Informed Choice

Informed choice is a fundamental principle of midwifery care in Saskatchewan. Clients have the right to receive information so that they can make informed decisions about their care. The interactive process of informed choice involves the promotion of shared responsibility between the midwife and the client. The informed choice process ultimately results in either informed consent or informed refusal. Informed choice discussions should be documented in the medical record and results communicated with the health care team.

GUIDELINE

 Midwives encourage and give guidance to clients wishing to seek out resources to assist them in the decision-making process. It is the responsibility of the midwife to facilitate the ongoing exchange of current knowledge in a non-authoritarian, culturally sensitive and co-operative manner, including sharing what is known and unknown about procedures, tests and medications. Each midwife has the continuing responsibility to practice according to standards of practice and may decline to be involved in care that is outside of accepted clinical practice guidelines. 

The Saskatchewan College of Midwives requires midwives to provide each client with the following information throughout the course of care: 

• potential benefits and risks of, and alternatives to, procedures, tests and medications, including the risks of not having any particular test, procedure or medication;
• relevant research evidence and clinical practice guidelines;
• Midwifery Standards of Practice
• community standards and practices;
• opportunities to discuss information;
• care that is individualized and sensitive to changes in the client’s circumstances throughout pregnancy.

Informed Choice and Requests for Care Outside of Standards 

 A midwife is not obligated to provide a client with a requested intervention or procedure that they believe may cause harm. Where a client chooses care outside standards, in-person informed choice discussions and more extensive, contemporaneous documentation and communication with the health care team is necessary. Midwives caring for clients choosing care outside standards should refer to the guideline Client Request for Care Outside of Standards. Saskatchewan 

Emergency Situations

As a clinical situation evolves, the midwife shall discuss with the client any obstetrical or neonatal emergency that can be reasonably anticipated. In the event of an unforeseen obstetrical or neonatal emergency, the midwife must make every reasonable effort to involve the client in decision-making when appropriate. When this cannot be achieved, the midwife must keep the client as informed and involved as possible. As soon as possible following the emergency event, the midwife shall engage the client in a full debrief of the care provided and document this discussion in the medical record.