Decision-making: Heart and Head

Through my practice, I have a lot of women coming to me who are experiencing conflict with regards to the choices they have made for their pregnancy and birth. Typically, they find (sometimes quite late in their pregnancy) that perhaps the choice they made right back at the start of their pregnancy, no longer works for the, or the choice that they made was perhaps not as well informed as they thought it was. Some women find it hard to take the attitude of interviewing potential care providers before pregnancy (or very early in pregnancy) and then choosing the midwife or obstetrician who is best able to meet their needs. The end result can often be a woman who chooses an obstetrician with the goal of a natural birth, only to discover that their doctor will only “deliver” their baby if they’re on their back in bed with an epidural in place. Or that induction is performed by 40 weeks, or that all women have their waters broken and all first time Mums have an episiotomy or so on. And sometimes, the more reading a woman does, the more she realises that this is not what she wants. I often ask the question, “What was it that made you decide on this particular care provider?”

And the responses are generally very interesting.

• My GP referred me • My mother / sister / friend / neighbour used this midwife and she said she’s wonderful • Well, when I got pregnant I went to my GP. She asked me if I have private health insurance and I said yes, so she wrote a referral to Dr XX.

I ask these women if they considered any other options. “What options?” comes the response.

I’m amazed that with the marvels of modern technology, internet etc, women don’t know they have other options. We have options with all sorts of things in life, and we don't shy away from discovering them either! It seems to be to be an interesting handing-over of responsibility when it comes to pregnancy and birth, and I’m curious why it happens with pregnancy and birth, but not in other aspects of life. Do we buy a particular computer – that can’t meet our needs – because it was recommended and we didn’t know there were other computers on the market? Do we buy a large house when we need a small house because it was recommended by the real estate agent?

In most other situations where choices are involved, people will engage in a process of assessing options.

We might list all the possible options and then assess each option across a range of qualities.

We ask questions.

We consider what it is that we really want, and then match it to what’s available, seeking the most compatible choice.

But sadly, this does not happen with pregnancy and birth. Perhaps it should?

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