Informed Choice Standard

December 1994
Revised September 2005

Purpose

This standard has been developed to facilitate appropriate care of clients, by defining the College's approach and requirements with respect to information provision, decision-making and the relationship between midwife and client. This document provides midwives with clear requirements for information provision.

Definition of Informed Choice

The midwife's role in the provision of informed choice is to be facilitative, informative and supportive, in a collaborative, non-authoritarian manner.

Informed Choice is a process which:

• Requires the development of trust and respect between the midwife and the woman,
  
  
• Involves a co-operative and collaborative information exchange between the midwife and the woman, with the woman taking an active part in the process,
  
  
• Allows adequate time for consideration by the woman,
  
  
• Takes into account factual information, risks and benefits, the clinical experience of the midwife, and the experience, feelings, beliefs, values and preferences of the woman,
  
  
• Respects and encourages the individual autonomy of the woman as the primary decision-maker,
  
  
• May include recommendations for care made by the midwife
  
  
• Results in a decision which is made by the woman, which is then supported by the midwife.

Required Information

In order to be "informed", the client's choice of midwifery care, procedures, tests, medications, and considerations of a management plan for care in the antenatal, intrapartum and postpartum period, should include a discussion of the following:

• A description of the care proposed
  
  
• The potential benefits, risks, and alternatives
  
  
• Relevant community standards
  
  
• Relevant research evidence
  
  
• Information related to midwifery standards and scope of practice
  
  
• Recommendations from the midwife related to the client's choices
  
  
• Implications, if any, of the client's potential choices
  
  
• Identification of the midwife's bias, if significant

Members are required to ensure that clients receive information that any reasonable person in a client's position and circumstance would be expected to receive to make choices or decisions.

Emergency or urgent situations

Discussion of common obstetrical emergencies should take place during prenatal care to permit appropriate discussion and decision-making. In the course of an emergency the midwife should make every effort to keep the client as informed and involved as possible. As soon as possible following the event a full discussion of the event and care should take place with the client.

Evidence of Informed Choice

Midwives must document that an informed choice discussion has occurred and include any suggestions/recommendations for care and the client's decision (if any) related to this discussion. In cases where a woman is making a choice outside of community standards or where the midwife feels there may be increased risk in the choice being made, more extensive documentation should be considered.

Exceptional situations

If the midwife determines that the choice of the client would require care outside midwifery standards or scope of practice, or would put the client at risk, she should follow the CMO Standard "When a Client Chooses Care Outside Midwifery Standards of Practice".

If there is a concern that the client may be incapacitated as it relates to this process, the midwife should refer to the Health Care Consent Act and/or CMO Health Care Consent Act Guideline 1996.

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