Childbirth Companion

Doula Care & Educational Support


Informed Choice or Just a Mirage?

Posted by Stephanie Hayes on February 6, 2012 at 10:10 PM

     In looking back over the changing tides of health care for the birthing family, we may come to wonder how much is truly for the benefit of the primary individuals involved - the pregnant mother and her unborn baby. Do women really have options and a voice about what goes on during their labours and births? Or is this simply an illusion that clouds a reality of a litigious, systems-oriented society that no longer has faith in a purely natural, physiological process – the age old art of childbirth?

     As women begin to question their birthing rights and freedoms, there is a drive to become more informed about their options, and to take back birth. But what is “informed choice”, really? Is it a real, viable option available to expectant mothers, or just a phrase coined to make us feel more in control? And what if we want to choose to say “no” or to utilize an unconventional option? Will our wishes be honoured, or will we be pressured and guilted into complying with the policies and procedures primarily designed for the political comfort and security of the institution rather than the emotional and physical wellbeing of the birthing woman? Will unbiased, clear, detailed information be provided to assist us in making a well-informed, educated decision, or will it be minimal and tanted in a way that is intended to steer us in a direction which confines us to the comfort zone of another whose birth experience this is not?

     To understand this more fully, we need to explore the phenomena of Informed Choice and its sister entities, Informed Consent and Informed Refusal. Each woman must know what this means in relation to her rights and her caregiver’s responsibilities. It is more than saying yes or no, and goes beyond simply signing a consent form. Each birth is unique with its own set of circumstances, and it is important that all those involved enter it with an open mind and a willingness to think outside the box.

     Informed choice means that the mother has reviewed what has been revealed, and based on that information, makes choices about her care, determining what she will or will not consent to. Medical practitioners must provide a mother with all relevant, unbiased, comprehensible information about a procedure or treatment prior to obtaining her consent to carry it out. This information must be provided in terms which she understands, covering the nature of the procedure, its risks and benefits, the availability of alternative treatments (including no treatment at all) along with their risks and benefits. As long as the pregnant woman is mentally and physically able to discuss her condition, medical care cannot begin unless she gives informed consent. And if she declines? A mother has the right to refuse any test or procedure for herself or her baby. With informed refusal, the health provider must inform her of the risks or consequences of refusing treatment, procedures or tests.

     Informed choice should not be about any one person vying for control over another or imposing their will on another. It should be about open communication between the expectant parents (the mother in particular) and their caregivers, with consideration for each one’s position. When placing her care in the hands of her medical provider, the mother is assuming that her best interests are at heart, so it is important that she is willing to consider her caregiver’s point of view. However, the same respect should be given to her feelings, wishes, and concerns as well. The pregnant woman has the right to hear the truth about birth, and not fear that the information she receives is biased or unfounded. It should be assumed that she will have full participation in all decisions regarding her care and that of her baby. Risks and benefits of any procedure or treatment should be explained clearly in terms that she understands, leaving her with the right to choose among available options or to refuse them altogether. A signed consent form or birth plan does not inhibit her from changing her mind at any time, and it is always within her rights to obtain information that is satisfactory to her, prior to her acceptance of a procedure or treatment.

     Now this may all sound well and good, but we all know that things don’t always go the way they’re intended to. How will you remember what questions to ask or if you’ve received good information? What if you don’t feel that you’re care provider is very open to your wishes or concerns? Or maybe during a busy shift change, the new staff members didn’t get a chance to review your birth plan before initiating care.

     We know that when a woman is in labour, it can be challenging for her to be aware of everything that may be going on, so she will undoubtedly benefit from having the assistance of her support team. Her husband can be specifically helpful in relaying her wishes and fielding questions due to his intimate connection with the birth of their baby. However, sometimes that can be overwhelming even for him, and the advocacy of their doula may prove invaluable. With her experience and knowledge of birth and alternative options, a doula can assist the parents in gleaning the information necessary to make informed choices. Ideally this will begin prenatally in preparation for birth, but may also become necessary during labour.

      Remembering the right questions to ask may not come easily, but this simple acronym may be helpful in “using your brains”.


B enefit – What is the benefit in moving ahead with the recommended treatment or procedure?

R isk – What about the risk involved?

A lternatives – What other options could we explore?

I ntuition – Don’t ignore your sense of intuition. Give consideration to your feelings as well.

N othing – Could it hurt to wait? Proposed interventions don’t often require immediate action.

S mile – When asking questions and stating your wishes, it is important to offer your caregivers the courtesy and respect you desire from them as well.


Questions to Consider Before Giving Your Consent

• How is this helpful to me or my baby?

• Are there any risks involved?

• Can you recommend a safe alternative including waiting? Their advantages? Disadvantages?

• How will this affect my labour? My baby?

• Will this procedure require the need for others, or can it lead to others?

• Do I have time to think about this and give you my answer later?

• If I choose not to go ahead with this recommendation, what possible consequences could there be for me or my baby?

• How do you feel about me getting a second opinion?



• Gentle Birth Choices, by Barbara Harper


For more information regarding doula care, birth planning, and informed choice, contact, Childbirth Companion.

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