Shared Decision Making

The sun is finally shining and even though I scraped ice off of the car this morning, I’m still seeing signs of spring prevailing everywhere I look. The promise of better weather brings a flush of new activity to the birth center as we look forward to bringing our first spring babies of the year into the world. With these new families come a swath of new decisions to make around pregnancy and birth. The topic of medical decision making is near and dear to my heart and is one of the reasons I opened Empowered Pregnancy.

There are several different models for medical decision making and every provider has their own methods for guiding patient choice. Some clinicians believe that a paternalistic approach to medical choices results in the best outcomes. The most paternalist clinician would tell their patient exactly what to do for the best-proven outcomes and expect their patient to make decisions that rely solely on that data. Others believe that the best outcomes result from allowing patients to be absolutely autonomous in their decisions. A provider who believes in this model provides the patient with all of the information and then executes whatever decision the patient makes bassed on their values, beliefs, and circumstances. Now, I’ve never met the most extreme versions of either one of these medical professionals but many clinicians lean to one side or the other of these polarities. In both of these cases, we most certainly will miss the mark. In one case because we overvalue clinical perfection to the detriment of patient needs, and in the other because we cannot make effective medical decisions without the valuable input of a trained clinician.

Over the last 30 years, there has been a push to break from this duality in search of a synthesis. The decision-making style that has emerged from this search is called “Shared Decision Making” (SDM). At its core, SDM holds that the best sort of medical decision is one that holds clinical knowledge AND client values in tandem. A motto of SDM “No decision about me, without me” is especially powerful in the labor room and can ensure that birthing parents are able to be seen and express themselves from the earliest moments of becoming a family. As a nurse-midwife, I believe I am uniquely able to offer care that is oriented towards shared decision making. Through a collaborative model of decision making, together we can ensure the best medical outcomes for you and your family.

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