Informed Choice & Protocols

Midwife having informed choice discussion with couple


Though rescinded, the College of Midwives of Ontario Informed Choice standard provides a useful definition of informed choice, describing it as “a collaborative information exchange between a midwife and her client that supports client decision-making.” These discussions incorporate potential benefits, risks, and alternatives, information about midwifery scope and standards, community standards, evidence, and identification of the midwife's bias. Both clinical practice guidelines (CPGs) and protocols contain information that the midwife shares to enable informed choice.

  • Checklists can be a useful tool to ensure that all informed choice topics are discussed with the client, especially in shared-care models. It is important to have protocols that address the items on the checklist. For example, if the checklist provides a space to indicate that the midwife has discussed choice of birth place with the client, a protocol can elaborate the information that is routinely shared during the discussion. When developing checklists, midwives should assess the advantages and some potential pitfalls of using checklists to document informed choice.
  • Sample protocols written and shared by midwives and template protocols developed by the AOM can provide a useful starting point for protocol development.
  • Other strategies can be implemented to tackle the work and successfully complete protocols.
  • Incorporating community standards in informed choice Clinical practice guidelines (CPGs) are often the sources of research-based information contained in practice protocols.
  • Client handouts can be useful tools to support clients to understand the information presented in informed choice discussions.
  • Clients may choose care which is outside community standard or midwifery recommendations. The CMO standard guides midwives on the process to follow in these circumstances.