Decision-making during labour

Giving birth is exciting, but not always straightforward. Your partner needs you there to help if decisions have to be made. Read on for some tips on how to make the right ones.

Will we be able to stick to our birth plan?

Labour and birth often don't go as expected. Try not to worry if you can't follow your birth plan exactly.

Perhaps the birth pool your partner has set her heart on is in use. Or maybe she ends up having an epidural when she thought she could manage with gas and air. Ultimately, what counts is that she and the new baby are happy and healthy.

Sometimes complications do arise and your medical team will have suggestions about how to proceed. It can be difficult to keep a level head when the pressure is on, especially when the wellbeing of your partner and baby are at stake.

Some people worry about being assertive or involving themselves in decision making. It's fine to make your views known, and helpful for your medical team.

Different healthcare professionals have different approaches. You and your partner have knowledge that they lack. After all, you know your partner best, and she knows better than anyone how she feels!

Usually, everyone wants the same result, but may have different ways of getting there. There are rarely absolute rights and wrongs.

What say do I have if there is an emergency?

When making a decision it is important that you have been given the information you need. You'll need time to take in the information and be sure that you understand it. Your medical team should involve and support you in making decisions, but sometimes it seems as if there is no time for discussion.

In this situation it can be helpful to ask: "Is this an emergency or do we have time to talk?" Another way to find out if the situation is urgent is to ask: "Is my partner OK? Is the baby OK?"

This will help you find out if the concerns are directly about your partner and baby or about something else, such as hospital policy or guidelines.

Decision making should be a team effort, although you and your partner have the final say. If this feels like a lot of responsibility, do tell your medical team. It is fine to acknowledge that you are upset or frightened. Being honest will help them support you and your partner.

How do I get the information I need?

There is a simple, easy-to-remember tool to help you make sound, informed decisions in even the most complicated situations. It is called Brain, which stands for:
  • benefits
  • risks
  • alternatives
  • instinct
  • nothing
Following the five Brain steps will help you get the right information, weigh up the pros and cons, and, finally, lead you to a decision you can be satisfied with.

Benefits: what are the benefits of this procedure?

First, make sure you understand what your medical team is proposing and why. Perhaps your partner is a week overdue and they are considering artificially starting labour?

Your midwife should explain that inducing labour reduces the tiny but slightly increased risk that you may lose your baby as the days tick by. Your partner may also be fed up with pregnancy and welcome the chance to get on with having her baby.

Risks: what are the risks of this procedure?

Most medical procedures have risks as well as benefits and you need to know what they are. For example, some methods of inducing labour (such as a membrane sweep) are uncomfortable. Other methods, such as using synthetic hormones, may make contractions more severe and painful.

There is also no guarantee these methods will work first time. They may have to be repeated. Also, despite being induced, your partner may still give birth to your baby by caesarean section.

You may also need to weigh up the pros and cons of an assisted birth. If your partner is becoming exhausted, your medical team may suggest using instruments such as forceps or ventouse to help your baby be born.

Both increase the likelihood of your partner suffering soreness and bruising afterwards. Your baby too may also have slight bruising on his face. However, bruises fade and serious injury to babies from forceps or ventouse is rare.

Alternatives: is there a choice of obstetric procedures?

Like everyone, midwives have their favourite ways of doing things, but these are rarely the only ways. If your baby is overdue, ask about the various methods of inducing labour, from a membrane sweep to synthetic hormones.

You may want to try an old-fashioned spicy curry followed by some gentle sex. But be warned. There's not much evidence of either of these working.

Similarly, when considering a caesarean section your partner may be offered the chance to try an assisted birth with a ventouse and an episiotomy first. If the assisted delivery doesn't work you have the back-up of a caesarean section. Although going through both could leave your partner feeling battered and bruised.

Instinct: what does your instinct tell you?

Pay attention to what your instincts are telling you. After all, you know your partner better than anyone else in the room. If you feel she is, for example, able to cope with the pushing stage for longer, then you should support her if she turns down an assisted birth.

But if you feel she is refusing forceps or ventouse simply because she always imagined having a totally natural birth then you should say so – tactfully!

Nothing: what happens if we do nothing?

Doing nothing can sometimes be justified. For example, if your baby is overdue, you and your partner may decide to wait a few days to see if nature will eventually take its course. The risk to your baby does rise, but only slightly. At 37 weeks of pregnancy, one in 3,000 babies is stillborn. This rises to four in 3,000 at 42 weeks

Doing nothing is rarely an option in a medical emergency. However, it is still worth asking your medical team "what happens if we do nothing?" as the answer may help to clarify your thoughts.

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