You may have seen an image floating around the internet – it’s titled “Things You Can Opt Out Of In Pregnancy + Birth”, which frankly is a terrible title. The list includes different things you may need to make an informed decision around during birth. Key word – informed decision. Of course that does mean you can choose not to do some of these things – and everyone will make their own, individual choices. What is important is that you get all the information around each one of these things and are able to make an informed choice about what you feel you wish to pursue, and what you feel might not be worth it.
What is informed choice?
An informed choice means can only be made if you are given all the support, information, and tools needed to make a decision. If you are making a decision – in any scenario, but especially in healthcare-related scenarios – without all the information, you could be putting yourself (or your baby, or others) at risk.
Your healthcare providers should be supporting you in your ability to make an informed choice. This means they are going to provide you with all the information they have on the options available to choose from. They will discuss both risks and benefits, based on current scientific evidence. This means they should provide this information in an unbiased fashion (ie. their own personal views should not impact the information provided). It means you should be given the opportunity to ask questions about each option or request more information. Don’t be afraid to ask questions, and remember that no question is a “stupid” question.
Sometimes your provider might need to refer to another provider or another source to help support you – that is not a bad thing. One provider simply cannot know everything – nor will a more generalist provider necessarily have the answers to more specific or niche/specialty questions. A good provider recognizes their knowledge deficits or gaps, and will take action to seek out what they are missing elsewhere.
Once you have all the necessary information and feel you have clarity with all your questions answered – you make a decision. That’s right – you. A provider is there to help you, support you and provide guidance or expertise in order for you to ultimately make an informed choice about what route you’d like to take.
If you don’t feel that a provider is helping you to make an informed choice – you should first try and discuss this with them, and if the issue is ongoing – perhaps seek out another provider who can better support you.
Informed Choices and Pregnancy/Birth
Both pregnancy and birth involve a lot of informed choices. From beginning to end, there are opportunities to discuss different things like screening and diagnostic testing options, treatments and procedures, birth plans, and baby care. I don’t agree with the way that the image I saw floating around was worded – if anything, it seemed to be encouraging people to “opt out” of things like ultrasounds or a hospital birth. Do people choose not to pursue some of these things? Absolutely – but this decision should never be made lightly. There will be a variety of factors that will impact decision making. Beyond just the information you’re given on each option, there will also be your own personal attitudes, beliefs and values to account for. That is why each of us, as human beings, make such unique and individualized decisions about the same choices!
I am not here to judge anyone’s decisions – but I do think it’s important for people to understand the gravity and importance of a decision. I hope to explore each of these topics in individual posts to bring more information to each decision, but your provider should also be going over this with you. That is their role!
I have previously done a post on the two primary genetic testing options of pregnancy in Ontario for example – that post is located here. Genetic testing was listed as one of the items on that list – and fair enough, genetic testing in general is an ethically complex topic. Some people may automatically decline this option, because of their own personal values/beliefs that do not align with genetic testing, for example. Others may be all for it, because of previous personal or family history. This is how values, beliefs and attitudes impact informed decision-making – but you should still be provided with the information so that the decision is also informed. Ultimately though, the decision lies in your hands. That is informed choice.
Some of the other items on the list do not have such a grey area though. There are many of things that were mentioned that are well supported by current scientific evidence – some of these things literally save lives, and the risks of pursuing them are much lower than the risks of “opting out”. I think that is why it’s important to review each of the listed items with your provider. At every decision point, you should be provided with information on all routes so that you are making a truly informed choice.
So – I will be starting a series of posts on these topics. Many of them have been covered by amazing resources like Evidence Based Birth too – and I’ll provide those links for further and more in-depth reading. Remember though that, as with everything in this blog – this is not medical advice.
When you’re going through pregnancy or birth, these things should be discussed with you. If they are not and you feel you have not been given the opportunity to make a choice, speak up. I know it can seem scary – but this is your body, your health and the health of your child (or children), we’re talking about. Doctors and healthcare providers can seem “intimidating”, but this should not be the case. You should be able to have discussions and advocate for your preferences without fear. I recognize that not everyone is able to do this, but if you are feeling pushed into a corner by a provider you can look for another, or in hospitals there is often options to request the assistance of a patient advocate – these are people who can help you have your voice heard with your provider. You can read more about Canada’s and Ontario’s health and patient advocates here.
But for now – let’s start out with one of the earlier decisions you make in pregnancy – ultrasounds! Stay tuned for my post later this week!