Making Informed Decisions About Your Care

What does making an informed decision mean?

Making informed medical decisions involves having a two-way conversation with your healthcare provider that results in you feeling confident in your understanding about your health concerns, and any medical test, treatment, or intervention options. This includes understanding the risks and benefits, for each option, for you and your baby, the alternatives, as well as the benefits and risks of doing nothing. It’s important that you come to a decision that feels right for both you and your baby. The informed decision-making process protects your right to informed consent or refusal.¹

• Every person is an individual with different values, preferences, and life experiences. These are important factors in making decisions in every aspect of your life, including medical decisions. Two different people with the same health issue may make different treatment decisions.

• Making informed decisions can have lasting effects on the health and well-being of your baby, yourself, and your family.¹
• Healthcare providers have a responsibility to provide evidence-based care, to support the process of informed decision-making and to respect your informed decision to consent to or to refuse a test, treatment, or procedure.

How can I actively participate?

Healthcare providers can offer accurate and up-to-date information to help you make informed decisions; however, it’s important that you are an active decision‐maker in the care that you receive by:

• Finding the best available information to learn about pregnancy and your birth options. Our Prenatal Health Education Programs can assist you with this.
• Asking your healthcare provider questions if you don’t understand something.
• Discussing your wishes and expectations for your birth and sharing what is important to you with your healthcare provider before going into labour.
• Asking your healthcare provider (and other members of your healthcare team) what their care practices and preferences are in relation to any interventions used during labour and birth.
• Asking about hospital policies related to any interventions or birth preferences you have.
• Understanding your healthcare provider’s care practices and preferences and hospital policies ahead of time can help ensure that you will be able to make an informed decision during your labour and birth. “When pregnant, giving birth, and in the postpartum period, it is your responsibility to make informed decisions for yourself and on behalf of your baby. It is your legal right to give – or deny – permission for care.”²

How do I ensure that I am making informed decisions?

When discussing your pregnancy, labour and birth options with your care provider use the B-R-A-I-N tool³:

• B enefits: How will this help my baby? How will this help me? How will this help my labour?

• R isks: How will this affect my baby? How will this affect me? How will this affect my labour?

• A lternatives: What are my other options including doing nothing? How will this affect my baby? How will this affect me? How will this affect my labour?

• I nstinct/Intuition: What is your inner voice telling you?

• N o or Not Now: What if we don’t do the procedure right now? What if we do nothing? Use language such as "I need time to think this decision through" or "I need a private moment to talk with my family". You have the right to informed refusal of care.

A helpful process for making an informed decision usually includes:

• Finding credible sources of evidence-based information to learn about the test or procedure.
• Thinking about and writing down why you would choose the test or procedure.
• Thinking about and writing down why you would not choose the test or procedure.
• Identifying which of the reasons matter most to you when you think about why you would or wouldn’t choose the procedure. This is an important step because the reasons you value most will help guide you to make your decision.
• Identifying which option you are leaning towards. If you are still undecided, list any remaining questions you have so you can ask your healthcare provider at your next appointment.

It is best to make decisions about your care together with your healthcare team. This is called shared decision-making. The tools (decision aids) below can help you feel more comfortable participating in the decision-making process. As your situation changes so can your decisions.

Tools to aid Informed Decision-Making

Decision aids were designed to help guide people faced with important decisions about their care. They support informed choice. Health information is presented in an easy-to-understand way so that options and possible outcomes can be understood better. Decision aids help people to make decisions that match their values and preferences.⁴

Making decisions that are right for you and your baby can be difficult when there is more than one option and when the options have advantages and disadvantages. You will feel happier about your decision, and it will be a more informed one when you:

• Learn about the benefits and risks of all your options and their alternatives
• Have a better understanding of the benefits and harms of the options
• Think about what really matters to you
• Come to a decision that is consistent with your values and preferences
• Consider whether you have the support you need from your healthcare provider and family for the decision you have made

The following decision aids were developed by a variety of healthcare organizations to help you make informed decisions for any health decision. and for labour and birth.

General

• The Ottawa Personal Decision Guides - a tool you can use for any health decision.
• The Ottawa Hospital: A to Z International Inventory of Decision Aids

Choice of Birthplace

• Association of Ontario Midwives: Your first birth: weighing your options for choice of birthplace
• NHS: Choices Where to Give Birth – The Options

Labour Pain Relief

• My Health Alberta: Pregnancy: Should I Have an Epidural During Childbirth?

Labour Induction

• Association of Ontario Midwives: When your pregnancy goes past your due date
• Association of Ontario Midwives: In Due Time...Pregnancy Beyond 40 and Induction of Labour
• Partner to Decide: Your Choice: Spontaneous Labor or Labor Induction?

Caesarean Section

• Perinatal Services BC: My Next Birth Decision Tool
• Association of Ontario Midwives: Thinking about VBAC: Deciding what’s right for me
• My Alberta Health: Should I Try Vaginal Birth After a Past C-Section (VBAC)?
• Quali-Dec app: vaginal delivery or caesarean section
• HealthLink BC Vaginal Birth After Caesarean (VBAC)

Delayed Umbilical Cord Clamping

• Umbilical cord management in preterm and term infants (Clinical Guideline from the Society of Obstetricians and Gynecologists of Canada and the Canadian Paediatric Society Fetus and Newborn Committee)

Baby’s Umbilical Cord Blood

• HealthLink BC Pregnancy: Should I Bank my Baby’s Umbilical Cord Blood