Making informed choices in pregnancy, birth and beyond

Knowledge is the foundation of informed consent. If you only know half the story, how can you make truly informed choices? 

In pregnancy and during childbirth, this knowledge is essential. It empowers you with control in situations where others may feel powerless. Knowledge helps you develop realistic preferences that suit your individual needs and will empower you to work more effectively with your maternity team. 

But as we know, there are many sources of information and not all are created equal! Let's look at which sources of information are most reliable for you during your pregnancy and use them to help you make informed choices, whether for your pregnancy or during labour and childbirth.

Firstly, your maternity team is an excellent source of information. Whether that's your community midwife during an antenatal appointment or doctors and specialists you may come across if you need extra help and support. 

I recommend writing down your questions before your appointment and taking a notepad, so you don't have to remember everything they tell you. Try to keep your list to the essentials, as your midwife packs a lot into an antenatal appointment, and there is not always much time for additional questions.   

Antenatal classes are also a great way to build up this knowledge; if taught by practising midwives, you have the added benefit of their medical knowledge being current and relevant to the maternity services available in your area. 

Their broad experience of supporting women and their birth partners through pregnancy, labour, childbirth and the early postnatal period puts them in a great position to help you. Plus, they generally have more time to answer questions your community midwife may not have time for.

Check out our multi-award-winning antenatal classes.

One word of caution: Use the internet wisely when doing your research. Some common issues that arise from 'Doctor Google' are that information can be:

• Out of date. Things move on. For example, what was relevant to our grandparents may not apply to us today. 
• Non-relevant. Such as relying on information from a country whose maternity services and practices differ entirely from ours - the US and the UK are good examples!
• Overgeneralisation. Sometimes people post their personal experiences as 'facts' that assumes a rule for what others will experience. Rather than looking at what the research says, which includes many people's experiences, it provides a more reliable expectation. 
• Untrue. There is a lot of online information that is just not true! 

Without a scientific background, navigating the world of research articles and looking at the evidence can be tricky, especially if one research paper contradicts another. The best place to start is to look for systematic reviews of the research; this is when the data from the best available research studies are combined to explore a topic more rigorously and remove bias. The researchers exclude poor-quality studies from this type of analysis, and it is generally considered a gold standard within research. 

Alternatively, you may turn to reputable websites that do the hard work for you and publish evidence-based information relevant to the services in your country of residence, where applicable. These websites tend to publish their sources, and articles are often written by or signed off by people with the right clinical experience to offer advice on that topic. 

For example, in the UK, these websites are an excellent place to start:

• NHS website 
• NICE guidelines
• Tommy's

If you want clarification on anything you read online, keep a list of questions to ask your midwife at your antenatal appointments or classes.

You will likely come across many statistics when researching your birth preferences, which may not always be helpful. Where possible, look for whole numbers rather than percentage increases. Doing this is essential if you want to make truly informed choices - especially as you explore the benefits and risks of options your midwife or doctor may present to you. 

For example, the NICE guidelines state that your midwife recommends induction if you do not go into labour within 24 hours of your waters breaking because the likelihood of your baby getting a serious infection increases. 

There are three ways to present you with this information: 

1. The likelihood of infection doubles after 24 hours. 
2. The chance of infection increases 100% after 24 hours.
3. The possibility of infection rises from 5 in 1,000 cases to 10 in 1,000 cases after 24 hours. 

All three statements are accurate, but the story each tells is quite different and may impact your choice considerably. It is important to remember that even when dealing with low numbers, you need to consider that as a possibility and decide how you would feel if it applied.

Doing thorough research is integral and using the BRAIN communication tool will ensure every decision is truly informed. 

The information contained above is provided for information purposes only. The contents of this article are not intended to amount to advice, and you should not rely on any of the contents of this article. Professional advice should be obtained before taking or refraining from taking any action as a result of the contents of this article. New Life Classes disclaims all liability and responsibility arising from any reliance placed on any of the contents of this article.

NICE Clinical guideline [CG190] Intrapartum care for healthy women and babies. Published December 2014. Updated February 2017.

NICE Clinical guideline [CG138] Patient experience in adult NHS services: improving the experience of care for people using adult NHS services. Published February 2012. Updated June 2021.

NICE Guideline [NG179] Shared decision making. Published June 2021.

Childbirth Connection. Making informed decisions.