Deciding to decline, or deciding to wait and see?

Birth decisions aren’t always as clear-but as some people think.

I have a friend called Jenna who became my friend after being a past midwifery client. We reconnected a few years after her birth when I asked her if I could share elements of her care story in ‘What’s Right For Me? Making decisions in pregnancy and childbirth.‘

Jenna was, of course a pseudonym and she and her partner Dev had been through a journey of decision-making around so-called post-term pregnancy.

In a nutshell, Jenna questioned why induction was recommended simply because a certain date had been reached. I looked at the research for her, so I could give her the actual risk statistics. More than twenty years later, I’m the author of two books about induction and Jenna’s baby is at university.

The value of being clear

It was in writing about Jenna and Dev’s story that I first started paying attention to the importance of being really clear about what is being decided when decisions are made.

Because the nature of my practise as an independent midwife (and the beliefs that underpin that) meant that I worked with many women, couples and families who decided to decline certain interventions which are offered routinely at a particular point.

I’m talking about things like induction of labour, vitamin K, group B strep, antenatal (and sometimes postnatal) Anti-D and the birth of the placenta.

It’s probably not coincidental that I ended up researching and writing books about so many of these topics. I have been inspired to do so by these women and families.

What’s really happening?

But there is an important nuance here, which I think is sometimes missed. Because in almost every case, these women and their families are not declining the intervention completely, or universally.

They are saying that they do not want to have it routinely, or unless they genuinely need it.

If it’s offered for an individual reason that they consider makes it right for them, they will often decide to have it. They just don’t think that, “because we offer this to everyone” is a good enough reason to say yes. More on that distinction here.

Staying open

Jenna decided to decline routine induction of her labour. But both she and Dev always remained open to changing their minds. Jenna always said that she would have considered induction if the information that we gathered during the period of ‘watchful waiting’ had suggested that this might be indicated.

By the same token, many of the parents I know who have declined routine vitamin K would have been more than happy to have it if their baby showed any sign of needing it in their first few days of life (and you can find out more about vitamin K here).

In another example, I have worked with a woman who declined routine antenatal Anti-D and then called me two days later and asked for it. She had been in a minor road traffic accident in which her airbag deployed. She considered Anti-D advisable after a potentially sensitising event, but not routinely.

And I have cared for several women who had decided to have a physiological placental birth rather than a managed third stage but who were more than happy to have an oxytocic when they lost more blood than average.

It’s not always a dichotomy

It’s not always about a yes/no, accept/decline dichotomy.

Often, there is a middle ground.

This middle ground is about making decisions as and about an individual within their own context and according to need.

Just not routinely.

Or based on what the guideline says.

Helping you make decisions

If you’re making decisions about your health or birth, you might want to bear this in mind.

Declining an intervention doesn’t always mean an absolute ‘no.’

You can say, ‘I want to wait and see.’

Or, ‘I don’t want routine intervention/induction/screening, but I’ll consider things that are right for me or my circumstances.’

Your body, your baby, your decisions.

Shifting tides

On a wider level, we’ve seen a shift – at least in some circles – from using the word ‘refuse’ (which is often deemed confrontational) to using the word ‘decline’. We still have much to debate there. Some people feel that the shift to saying ‘decline’ is playing into the idea that we should be polite and not stress our needs too strongly.

But, whatever we decide on that one, wouldn’t it be great if we could take the next step?

What if we could expand the discussion and our vocabulary further?

To indicate that many of those who are seen by some as declining intervention are actually actively seeking individualised care. Which might well include deciding to have those very same interventions, but on a used-when-needed rather than routine basis?

Find out more about What’s Right For Me?

And you might like to read more about induction of labour, vitamin K, group B strep, Anti-D and the birth of the placenta.