Doctor Knows Best - Royal College Of Obstetricians And Gynaecologists

Main Category: Pregnancy / Obstetrics
Also Included In: Women's Health / Gynecology
Article Date: 14 May 2009 - 7:00 PDT

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In a commentary published in BJOG: An International Journal of Obstetrics and Gynaecology, doctors discuss the types of information pregnant women would welcome and why the advice provided to women by doctors is considered trustworthy.

Although NICE maternity care guidelines state that women should 'be offered information based on the current available evidence together with support to enable them to make informed decisions about their care', there is little guidance on the best ways to provide such information.

Research suggests women want information and involvement in decision-making. When appropriately provided by credible sources, women's experiences of childbirth have been shown to improve. However, the proliferation of online information has meant that women are now overwhelmed by information. In some cases, advice is inaccurate and dubious.

Consultant obstetrician Andrew Weeks and Specialist Registrar Linda Watkins, both at the Liverpool Women's Hospital, refer to two studies published in the same edition of BJOG which demonstrate how good quality and structured information can reduce feelings of uncertainty in women. More importantly, women showed they were willing to rely on clinicians to make the most appropriate decisions for them, in recognition of the expertise of doctors. Provided care was tailored to their individual needs, and it was a collaborative effort between doctor and patient, women are appreciative of the advice received from senior clinicians.

True informed consent can only be given if women are aware and comprehend the risks and benefits they face before choosing a particular mode of treatment. The authors suggest that in providing information to this very specific group of patients, some broad principles are needed:

- Information should include detailed information about risks in mid-late pregnancy. Information increases knowledge and reduces uncertainty.

- Systematic data provision is beneficial to women. These could take the form of step-by-step aids to help in the decision-making process.

Dr Watkins said, "When it comes to the crunch, most women just want a good outcome for themselves and their babies. And they will usually accept the advice of the professionals who have the training and experience to make the right decision. Furthermore, many do not want the responsibility of making a life or death clinical decision regarding their baby.

"As a doctor, a large part of the job is about taking responsibility. That is not to say we should not help and support patients to make important decisions about healthcare but I think at the end of the day that is what we are paid to do. And the women in these surveys seemed to agree. As Kingdon states in her paper 'whilst women want to be informed and involved in the decision-making process surrounding birth method, it does not necessarily follow that they want the final say'."

Michael Marsh, a consultant obstetrician and gynaecologist and BJOG deputy editor-in-chief said "Pregnant women wish and need to make decisions about childbirth based on impartial information from reliable sources, whether this is an information leaflet, a computerised decision aid or a knowledgeable clinician.

"Information aids may help to ensure consistent facts are given, but it seems clear that the degree to which women like to have guidance from midwives and obstetricians about 'what is best' varies greatly. Information aids should enhance the factual quality of advice, but will not replace informed discussion between the woman and her midwife or obstetrician."

References

Watkins L, Weeks A. Providing information to pregnant women: how, what and where? BJOG 2009;116:1-3.

The two papers referenced by the authors are:

Frost J, Shaw A, Montgomery A, Murphy D. Women's views on the use of decision aids for decision making about the method of delivery following a previous caesarean section: qualitative interview study. BJOG 2009; 116: 1-10.

Kingdon C, Neilson J, Singleton V, Gyte G, Hart A, Gabbay M, Lavender T. Choice and birth method: mixed-method study of caesarean delivery for maternal request. BJOG 2009;116:1-10.

Source
Royal College of Obstetricians and Gynaecologists

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