2.3 Providing information and support so that women can make decisions

“Women should be provided with evidence-based information and encouraged to participate in decisions about care.” (Chalmers et al 2001)

In any health interaction, a woman has the right to (adapted from Charter of Health Consumer Rights [CHF 2004]):

• determine what treatment she accepts or chooses not to accept;
• be given easily understandable explanations in her first language of the details of her specific health problem, any proposed treatments or procedures and the results of any tests performed;
• have access to all health information about herself and her baby; and
• have her privacy respected, be treated with respect and dignity and know that all her own health information is confidential.

Health professionals and women need to communicate and collaborate in a team approach (Kryzanauskas 2005; NZ MOH 2008). The woman’s input — and her family’s when she chooses — is an important part of this process (NHMRC 2010). Consistency of information, especially if this is provided by different professionals, is very important (Jones et al 1999; Price et al 2005).

Making a choice or consenting should be an ongoing process of discussion between a woman and the health professionals involved in her care. Factors that may assist women in decision-making include:

• determining how much prior knowledge the woman has (Kruske et al 2010);
• asking open-ended questions and listening to the answers;
• attending to verbal and non-verbal cues;
• clarifying the information provided by the woman;
• clarifying the woman’s understanding of the information provided to her;
• providing easy to understand verbal explanation and written or audiovisual information in the woman’s preferred language (where available); and
• where appropriate, using accredited interpreters to ensure effective communication.

Women have the right to decline care or advice if they choose, or to withdraw consent at any time and have these choices respected (UNESCO 2005). It is important that the level of care provided does not alter because of this choice (FPA Health & Read 2006; Faunce 2008; NHMRC 2010).

2.3.1 Documenting discussions and decisions

Documenting discussions and decisions is important and should include clear and consistent records of (NHMRC 2010):

• information provided to the woman and indications that the messages have been understood;
• informed consent, responsibility and accountability for decisions; and
• the woman’s understanding of risk and her responsibility for her own choices and decisions about care, especially if these decisions are in conflict with professional advice (in such circumstances it must be clearly documented that the woman has accepted a certain level of risk ³).

Shared and reciprocal documentation, including some form of woman-held record, ensures that all members of the collaboration are aware of essential information throughout maternity care. Several jurisdictions in Australia regularly use woman-held records, which have been found to be an excellent way to improve communication (NHMRC 2010). A woman-held record means the woman has a better chance of controlling her health information, encouraging respectful language and, as a result, enabling her to feel more in control during her maternity care (NHMRC 2010).

Electronic (eg web-based or e-health) or triplicate records allow sharing of accurate documentation and also reduce duplication of effort, enabling more streamlined care for women (NHMRC 2010).

³ Several Australian States and Territories have schedules in their health legislation that outline health practitioners’ obligations and protections if treatment is refused. These include refusal of treatment certificates, which may help in recording decisions and avoiding confusion if care is transferred.