I often see women saying that they “can’t” make an informed decision because they “are not the expert” or “that’s what I hire my OB for”.
But here’s the problem: You are responsible for all the decisions that get made and all the things that you do and don’t consent to. Regardless of what you base your choices on and who, ultimately, makes the choice. And if you are going to be held responsible for your choices and decisions you may as well ensure that they are informed!
Making an informed decision isn’t really as hard as it sounds. You don’t suddenly need to be able to read hardcore scientific journals or go to uni to study obstetrics for several years.
Making an informed decision involves a couple of basic steps which can be set out in the acronym: BRAIN.
When I tell women to “Use your BRAIN”, I’m not being rude! I’m suggesting that they use this decision-making tool to help them to make an informed decision.
When someone suggests a course of action, you need to know the benefits. If someone is trying to sell you something they will generally be VERY forthcoming with this so it’s usually pretty easy to come by this info. For example: If your care provider is suggesting that you have an induction they will very happily tell you all the benefits involved with having an induction.
You often need to press a little harder or do some wider research for this one. One of the most important things to remember here is that NOTHING is risk-free. So if your care provider fobs you off with “oh there’s not really any risks” you know they are having you on. You actually can’t be said to have given legal consent if you haven’t been advised of the risks of the course of action you are undertaking, so it’s a good idea to be a little forceful on this one.
There are always alternatives – even if it’s just do nothing. I’m not saying that the alternatives are always good. Sometimes your options are all crap. But just because they are crap doesn’t mean that they don’t exist or aren’t worth exploring. You never know when a “crap” alternative may suddenly become a better one and it’s great to already have some information on it.
Getting in touch with your instincts can be hard. We are so often told that our instincts aren’t worth listening to or that they are unreasonable (or hysterical or irrational). Yet I know so many women who tell me that the first sign of something being wrong in their labour was their instinct.
I know women who have asked for a caesarean because they felt something was wrong only to be told that “everything is fine according to the monitoring” and to then later find out that something actually was wrong. I’ve also seen it go the other way where women feel that everything is fine and this is later confirmed.
“N” is often used as “nothing”, but since I include that as an alternative I like to use the N as Next. A very important question can be: “If I choose this course of action what happens next? What if this doesn’t work? Or it does? Or we experience one of the risks?”
Without getting too caught up in the “what ifs” it’s useful to have an idea of what the plan is after this. For example: If you consent to a VE what will be recommended if you are found to be the same as before? Or if you are found to be 5cms? Or 10cms? How do you feel about these potential recommendations? It’s generally much easier to make choices when you are NOT in that moment so get the info and make some decisions beforehand.
Where can I get this information from?
I always recommend that these questions (aside from instinct, obviously) are best asked of your care provider in the first instance. However, you can acquire a lot of this info from a variety of sources: OBs, midwives, scientific journals, doulas, childbirth educators, friends, relatives, blogs, facebook forums, books, websites.
I think it’s really important to get as much information from as many different sources as you can so that you have the widest possible perspective. An OB who attended a uterine rupture last week will likely give different information about the risks of a VBAC than a homebirth midwife who has never seen a rupture or your friend who VBACed her babies, complication free. Being able to see bias is important. It doesn’t make the information invalid, but it does mean that getting another perspective is advisable.
When you first start it can be worth writing down BRAIN when faced with a decision and going through the process, but it won’t be long until you just do this automatically with ALL decisions that you need to make! It is simple, effective and can be used in all situations.
Your body, your birth, your choice – always!
Read how to choose a pregnancy and birth care provider, another of Lizzie’s helpful articles.
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