Informed Decision Making?

Recent Canadian studies on the knowledge and beliefs about birth practices among first-time pregnant women and their care providers indicates that many women are inadequately informed and that many care providers deliver non-evidence-based care.

Consequently, informed decision making is problematic ... and perhaps even questionable.

In the Canadian study, 43% women were cared for by an obstetrician, 29% by a family physician (GP), and 28% by a registered midwife.
Only 30% of the women had attended childbirth education classes, and books and the Internet were the main sources of information.
The study found that women who attended obstetricians were more favourable to  technology and less supportive of women’s roles in their own birth experiences.
Women who attended midwives were less favourable to the use of technology and more supportive of women’s roles in their birth experiences.
GPs' patients’ viewpoints fell between the two other groups.

Lack of informed knowledge surrounded the use of common interventions such as epidurals, assisted birth, caesarean, episiotomy and so on.

As well as this, women were poorly informed of their choices around care providers and place of birth, including hospital, birth centre and home.

However, it became apparent that women who attended registered midwives had more evidence-based knowledge than women who attended obstetricians.

20% women who attended an obstetrician believed that caesareans were at least as safe as vaginal birth, and many believed that epidurals did not interfere with the labour and birth processes.

Interestingly, younger obstetricians were more likely than older obstetricians to believe that epidurals did not interfere with labour; that caesareans protected against pelvic floor dysfunction, sexual problems, and urinary incontinence; and that caesarean surgery was safer for mother and baby. Obstetricians in the younger group were less favourable to birth plans, less likely to acknowledge the importance of the woman’s role in her own birth experience, and more likely to view caesarean surgery as “just another way to have a baby.”

All of this put together, it raises the question of informed consent and informed refusal.  With many women mis-informed, and some care providers providing non-evidence-based information, women are placed in a vulnerable position.

Interestingly, the women who were cared for by registered midwives seemed to have the most evidence-based information and healthiest views of pregnancy and birth, however this is rarely offered as an option in the private sector in Australia.

Learn more about private midwifery care and shared care.