Making Decisions

updated post July 13, 2025 (includes findings from The Birth Map Study)
EXCERPT FROM The Birth Map pages 45 – 51

Due to the nature of decisions, different people facing similar situations will make different choices.

You (and your partner and/or birth support) do not have to face your decisions alone; there are avenues of support available to help guide you through the process:

• Building a relationship with your care team, through meaningful conversations is essential (The Questions in  the next step help you do this). 
• Finding a doula or mentor can help you make sense of your options and put it into context with your circumstances.  Many doulas offer preparation only services. 

Elements of Decision Making

Foundation

Our foundation is made up of personal experiences, including from childhood, anecdotal information, and even evidence-based information.  It influences the interpretation, evaluation, and incorporation of new information, making it important to address as part of the decision making process.  It can be helpful to spend some time unravelling this, questioning, considering, accepting, rejecting, or altering it using new information.  This can be quite confronting if challenging long accepted understanding; it can help to work through this with a doula.  This process may include sensemaking of previous pregnancy or birth experiences. This also includes our values, religion and philosophies. Much of our foundation is fixed, and we must balance the circumstances and information within this context.

Circumstances

This is your current environment, your relationship main influences and supports, anxieties and fears, financial situation, work life, future plans, location..some circumstances will be helpful, some are more challenging. You may have a medical condition that affects your decisions. Your care provider and place of birth are also important aspects of your circumstances, sometimes out of your control.

Information

Ideally, new information comes from evidence-based sources.  The information needs to be relevant to your circumstances and foundation.  When different sources of information conflict with each other, or with our circumstances or foundation, it can be overwhelming and confusing, leaving us unsure of what is reliable. There are a few questions to keep in mind when researching new information that can help determine its value.

Reliability – who wrote it, is it well written; who said it, why, based on what?

Is it selling something?

Is it sponsored (beware of the formula company giving breastfeeding information)?

How up to date is it?

Does it have an ‘agenda’?

I recommend reading Birth with Confidence and Making Informed Decisions on Childbirth (further recommendations can be found in the free member access)

Understanding your Options: Sensemaking

Sensemaking is a process of understanding your options and placing it within your context.  In Step One, you built an understanding of what your Beyond Birth context could be, and coming up in Step Three, you will reflect on your beliefs and expectations.  This context is your foundation.  How you evaluate your options, weighing up the information with your circumstances, is influenced by this foundation.  Understanding what a risk really means can be frustrating and confusing.  For example, you might hear:

a 1 in X chance,

or x% chance, or

‘twice as likely’

It can be hard to know what it means for you.  Twice as likely could mean that instead of 1 in a million, you have a 1 in 500 000 chance or a 0.2% risk becomes 0.4% – still very low.

If you have a ‘low risk’ pregnancy, and feel well and prepared, you will view risk differently to someone who is considered ‘high risk’.  If you are considered high risk, what the risk is will determine what interventions are likely to be offered or needed. 

You may decide the risk is not significant and so opt to do nothing (wait and see); or you may decide the risk is too high and opt for some or all possible interventions.  Keep in mind that once a decision is made to use a particular intervention, the pathways will change.  When decisions are not urgent, the ‘do nothing’ option allows more time to consider all the (remaining) options.  Sometimes the choice is clear to accept an intervention.  The key is knowing your options and the pathways they lead to in advance.

It is a very personal decision.  It is important not to rely on a single source of information (be it a person, a pamphlet, or a forum).  Find various sources; consider using a doula to help navigate the information.  A doula can guide you towards reputable sources of information but will not influence your decision or advise you on your decision.  Knowing the questions helps discover your options.  The more information you seek, the more likely you are to find even more questions you need to ask and be able to come to a balanced decision.

Danger, Risk, Chance and Opportunity

Birth is Dangerous!  Or is it?  ‘Danger’ and ‘Risk’ are sometimes used interchangeably, but they mean very different things.  To use ‘danger’ when you mean ‘risk’ could be very damaging. The Nocebo Effect (opposite to The Placebo Effect) is a very real phenomenon, and our words are very powerful.

Using ‘danger’ when you mean ‘risk’, and ‘risk’ when you mean ‘chance’, overstates the issue.  Using ‘chance’ when you could use ‘opportunity’ is misleading.

Let’s put it in context.

There was danger she could birth at home
There was a risk she could birth at home
There was a chance she could birth at home
There was an opportunity she could birth at home

When evaluating situations, the BRAIN guide is a useful tool.  This tool helps determine the context.  When no, or a very low, likelihood of a negative outcome is determined, then we start to see opportunity. For example:

You are approaching your ‘due date’, you are offered an induction.  You are healthy; the offer is based on the estimated date alone.

The Benefits to you: meet your baby sooner.

The Benefits to baby: none

The Benefits to the care provider:  scheduled ‘delivery’, easier to ‘manage’.

The Risks to you: ‘cascade of intervention’, which can lead to possible emotional and physical trauma

The Risks to the baby: possible time in NICU, possible exposure to intervention drugs (which may have long-term impacts), and possibly being born prematurely.

The Risk to the care provider: none

The Alternatives for you: wait (no risk)

The Alternatives for baby: wait (no risk)

The Alternatives for the care provider: wait (no risk)

Your Instinct:  what do you feel most comfortable with?

Doing Nothing:  In this case, ‘nothing’ is the opportunity to wait.