Embracing Your Role as Decision-Maker

Let's talk about something that affects every aspect of life, from the mundane to the monumental: decision-making. Whether it's picking what to have for breakfast or deciding on a career change, our choices shape our lives in profound ways. And when it comes to the journey of pregnancy, birth, and postpartum, decision-making takes on a whole new level of importance. From routine prenatal care and birth plans to navigating birth and postpartum in the moment, your decisions matter.

It’s also important to understand your role in the decision-making process. Ultimately, you are in charge. You can say yes or no to any exam, procedure, medication, test, etc. It’s your pregnancy/ birth/ body/ baby. You can choose to follow medical advice, to pick an alternative option, or to do nothing at all. 

Having ongoing discussions during your prenatal care visits about your options can give you invaluable insight into how you might be treated during birth. Does your care provider seem to respect your autonomy and role as the ultimate decision-maker? Unfortunately, this isn’t always the case. Here’s a quote from Cristin Pascucci of Birth Monopoly:

For most women, pregnancy and childbirth are one of the few times we let other adults tell us what we are “allowed” and “not allowed” to do with our own bodies. It’s time to change our language around this to reflect the legal and ethical reality that it is the patient who chooses to allow the provider to do something—not the other way around—and to eliminate a word that has no place between true partners in care.

You can read the entire article here:

🔗 You’re Not Allowed to Not Allow Me | Birth Monopoly

One of the most important decisions you can make for your pregnancy and birth is who you choose as your care provider. It’s important to find someone who recognizes and respects your role as decision-maker. 

Decision-Making Process

I like to think of decision-making as a flexible, four-phase process:

• Discover
• Discuss
• Decide
• Document

I’m going to go into more detail about each phase in just a minute. But, first, I want to emphasize that this process can be used no matter what kind of decision needs to be made. You can use it for making decisions about prenatal care, in birth planning, when navigating the unexpected during birth, and for making medical decisions for your child. Some decisions can be made in advance, while others happen in the moment. Either way, the four phases are the same.

Discover

The first phase is all about discovering…

• …that a decision needs to be made
• …what routine care looks like
• …what normal looks like
• …that something unexpected has happened
• …what options are available to you
• …common reasons for needing medical interventions during birth
• …what the research says about options you are considering

When it comes to prenatal care, this can look like deciding whether or not to consent to an exam or do prenatal genetic testing. If any complications or risk factors develop, there could be decisions to make that go beyond routine care.

When birth planning, this first step can look like discovering what all of your options are and learning all about them (childbirth education is great for this!).

During birth, this can look like discovering that a complication has developed, and a decision needs to be made that differs from what was planned or expected.

There are also decisions you can make in advance about routine newborn care.

This phase is very much dependent on the situation. There is more time for discovery when you’re approaching decisions from a planning perspective than when faced with something more time-critical. However, childbirth education and learning about birth in advance can help you discover information that could help you later on in the moment. 

When discovering more about your options in advance, you’ll want to pay attention to benefits and risks of each. If you’re starting to gravitate toward one particular option, take note of that.

Please be aware that misinformation is everywhere, and you don’t want to include anything inaccurate or misleading into your decision-making. It’s so important to use trustworthy sources as you’re discovering and learning. Here are some examples:

• Evidence Based Birth®
• Cochrane Library
• Resources from organizations like ACOG (American College of Obstetricians and Gynecologists) and ACNM (American College of Nurse-Midwives)
• Care provider
• Childbirth education class or resources
• Doula

📝 Note: My Resource Database is a curated collection of quality resources to help you gather evidence-based information to inform your decisions.

While decisions don’t need to be made on evidence alone, it’s critical that they are informed by reliable and accurate information. 

Discuss

Discussions with your care provider is an important part of the decision-making process.

This phase can be initiated by your care provider after they have presented you with a decision that needs to be made about your care. This phase can also be initiated by you when you want to discuss your options. 

It’s important to understand that routine care can sometimes be presented in a way that feels like a requirement or that you don’t really have a choice. This is true when it comes to prenatal care, in birth, and postpartum. Just remember you can always initiate a discussion before consenting to or refusing an exam, procedure, test, medication, etc.

Your care provider’s role is to provide you with medical advice and to make sure you fully understand the benefits and risks of any decisions you make.This means they use their experience and expertise to help you understand how the evidence applies to you, specifically. Your health history and current pregnancy status may have an impact. Your care provider may recommend one option over the others. Make sure you understand why.

If your care provider says anything that differs from what you’ve found in your own research from the discover phase, consider bringing this up in your discussion.

You may also find out that a particular option you’ve researched isn’t available to you. Use this opportunity to get clarity on why this might be. Here are some possible reasons:

• Equipment or resources are not available at your birth location
• Limitations imposed by your health insurance plan
• Care provider experience and expertise
• Policies that have been put in place
• Complications or risk factors associated with your pregnancy

‼️ Important: This phase is especially important when making in-the-moment, unexpected, and time-critical decisions. It’s not always possible to research your options in advance, like when you are birth planning. 

Decide

Now it’s time to make an informed decision, based on the options that are available to you. This is where you consider your preferences, priorities, values, and goals, along with the evidence-based information you’ve gathered and medical advice you’ve received.

It’s so important to understand that this decision is yours. You have the right to bodily autonomy and are the ultimate authority when it comes to decisions about it, as well as your pregnancy, birth, and baby.

There are benefits and risks to all options. How those might impact you and how you interpret the benefits and risks can differ from someone else.

Document

Informed consent or refusal can be given verbally, and it will be documented in your medical records. In some cases, however, you may be asked to document your decision on a form (indicating your informed consent or refusal). Keep in mind, you have the right to change your mind, even if you’ve signed a form.

‼️ Important: Signing a consent form upon admission to a hospital is not the same thing as giving informed consent for specific medical interventions, procedures, etc.

Also, birth plans are a great way to document any decisions you’ve made in advance and serve as a communication tool for your birth team. You are more likely to meet resistance in the moment when it comes to certain decisions if you haven’t gone through the discuss phase with your care provider in advance. Think of birth planning as encompassing all of the phases of this decision-making process.

Final Thoughts

Learning how to make informed decisions is a crucial life skill that can serve you well now AND beyond pregnancy, birth, and postpartum. This skill also independent of any particular birth method or ideology. Your decisions are yours to make.

How do you want to approach your own decisions and experience? Discover your Birth Journey Archetype and gain some helpful insight!

Click here to take the quiz!