In teaching informed decision-making, it’s not just about teaching birth plans, or just teaching key questions. There need to be at least four steps:
- Figure out your goals and preferences first (values clarification)
1a. Choose the care provider and birth place that are most in alignment with your goals, preferences, and unique health needs (caregiver choices)
- Articulate those priorities for care providers (birth plan)
- Then if an intervention is proposed that is outside your birth plan, gather data on it (key questions).
- Then take that information and weigh it against your values to make the decision that is right for you. (informed decision-making)
And teaching these things is not just about Theory – we also have to Practice!
A quick note about step 1a: Ideally, this would always be the process. If I was talking to someone in early pregnancy who hadn’t yet chosen, I would absolutely cover that step. But, in childbirth classes, when I’m speaking to people in their third trimester, that choice was made long ago. So I won’t cover 1a. (But some of the other steps may lead students to question for themselves whether the caregiver choice they made was the right one.)
Let’s look at options for teaching each of those.
1. Values Clarification: The goal is to talk about what they want their birth to look like – what kind of labor support do they want, what are their views on interventions and pain medications, how involved they want to be in decision-making, and generally: what would help this birth be satisfying for them. There are many ways you could do this. I created a worksheet that could be used in class, or as a homework assignment, that would be one way of exploring these questions. The pregnant parent fills out one form with their values, the partner fills out a slightly different form with their values. Then they compare their answers and discuss them. How do they come to have a common vision of their goals and priorities? (And if they can’t, with birth, the pregnant parent’s priorities need to win in the end, so they may need to agree to that.) They can also discuss here whether their caregiver and birthplace share those values. Here’s the Values Clarification worksheet.
1a. Choose the caregivers that match that. (Check out the quiz at the beginning of the Great Starts Guide for one approach to this step.)
2. Articulate those priorities in a birth plan. (See Pregnancy, Childbirth, and the Newborn for our approach to birth plans.)
3. Key Questions. Here’s what we teach:
Whenever a test or procedure is offered, first ask how urgent / severe the situation is and whether you have time to ask questions, discuss options, and consider the information you’ve learned. Then, ask:
- Benefits: What’s the problem we’re trying to identify, prevent, or fix? How is the test or procedure done? Will it work?
- Risks: What are the possible tradeoffs, side effects, or risks for my baby or me? How are they handled?
- Alternatives: What other options are available? What if I wait? Or do nothing?
- Next steps: If the procedure doesn’t identify or solve the problem, what will we need to do next?
It would be all too easy to stop with the key questions, thinking we’ve done our job, but we just missed they key point of decision making: MAKING THE DECISION!
We need to remind them that although their caregiver is an expert source of information and advice on benefits and risks, that only they can take into account all their goals and priorities and make the choice that is best for them. We also need to acknowledge that sometimes the choice we need to make is NOT something we wanted. But we want parents to feel in retrospect, that the choice they made DID line up with their values, and WAS the best decision available at the time.
4.Teaching Informed Decision-Making. Check out my next post for this one…