Decision Making in Childbirth

The journey of pregnancy and childbirth is often marked by a series of pivotal decisions that shape the entire process. From choosing a birth plan to making medical choices during labour, decision-making in childbirth can hold immense significance for both you and your birth patrner, and also your healthcare providers. In this blog article, we delve into useful tools that can aid and ease the process of decision-making in childbirth. We will explore the pivotal role of informed consent and the dynamics of shared decision-making with healthcare professionals.

Being empowered to make your own decisions in childbirth increases your chances of interpreting your birth experience as positive. To experience a positive birth does not mean that one needs to experience a natural birth, or a drug-free birth. A positive birth experience is more about how your health care providers made you feel during your pregnancy and birth journey. This includes how actively involved and informed you were in the decision-making process. Thankfully, pregnancy is a nine-month journey which allows plenty of time to find out information, have meaningful discussions with your partner / birth partner and make decisions.

The key is to be prepared. When during an antenatal visit or in the birth room you are faced with a decision to make, remember to use the acronym BRAIN. Unless it’s an emergency, remember to pause and ask yourself and your health care providers these 5 simple questions:

1-     What are the Benefits?

2-     What are the Risks?

3-     What are the Alternatives?

4-     What does my Intuition say?

5-     What if we do Noting?

Asking and discussing these 5 simple questions will help you to A. pause to get some clarity and understanding of the situation, B. helps you feel in control of your pregnancy journey which will contribute to a positive pregnancy and birth experience (regardless of the mode of delivery) and C. facilitates you making an informed decision.  

Once you have asked yourself these 5 questions, ask for some time alone with your partner / birth partner to further discuss and get his/her concerns addressed. If this happens during an antenatal check-up (in a case where there is no emergency), you can ask your health care provider to rediscuss and give an answer at the next antenatal visit. If it’s during birth, you can ask your health care providers for a couple of minutes alone to discuss further with your birth partner.

 Once a decision is made, it is time to tell your health care provider your decision. If your decision agrees with that of your health care provider(s), then it is so far so good. When your decision is different from what your health care providers are suggesting you may feel vulnerable and scared to voice your decision. This is where you need to use your HEART and communicate your decision to your health care team. Wildly used in customer service, HEART is an acronym that can be used to convey your decision.

Hearing

Empathize

Assertive

Reassuring

Thank you

Remember, it is perfectly normal that with your decision, your health care professionals might feel that their expertise is being undermined or that other people are convincing you to go against their recommendations. This in fact is a very human reaction. Start your conversation by saying that you are Hearing what they are saying, and it is thanks to their time and dedication that you can understand their recommendations. Empathize that you know they want what’s best for you and your baby.  Be Assertive and express your wishes (I would like to wait or try an alternative), all the while reassuring them that if anything changes you will let them know with your new decision. Finally, thank them for their time and for taking such sterling care of you and your family.

Informed consent is a fundamental part of respectful, family centered care. It means that every parent has the right to receive clear, evidence-based information about their options, including the benefits, risks, and alternatives without pressure or coercion. Importantly, couples also have the legal and ethical right to decline or refuse any intervention, even if it goes against their healthcare provider’s recommendation. Signing "against medical advice" simply means they have made an informed decision that aligns with their own values, priorities, and circumstances.

Ultimately, whichever decision you take, be it big or small, always remember to listen to your intuition and be sure that you are at peace with your decision. It is essential to recognize that every birth is unique, and there is no one-size-fits-all approach to decision-making in childbirth.

Ruth Marie Xuereb

Senior Midwife,

Positive Birth Malta