Choice, you know is important. Everyday you make so many, from what to wear, what coffee you want on the way to work, to big things like where to live or the career you want. There are also many reasons you make choices. Sometimes it’s a feeling, sometimes a split second decision or sometimes because you feel pressured by others. Sometimes you can feel choice is taken out your hands because of the situation or circumstances you find yourself in.
When it comes to pregnancy, birth, the way you care for your baby, or how you parent you need to ask yourself, what is really guiding my choices? Am I truly making informed choices?
What is informed choice?
Informed choice can be defined in a number of ways.
Informed choice – One that is informed, consistent with the decision maker’s values, and behaviourally implemented
Informed decision – where a reasoned choice is made by a reasonable individual using relevant information about the advantages and disadvantages of all the possible courses of action, in accord with the individual’s beliefs
Autonomous choice – One which occurs when people act (1) intentionally, (2) with understanding, and (3) without controlling influences that determine their actions
Evidence based patient choice – The use of evidence based information as a way of enhancing people’s choices when these people are patients
(From: Jepson et al 2005)
There are a few common themes that run throughout the definitions namely, that choices should be made on evidenced based information, that they are made with the person’s consent and respect their beliefs, but also that they are free of other controlling influences.
So as families when you think about the choices you make regarding pregnancy, giving birth and parenting the question you need to ask is, are you really making informed choices? Are they evidence based and free of other controlling influences. If you support families, do you help them to make informed choices, do you respect their beliefs and do you make sure that you yourself do not become a controlling influence? Let’s look at birth and one aspect of caring for your baby to see what is meant by informed choice.
When it comes to birth, families have a right to know what choices are available to them and then make choices that are right for them and their family. Much comes into play for a family when weighing up the right choice. Everyone has unique situations, family backgrounds, personalities, life history or experiences and beliefs,these maybe cultural, personal or religious. These can all affect the choices they make. It can also mean that the choices they do make may not be the choice that is seemly right for them ‘on paper’. A difficult childhood, a previous loss of a baby, fear or a mental health condition may mean that the choice they make is based on not only what they as a families would like, the situation, but also a previous experience, or out of a need to manage a current health problem. How can families be helped to still make informed choices?
Firstly it is important that they are given information that is evidence based. It is also important though that this is given in way that does not become a controlling influence. what does this mean? Information given can be given in such a way that it leans towards a ‘preferred’ option. The risks can be dwelled on, but the benefits skimmed over. Why? It maybe that guidelines or policies in place mean that things like to be done in a certain way and families are expected to fall into certain brackets. If maybe that staff in order to keep services functioning prefer a certain way of working, that doesn’t always allow for easy adaptation for complex situations or issues. It can then be the case that information given is tailored to suit these needs, rather than allowing an unbiased approach that enables more individualised care.
It can be especially challenging if families wish to make choices that seem to go against the ‘recommended’ advice. It is so important that families are given accurate, up to date, evidence based information that enables them to discuss with care providers the risks and benefits of the choice they are considering. It can be hard to support choices that you personally may feel are unwise or that you would handle a different way. However if the information you have given is accurate and given in the right manner and a family are clear about what may happen as a result of their choice, then it is important to support the choice made to the best of your ability.
For families it is important that they really take the time to find out their option and look at the evidence, weighing this up with their own personal circumstances. This may take time and effort but it is important to make sure that you are fully aware of the whole picture and not just the bits that you wish to see. Communication with those providing your care, as well as things that can be adapted should things change are good ways to make sure you are prepared. Choice can be ever changing too so while at first you may be sure of the choice you have made, remember that it is important to continue to review those choices in line with any advice you may be given or changes in circumstances.
Feeding your baby
One of the most controversial aspects of caring for your baby has to be the choice around feeding. The so called ‘mummy wars’ see endless battles, often with mums pitched in different corners, each claiming to have made the right choice. We hear lots about informed choice regarding feeding. So are families really making informed choices regarding how they feed their baby?
Evidence based information will clearly show that giving a baby breastmilk has many benefits for both baby but also the mother. However to actually make an informed choice is hard. Why? Because while we know that giving a baby breastmilk is beneficial, it is not easy to do. There is so much miss information out there regarding feeding it is hard for families to know what to do. Families can be bombarded with ‘breast is best’ or ‘formula is just as good, my baby is fine’ as well as many other claims. With the decline in families breastfeeding, and in order to again normalise breastfeeding anything that may be considered to make breastfeeding more difficult is frowned upon, such as explaining how to feed your baby with artificial milk and thus many families find that there can be a lack of information around feeding full stop. This does not allow for for informed choice. It is important that families are given the information on the risks and benefits of all ways to feed their baby so they can truly make a choice that is right for them. This can be hard because it is a very emotive subject. However in order to make an informed choice we must do the research and then accept what we find. This may not change our choice or the reasons behind it but if after knowing the risks and the benefits families make a choice, then they have made an informed choice. The question is are we really getting the right information regarding feeding?
There is another reason we need to question if informed choices are really being made. We spoke about controlling influences, unfortunately artificial milk is big business, in fact so much so that the companies involved spend millions of pounds and use the media to ‘influence’ families regarding how they feed their baby. Inaccurate claims and information, as well as misleading advertising, leave little space for informed choice. Very few parents are told how giving artificial milk can impact breastfeeding or the health implications. Often out of fear of unsetting ones or making ones feel guilty the information gets watered down. Can we really say that informed choice is possible when much of the information families receive is from the media or companies trying to make money or is watered down so as to not upset anyone? But ask yourself is this fair, is this really enabling you to make the right choice? You deserve to have the most accurate information available, without bias.
What about families that do wish to try to give their baby breastmilk? Again with little accurate information, very little in the way of practical support and with the media often only publishing negative stories around breastfeeding, again making a true informed choice can be very difficult. Add to this other other issues that need to be considered such as personal circumstances, health of the mother or baby and healthcare professions often not trained to offer support, and choice goes out the window.Women can feel that they have no choice but due to outside pressure or lack of support often find the circumstances dictate the choice. Often pitched against each other mums instead of supporting choice find themselves arguing about feeding choice often realising that neither has actually made an informed choice.
Sometimes the hardest part of making an informed choice is acceptance.
Informed choice how?
So how can we make a informed choice and what do we need to remember about informed choice?
- Remember it is important to get accurate, evidence based information. If you search long enough you can find information on the internet to back up anything. Evidence based information, will be easy to see. It will be a documented study, and academically acclaimed. There are plenty of very good recommended places to get information regarding birth and caring for your baby such as the Cochrane library, NICE guidelines, First steps nutrition, Birth choice uk, to mention just a few. The onus is on us to go out there and find the information. While others can offer support the real buck stops with us. We each have a responsibility to seek the information needed to care for ourselves and our families. We cannot pass this buck and leave it to someone else. So when considering your choices around pregnancy, birth or caring for your baby, be proactive, ‘seek and ye shall find’.
- Do not be fooled by the media or big business. The media loves controversy, headlines that cause everyone to have a good old debate. Don’t fall for it. All families are doing the best they can and while the media would love you to think that everyone else’s choices are better than yours, that just isn’t true. As for big business, they want your money. They don’t really care about what is best for you and your family, they are in this to make as much money as they can and they will use every trick they can get away with. They will convince you that need it, tell you its the best there is, and promise you everything. Instead look to unbiased information, who do care about the health of you and your baby.
- Look at the benefits and be aware of the risks. There will be both for everything. Make sure that you consider both carefully and do not minimise either. It can be difficult to sometimes look at both objectively, but it is important to do so. Informed choice means that you are fully aware of the risks you are likely to face but also the benefits of what you may decide.
- Be honest with yourself. Do you really know about sleep and babies? Do you really know the effect one feed of artificial milk can have? Do you really understand newborn behaviour such as why your baby wants to be held all the time? Do you know under what circumstances a home birth is safe? Why certain tests are needed in pregnancy? If you don’t then find out. Do not rely on others, even healthcare professionals don’t know everything, internet forums, or the lovely parenting book your friends brought you will have there own slant, so make sure you do your research, be honest and open. Question the things you read and hear and don’t be afraid to ask or question any advice or information you are given.
- Acceptance. Sometimes the hardest part of making an informed choice is acceptance. It maybe that the information doesn’t sit well with what you personally believe or want to do. If you do not want to give your baby breastmilk it can be very hard to accept that the evidence says this is the most beneficial way to feed your baby. If you want a home birth it can be very hard to accept that for ‘you’ their maybe risks. Or it maybe that for you a home birth is the recommended thing but you wish to choose a birth in hospital. This does not mean that you cannot make that choice. It does mean however that you must make sure you take all the information you have and really think about what is best for ‘you’ in your circumstances. Others may not agree, others may put pressure on you to make a difference choice. Ultimately if you have weighed up all the evidence and then made your choice, then you have done what is right for you.
- Consequences. Along with our choices come consequences. Most of the time they will be good consequences but sometimes they won’t. Our own views, wants and needs will affect the choices we make but we then have to accept that we have to live with the consequences. This can be hard if things don’t then pan out as we thought they would or worse things happen that result in harm of ourselves or others. Making a choice that is informed is crucial to helping us make sure, to the best of our ability, that the choice we make has a happy outcome. However even with all the right information, the right motives and weighing up all the risks and benefits it doesn’t guarantee that things will be ok. So whenever we do make a choice it is good to ask ourselves, can I live with the choice I am making if the outcome is not what I am hoping for? Sometimes that choice can result in life changing consequences.
- Leave guilt behind. If after all this you make your choice, leave guilt behind. What do I mean? If you weigh up the evidence, know the risks and choice a certain course then why feel guilty? You did the best you could and what you felt was right for you. There is no need to feel guilt. If others question that choice then that is their issue. Own your choices and your reasons behind them. So to0 do not question other people’s choices. We can never fully know why someone has made the choice they have, and it isn’t our place to judge. Instead let us all support each other and trust that the choice was right for them, at that particular time. If in time you come to see that your choices were wrong and new information has cleared up the understanding, then again there is no need for guilt. Everyone is trying their best and things will constantly change as we advance in knowledge and research.
So are you making an informed choice? The truth is only you really know the answer. Only you know if you have done the research, weighed up the risks and benefits and done what is right for you and your family in the circumstances you are in. No choice will ever be prefect, but you can make sure that the choices you make are your choices, that they are well informed because that what you and your family deserve.