Ahhh CHOICE, what an emotive word

We live in a world full of it and I sometimes wonder if there is’t too much of it – especially when I’m in a supermarket or am flicking through my 100+ TV channels.  So I felt moved to look up the definition – so here you are:

1. The act of choosing; selection.
2. The power, right, or liberty to choose; option.
3. One that is chosen.
4. A number or variety from which to choose: a wide choice of styles and colors.
5. The best or most preferable part.
6. Care in choosing.
7. An alternative.

So what has this got to do with childbirth? After all, having a baby is hardly comparable to buying a car or choosing new wallpaper, right? How can I 1. ‘make a selection’ when I know nothing about obstetrics or worse, know nothing of my options?

To play with a famous quote, “Pregnancy is another country; they do things differently there”.  Most women, after seeing that thin blue line are catapulted into a place where they don’t speak the language, all the rules seem different and the only option is to cling to any life raft that is offered. It can seem comforting to be led by the hand through the corridors of pregnancy and birth. They don’t see all the other possible routes or the doors that could be opened. I mean the docs are the experts, right? I wouldn’t even consider trying to change the head gasket – I need a mechanic!

So, do we 2. have the ‘The power, right, or liberty to choose’? Certainly women are often not given this right – after all, how can we choose something we don’t know exists or is possible? But yes, your Caregivers should be giving you choice – for these reasons:

A. There almost always is an alternative or an option to do nothing.

B. Because you have autonomy over your own body. You own yourself and you get to choose who does what to you and your bits and pieces! This is a fundemental human right that we often forget when it comes to childbirth. No-one would ordinarily have the right, for example, to insert their fingers in your lady-parts without asking your permission and explaining why, right?

So what about 3 & 4? Making your choices for birth may be simple, complicated by numerous options or narrowed by health concerns for you or your baby. But there will always be a 5 – the route or option that feels optimal for you, the scenario that seems closest to your heart’s desire. This is your maternal instinct and can be overlooked or forgotten in the decision-making process.

But it is number 6 that is enshrined in our medical system – a gold standard that all health care providers should aspire to, which is written into the very fabric of philosophies of patient care: Informed Choice.

Informed means that you have enough information and have understood enough in order to choose, or give consent. Here’s how it should be:

consent requires the following elements:

• Competence. As a Client has autonomy, she has the right to makedecisions which may not seem to a Professional to be the best for the Client, despite information being provided.

• Information. Enough information must be provided for the Client toreach an informed decision; if only one side of the argument is fully explained in order to steer the Client into making a particular decision, then informed consent has not been obtained.

• Voluntariness. Free from coercion in which coercion may not beovert but may take the form of withdrawal of support if the desired outcome (from the Professional’s point of view) is not forthcoming.

• Decision. If a Client feels obliged to acquiesce i.e. to agree to a cause of action without reflection, consent has not been properly sought. [Draper (1996)]

And number 7? Well, there almost always is one. It might be so ‘out there’ or risky to be almost universally ignored or declined – but does anyone have the right to make that assumption on your behalf? As a competent, intelligent adult, you should be the one to say, “actually, I’ve decided I’m not going to give birth at home while suffering from pre-eclampsia”. A choice to homebirth in these circumstances would make many uncomfortable, even angry and outraged, but the fact remains that it is your right to take this course of action, however risky, unless someone can prove you need to be carted away to the funny farm.

Freedom of choice, freedom of action, freedom to bear the results of action—these are the three great freedoms that constitute personal responsibility. That responsibility for self feels very grown-up and I certainly don’t blame people who feel the need of the security blanket of ‘conveyor-belt care’. But what I do passionately believe is that doing nothing and enjoying being told what to do and when should also be a decision that is the perogative of the receiver of that care.

You’re having a baby. That’s parenthood. The choices you make for the birth of your baby are you flexing your parenting muscles in preparation for all the other choices and decisions you’ll be making for your child for the next 18-odd years. So if you feel the need for a little bit of help with the myriad decisions you may be presented with on your journey, let me remind you of this little thing:

B is for Benefits – what, dear Doctor, do you say will be the benefits of what you are proposing?

R is for Risks – and the downsides/side effects/possible repercussions?

A is for Alternatives – is there something else we could do?

I is for instinct – what’s that lovely gut instinct of yours saying?

N is for nothing – what if we do nowt and await events?

Oh and not to forget the other definition of ‘choice’ – as in ‘appealing to refined taste’, as in ‘ a choice dish’. I do hope your choices result in a choice labour and birth and the empowered feeling that comes from having called the shots – because you’re the boss!