Deciding to decline, or deciding to wait and see?

Introducing Jenna

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 a book chapter, and 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.

Some 25 years later, I’m the author of two books about induction and Jenna’s baby has just graduated 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 practice 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?

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 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, even though it wasn’t something she wanted routinely, without a good reason.

I have also 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 medication 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?

For more intervention

If you’d like to know more about this, my book, What’s Right For Me? can help.

What’s Right For Me?

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

 

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Books to help you become informed and make the decisions that are right for you…

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