Articles

Key takeaways

• You have the right to make decisions about your pregnancy and birth.
• Use the B.R.A.I.N.S. framework to ask questions about your care.
• Any treatment of procedure should have your informed consent before going ahead.
• Gather information and consider your personal situation when weighing options.

A framework for making decisions in pregnancy

Making decisions about your pregnancy and birth can sometimes be difficult. You will need to think about different risks and benefits. You will decide what is best for both you and your baby.

There is often no perfect solution or right answer. Sometimes you might feel like you are being told something will happen but remember is always your choice.

You have a right to say yes or no to any type of treatment, test, examination, or procedure. You might be happy to accept your midwife or doctor's recommendations, however it is best to listen to the options before finalising a decision.

Questions or worries about your choice can be normal. It is the role of a healthcare professional to support you and respect your decisions. Sometimes you might need to do your own research and take time to consider.

Using the B.R.A.I.N.S. framework

The B.R.A.I.N.S. framework is a way to remember important things to ask yourself and your midwife or doctor. This can help when decisions feel hard or complicated. It is especially helpful in times of stress when making a choice is more challenging.

• Benefits – What are the benefits of having this treatment?
• Risks – What are the risks (short and long term) to you and your baby, and what are the risks of not having it? What risks are you comfortable with?
• Alternatives – What are the alternatives? Can it be carried out differently if you need it to be?
• Instinct – What is your instinct telling you? What feels right for you?
• Nothing – What happens if you do nothing right now? What if you are not ready to do anything yet or need more time?
• Second opinion – Can you get a second opinion from another doctor or midwife? Who else could you talk to about this, such as friends, family, or your partner?

Some situations require quicker decisions. For example, when you are in labour, you may have to decide more quickly. It can help if you have discussed possible scenarios and thought through things beforehand.

Some people make a birth plan and also include their preferences if things do not happen the way they first hoped. This is like having a plan B and C.

Understanding your right to choose

You have a right to make decisions about your care. You can say yes, no, or not right now. This applies to any type of treatment, test, or examination. Healthcare professionals have a duty to make sure the choice is yours.

You can only be treated without your consent in rare situations. For example, an emergency or life-saving treatment is needed but you are unconscious.

What is informed consent?

Consent means saying yes to care or treatment. It can only be given by you. Informed consent means knowing exactly what you are agreeing to, refusing, or delaying.

To give consent, you must understand several things:

• What the treatment is and what it involves.
• The risks, what might happen, and benefits.
• All the other options.
• What will happen if you accept treatment and if you do not.

You must be given all the information about the risks and benefits to you personally. This includes what happens if you do nothing. The information must be given in a way that you understand.

You should not be forced into making a decision quickly. Time should be given to think about your decision and consider what is important to you.

Consent can be given by speaking, nodding, or in written form. Consent can also be implied by an action, such as holding out your arm for a blood pressure check. Informed consent should be given freely.

No one should pressure you into making a decision. Even if a midwife or doctor disagrees, they must respect your decisions. If you feel pressured, you can ask for a different doctor or midwife.

Birth partners can help by asking questions, explaining preferences, and speaking up about concerns. You can listen to and take advice from those that you trust. However, they cannot give consent.

Your right to refuse or withdraw consent

No one can touch or treat you without your consent. This is against the law.

You do not have to give consent. You do not have to explain why you do not give consent. However, it may be helpful for the doctor or midwife to understand.

You can change your mind at any time. This is called withdrawing consent.

The role of healthcare professionals

Healthcare professionals must ask for consent every time before they touch you or do a procedure. This includes minor checks.

If care changes, they must explain and ask for consent again. Even with prior consent, you should still discuss the treatment or check immediately beforehand.

Staff must be clear about what they are asking. For example, if a midwife offers to perform a vaginal examination, they must tell you they will put their fingers inside you and why.

You and your healthcare professional should have a conversation about the treatment at the time it is happening. This should be a two-way chat, not just them giving you information. Your healthcare team cannot just rely on a signed consent form to know that you have understood everything.

How to weigh the pros and cons

Using the B.R.A.I.N.S. framework can help you weigh the pros and cons of different options. This involves using the B.R.A.I.N.S. questions you learned about earlier.

Finding reliable information

Doing your own research can help you feel confident and comfortable with your decision. There are many ways you can find out more.

• Trusted websites – Find useful pregnancy and birth information from trusted sources, such as the NHS or Tommy’s. These pages should be based on the latest research and guidelines.
• Ask midwives – Midwives are happy to talk to you about any aspects of your pregnancy and birth. They can help you make decisions about your care. They should be using up to date, evidence based information.
• Talk to other people – Partners, family members, and friends may all have different and useful opinions. Simply talking through things with someone you trust can be helpful.
• Get a second opinion – Other healthcare professionals have different training, experience, and opinions. You can get a second opinion to ensure you get balanced advice.
• Ask experts – Organisations like BUMPS (Best Use of Medicine in Pregnancy) or the RCOG (Royal College of Obstetrics and Gynaecologists) provide reliable information about medicines and treatments in pregnancy.

Understanding risks

Some risks and benefits are easier to measure than others. For example, it is easier to measure short-term physical risks than long-term emotional health risks. This means we know more about some risks than others.

A risk threshold is when a risk becomes too high for you to be comfortable with. This threshold can be different for different people.

Because the safest outcome for you and your baby is a priority, the official advice on pregnancy and birth is often very cautious. This means the risk threshold in maternity guidelines are very low. Many guidelines and policies take a cautious approach.

Personal vs. population risk

Most information will give you an idea of how likely something is to happen to any one person in the population. National guidelines are based on the risks and benefits for a large group of people.

However, guidelines and pregnancy information cannot tell you how likely these things are to happen to you personally. They do not consider your personal medical history and circumstances.

Asking questions about recommendations

You can always ask more questions about anything that is suggested. Here are some examples:

• Can you explain any risks to me or my baby of following this recommendation?
• Is this something that is recommended for everyone? Why?
• What is the risk of this problem for me specifically?
• What would happen if we waited a bit longer?

The balance of risks and benefits is different for everyone.

Talking to your doctor or midwife

Your midwife or doctor has to offer you certain things because of hospital policy or national guidelines. They should explain why clearly and give you time to ask questions.

They should still support you if you ask for more information about other options. They should also support you if you need more time to decide.

It is not okay for health professionals to use fear-based tactics or make assumptions before you have had the time and all of the information in order to make your own decision.

It can help to have someone you trust with you for support.