I recently read this excerpt from Emily Oster’s book, “Expecting Better: Why The Conventional Pregnancy Wisdom Is Wrong — and What You Really Need to Know.”
In her book Oster presents the model that she teaches university business students to make informed decisions. It is the model we use when buying a business, house or car, even when choosing a mate and it is the model we should be using when making decisions about our pregnancy, birth, and health and lifestyle decisions for our children.
Pregnancy and childbirth is when parenting starts. This is when parents need to become responsible for informed decision making for the health and well-being of their child. Decision making isn’t black and white. I have always said that we all assess risk differently and we assess benefits differently. We can make different decisions with the same information and both people can be right, for them.
“I try to teach them that making good decisions — in business, and in life — requires two things. First, they need all the information about the decision — they need the right data. Second, they need to think about the right way to weigh the pluses and minuses of the decision (in class we call this costs and benefits) for them personally. The key is that even with the same data, this second part — this weighing of the pluses and minuses — may result in different decisions for different people. Individuals may value the same thing differently.”
Unfortunately, it seems that once a women is pregnant she is deemed incapable of decision making and instead is expected to blindly trust the “experts,” not ask questions, and do as she is told.
Let’s use breech birth as an example. The current practice in many facilities is that if a baby is breech at the end of a pregnancy, then a cesarean section will be scheduled as the mode of delivery, typically by 39 weeks. This is a blanket, one size fits all recommendation, and often no one even considers that the mother may actually want to consider a different choice.
The mother is often not informed that current evidence suggests that the long term risk to the baby is the same regardless of mode of delivery but the risk to the moms health and life go up with cesarean vs vaginal breech birth. Instead, she is told that cesarean is the way it is done and she has no choice. In reality, she is the only one with decision making authority over her body and she must be the one to decide IF she wants to decide on a cesarean birth.
For proper decision making, she should be informed of the benefits of cesarean birth in the case of breech, the risks of cesarean (physical, mental and emotional both short term and long term) to her and her baby, the benefits of vaginal breech birth, and risks associated with vaginal breech birth,and if she has an alternative options (like trying to turn the breech baby, waiting until labor starts to see if the baby turns on its own, etc).
She then needs to take that data and figure out how that information would impact her and her family. Only she can take those numbers and formulate how they apply to her individually. Because of this she is the ONLY one qualified to make the decision about her birth.
What would a good outcome look like for her? How would she process an unexpected outcome? Does the risk to her outweigh the risk to her baby or the other way around?
Care providers may assess this differently than the woman because they don’t have to live with the long term outcomes. They also add in medico-legal risk (the risk of being sued) into their recommendations so they have a different bias. Some will even factor in their personal financial gain or interprofessional relations if they would have to refer you out to get you a qualified vaginal breech provider or if their facility had policies against supporting a woman’s right to choose her birth.
This isn’t a mathematical equation it is a human one and one that only the human whose life circumstance is at stake is able to make.
We have been told that when it comes to pregnancy, birth,and parenting that self proclaimed ‘experts” are the ones who hold the “right” answers. When someone goes ahead and questions that apparent authority and chooses something different, others mistakenly believe that they must be doing something “wrong.” This isn’t true. They are doing something right, for them, even if that is different than what is right for you.
Lack of understanding the decision making process is part of what has contributed to this idea of the “mommy wars.” If I got this info and I decide X and you got the same info and you decide Y, one of us must be wrong, and since I understand my decision making process, it must be you that is wrong. Nothing could be further from the truth. Both are right, for them.
Next time you find someone who has chosen to live or parent differently than you, instead of telling them they are doing it wrong, maybe ask them how they came to that decision. Maybe they need access to more information to make an informed decision or maybe it is a well thought out conscious choice that happens to be different than yours.
When dealing with care providers, make it abundantly clear what their role is. They are not there to be dictators over your life. They are paid by you to be consultants from which you gather information so you can make informed decisions. They also serve as skilled providers to give you the care you decide you want. It is your body and always your choice. This applies beyond pregnancy and birth to your child’s health care. Only you get to choose what is right for your family.