An informed decision is a voluntary, well considered decision that an individual (or a couple) make on the basis of different options, knowledge, information and understanding. Any sort of decision can be difficult, but making informed decisions during pregnancy, childbirth and parenting is complex and has many layers (Goldberg, 2009:35). Even when given the pros, cons and alternatives there are many other factors and barriers, which can influence how an individual, or couple, make a decision.
There is no right or wrong way and what works for one person may not work for another, as individuals have different beliefs, circumstances and experiences that they draw on when making a decision.
During my training as an antenatal teacher, I had a ‘penny dropping’ moment about the difference between informed choice and informed decision. Previously, I had thought it was the same thing, i.e. you are making a choice or making a decision, it was just a different word to use. However, when you look at the language below, it is different.
The Definitions [via Answers.com ]
• A choice is a selection from a number or variety of options.
• A decision is reaching a conclusion or passing judgment on an issue.
When we choose, it’s like picking an item from a menu. If we come back the next time, we can make another choice. But a decision, by its very definition is a turning point and often something that can’t be changed afterwards.
Factors that may influence how people make decisions
There are many factors that influence the decision making process, including information, time, fear and support available. Sometimes the way an option is given limits its choice, for informed decision making is not just about choosing, but also knowing what the available options are. By not telling women about all the options, it is withholding information which could be used to make an informed decision.
The NICE (National Institute for Clinical Excellence) intrapartum care guidance states:
‘Women should have the opportunity to make informed decisions about their care and any treatment needed… Good communication between healthcare professionals and the woman and her family is essential. It should be supported by the provision of evidence-based written information tailored to the needs of the individual woman. Care and information should be appropriate to the woman, and her cultural practices should be taken into account. All information given should also be accessible to women, their partners and families.’
Tools for helping to make informed decisions
BRAIN is a good acronym for thinking through information before making a decision, but before you think about benefits and risks, ask if it’s an emergency and ask why something is being suggested. People often forget this once they are in a situation that requires a decision.
T ime – is it an emergency or have you got some time for questions?
Y – why? Asking why a procedure, intervention etc is being suggested
I nstincts / intuition?
Whose responsibility is it?
Again, there is no right or wrong answer here, some people want others to make decisions for them, they don’t want to make a decision, which in itself is a decision. Whilst others want lots of information and will read everything and talk to others about their experiences. ‘We make decisions based on the information we have available to us at the time’ ?REF?. People feel better about their birth experience, regardless of whether their birth plan was followed, if they feel that they were part of the decision making, that they had a say and some control, and did not feel they were just having stuff done to them.
When researching any aspect of pregnancy, labour and birth, be aware that anyone can put anything on the internet and that books go out of date quickly. Websites may or may not contain evidence based information, although also bear in mind that research studies can be made to say whatever the researcher (or funder) wants them to say. Try to locate all round information rather than just one sided points of view. Well established organisations such as NCT, AIMS, MIDIRS offer baseline resources which you may find a useful place to start.
Try to hold in mind that whatever your sister, aunt , mum, best friend, colleague or random stranger shared about her horror story of a birth, isn’t necessarily going to happen to you.
Each birth is unique and each one is a little miracle, research moves on, policies and practices change.