Running head: SHARED DECISION MAKING 1

Connections to Midwifery Classes - Shared Decision Making

Taylor Rackey

CLNC 1010

Instructor: Kaylee Ridd, BS

January 10th, 2019

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Connections to Midwifery Classes - Shared Decision Making

In the course Foundations in Public Health and Health Education for Midwives (HLTH

1030), we were taught how to participate in the process of shared decision making with clients.

Our instructor gave us multiple different scenarios in which we worked towards a plan based on

evidence that balanced both the risk and benefits with the client’s feelings and choices in mind.

This process helped to show the benefits of bringing both care provider and client together to

participate in the decision making process as a team, while supporting and respecting bodily

autonomy.

The process of shared decision became inherently important during a situation that

involved an antenatal transfer for a post-dates client. This individual was considered advanced

maternal age, with a pre-existing thyroid condition called Hashimoto’s disease. At 41 weeks and

3 days gestation, she was sent for a biophysical profile (BPP) and non-stress test (NST), both of

which came back within normal limits to continue as a candidate for out of hospital (OOH)

midwifery care. However, the senior midwives wanted to see something different when it came

to transferring for post-dates and what tended to occur, which was in essence, seemed to be a

ticking time bomb. There would be a nervous countdown to the 42 and 43 week mark, as one

would indicate the need for transfer due to state medicaid regulations, and the other due to

license regulations.

With careful consideration, a mutual agreement was made together that this family would

benefit from a slow process to get the induction “ball rolling.” They were given a tour of the

hospital, a meet and greet with the doctors who would be on call, and were eased into the change

of venue that would be occurring if she was not in natural labor by 42 weeks gestation. Our
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client was given information to make her decision based on her maternal age and thyroid issues,

and with this, made the informed choice to consent to a slow induction, with cytotec, and a foley

bulb at 41 weeks and 5 days. During the induction, the client and her husband requested support

from the midwife and multiple students to help with doula support, which the hospital happily

obliged to. Our client was able to have an uninterrupted labor space, in which she was free to use

a birthing ball, the shower, and tub at her will, all while indulging on an array of wholesome

foods and drinking infused tea. When we came in, she had already set up the birth space with

stuffed frogs and had clary sage diffusing in the corner, the room was darkly lit, and beautiful

music played through the speakers that filled the room with a calm sense of security. She was

able to direct her labor exactly how she had wanted to, something that she had been worried

about with the transfer to a hospital delivery, though she claimed to have felt supported and

empowered through shared decision making to be able to advocate for herself when needed.

After the birth, which was lovely, serene and as intervention free as possible, she was

asked in regards to the transfer and how she felt with the entire process. She emphasized that the

change of venue from birth center to hospital, though not originally planned nor anticipated, was

absolutely seamless and that she felt extremely comfortable and supported with her choices that

were being made, as she knew that she was a working part of the decision making process. This

experience made our birth center approach the way that we handle post-date transfers differently

than ever before, with a slow process starting as a way to ease the adjustment, rather than

bombarding through the emergency room doors needing an induction due to license regulations.

Though we have not had to use this process since, it was a great learning experience and
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something that I feel impacted the client in a positive way that I will consider using in my future

practices as a midwife.