Shared decision making in obstetric care means your clinician and you work through a decision together — explaining the options, the likely benefits, the risks and what is genuinely uncertain, then agreeing on a plan that fits your values and your circumstances. It looks less like a signature on a form and more like a series of unhurried conversations that keep going through pregnancy, labor and the first hours after birth.
That distinction matters because obstetric decisions arrive under pressure, often during pain, at hours when nobody feels like negotiating. The WHO shared decision-making toolkit and the patient-centred maternity care work that followed it describe the same goal: the person giving birth is a participant in the decision, not a recipient of one.
Here is what the process actually looks like, in the words clinicians use and in the moments where it either happens or does not.
Table of Contents
- What shared decision making looks like in obstetric care
- How is shared decision making different from informed consent?
- What information should be shared before a birth decision?
- How do patients and clinicians make a decision together?
- Choice talk names the decision and what matters most to you
- Option talk lays out the realistic choices
- Decision talk agrees on a plan and a plan B
- What does shared decision making look like during labor?
- How can a patient ask for shared decision making?
- What are common barriers to shared decision making in obstetric care?
- Frequently Asked Questions
- What are some examples of shared decision making?
- What are the three key elements of shared decision making?
- What are the five essential steps of shared decision making?
- Can you provide some examples of medical decision making?
- How do I know if my doctor practices shared decision making?
- What happens if my birth plan does not work out?
- Where to start
What shared decision making looks like in obstetric care
At its core, shared decision making in labor and maternity care is a process, not a promise. A clinician describes a decision that needs to be made, lays out the realistic options with their benefits and limitations, asks what matters most to the patient, and then the two of them decide together and record the plan.
Three things it is not worth confusing with it. It is not agreeing because you were asked whether you have questions. It is not a birth plan taped to the chart and never opened again. And it is not the absence of clinical judgement — the clinician still brings expertise, and a good shared decision often ends with the recommendation you would have guessed, arrived at together rather than announced.
A prenatal example: at a routine visit you are offered a screening test. Shared decision making would sound like the clinician explaining what the test can and cannot detect, what happens if a result is unclear, what the next steps would be, and then asking how much uncertainty you are comfortable living with before deciding together whether to proceed now, later, or not at all.
How is shared decision making different from informed consent?
Informed consent is permission for a specific act. Shared decision making is the conversation that happens before and around that permission, and it runs through dozens of decisions across a pregnancy rather than one signature on one form.
| Informed consent | Shared decision making |
|---|---|
| Confirms you agree to a named procedure | Works through which option fits your values |
| Often delivered quickly, near the procedure | Spread across visits, with time to think |
| One-directional: the clinician asks, you answer | Two-directional: preferences shape the options |
| Binary — consent or refusal | Often several acceptable paths, including deciding to wait |
| Protects the clinician legally as much as the patient | Protects the patient’s voice inside the plan |
Consent still has to happen — nobody is waiving it — but consent on its own can be quick and unexamined. Two patients can sign identical consent forms for a planned induction and leave the hospital with completely different levels of understanding about why the induction was recommended, what would happen next, and what their options were.
What information should be shared before a birth decision?
Before any obstetric decision, the information exchanged should cover five things: the best available evidence for each option, the likely benefits, the limitations of that evidence, the risks of each path including the risk of doing nothing, and the alternatives including the option of changing course later.
Three questions help separate a real conversation from a formality. What is known about this for someone with my situation? What is uncertain? What would be different about my care than someone else’s with the same recommendation?
That last question matters more than it sounds. A first-time patient with no diabetes and a patient with a high body mass index and gestational diabetes may both be offered induction at 39 weeks, and the reasons, the timing and the alternatives differ substantially between them.
Patient decision aids — short, plain-language booklets or videos comparing options — help here. A 2011 systematic review by Say and colleagues found decision aids improved knowledge and made people more comfortable with whatever they chose. They are a starting point for the conversation, not a replacement for it, and asking your care team whether one exists for your particular decision is itself a reasonable test of whether they practice shared decision making.
How do patients and clinicians make a decision together?
The conversation usually runs through three elements that clinical communication researchers call choice talk, option talk and decision talk, each mapped to a different job.
Choice talk names the decision and what matters most to you
This is the step most often skipped. Before options get discussed, the clinician says plainly that a decision exists and asks what the patient values — pain relief, mobility, avoiding a surgical birth, having a support person present, minimizing interventions for the newborn. Without that step, options are presented in the clinician’s order of preference rather than yours.
Option talk lays out the realistic choices
Each option gets its own description: what it involves, what it typically achieves, what it does not achieve, how often it works, and what else you could do instead. In obstetrics this often looks like a genuine comparison of continuing the pregnancy with monitoring, induction by different methods, or cesarean delivery, with the specific tradeoffs named rather than softened.
Decision talk agrees on a plan and a plan B
The decision is made out loud, in plain language, and includes what would trigger a change. Deciding in advance what signals a change — a fetal heart rate pattern that concerns the team, an induction that is not progressing, a change in the baby’s position — makes a mid-labor conversation far calmer.
Mapped to real moments, the same three elements recur: whether to plan an induction date for a low-risk pregnancy, whether to use an epidural or nitrous, how long to wait before recommending a cesarean when labor is not progressing, and whether a routine newborn procedure is done in the delivery room or delayed in the nursery.
What does shared decision making look like during labor?
During labor, the decisions cluster around six areas: monitoring, movement and position, pain management, nutrition and hydration, interventions such as augmentation or induction, and newborn care in the first hour.
A good version of monitoring looks like being told how often checks are recommended, what the tracing can and cannot tell you, and what would prompt a change of plan — rather than discovering the policy at admission. Good movement and position decisions involve being told which positions are actually available in the room you are in, since the answer depends on monitoring, membranes, fetal position and staffing.
When time is short, shared decision making does not disappear, it compresses. The version that works is short and specific: here is what I am seeing, here is why I am recommending this, here is what else we could do, here is when we would revisit it. Naming the reason and the time frame is the part patients say they need most.
Preferences get revised, and that is not a failure of the process. A birth plan written at 30 weeks cannot anticipate a fetal malposition found at 36 weeks, an induction that stalls, or a blood pressure reading that changes everything. What shared decision making buys you is not a guaranteed outcome — it is a say in the revision. If a recommendation arrives that has never been discussed, that is a conversation to insist on, calmly and as often as it takes.
How can a patient ask for shared decision making?
Asking for it is ordinary and much less confrontational than people expect. Most clinicians have heard the request before and most hospitals have a version of it written into their policy.
Phrases that open a shared decision, and phrases that close it:
| Invites a shared decision | Shuts it down |
|---|---|
| What are my options here? | You really need to get in today. |
| What matters most to you in how this goes? | Trust me, this is the only way. |
| What are the tradeoffs of each? | There is nothing to discuss here. |
| How certain is that for someone with my history? | Don’t worry about that. |
| What would tell us to change course? | It is too late to change your mind. |
| Can we wait an hour and decide then? | Sign this and we’ll get started. |
At hospital admission, ask who your named nurse is, what the unit’s policy is on movement, food and monitoring, and how preferences get into the chart in a way the next shift will see. Ask again at shift change, because staffing changes are the single most common reason a stated preference gets missed.
Plan for the possibility that you cannot advocate for yourself. Many people write their preferences down, keep a copy visible, and name in advance a partner, doula or nurse who knows what they want and is allowed to speak for them if they cannot. Doulas are not clinical care providers and cannot consent on your behalf, but they are there specifically to speak your preferences back to the team. Researchers such as Klassa and colleagues in 2016 described listening and giving options during labor as a core nursing function, not a bonus.
What are common barriers to shared decision making in obstetric care?
Most of the time shared decision making falls short for structural reasons rather than because anyone is hostile. Knowing which barrier you are hitting changes what you do next.
- Time pressure. Twelve minutes in a prenatal visit, a shift change mid-labor. Ask for the decision that cannot wait to be made now and the rest to be scheduled.
- Unequal information. Some patients arrive with hours of research, some with none, and the quality of the conversation varies with the person asking. Ask for the decision aid and for written material to read later.
- Institutional protocol. Policies on monitoring, eating in labor and IV placement often govern before any conversation happens. Ask what the policy is and whether exceptions exist — many do, but they have to be requested.
- Language access. A short interpreter on a phone is not the same as a clinician who can check understanding. Ask for a qualified interpreter and keep using your own words, not a summary passed through two people.
- Prior trauma. A previous traumatic birth changes what being asked to consent feels like. Naming it plainly — “I have a history of a difficult birth and I need to know what will happen before it does” — usually gets a better response than a preference written on a form.
- Disability and access needs. Communication access, mobility, sensory needs and interpreters should be arranged before admission, not at the door. Raise them in writing at a prenatal visit so they are in the chart.
- Fear of being difficult. The fear is real and widespread, and it is a documented driver of worse birth experiences. Using a written list removes some of the burden of remembering and finding words.
How you respond depends on which kind of limit you are hitting. A structural constraint — a full unit, no anesthesia available tonight, a hospital policy that cannot bend — is usually better solved by asking about alternatives than by pushing. A dismissive response, where your question is deflected twice or you are labelled for asking, is worth naming calmly, and asking to speak with the charge nurse or a supervisor. If a pattern continues across visits, changing providers is a reasonable step, and asking a new practice about their communication practice before transferring is worth doing.
If you are in labor and feel unsafe, ask for the charge nurse by name and ask them to stay in the room. That is a normal request.
Frequently Asked Questions
What are some examples of shared decision making?
Obstetric examples include deciding on induction of labor for a low-risk pregnancy, comparing epidural, nitrous and medication-free pain management, choosing positions and movement during pushing, weighing a cesarean when labor is not progressing, deciding about routine newborn procedures such as antibiotic ointment or a vitamin K injection, and planning feeding support in the first hours. In each case, the clinician explains options and risks, the patient describes what matters to them, and the plan is agreed out loud.
What are the three key elements of shared decision making?
The three elements are choice talk, option talk and decision talk. Choice talk names the decision and elicits what matters most to the patient. Option talk describes each realistic option with its benefits, risks and alternatives. Decision talk agrees on a plan, including the conditions that would trigger a change. In obstetric care the framework is often credited to clinical communication training models used in shared decision-making programs.
What are the five essential steps of shared decision making?
The five steps are: identify the decision that needs to be made, explain the options with benefits and limitations, elicit and weigh the patient’s values and preferences, make the decision together and record the plan, then review how it went and whether circumstances have changed. In maternity care the review step often happens postpartum, which is when patient-reported measures such as the CHOICEs instrument are used to capture whether it felt shared.
Can you provide some examples of medical decision making?
Beyond obstetrics, examples include choosing between surgical and conservative treatment for a back injury, deciding on statin therapy after a heart attack, selecting a screening test with different false positive rates, and choosing whether to take a preventive medication with modest benefit and real side effects. What these have in common is a structure: more than one defensible option, evidence that does not dictate one answer, and outcomes that depend partly on what the patient values.
How do I know if my doctor practices shared decision making?
Ask a few neutral questions at a prenatal visit: what happens if I want to decline this, are there alternatives, what would change your recommendation, and can we talk about it again at the next visit. Clinicians who practice it welcome the questions. Notice whether you get straight answers about uncertainty and tradeoffs, and whether your preferences show up in the chart. Ask to speak with the nurse educator about the unit’s policies on movement, monitoring and support people.
What happens if my birth plan does not work out?
A birth plan is a set of preferences, not a contract, and labor often changes the circumstances it was written for. The useful thing to decide in advance is not only what you want but what would trigger a change, and who you want to speak for you if you cannot. If a recommendation arrives that you have never discussed, ask what has changed, what the options are, and how long you have — a calm, specific question is legitimate even at full dilation.
Where to start
Pick the one decision you are most likely to face in the next few weeks — induction timing, pain relief, or what happens in the first hour after birth. Write down three things that matter most to you about it, then ask your clinician what your options are, what would change the recommendation, and what the plan B is.
That single conversation is what shared decision making looks like in obstetric care: not a document, and not a personality, but a repeatable way of deciding together. Last reviewed in 2026. This article is general education about a care process and is not medical advice — for decisions about your own pregnancy or birth, talk with your midwife, obstetrician or nurse, and in an emergency follow your clinical team’s instructions.
