Monday, July 20, 2009

Informed Choice: a privilege but NOT a right

There are some phrases that wend their way into the conversations of groups of people, and noone really remembers when that phrase first came up, or what it really means.

'Informed choice' is one of those phrases, and it has come into general acceptance in midwifery along with 'evidence based practice'. It is meant to refer to the consumer's ability to choose from a range of reasonable options. Sounds fair enough!

What information does a young woman who is pregnant for the first time have access to, so that she can make a choice?
The local GP says "Do you want to go private or public?" - Choice #1
"Which hospital do you want to book with?" Choice #2

... and so on. Informed choices, if you look at the information provided, and the choice made. It's unlikely that any evidence will be offered, unless this green newbie to the birthing market talks about homebirth! At this point we can skip information, choice, research and evidence, and go directly to emotional manipulation and downright bullying.

There is only one basic choice in childbearing - either do it yourself, or find someone else who will do it for you. I can not stand under the 'every woman, every choice' banner. I will wave a banner 'every woman: one choice'. And the one professional attendant who has the duty to promote normal birth, and has the skill to harmonise with the natural physiological processes is the midwife.

I live and work amongst women who are enormously privileged in access to information, options, and services. But there are some even within metropolitan Melbourne, and definitely in other parts of this vast land, who are less able to access what most take for granted.

What 'informed choice' is available to the mother who lives on a cattle property 60k out of the nearest town; where the internet connection doesn't always do the job; where midwives are nurses who assist at hospital births; where the hospital is run like a military outpost to train new doctors, and the folk are told they should consider themselves lucky that they even have doctors? Her choice is to get to the local hospital to give birth, and to do as she is told and hope for the best, or to make a booking in the city and get to the city hospital to give birth, and to do as she is told and hope for the best. Even if she is philosophically committed to 'natural' birthing, it's likely that a 'choice' will be presented that subtly but effectively removes that option.

Yet there's one key decision she has to make: either do it yourself, or ask someone else to do it for you.

AND - in case anyone reading this is not sure of the facts, if you ask what would be the safest way; what is the 'evidence based' way? In almost every case, the safest way for mother and baby is that they do it themselves, with a midwife as primary care provider, UNLESS there is a valid reason to interrupt/intervene/interfere with the natural process.

1 comment:

mizz said...

nicely said mum!