes or no. And you can't make an informed choice if you are not being given all the benefits and risks, as well as alternatives, to an intervention.
Remember: if something is not part of the natural process, however insignificant it might seem - or it might be presented to you, it is an intervention.
The Decision-making Framework
Below is the decision-making framework I share with all the parents I support through my birth preparation courses.
I hope you'll find it helpful if you're being offered an intervention during your pregnancy or during labour, and suddenly have to make a choice.
Note: This framework can be used for any type of intervention but is particularly helpful in the context of induction of labour.
1. Understand why the intervention is offered.
Ask yourself and your caregiver the following questions:
Is your situation a complication or a variation?
Complication = there is already a problem.
Variation = mum and baby are currently well but there is a higher chance of a complication occurring in the future.
What are the complications associated to your situation = why it has been offered?
What are the general chances of these complications occurring?
Do you have individual factors that may impact these chances?
Will an intervention truly reduce the chance of these complications occurring? (ask for existing research/ data)
How will it reduce the chance of complications?
2. Consider the risks associated with this intervention, and the impact it will/ might have on your birth experience.
What are your thoughts / preferences before labour starts?
How will this intervention impact your birth wishes/ preferences?
What are the risks associated with this intervention in your situation?
3. Consider the alternative options to the intervention.
What are your thoughts about alternative options?
What are the benefits and risks of these alternative options?
4. Make your decision
Evaluate the information you've considered in the previous questions. To do this, you can create a summary using the B.R.A.I.N framework (see below).
Benefits & Risks – what are the benefits AND the risks of doing and NOT doing something?
Alternatives – there are pretty much always options, so find out what they are. If it’s the way that things have always been done, then it's not good enough as a reason.
Intuition – very important, trust your gut feelings.
Nothing – what if you wait 1 day, 1 week or do nothing at all?
5. Communicate your decision
Remember that your Caregiver's obligation is to support your decision.
You do not have to justify your decision. It’s your body, your baby, your choice.
Coercion is not acceptable – if you do not feel supported, you can ask for another care provider.
Useful links
Below are a few useful links to websites and organisations that provide evidence-based information (1 & 2) and advocacy support (3).
Feel free to get in touch if you have any questions or need any support.
For more information about my complete birth preparation course, visit this page.