When I was pregnant with my last child, my health care provider assumed I

would be having an amniocentesis. It’s a fairly common procedure for women my age (over 35) that examines amniotic fluid for potential genetic problems. However, because I am a Lamaze teacher and a writer specializing in interpreting obstetric research, I knew this was not nearly as straight forward an issue as it seemed to him. I knew I needed to gather information so that I could weigh the advantages of what amniocentesis could tell me against the risks of the procedure.

Were I pregnant today, 15 years later, my choices would be even more complex because there are more alternatives. Now there’s a blood test that can narrow down which babies have a higher probability of having certain abnormalities, including Down’s Syndrome. We also have high-resolution ultrasound scans that have no known risks but bring more uncertainty with their results.

Additionally, my health care provider’s presumption neglected my personal values and beliefs, crucial elements of the amniocentesis decision. If you were buying a car or a computer, you would probably know what to ask to get the information you need to make your selection, or if you didn’t, you could readily find out. Like making consumer purchases, having a baby involves making many choices. Rarely is there only one right thing to do, or is it necessary, at least in the short term, to do anything at all, according to Jean Rasch, a nurse-midwife and recent law school graduate based in Redwood City, California. Few pregnant women, though, think to ask questions about the tests or treatments their caregivers recommend. Either they don’t realize they have options and that the choice is up to them, or they don’t know what to ask. In point of fact, it is your legal right to have the final say about your care. But legality aside, the conversations generated by your questions serves your caregivers as well as you. You are more likely to be satisfied with your care when you know your options and their potential consequences and have participated fully in the decision making process.

You can, of course, leave all or most decisions up to your midwife or doctor. That is certainly a valid choice. The important thing is that it is a deliberate choice, not one you felt you had to make. For cases where you do want the ultimate say-so, Rasch offers a simple set of questions that will enable you to make an informed choice. For a proposed procedure, medication, or restriction, ask:

• How will this benefit me or my baby?
• Could it cause any problems or complications? How often do the serious ones (if any) occur?
  
• Does having this procedure/medication/restriction lead to more interventions? How likely is that to happen? Like tipping the first domino in a row, having one intervention tends to lead to another. You may wish to explore the pros — and especially the cons — of any treatments or restrictions that will or could become necessary as a result of having the first one. A classic example of this is the epidural. An epidural requires an IV and continuous electronic fetal monitoring. You will be confined to bed. You may need intravenous Pitocin (oxytocin) to stimulate stronger contractions, and you may need bladder catheterization. You may also increase your chances of having a vacuum extraction or forceps delivery.
  
• How else might we handle this situation?
  
• What are the advantages and disadvantages of those alternatives?
  
• What are the advantages and disadvantages of doing nothing or waiting longer before doing something?

In labor, Rasch cautions, while emergencies are rare, the urgency of the situation may mean abbreviating or eliminating this discussion. That makes the trust and understanding of values that builds during prenatal care even more important because if an emergency arises, there may be little time to talk. Even so, explanations should be given and agreement solicited.

If a test is under consideration, Rasch suggests that you ask:

• What information will this test give us and why is it important to my pregnancy?
  
• What is involved in having this test? Besides describing the procedure, you will want to know how unpleasant or painful the test may be.
  
• Could this test cause any problems or complications? How often do the serious ones (if any) occur?
  
• How are the results reported?
  
• How likely is a “positive” or “negative” test result to be wrong?

No test is 100 percent accurate in determining the presence or absence of a problem. In particular, many of the evaluations of fetal well-being, such as the non-stress test or electronic fetal monitoring, have low false-negative rates but high false-positive rates. This means that when the test says the baby is OK, it is probably correct, but when the test indicates that a baby with no predisposing reasons to have problems seems to be in trouble, it is likely to be wrong. Other tests such as due date predictions or fetal weight evaluations are not exact. For example, the due date produced by a first-trimester ultrasound is actually plus or minus five days.

As with treatments, you may wish to consider the ramifications of a test before proceeding.

• How will the results of this test affect my care?

If the answer to this question is “They won’t,” there is no reason to have the test. An example of this would be an ultrasound scan performed to enhance “bonding” with your unborn baby.

In the end, it isn’t that you will be questioning every aspect of your care, but that you make an informed choice when choosing a midwife or doctor. You want someone you can trust. This means someone who is not only skilled and knowledgeable but who shares your philosophy and approach to pregnancy and birth, someone who considers the same things you would when making recommendations to you. Even more important, you want someone who trusts you, someone who believes that the best decisions will be made when you are given full information about your options, and who thinks decisions should be made jointly, not by the care provider alone.

*taken from, “Making Informed Choices” By Henci Goer, Every Baby magazine, Issue One.