Making Decisions TOGETHER with Your Care Provider

In the time of COVID-19 (and in reality, anytime during pregnancy), making decisions can seem like an overwhelming task. Aside from determining which car seat is safest, there are the larger looming questions about deciding which procedures and tests are right for you and your baby. 

In an ideal world, you would participate in "shared decision making" at every junction of pregnancy, birth, and parenting.  The Agency for Healthcare Research and Quality (AHRQ) states that shared decision making occurs when a health care provider and a patient work together to make a health care decision that is best for the patient. Optimal decision making takes into account evidence-based information about the available options, the health care provider's knowledge and experience, and your values and preferences.  Sounds like a lot, but the greatest takeaway is that shared decision making is done together. You and your health care provider work together.

There are benefits to shared decision making,  like increased satisfaction/experience, improved quality of care, and improved adherence to treatment plans.  These are well documented in medical literature, as shared decision making has become more popular in the last few decades. 

The AHRQ has created a model called SHARE.  Using the acronym SHARE, providers can move through 5 simple steps to help their patients reach a decision regarding their care.

1. Seek your patient’s participation
2. Help your patient explore & compare treatment options
3. Assess your patient’s values and preferences
4. Reach a decision with your patient
5. Evaluate your patient’s decision

It is a well laid out plan, one that takes time and thoughtfulness.  When done correctly, it certainly places the power into your hands.  The AHRQ also has a section that is directed to the health care consumer.  Their main suggestion is for patients to ask prepared questions. 

Since AHRQ is geared toward general health care, I am going to suggest some questions, in addition to your own, that may be more applicable childbirth. 

1. What is the reason for this test or procedure?
2. Are there any risks or side effects to me or my baby?
3. What will you do with this information? 
4. How will it help you or me make future decisions?
5. If I decline, are there any alternatives?
6. Does my _____________ (religious belief, desire for minimal interventions, cultural preference, etc) change the conversation?
7. Is there time to make a decision?

The above questions are not in anyway exhaustive.  Knowing in advance options that require a decision can be helpful.  Therefore, a good final question to consider at each of your appointments might be, "Are there any tests, procedures or decisions I will need to make at my next appointment that I can start to think about now?" 

With frequent contact between you and your care provider, pregnancy is an ideal time to learn how to engage in shared decision making.  Writing down a few simple questions prior to your next visit can change the conversation. 

Have you had opportunities to walk through decisions with your provider?  Was there anything in particular that helped the process? 

About the Author

Knowing her love for pregnancy and all things baby, Jessica Deeb started her nursing career in obstetrics.  In addition to completing her Master of Science in Women's Health Nursing, Jessica is also an International Board Certified Lactation Consultant and a Lamaze Certified Childbirth Educator. Currently she is working part time at a New York City academic medical center as a quality specialist and childbirth educator.  Jessica also spends several hours volunteering each month, including on the Lamaze Board of Directors.  But most important to her, is her role as a wife and a mom to her four children.  Jessica and her family reside in the New York State Capital Region.