Shared Decision Making in Maternity Care
Earlier this week, I had the great honor to be part of a webinar discussing shared decision making in maternity care.
Hosted by the Informed Medical Decisions Foundation and presented in conjunction with Shared Decision Making Month, the panel was moderated by Childbirth Connection’s Executive Director, Maureen Corry, and also included my fabulous co-panelists, Kate Chenok and Dr. Kimberly Gregory.
Though I’ve made my Prezi slides and a recording of the webinar available below, I do want to outline my position on shared decision making here. For as a parent, as a patient, as a doula, and as a birth advocate in general, shared decision making in health care generally and in maternity care specifically is something that I champion wholeheartedly.
As a parent and patient, I want my care provider to see me and treat me as an active participant in my care.
The importance of this care provider/patient model became most salient to me when I was planning my VBAC with my second child. When faced with a physician who no longer respected my desire to engage in discussions with him about pregnancy and birth preferences, I found myself seeking out a new care provider: one who was willing to share the decision-making process with me, and one who was willing to leave the ultimate decisions for my care up to me.
Thus, as with many childbearing women, I want my care providers to offer individualized, personalized maternity care. I want decisions about my care to reflect both their expertise and my unique health circumstances, values, and preferences.
And this, I think, is not too much to ask of any care provider/patient dyad.
As a doula, I also work to help my clients seek a relationship based in shared decision-making with their care provider.
This does not mean that I speak for my clients, nor does it mean that I offer them any medical advice or treatment. These actions would be outside my scope of practice.
Instead, I encourage my clients to view themselves as active participants in their maternity care, and I encourage them to pursue that sort of relationship with their care providers. In that respect, I don’t position myself as a savior of pregnant and laboring women but instead as a facilitator of communication. And in keeping within my scope, I’d much rather help women feel empowered to speak for themselves than to take away some of that power by speaking for them.
On a more specific level, this is also why I frame birth plans as “birth preference lists.” As I tell my clients, you can’t plan a birth, but you can articulate your preferences to your care provider and engage in meaningful discussion with them regarding those preferences. And when these conversations are initiated with a sense of mutual respect, they can be fertile ground for true shared decision-making.
Finally, as a maternity care advocate, I devote a great deal of my work to reinforcing the autonomy and radical individuality of pregnant women, and I encourage them to seek out care providers who engage in shared decision-making.
I sing the praises of nuance, respect, and education, and I caution against the stereotyping and careless universalizing that often permeates discussions about pregnancy and birth. And I work toward making maternity care information more accurate, transparent, and accessible for all pregnant women and their families.
And I think more is at stake than just an intellectual nod to the concept of shared decision-making. Women’s autonomy matters. Our bodily integrity matters. Our satisfaction with childbirth matters, and our mental health outcomes following birth matter. And I think that each one of these things is affected in big and small ways by the extent to which we are able to engage in shared decision-making with our care providers.
To see more from my presentation, you can view my Prezi slides here:
The Informed Medical Decisions Foundation has also made it possible for you to view the other presenters’ slide presentations and to view a recording of the entire webinar. Many thanks to the webinar organizers, to the moderator, and to the other panelists for their fine work on this topic!