Informed Choice vs Too Much Information: Striking a Balance in Birth preparation

When it comes to understanding and weighing up your options about birth, it’s easy to feel daunted as there is a lot of information out there.  How do you find the information that will prepare you for birth, and not scare you?  Where do you start, and what do you really need to know in order to make an informed choice?  Here Daisy teacher Ceri Elms explains all…

Learning to work with your body 

First things first, you already know how to give birth. It is something women have been doing quite literally since the beginning of womankind so you have the natural ability and instincts within you already.  You just need to believe in yourself, trust your body and use the resources available to you to make the experience as positive and efficient as possible.

Learning what is happening to your body in pregnancy and labour can help you to feel more confident and prepared and make you feel more in control, no matter what happens.  When you learn that you can use gentle movements to ease indigestion, or that the positions you get into on a regular daily basis can affect the position your baby gets into in the womb you can work with your body and feel empowered through knowledge.  For example, if you often lay back on the sofa to rest and sit at a desk all day leaning back in your chair, you may find that your baby is encouraged to settle into a posterior position (back to back) which can make their descent less efficient and more challenging for you.   Learning other positions that you can adopt instead, such as getting into all fours, using a birthing ball as a seat or sitting cross legged, can encourage your baby into a more favourable anterior position.  These positions can also help to bring balance to your womb and open up and release vital birthing muscles.  As well as making things more comfortable for you in the long run,  this is very powerful practical information to have at your disposal.

 Birth Choices

It’s clear to see how learning more about the changes in your body during pregnancy and birth  and what may happen in labour may help you to keep calm and feel in control.  In addition, learning the practical things you can do to look after yourself and your growing baby makes sense and has huge benefits.  But how about your birth choices?  How can you make sense of all the options available to you?  From the kind of birth you want (homebirth, hospital birth, c-section, vaginal delivery etc…); to the finer details e.g. do you want a managed or natural 3rd stage of labour (the expulsion of the placenta)?  How do you even know which option you do want, and can you change your mind?!  It may seem overwhelming at first, but there are only so many ways a baby can be born and only a certain number of drugs, interventions and treatments that may be proposed, so getting a good balanced over-view is actually easier than you may think (as is getting too much information, but we will come to that in a bit!).

 The best way to get your head around your birth and what you want is to prepare and ask questions now, whilst you are pregnant.  Use your midwife and consultants, or your GP.  They are used to people asking questions and they are there to help you decide what is right for you and your baby.  Never feel afraid of asking ‘too many questions’.  I kept a log of questions on my phone which I kept adding to whenever a new thought or worry popped into my head, and whenever I had a midwife appointment I went through my list and wrote her answers in brief next to each one.  We did joke about my ‘never-ending’ list of questions, but she answered every one of them and I had them to hand to refer to when I was making my birth plan and it just made me feel more confident, less anxious and more clued up.

 Informed Choice

Making an informed choice about your birth means knowing what your options are in each scenario through asking questions.  Perhaps you may join an antenatal course where you can discuss options freely and openly.  In addition, you can do some of your own research and reading on reputable sites such as www.nhschoices.co.uk or https://www.which.co.uk/birth-choice.  The Daisy Foundation also has a fantastic, accessible round up of the key informed choices you will want to consider around birth, and other areas of parenting too, all in one handy place – bookmark this and use it as a starting point to creating your own fully informed choices http://2018_beta/thedaisyfoundation.com/backup/inform-my-choice/  

 Remember that you do have choices in every birth scenario, even if it doesn’t feel like it.  For example, you might be thinking “I’m having a caesarean, so what choices do I have?”  Lots!  You can choose if you want to see the birth by having the screen lowered (if not an emergency); you can choose to walk to the operating theatre and put yourself on to the operating table, rather than be ‘wheeled’ in; you can choose to be talked through the operation (if not under general anaesthetic).  There are always choices in every birth situation so always ask.

 You can consent, decline or ask for more information at any point.  Whether it is about a drug, intervention or treatment being recommended to you; or a change of course to your desired birth direction being discussed – to every detail in-between.  If you feel pressured into making a certain decision through fear or coercion then this is not consent.  Informed consent is when you are told about and understand the risks and benefits to any treatment or option being offered to you, as well as being informed about other options you could take instead.  This may include the option of doing nothing (more on that later).  You  should also be given the chance and plenty of time to ask further questions and have them answered to your satisfaction as well as being able to discuss what you want to do with medical staff and/or your family/birth partner/s etc…  All of these steps should lead to you making a decision that you believe is in the best interest for you and your baby, based on facts and information.

 Preparing for birth

To help you prepare for birth, it is a great idea to book in a visit to the labour ward or birth centre that you plan to use to have a tour and talk with the midwives – usually you can just call them up to book a slot or speak to your midwife about this at your next appointment.  However, some maternity suites don’t offer this anymore as they are simply too busy, but they should have an option to access an online tour via their NHS website so do ask your midwives about this.  Walking around or seeing the rooms online and noting the different options first hand; familiarising yourself with the space, the smell (if possible), the lights; finding out how to access the building at 4am in the morning; knowing where to park etc… can all really help you to relax.  And to see what a ventouse or foetal monitoring unit looks like, and to find out if there are mobile epidural units at the hospital and see one up close.  This can make them all suddenly much less intimidating.  Then if you do decide to use them, or end up having to for any reason, the fear of the unknown will already have been removed, so you can focus on staying calm, breathing and keeping that adrenalin at bay.  If you are having a home birth, find out what the set up will be and what your midwives will be bringing and when etc..  If you want a water birth, take a look at a birthing pool and find out how long it takes to fill etc.. to make everything more familiar before your birthday day.

 Trust your instincts

Making informed choices is also about trusting your gut and going with your instincts.  Only you know what you want and it’s your birth at the end of the day.  You may understand the reasons for a ‘natural’ drug-free labour, and be fully armed with your Daisy breathing and active birth movements, but still want to have gas and air and pethidine if you need it because that’s your choice.  You don’t have to explain your reasons, just trust your instincts and get enough information to feel confident that whatever you decide is right for you and your baby.  Know as well that you can change your mind too (it’s advisable to speak to your midwife/consultant team about local protocol around birth options and changing them on the day too so you know what to expect). 

 Use your B.R.A.I.N!

The key questions to ask about each stage of birth and any interventions, drugs, treatments or courses of action being discussed or proposed are: what are my options?; what are the pros and cons to each of them?; and what support will I receive to make the right decision for me and my baby?

 A great way to remember how to make a calm and informed decision, in any situation, is to use your B.R.A.I.N and ask the following questions (it’s also a great idea to share this with your birth partner so they can support you in making the right decision):

 B – BENEFITS: what are the benefits of this option?

R – RISKS: what are the risks involved?

A – ALTERNATIVES: are there any other alternatives available?

I – INTUITION: what does your intuition say, how do you feel about it in your gut?

N – NOTHING: what will happen if you do nothing? (Sometimes simply waiting for a bit can be an option too)

If you have given yourself time to find out about all your options, even if you don’t think you will need them, you will be confident enough to make a change that’s right for you in the moment.  You might be planning a home water birth so don’t think you need to know about c-sections or labour wards, but birth doesn’t always follow the path we would like it to. You may end up having to go to hospital and having a caesarean if complications arise.  If you haven’t prepared yourself for this as a possibility at all and don’t know what may happen or what options and rights you have in this situation or what you can still do to keep calm and positive, it could be a scary and potentially traumatic experience.  But it really doesn’t have to be.  It’s all about building as full a picture as possible of ‘what happens if…’, so you can pick and choose the elements that work for you and understand what is happening if things change course, as they may well do.  Being prepared is the key to staying calm, confident and positive.

 Too much information?

There is a tipping point however, when ensuring you are informed and know your options, can turn into over saturating yourself with too much information which can be confusing, make you more anxious and cause you to question what you really feel.  The best advice I can give you, that I wish I had followed during my pregnancy and birth planning, is step away from search engines and chat forums (and you don’t need to read all the birth books!).  It’s so tempting to keep searching for article after article, blog after blog and opinion after opinion about birth or perhaps get fixated on a certain area of birth that really scares you.  For me, that was episiotomies and the bearing down stage which I didn’t think I had the ability to do.  As a result, I read too much about both and became even more frightened of being cut or tearing, and even more convinced I wasn’t capable of giving birth (I hadn’t found Daisy Birthing at this point sadly!).  In the end, I had an episiotomy and I didn’t care one bit as at the time it was the best decision for my baby, and I managed to give birth and bear down just fine, despite doubting myself and despite every horror story I had read and listened to about possible complications and negative birth experiences.

That’s the other main piece of advice I’d like to give you, take friends, family members, and other well-meaning people’s birth stories as just that – their stories.  Just because it happened to them or their friend’s aunt’s daughter, doesn’t mean it will happen to you!  We still have a society that likes to shout about the negative, traumatic and horrible things that can happen – rather than celebrating the wonderful births that take place every day where things do go to plan; or things work out well regardless of the twists and turns!  These births, the positive, empowering and ‘ordinary’ ones (though no births are ever ordinary in my opinion as birth, in all its forms, is amazing!), are actually the most common.  They just don’t make as juicy a headline, or as shocking a story so sadly they don’t get the air time or sharing that they really should.

I hope you have the birth that you want, and that you find the time to prepare yourself for what can happen, even if it isn’t what you want right now. I also hope that if your birth doesn’t ‘go to plan’, and isn’t quite what you imagined, that you have the confidence to ask questions, make informed choices and to understand the other options available to you.  However your birth happens, I hope you feel as calm, positive and as in control as you possibly can, and that you feel listened to and empowered by having choices.  And let’s do all women a favour, and keep sharing more of our positive birth experiences.

Love Daisy x