Informed Decision Making
Who is responsible for making informed maternity decisions?
Why is my involvement in maternity care decisions important?
What are important factors for informed maternity decision making?
Where can I find the best evidence about safe and effective maternity care?
What does it mean to give "informed consent?"
What are my legal rights to "informed consent" and "informed refusal?"
What are some tips to help me explore these issues with my doctor or midwife?
What happens if I disagree with my caregiver?
Shared decision making: The growing standard
Listening to Mothers survey found that most women fully understood their right to make informed maternity care decisions, strongly supported having choices about mode of birth, and wanted to understand potential complications before agreeing to have major maternity interventions.
Maternity professionals are responsible for providing scientifically supported care and for meeting the legal standard of informed consent. Legally, more and more states are adopting a "patient viewpoint standard." This means that clinicians must tell you about the possible benefits and harms that a reasonable person in your situation would want to know to make an informed decision. This is replacing a "clinician viewpoint standard," what a typical clinician feels you need to know.
It takes time and work to meet these legal and ethical standards for informed consent. It is crucial to have full and accurate information about labor and birth decision points and interventions well before labor in order to pursue the care of your choice and make informed decisions around the time of birth.
It is always important to understand whether there is a clear, well-supported rationale for having any procedure, drug, test or treatment that is being considered. In many care settings, medical interventions are used freely and even routinely, even when the mother or the baby have not shown a clear need. Although these practices may be of value to women or babies in certain situations, they may be unnecessary for most. They may be disruptive and uncomfortable, can cause more serious side effects, and often involve extra interventions to monitor, prevent, or treat unwanted effects. They also contribute to needlessly high costs of maternity care. For these reasons, interventions should not be used routinely or unnecessarily.
Research about maternity care decision making shows that care processes often fail to meet legal standards for providing adequate information and choice of care. As you cannot count on the health care system to meet these standards, it would be wise to be pro-active about recognizing decision points, seeking needed information, making informed decisions, and communicating these to your care team. If, during pregnancy, you have concerns that your care team or planned birth setting is not a good match for your values and preferences, you may want to explore other options.
evidence-based maternity care. The unique features in the For Women area of this site provide trustworthy information about safe and effective maternity care, with tips and tools to help with decisions and carefully selected resources for learning more.
You may feel uncertain about becoming actively involved in decision making. Information and advice from studies, news reports, online features, and friends and relatives can differ. It can be challenging to know what or whom to believe, especially when facing decisions that can have lasting effects on you and your children.
Many women trust their caregivers to provide care that is safe and effective for themselves and their babies. Yet, some forms of maternity care are overused and provided to many women when they are not needed but may cause discomfort, side effects, and extra expense. Examples include labor induction, episiotomy, cesarean section, and staff-directed pushing. Some types of beneficial care are not provided often enough. Examples include help with quitting smoking, support for breastfeeding, continuous labor support, and vaginal birth after cesarean. We urge childbearing women to become active participants in their care by becoming informed, clarifying goals, and seeking care that is right for you and your baby. Our goal is to help you make informed decisions about care that is best for you and your baby by providing you with the best, up-to-date information on common maternity care practices. This website also helps you understand that your choice of caregiver and choice of a place of birth can have a major impact on the care that you receive. We urge you to make those decisions with great care.
You have a right to clear and full explanations about your care and answers to any questions you may have. You also have the right to request and receive a copy of your medical records and to get a second opinion.
Then, by law, you have the right to decide whether to accept the care that is offered. If you disagree with your caregiver and decide not to accept that care, you have a right to this "informed refusal." Even if you signed a form agreeing to a particular type of care, you have the right to change your mind. Although these are well-established legal rights, they have been challenged in a few recent cases.
It can be difficult to carry out the informed consent process in busy health care settings. Even so, it is wise to set aside the time to discuss these issues in advance with your caregiver whenever possible, and again when it is time to make a decision. Avoid learning about procedures and options for the first time while you are in labor and facing important decisions. At that time, it may be too late to get all questions answered, weigh options, and pursue specific preferences.
While talking with caregivers, you can say:
These issues speak to the importance of having a good working relationship with your provider that includes open communication, mutual respect, and shared points of view. Be sure to take care to choose a doctor or midwife who respects your needs, values and goals. If you discover in the course of your care that you disagree with your caregiver or your policies at your planned birth setting on important issues, it would be wise to explore other options. Early action is recommended when seeking another caregiver: it can be hard to find a good match who accepts care transfers later in pregnancy.
Unfortunately, few decision aids that meet international standards are available for maternity care topics at this time. We expect that a growing number of high-quality maternity care decision aids will be available in the coming years.
© 2015 Childbirth Connection. All rights reserved.
Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families.
Most recent page update: 1/17/2013