10 Things You Need To Know About Informed Decision Making.

1. In (almost) all health situations you alone have the right to make decisions about your own health care.

The only exceptions are

• In an emergency when a health or social care practitioner needs to act straight away.

• When someone cannot decide or make a decision by themselves (this is called lacking 'capacity').

• When people are being treated under some sections of the Mental Health Act.

2. The way information is presented about decisions doesn't always make it obvious that medical interventions are offered and can be declined if that is your informed decision.

Time is often short in appointments and your health care provider may use language like "I'll just book this test for you" or "I'll just give you..." This is simply because they have routine care which is offered to everyone and not because they aren't happy to answer questions or have you say "thanks for the offer but no thanks".

3. You can be prepared with your own research and ideas before appointments and you can ask for more information during your appointment.

Taking the initiative to learn about things that you may have to make decisions about will allow you to ask questions that help you feel confident in your choices. There are some good ideas on how to prepare for appointments and what to do in the appointment on the NICE website page "Making Decisions About Your Care"

4. Your healthcare providers are responsible for making sure you are given the information you need to make decisions and to give consent. You're not being difficult or causing trouble asking for more information.

NICE Guidelines are set out for health professionals to follow and make sure they are offering the best available information and standard of care. But they can also be a helpful source of information when doing your own research about what is on offer.

Your right to informed choice is set out right at the start of the guidance on perinatal care.

Whenever you are looking for information about anything pregnancy, birth or postnatal related the NICE Guidelines can be a useful source of information.

5. Information is not advice. If you are given advice you don't have to take it without question.

You can listen to or read other points of view about any intervention you are advised to take. You will need to filter information

and advice and work out if it's informed by someone's biases and fears or by facts and research evidence. But remember all research has to be interpreted so your responsibility is to evaluate the research and then trust your own instinct as to what is the right decision for you. All information isn't equal, for example, if you see some research reported under a sensational headline in a tabloid newspaper it's wise to look around and see what some reliable sources like Evidence Based Birth, Sara Wickham, or Midwife Thinking have said about the topic. And as you will find more and more when you get further into parenting, just because something is how your mum or aunty etc has always done it that doesn't mean it will definitely be the right choice for you and your baby!

If you feel you're being given advice that you don't feel is right for you and want to find someone who can help you find unbiased information and support you to make your own decision confidently even in the face of pressure you're welcome to come along to any of our meet-ups and/or join our Facebook Group (where you can also ask your question/ask for support anonymously if that feels easier). You might also want to consider getting a doula to support you. Check out Doula UK for more information.

6. Information should be presented in an easy to understand way.

This means any situation or condition-specific vocabulary should be explained to you and any statistics should be given in meaningful ways. One thing shouldn't be described as twice as likely as another unless you also know what the likelihood of the first thing is. Bear in mind if something has a 0.5% chance of happening and something else has double the chance of happening it still only has a 1% chance of happening. This is very different to something that has a 10% chance of happening and something being double the chance of that would be a 20% chance of happening. If the statistics you're given are not clear then you can ask for them to be explained and the actual chance of something happening to you specifically.

7. You are not a statistic.

Even when you know all the statistics about how often things happen and have all the numbers these are for the whole population. What feels like the right choice for you as an individual will still have to be your own decision.

8. Using your BRAIN can help you make an informed choice.

The BRAIN acronym is a really useful tool for getting your thoughts in order and helping you remember the questions you may want to ask.

The BRA helps you remember the questions you may want to know before making a decision about an intervention you're offered. You can ask for the benefits of the intervention, these will tell you why it's being offered. You can ask for the risks of the intervention, nothing is risk-free everything must be evaluated as of greater benefit than risk to be considered worth doing. Asking what the alternatives are will give you the opportunity to understand your options and why one intervention is being recommended rather than any other option. Is it just because it's the routine or is there a medical reason you personally may benefit from this specific course of action?

The I is a question you ask yourself. What are my instincts telling me? Think about the options and listen to your body how does it react to each of the options do they make you feel safe and relaxed or are they making you feel on edge even if you can't explain exactly why. If you have anxiety or are very uneasy with listening to your instincts through previous experience or just lack of experience you can have a chat through everything with your support person and have them make a suggestion and see how they think you feel and then how you react to that.

The N is another question you can ask, what happens if we do nothing. It could also be a W for wait. The question do we have to make this decision now, is this situation urgent or can we take some time to think and see how things are going in an hour or a day. If we choose to wait what can we do to keep an eye on my health and my baby's health while we wait?

9. You are allowed to change your mind.

If you make an informed decision and then some time passes or other events occur and you start to feel you would like to change your mind and make a new informed decision that's completely fine. You're not failing to do the thing you originally decided on and you're not inconveniencing anyone who had prepared for things based on your first decision. You don't have to change your mind to make things more convienient for anyone else and you don't have to change your mind because there's pressure to make a different decision that still feels wrong to you. But if something different starts to feel right for you your choice is still the deciding factor in any situation.

10. You're allowed to feel sad about past choices but remember not to blame yourself or spiral into guilt.

You may have known you were being bullied into a decision or that circumstances or events were forcing you into a situation you wouldn't have chosen. Or you might have felt you had no other options or that this was what you wanted at the time. But if you look back after the event and feel sad you had no other choices or that you wish you had made different choices that's okay. Allow yourself to feel sad but don't allow yourself to believe that those choices mean you failed or that you're not a good parent. If those thoughts start to go round in your head then you need to reach out to people who can positively support you. Talk to your midwife about how you're feeling, talk to your partner or to a good friend. Come and talk to other parents at one of our meet-ups or join our Facebook Group and ask if anyone else has been in the same situation. If you're really struggling with what happened during pregnancy birth or postnatally then you might want to read about the support that's available in our blog post about feeling sad about birth or to read or watch our information on mental health support.

Perinatal Mental Health

What is perinatal mental health?

Perinatal covers through pregnancy and the first year of your baby's life. Mental health is something we all have. Just like with physical health mental health can be good or we can be ill and sometimes we're not great but doing okay. Also, just like we can eat healthy food and keep our bodies active to keep our bodies in good physical health we can look after our minds and keep our mental health generally positive too. But we also need to be aware of how to know if we need extra support with our mental health just like we do with our physical health. The year around when our babies are born can be a time that our mental health needs some extra care and when we need to be especially aware that if it doesn't feel right it's okay to seek out support.

These slides were produced by our Committee Vice-Chair Sinead who is a counsellor with a special interest in perinatal mental health for one of our monthly meet-ups when mental health was our topic. You can hear her chatting more about this topic in the video below.

Our blog editor Sarah also had a chat with our Committee Secretary Sally who is a Doula and has personal experience of perinatal mental health challenges.

Risk factors for perinatal mental health issues.

Perinatal mental health issues can happen to everyone but if you have had previous mental health issues you may be more likely to have them reoccur during pregnancy or postnatally. However, if you've had mental health issues before you may also be more aware of what you can do to help yourself. If you have unresolved previous traumas including having had a previous traumatic birth finding support with this during pregnancy is a really good way of mitigating this potential risk factor. Check out our blog post about recovering from traumatic birth for more information on this including links to people who can support you. If you have a previous experience with psychosis it's very important that you and your care providers are aware that there is a risk of this recurring postnatally and are prepared if extra support is needed. Check out Action On Postpartum Psychosis for more information.

Your lifestyle and previous life expectations especially if you are pregnant for the first time at an older age and have had a lot of control in your professional life up to this point can be a risk factor. If you're used to being able to keep everything really perfect in your home and personal life you may need to prepare for the realities of life with a newborn for the sake of your mental health.

How can I help myself have good mental health?

These ideas won't cure your mental illness you will need professional support with that but they are very good for keeping yourself in good mental health.

Keep moving, gentle exercise isn't just good for your body it's good for your mind too. This can be combined with spending time in nature which is also good for your mental well being. Take walks in the wood or by the sea or in the park, wherever is accessible for you. Have a balanced diet. Keeping your blood sugar levels at a balanced level will help you have a steady mood.

Practice mindfulness. Become aware of your thought patterns and self-talk. If you find self-talk is a source of negativity for you you might want to consider a course in mindfulness and/or cognitive behavioural therapy. There are lots of people who can help and support you with this. One place that has a lot of local resources is the charity Mind. You can check out the local Solent Mind website for information.

If you want to try mindfulness you can find tracks on YouTube or on several different Podcasts on Spotify. If you don't feel comfortable with mindfulness you might find a creative activity has a similar positive effect of keeping you "in the moment". This could be art (again lots of simple learn to draw videos on YouTube for beginners) or a craft such as knitting or cross-stitch or it could be something like putting lego models together. The important thing is that it's fun for you.

Practice Gratitude. Pregnancy is a great time to take up journaling, which is just writing out your feelings to help you express them rather than letting them build up in your head. A gratitude journal where each day you list some things you are grateful for can really help to create positive thought processes.

Join groups. It doesn't have to be specific mental health support groups, although those are available, any group where you chat to people at a similar stage of life to you will allow you to feel you're not alone and other people have the same thoughts and struggles. You may want to start by joining Facebook groups as it sometimes feels a little easier to get into conversation and get to know people that way before meeting people face to face. You're always welcome to come along to our groups. If you're planning to breastfeed you might find it helpful to go along to a local breastfeeding support group while you're pregnant as learning to breastfeed can involve a lot of different feelings and experiences which peer support can be really vital in coming through happily.

Who can help me if my mental health becomes a problem?

The Daisy Team. Local to us in Portsmouth we have a team of specialist mental health midwives who support anyone who has mental health challenges including people with diagnosed mental health illnesses, those who are struggling with tokophobia (fear of pregnancy and birth) and people who have had previous traumatic birth experiences.

Your own GP. Your doctor can support you in pregnancy especially if you're already taking medication for a mental health condition such as depression or anxiety. It's really important not to suddenly stop taking your medication when you get pregnant. It may be that you will be fine on the same medication through pregnancy or that you change or wean off medication but you should only ever do this with your doctor's support.

Talking therapies. These can be very useful for all kinds of mental health issues and can work well alongside medication or other alternative therapies such as acupuncture, chiropractic care, homoeopathy. You can access talking therapies through self-referral In Portsmouth through Talking Change and Hampshire through italk (in other areas you should find your local service with a web search for talking therapy self-referral *placename*).

Doulas. Doulas are people who are trained to support families through the perinatal years. They provide practical and emotional support which has been shown to have a very positive impact on mental health and can provide signposting when more intensive mental health support is needed. A good place to start finding out more is via Doula UK.

What about partners can they have perinatal mental health challenges too?

Absolutely mental health issues can happen for anyone in times of change in their lives and you don't have to be the one who is pregnant for this time to be challenging for you. Partners can use all the same positive mental health supports and can access support from their GP and from self-referral to talking therapies also. There are also organisations that can offer specific support Dad's Matter is a national organisation, Dadzclub is local to us in Portsmouth and The Queer Parenting Partnership offers support to partners and families who are LGBTQ+

Information not advice

As with everything we produce this blog is just information, not advice. If you need advice on your own mental health please always speak to your doctor or midwife.

Labour and Birth at Home

This post isn't just for people who plan to birth at home. That's why the title is labour and birth at home rather than homebirth. Unless your labour starts by being induced in the hospital (check out our post about that if that might be offered to you) some of your birth experience will be at home. If you have a super-fast labour it might all be at home whether you planned it that way or not. If you have a moderately fast labour it might be just a short time at home before you transfer to the birth centre or labour ward. If you have a slower burning longer labour it might be at home for a relatively long time before you transfer to your chosen birth location. So for everyone, there's some time labouring in the comfort of your own home. The good news about this is there's plenty of evidence that the home comforts can be very beneficial to you during that time.

So this post is going to be all about what you can do to help yourself labour and birth comfortably at home. If you're still wondering if choosing to birth at home as well as labour is for you or not you might want to check out the page about homebirth on Cathy William's Chilled Mama website too. It covers lots of information about statistics on the safety of birthing at home. Cathy's the author of the quote in the picture here "All births that start spontaneously are homebirths. It's just that some have planned transfers. This quote is mentioned by our committee secretary Sally during the video chat we recently had about home birth which you can watch below.

This is the link to the video Sinead mentioned in the chat.

Our practical tips for labour and birth at home.

If you don't already know about oxytocin you might want to do some reading up about it wherever you plan to birth. One place you could start is our blog post of ideas for helping yourself through labour.

In your own home, you have the safety and comfort you need to build up your own oxytocin and endorphin levels. In early labour, this might include privacy for smooching or massage etc from your partner. Or if you don't feel like being touched at the time it's a space and facilities for watching funny TV or listening to funny podcasts.

It's completely up to you who you have with you in your own home, have your older children with you, or have someone else around to look after them whichever helps you feel the most relaxed. Have family members or friends who make you feel relaxed and happy or who can make you laugh. Or ask everyone to leave or go downstairs while you shut yourself in the bathroom in the quiet and dark.

Your own bathroom is a brilliant tool for helping yourself to progress in labour, the safety and natural feeling of release you get when you sit on the toilet can be really helpful Or you can take a bath or a shower and the water can be fantastic for helping you relax.

Your own kitchen means you can eat what you like when you like and so can your birth partner and team. Some people find making a cake is a great distraction for during early

labour.

You can set yourself up a birthing nest in your favourite room of your house. Set up a birth pool that you know will be available for you. Set up a display of your favouite positive affirmations, put up fairy lights, make it cosy for yourself. Also remember that when you're in labour you may find yourself picking some other place around the house. But even if you do that in labour the positives from just preparing that space are all the relaxing effects during the last days of your pregnancy. Plus wherever you birth you will have that lovely set up to relax in once baby arrives.

Being able to cuddle up in your own bed once baby is here and everyone but your new family is gone is such a lovely feeling. One brilliant tip from the team is to make your bed with lovely sheets, then cover those with a waterproof layer then a set of old sheets. So if the bed gets messy during labour you can peel off the top layer, pop it in the washing machine and snuggle down in your nice clean sheets when you're ready.

Plans in advance and decisions on the day.

One of the things we talk about in the video and that we talk about very often is to remember that plans are flexible. You might plan a homebirth and on the day decide for some reason you want to go into hospital, you might plan a hospital birth and on the day

your baby might have other ideas and arrive before you expect while you're still at home.

It's really important to remember that there are no wrong decisions, you make the right decision for you at that moment with the information available to you at the time. Birth is not a pass or fail event, if you hear terms like failed homebirth remind yourself that language isn't helpful or accurate. It's much more accurate to say homebirth with transfer during labour or after the birth. Making the decision to do something differently to your plan A (including transfer to hospital) when information or events make that the right choice for you at the time is always part of the plan for any birth.

Sometimes labour can happen faster than expected and being prepared for the possibility that your baby could arrive before the midwife will make that a much less scary event should it happen to you. The team's ideas for being prepared include watching lots of homebirth videos (available on YouTube for example) so you're used to seeing the natural progress of uninterrupted birth and doing a course that covers first aid and specifically first aid for childbirth. Such as this one from midwife Joy Horner.

Homebirth Stories

Keep your eyes peeled here for when our new birth stories podcast launches soon. If you can't wait for that pop over to our Instagram and check out the Birth Stories Highlight.