Birth Choices: Are You Informed?

In a recent Canadian study that was reviewed in The Journal of Perinatal Education, researcher Michael Klein, MD, reports that women are inadequately informed and care providers are not delivering evidence-based information when it comes to birth practices. (1) This dangerous combination makes it hard, if not impossible, for women to make informed decisions. A truly informed decision comes when a person has been given complete and unbiased information on which to base her action.  Among the study’s findings:

The women’s lack of evidence-based knowledge about epidural analgesia included failure to appreciate that it interfered with labor and was associated with an increase in the use of forceps and vacuum. Many were unaware of the benefits and risks of cesarean surgery, including whether it was associated with urinary incontinence or sexual issues. The women’s knowledge was also insufficient about the benefits and risks of episiotomy, the role of doulas in improving outcomes for mother and baby, and the place and mode of birth, including a birth center or home birth.

Further compounding the search for evidence-based information in birth is the diverse and conflicting information that is published in mainstream media. Earlier this month, articles from two different large media outlets questioned the true dangers of epidurals and whether they were overstated. (2,3) The articles provide both anecdotal information about each authors’ birth experiences and point to scientific studies. After presenting and debating the science, author Melinda Wenner Moyer says, “Women shouldn’t cave to pressure from either side. They should make informed decisions based on their goals and priorities.” The problem is — once again — how can a woman develop her goals and priorities if she is not truly informed?

At the end of her piece, Moyer sums it up by saying, “My unnatural childbirth left me with a memory that does not involve intolerable pain, and that’s exactly what I wanted.” It’s great that she achieved the birth she wanted! Unfortunately, however, her description negatively influences other mothers’ perception of birth. My unmedicated (aka, “natural”) third birth was painful, yes, but it was not “intolerable.” When mothers believe that the pain of birth is intolerable (as many moms do in the United States), they are driven to choose an epidural without considering alternatives that can make birth just as enjoyable, not to mention healthy!

So with all the obstacles to becoming truly informed, how do you navigate the jungle of mass-misinformation-overload? Lamaze childbirth educator (and Giving Birth with Confidence contributor) Ami Burns responded aptly on the Lamaze Facebook page, “Yet another reason why comprehensive childbirth education is needed. Moms need the information — even when research may be inconclusive — so they can decide for themselves.” Childbirth education, when chosen wisely, helps women look at all of the options by providing pros and cons, risks and rewards to the many decisions a woman can make during labor and birth. Contrary to what some may believe, a good childbirth class doesn’t deliver the “natural birth or bust!” philosophy. A good childbirth class provides evidence-based information to help women be as prepared as possible to make the best decision for her and her baby.


How did you seek information on birth? What helped in your decision-making process? What hindered it?

 

References:

(1) Klein, Michael C. Many Women and Providers Are Unprepared for an Evidence-Based, Educated Conversation About Birth. The Journal of Perinatal Education, Volume 20, Number 4, 2011 , pp. 185-187(3).

(2) Moyer, Melinda W. The Truth About Epidurals. Slate. January 11, 2012.

(3) Dell’Antonia, KJ. Are the Dangers of Epidurals Overstated? The New York Times. January 23, 2012.

Avatar of Cara TerreriAbout Cara Terreri
Cara began working with Lamaze in 2004, two years before becoming a mother. Three kids later, she's a full-fledged healthy birth advocate and the Site Administrator for Giving Birth with Confidence. Most recently Cara began study to become a Lamaze Certified Childbirth Educator and DONA certified doula (learn more about her services at www.SimpleSupportBirth.com). She continues to stand in awe of the power and beauty in pregnancy and birth, and enjoys helping women discover their own power and joy in the journey to motherhood.

Comments

  1. Danika Surm says:

    How can we better support women to understand that they have options? That what their health care provider says is not written in stone. I feel like, too often, medical interventions are used as a one-size-fits-all model. For instance, I have seen too many of my clients be induced, not because of a concern about the baby’s wellbeing, but because of time constraints, fear, and/or hospital policy. Women need to be given the space to await labor and labor as they see fit, not coaxed into accepting medical assistance simply because of its availability.

    Induction is one of those medical interventions, like epidural anesthesia, where the true risks and benefits and alternatives of the procedure are not (usually) presented to a woman in a fair and unbiased manner. How can a woman make an informed choice when her care provider simply says that an induction will be necessary at 41+2 weeks? Inductions are not without risks, just like waiting for a baby to make his/her natural appearance is not (sometimes) without risk. But how can a woman weigh her options when she is not informed that she even has options?

    Health Canada says that “the decision to induce labour should only be made when the risk associated with continuing pregnancy is greater than the risk associated with induction”, and the WHO states that induction should occur only with an [medical] indication – and yet one Canadian study showed an induction rate of 44.8% (Chalmers, Kaczorowski, Levitt, Dzakpasu, O’Brien, Lee, Boscoe, & Young, 2009)! Surely 44.8% of babies aren’t displaying warning signs of postmaturity?

    This is just one example that I think exemplifies Klien’s findings and is an indicator of the need, as stated by Klien, for “women…to take the lead in providing themselves with the needed information to have an educated conversation with whoever is following them in pregnancy and attending their birth”. I think childbirth educators are an invaluable part of this process – giving women the tools they need to approach their care providers, have informed conversations, and make educated decisions right for themselves and their family.

  2. Christine Morton says:

    In the future, please provide the full citation for articles under discussion so we may look it up! the link to JPE isn’t working on my browser. I assume this is the article referred to?

    Klein MC, Kaczorowski J, Hearps SJ, Tomkinson J, Baradaran N, Hall WA, McNiven P, Brant R, Grant J, Dore S, Brasset-Latulippe A, Fraser WD. Birth technology and maternal roles in birth: knowledge and attitudes of canadian women approaching childbirth for the first time. J Obstet Gynaecol Can. 2011 Jun;33(6):598-608.

  3. Avatar of Cara Terreri Cara Terreri says:

    Hi Christine– thank you for pointing that out. No, that is not the article to which I am referring. I have updated the post with the referenced article.

  4. Danika Surm says:

    Thanks for the reminder! In case you were referring to the articles I cited, I was looking at:

    Chalmers, B., Kaczorowski, J., Levitt, C., Dzakpasu, S., O’Brien, B., Lee, L., Boscoe, M., & Young, D. (2009). Use of routine interventions in vaginal labor and birth: Findings from the maternity experiences survey. Birth, 36(1), 13-25. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1523-536X.2008.00291.x/full

    The other article was:

    Klien, M. (2011). Many women and providers are unprepared for an evidence-based, educated conversation about birth [Guest editorial]. Journal of Perinatal Education, 20(4) 185-187. doi: 10.1891/1058-1243.20.4.185

    My apologies again,
    Danika

  5. Kelly Reed says:

    I wish more people were presented with accurate and informative information regarding their birth choices in the US as well. I was basically scared into an induction when I was pregnant with my first child at 20 years old, with my obstetrician citing that after 40 weeks the overall health of the placenta deteriorates and can endanger my baby. At no time did she mention that there are many, many ways of starting labor through natural means, she never offered advice on the risk of waiting beyond that it put my baby at risk even though he and I were completely healthy and had no complications present, and never did she mention the risks involved with induction as having any weight whatsoever in not only that child birth, but those I might have in the future. I had a very long and painful induction, was forced to labor in a bed for almost 12 hours with no ability to shift positions because of constant fetal monitoring and had such intense and terrifying pain that I caved in when my doctor actually advised an epidural to “allow me to relax” so my baby could be born. Instead, the medication totally stopped the contractions, which of course she also used to scare me into having my water broken to “get it started again”, which it didn’t and I was soon on the fast track to high pressure tactics pushing me into Cesarean. Having a completely unnecessary Cesarean left a black mark on my record, so to speak, and each pregnancy since then (I’m due with my 4th child in April) has been a struggle in regard to planning the birthing process. Being a VBAC (vaginal birth after Cesarean) patient has made certain birthing options unavailable to me, and many care providers have told me that they can “let me labor as long as possible” before they are forced to “take the baby”, as though being a VBAC makes me incapable of natural birth and therefore some sort of farm animal with no options and no choice, whether health risks are present are not. I hope more women take it upon themselves to learn the risks and benefits of birthing options and that they apply what they learn to their future, because had I known what that first birth experience would mean in the long run, I’d have fought much more to deliver naturally and avoid all of the so-called helpful interventions that can destroy a perfectly healthy labor.

  6. Avatar of Cara Terreri Cara Terreri says:

    Kelly, thank you for sharing your story. It is important for women to know how the choices in one birth can lead to lack of choices in future births. It’s atrocious that we don’t have a consistent standard of maternity care for women. It’s this kind of non-evidence based care — like that which you received during your first birth — that needs to be systematically changed. Until then, women must learn their options and get to know their care provider BEFORE entrusting her with the birth of her child. Learning about options starts with quality childbirth education: Women, just do it! Get informed, go thee to a childbirth class!

  7. The Protect Babies and Mothers Too is a Petition site. Please have more Canadian mothers informed. I would like to form a group of violated women with their violated children take the no informed consent to a violations of human rights, the right to know. Would interested persons wanting to fight back of not being told the whole truth or our rights to birth of what is called primal natural birth in the local hospitals, anywhere, in Canada, and in the world. The baby have a legal right to remain of what I have termed, a “biological, reciprocal, and sealed-unit.” No baby needs to be clamped on their umbilical cord, finger-thumb-squeezed off, or tied off.

    The only two reasons of the cord to be tied into the blood vessels is if they dropped the baby and tore away the cord or they put a knife into the cord, the placenta or both of them. All other reasons are fear factors. You put a soft object between the neck and the cord, for a cord around the neck, to prevent neck or vocal chord injury. When the rest of the baby is born, you unwind the cord, not of sufficient length to do so. You do not need to tie into the cord to take a pH blood sample, a tiny needle and a thin needle may be inserted into the umbilical cord for any necessary blood sample, so if you have been deceived, please contact me, for two or more person to represent unnecessary medical protocols imposed on them in Canada.

    You may call me, toll free, 1-877-782-9223. I have no interest in profits of any kind, I simple want the issue before a Judge, how babies and mothers have been violated and of no true consent or the means to protect our babies from being exploited for their deprived placenta whole blood. This was wrongfully sought as a waste product. It is a local violation that happens across Canada, and in other parts of the world.
    Donna

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