The expression “life is what happens while you are busy making other plans,” often applies in both life and labor. Labor is frequently the initiation for parents into the reality that kids will most often do what they want, in the way they want, when they want and parental control and influence over them is limited. This recognition of the unpredictability of the labor process and a willingness to adapt one’s plan for labor in response to the situation is important for all women intending to labor naturally, as it helps reduce the negative feelings of disappointment or failure that may otherwise develop if the need for medical intervention arises. However, it is equally important for medical staff to recognize that helping laboring women maintain as much control over the process as possible reduces the likelihood that the birth will be traumatic for their patients or that their patients will suffer from postpartum depression and anxiety disorders.1 Too often, when a natural labor begins to veer off course, to borrow from another common expression, the baby is thrown out with the bath water. The decision to alter course and utilize any medical intervention in the labor process leads to a complete abandonment of all the intentions the parents had for their delivery and a uniform adoption of the traditional medical birth model. This tendency is not usually necessary and often leaves mothers feeling that they in some way failed or that their desired birth was taken from them.
THE STEPWISE MODEL FOR MEDICAL INTERVENTION
When intervention is truly indicated, a preferable management strategy is a stepwise model. In this model, medical intervention is implemented in progressive fashion, both in terms of the aggressiveness and quantity of interventions. The goal is to utilize the intervention that addresses care goals but interferes with the patient’s birth plan to the least degree and to introduce only a single intervention at a time, to the degree possible given the specific indication for the modification in plans. This method is best illustrated through several real-life examples. However, prior to those examples, it is important to also explore how decision making is approached within the stepwise model. Integral to the stepwise model of intervention is a shared decision-making process, which is borne out in the medical literature as a sound method for making medical decisions that are effective in terms of outcomes and satisfying for the patient involved. This method of decision making is advocated by proponents of a true informed consent dialogue between patients and providers, rather than the typical paper form, sign on the bottom line, style of informed consent which is most commonly performed.
Shared decision making is defined as “an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, ...