Informed Choice vs. Informed Consent

Informed Consent VS. Informed Choice

Ok, so Informed Consent is what most people in a traditional Doctor/Patient relationships are offered. This means that the patient is informed of all the benefits and risks of the proceedure being performed and asked to give their consent for that specific procedure. Informed Choice means that the client (I am changing my word usage on purpose here) is informed of all the options available to them and all the risks and benefits associated with those options.
Here is a childbirth related example: Informed Consent - you are seven days past your due date and are ready to have this baby. You ask your doctor and are informed that you can have Amniotomy, amniotic sac ruptured by the Dr. (this is only one method that Dr.s may use to induce labour, chosen for this example). You will be informed that this increases you risk of infection, that it may still take hours for labour to begin, that there is a significant chance that other measures will have to be taken to augment the labour, that there will be a time limit put on your labour and any other information about this particular procedure. You will then be asked to sign a consent form and the procedure will be booked.
Informed Choice - You are seven days overdue and ready to have this baby. You ask your Doula or Midwife what your options are and they inform you that you can have a medical procedure such as Amniotomy, or Prostoglandin gell, or pitocin, or you can have your membranes stripped. They will also inform you that you can try natural ways of inducing labour first. Such as, exercise, homeopathics and herbal remedies or, intercourse. Your Doula or Midwife will give you the information on the effectiveness of each option, the risks and benefits and, will give you time to research, ask questions and make your decision. A Doula or Midwife will then support your choice and assist you in whatever way is needed.
The fact that a doctor is not likely to present you with informed choice does not make doctors bad or evil or even a wrong choice. Informed consent is part of the medical model and for some people the medical model is the right fit for their birth. however, if you pref to have options and to be given a distinct say in your birth experience then you may want to consider finding a Midwife or hiring a Doula

Doulas and Partners

How does a Doula help from the Perspective of a birth partner? When I meet with couples for the first time, it often becomes obvious that the mother is the driving force behind contacting a Doula. I have had fathers ask "will I be doing anything during the labour if you are there?", "I don't get why she needs someone besides me" and, " I don't want to be left out". The fact is, a Doula is there to assist the couple in their birth experience, not just the mother. A Doula will coach the partner in how to assist with massage, physical support and encouragement. She will provide the couple with information throughout their pregnancy and birth to support and empower them. A Doula will never "take charge" unless asked. a Doula is there to provide support, information, education, empowerment, and to act as an advocate for the birthing couple.
a Doula will also support the partner by "covering for them during bathroom breaks, getting food and water and reminding them to care for their own well being as well as there birthing partner's. if a couple is doing very well during labour, I will step back and give them space until there is need for a break or a change in position or location.
It can also be useful for the partner to have a Doula there if unfortunately the baby needs to be taken to NICU at birth, in this instance, the Father can accompany the baby and the Doula can remain with the mother for support and to funnel information.
A Doula is there to support the birthing couple, each couples needs are different however, a Doula should always be an addition not an interference.

How Can A Doula Assist With A Scheduled Cesarean?

Some medical circumstances make it necessary to plan a cesarean section for your birth.  If this is the case, you may discount the support of a Doula thinking that since you are not going to experience labour, you will not need a labour support person.  However, a Doula may be of great assistance through a planned cesarean section especially if the Doula has experience working cesarean section births.
When you birth through a cesarean section, you are still birthing a child and all the emotions will still be there however, you are adding major abdominal surgery to the experience of becoming a new parent.
A Doula can assist you in preparing for the surgery, knowing what to expect and how it is going to play out.  A Doula can also support you and your partner on the day of at the hospital, keeping you and your partner company and walking you through the emotional and personal aspects of the cesarean birth.
In advance of the scheduled birth day, a Doula can assist you in preparing yourself, your support system and your home for the arrival of your child after the birth.  Recovery from a cesarean birth is longer and physically different from that of a vaginal birth, you will need physical assistance and starting breastfeeding can be more complicated after surgery.  A Doula can assist you in the hospital during recovery and when you return home to make sure that everything is going well and to provide you with resources if you are experiencing complications.
Your Doula is your 24/7 contact throughout your birth experience and can provide you and your partner/support network with information and reassurance before, during and after your birth.

Its useful to have a doula

Why have a Doula? It has been shown through numerous studies that having a Doula present at your birth significantly increases the success rate of natural births. Why? Because a Doula is specifically trained to support you during your birth experience. Doulas know birth, they know what the options are, and why interventions happen. a Doula also spends time with you before your birth to get to know your goals and limits. a Doula will assist you physically, emotionally and will help you to advocate for yourself during the birth.
a Doula is there to support and to advocate for you and your family.

In honour of my son's t8th birthday, I am reposting his birth story

My first child was due on May 1^st, 2008.  My Partner and I had chosen to have a midwife deliver our baby at a hospital.  I wanted a vaginal birth with absolutely no intervention.  My intention was to labour at home for as long as possible and then move to the hospital to deliver my baby and return home within six hours of the birth. 

I had no fear of labour pain and was intent on pushing out my baby and having him immediately placed on my chest, I wanted to begin nursing right away and I wanted to take my family home as soon as possible.

On the morning of April 27^Th, 2008 my water broke waking us up.  Contractions began about ten minutes later.  We called the midwife who was at our house by 9:30 am.  She checked me and was concerned because my blood pressure had spiked, she told us to monitor the contractions and if everything continued as was to meet her at the hospital at 2:30pm.  Within the hour after she left my contractions increased to two minutes apart, and forty-five seconds to one minute in length.

We again called the midwife who arranged to meet us at the hospital at noon.  Once at the hospital I was monitored briefly and because my blood pressure was still fluctuating I was then admitted to a birthing room with my partner and the midwife.  I was having back labour because the baby was in an Occiput Posterior Position.   I laboured through the day with little change.  I used many different labouring positions including a birthing stool, a birthing ball, toilet sitting, walking the halls, showering and slow dancing.  Around 9:00 pm I still had not dilated beyond five centimeters this was due to the OP positioning and the fact that the baby had not fully decended into the pelvis prior the water breaking.  At this time I was given the option of a Pitocin drip to help move things along.  I declined this as I felt fine and wanted to continue to labour without intervention.  Between 10:00 and 11:00 pm we had a midwife change over and in between a Doctor tried once again to put me on the Pitocin, again I declined.  With the arrival of the second Midwife I laboured through the night and well into the next day still with little change.  At some point during the night the midwife performed a Stretch and Sweep to try and increase dilation.  I remained active throughout the night and continued to take in fluids to keep up my energy.  During the night I did spend some time in bed side lying to attempt to turn the baby.  By 1:30 pm on April 28^Th, I had not dilated past five centimeters and my contractions had begun to slow.

At this point the Midwife spoke with me about an Epidural so that I could rest in order to be able to push when the time came, and a Pitocin drip to increase the intensity of the contractions so that I would dilate and transition to pushing.  We had an emotional heart to heart and decided to go ahead with the intervention – at this time we had been warned that because of the posterior positioning of the baby, the lack of decent and the length of my labour, that a Cesarean was a possibility.  I still hoped to deliver my baby naturally and felt that this intervention would give me the best chance to still meet that goal.

After a few hours on the Pitocin with the Epidural I had not dilated further and my contractions had slowed.  I was having back pain and feeling nauseous.  At 6:00 pm the Doctor examined me and declared that I would need a Cesarean.  Again after much crying and reassurance from my Midwife that this had to be, we consented to the surgery and our son was born at 7:15 pm on April 28^Th, 2008 via Cesarean Section.

When he was born, both of us spiked fevers and he had what they called a respiratory hiccup.  He did not pass the APGAR and a Pediatric Respiratory Specialist was called into the delivery room.  During this time the surgery on me was being completed and I could only see my son from a distance as he remained on the warming bed with staff buzzing about.

I was taken into the recovery room and on my pa'srtner insistence the baby was briefly brought to me on his way to the NICU.  He and I were separated until 11:00 am the next day when I was taken to the NICU to nurse him for the first time.  We remained in the hospital until May 1^st when on my insistence and my Midwife’s assurance, I was discharged one day ahead of schedule.

In honour of my daughter'6th birthday I am re-posting her birth story

I found out I was pregnant with my second child one month after we purchased our first home.  My due date was exactly two years after my first child's due date, so we had actually accomplished having children two years apart.

This pregnancy was more stressful than the first.  We were moving, I was having a stressful year at work and we had a toddler, there was non of the cozy evening with just my partner and I dreaming about the baby, like we had during our first pregnancy.  The other stress factor making the decision to have a Trial of Labour leading to a Vaginal Birth After Cesarean (VBAC) or to schedule a Repeat Cesarean Section.

We had again chosen the care of Midwives and were fortunate enough to have the same midwives that we had had during our first birth.  To tell you the truth both birth options terrified me, both were unknown to me in some way.  If I had a successful VBAC, I had not experienced transition labour or second stage labour (pushing).  I had experienced a very long labour and that didn't scare me in fact, I looked forward to the surprise of going into labour, what I didn't want was a repeat of the results of that very long labour, having my child sent to NICU and not being able to hold the child right at birth.  What scared my about a scheduled repeat Cesarean Section was going into surgery without the exhaustion and stress - I know this sounds bizarre but I am incredibly afraid of needles and was terrified of the surgical prep.

So, my partner and I questioned the midwives and started our own research and took a long time to decide.  Eventually we decided to go for the Trial of Labour, our research told us that it was better for the baby to go into labour even for a short time and, with the shorter recovery time on a vaginal birth it would be easier dealing with a toddler.

We set limits, I did not want to be in labour for 36 hours again.  I wanted to do everything possible to hold my child right away and to begin nursing as soon as possible.  My ultimate goal was immediate contact with my child.  My other goals included being able to move around as much as possible and staying home as long as possible before going to the hospital.

Now in Toronto, VBAC must be attempted in a hospital, you are supposed to be monitored all the time and have an IV in as soon as you go to the hospital.  I refused continuous  monitoring and the IV because I wanted as much freedom as possible to move during labour.  Movement had really helped during my first labour. 

I was still scared of the unknown but was glad I had made the decision to have a natural labour.

My due date was May 1st 2010 and labour began when my water broke at 1:15 am on April 12th.  Much like my first birth, my contractions started within minutes and were 5-6 minutes apart right off the bat and lasting about 45 seconds.  We were not really prepared for the baby to arrive three weeks ahead of schedule so the next few hours at our house were very comical.  My partner was running around packing a bag, tidying up our messy, in progress house and throwing the uninstalled car seat into the trunk, box and all!  I spent the time labouring, talking to my midwife on the phone and making a list of meal times and options for my son so that my brother-in-law was not at a total loss.

My midwife showed up with a student in tow at about 3:00am and my contractions were about 2 minutes apart and 45 -60 seconds in length, gaining intensity with everyone.  My brother-in-law showed up shortly after and we were on our way to the hospital just after 4:00am.

My contractions increased in intensity quickly on the way to the hospital.  When we arrived at the birthing room I was feeling the urge to push.  However, when the midwife checked my dilation, I was only 4cm.  This was an issue as the babies head was pushing against my cervix and starting to swell.  The intensity of my contractions was much higher then I had experienced with my son and it was taking everything in my power to not push at this point.  The midwife called in a consult with the OB on call and by the time she arrived, I had dilated to 6cm but my contractions were still too intense for the amount of dilation.   So, in consultation with the doctor we decided to try and Epidural to decrease the intensity of the contractions so that I could dilate without injury to the baby.

I was put on the Epidural at around 7am and was given a second dose about an hour later because I was not getting much pain relief.  Once the Epidural was in I dilated quickly to 9 cm and then my contractions slowed considerably and in 5 hours didn't dilate any further.  So, at about 1:00 pm on April 12th, the decision was made that I would have a Cesarean Section and at 2:06 pm my daughter was born!   this time after 13 hours of labour and surgery, I was able to have my daughter brought to me right away and began nursing her in the recovery room (later I did struggle with breast feeding, this story will follow).

Baking Good Snacks

Like most parents, I want my children to eat well and to have only the best.  If I could afford it, I would buy only organic sadly, it is not in my budget to be truely organic.  However, I can controll perservatives, sugars and additives by making our food myself.  My partner and I have always eaten pretty well but a year or so before our son was born we started really makning an effort to not eat processed food and to cut down on refined foods and salt.  I have to say that I lost weight without trying and generally felt better.  Now that we have children we are trying to be even more dilligent about healthy eating.  Luckily both my children will eat pretty much anything with no wierd picky habits, like only eating white food (I read this once in a parentling magazine)?
Now, I love sweets.  I love chocolate, I really like cookies and I crave sugar.  I can't very well deny my children sweets when I want them all the time so, I have started researching alternatives to processed sugars.
I have tried a number of things:
Agave Necture - this works well but is expensive

Molassis - agian, works but is very heavy and has a distinctive flavor

Honey - I actually find this too sweet and you are not supposed to give children under a year honey

Dates - this is one of my favorites, if you majic bullet the dates with a little water you can relace the sugar in a recipe with them.  This works best in savory cookies and muffins.  It is also O.K. in brownies.

Concentrated Pinapple Juice - this is my favorite.  I have used this in cookies, muffins and brownies.  I use the same amount as sugar in the recipe and it is sweet enough.  I also have been substituting apple sauce for butter or oil and this also lends sweetness.


In my attempt to not have refiend foods I witched to whole wheat flour however, I find this can be a bit heavy in cakes but is O.K. in in cookies, muffins and pancakes.  The recent alternative that I have used to much success is Oatmeal.  I grind it into a powder in my Magic Bullet and substitute in the same amount for flour.  This is great in oatmeal muffins, pancakes and also works in cookies and brownies.

Here a recipe that my son and I made today ( he likes to stir).

Chocolate Mini Muffins:

Mix together
3 tbl unsweetened applesauce
1/4 cup pinapple juice concentrate
1 egg (or just the yolk if you have children under one year of age)
3 tsp of baking powder
1/2 tsp cinnimon
1 tsp vanilla
1 1/2 cup of powdered oatmeal
1/3 cup of cocoa
1/2 cup of white chocolate chips (optional)

spoon into mini muffin tins and bake at 400 for 15 minutes.  This will make 24 mini muffins or 12 regular size muffins.