There is a Difference Between a Maternity Care Recommendation and Your Decision

Orders, Advice and Choice: Understanding the Difference in Maternity Care

One of the most important things I want every pregnant and birthing person to understand is this:

There is a difference between a recommendation and a decision...

Healthcare professionals have an important role in your pregnancy and birth. They bring clinical knowledge, experience and expertise. They assess, advise, explain and recommend care based on your individual circumstances. But there is one thing they cannot do. They cannot make decisions about your body on your behalf. That decision belongs to you.

Recommendations are part of good care. They are an important part of maternity care. They are based on clinical judgement, experience, evidence and your individual circumstances. There may be times during your pregnancy or labour when your midwife or obstetrician recommends a particular course of action. Perhaps an induction of labour. Additional monitoring. Pain relief. An assisted birth A caesarean birth. Or another intervention they believe may be beneficial. Hearing a recommendation does not mean something is wrong. Nor does it mean you have no choice. A recommendation should be the beginning of a conversation, not the end of one and this is your right to informed decision making.

What informed decision making should look like....

When a recommendation is made, you should have the opportunity to understand:

Why is this being recommended for me?

What are the benefits for me and my baby?

What are the risks for me and my baby?

What alternatives are available?

What are the risks and benefits to me and my baby if we wait?

What might happen if I decide not to accept this recommendation?

Is there evidence that is relevant to my particular circumstances that supports the recommendation you are making?

Only when you have had the opportunity to understand your options can you decide what feels right for you. Sometimes your answer will be yes. Sometimes it will be no. Sometimes it will be, “I’d like more time to think.” Each of those responses is part of your informed decision-making and they are your choices to make.

When advice becomes pressure ....

Most healthcare professionals want to provide safe, compassionate care and support families to make informed decisions. However, there are times when pregnant and birthing people have told me they have experienced a conversation that no longer feels like advice. Instead, it feels like PRESSURE.

Perhaps you’ve heard phrases such as:

“You have to…”

“We’re not allowing…”

“You don’t have a choice.”

“Hospital policy says…”

“If you don’t agree, you’re putting your baby at risk.”

Hearing these words can feel frightening, particularly during pregnancy or labour. They can make it seem as though the decision has already been made for you. When that happens, it can become difficult to ask questions, process information or consider what matters most to you but you should never feel ordered into care.

Clinical expertise and personal autonomy are not competing ideas.....

Maternity care professionals have both legal and professional responsibilities. They should recommend what they believe is clinically appropriate, explain the reasons for those recommendations and answer your questions honestly. Equally, your role is not simply to agree. Your role is to consider the information, reflect on your own circumstances and make an informed decision. Respectful maternity care recognises that these two responsibilities work together. Both are essential parts of good care.

You are allowed to ask for the conversation to slow down. If a recommendation feels overwhelming, it is okay to pause.

You might say:

“Can you explain why you’re recommending this?”

“How does this apply to my individual situation?”

“Can we talk about the alternatives?”

“I’d like a few minutes to think.”

“I would like my birth partner be part of this conversation”

These are not confrontational questions. They are thoughtful questions, they help create the space needed for informed decision-making, and respectful care allows room for different decisions

Sometimes, after understanding all of the information, you may decide to accept the recommendation. Sometimes you may decide on a different approach. Sometimes your decision may change as your pregnancy or labour progresses. That is entirely normal. Good maternity care is not about persuading you towards one particular outcome, it is about ensuring that whatever decision you make is informed, voluntary and based on what matters most to you.

My role as your pregnancy and birth companion....

One of the most important parts of my role is helping you feel confident enough to take part in these conversations. Not by telling you what decision to make. Not by encouraging you towards one particular type of birth, but by helping you understand your options, prepare your questions and explore what feels right for you.

Because the best decisions are rarely made through fear. They are made through understanding. Through respectful conversations. Through balanced information, and through recognising that your voice belongs in every discussion about your pregnancy and birth.

Medical advice has an important place in maternity care. So does your knowledge of yourself and the best maternity care happens when both are welcomed into the room, and every decision is made WITH you, not FOR you