Your Birth, Your Choices: Informed Decision-Making in Central Scotland

Pregnancy and birth are deeply personal but in hospital settings, it can sometimes feel like the decisions are being made for you. Many parents I meet in The Lothians and Central Belt admit to “white coat syndrome” - feeling they can’t question a midwife or doctor.

Here’s the truth: your doctor doesn’t always know best for you. They know the guidelines, hospital policies, and their own past experiences but none of that replaces your right to be fully informed and make decisions that fit your values, your body, and your baby.

Informed decision-making is about balancing evidence with your own preferences, not about “telling staff what to do.”

Caesarean & Induction Rates in Scotland

The bigger picture in Scotland shows why these conversations matter.

In 2020/21, during the height of the Covid pandemic, Scotland recorded:

• The lowest rate of spontaneous vaginal birth since the 1970s (just 51.6%).

• The highest ever caesarean rate, reaching 36.1% of births. (Public Health Scotland, 2021).

There are many reasons behind the rising caesarean rate:

• Increasing maternal age.

• Higher average BMI.

• More women with previous caesareans.

• Maternal request.

• Fear of litigation.

• And significantly: rising induction of labour rates, which are linked to higher intervention and caesarean rates.

As the Scottish Government’s Best Start Review points out, caesarean decisions are also influenced by the beliefs and perceptions of individual clinicians. Their views on safety, risk, and even their personal experience can have a real impact on the recommendations they make.

Why Guidelines Differ Between Hospitals

Hospital guidelines are not laws. They are written to support staff in managing risk, but they’re interpreted differently from one place to another.

Take colostrum harvesting as an example:

• In NHS Forth Valley and NHS Fife parents are often encouraged to hand express and collect colostrum from around 37 weeks.

• In NHS Lothian, staff are generally more cautious and often discourage it unless there’s a specific medical reason, such as diabetes in pregnancy.

Both areas are working from the same evidence base, but the interpretation is different. That’s why informed decision-making matters - so you’re not just swept along by the culture of the hospital you happen to walk into.

NICE guidance (2015) reminds us that “pregnant women should be offered evidence-based information and supported to make decisions about their care”. That includes when policies are inconsistent.

The Human Factor: Experience Shapes Care

Clinicians are human too. Their past experiences inevitably shape their practice and perception of risk.

For example, anaesthetists often tell me they rarely witness straightforward, calm births - they’re called in when complications arise. That colours their view of labour.

I saw the same principle in my own life when I had a mole checked. The doctor was 98% sure it wasn’t sinister but decided to remove it anyway. Why? Because he’d once had a patient with a similar history whose mole turned out to be malignant. His past experience shaped his recommendation, and because he was open about it, I could make an informed choice. (Thankfully, the mole was benign.)

This is exactly what happens in maternity care. Two doctors can give different advice based on their training, experience, or comfort with risk. One midwife may praise a baby’s latch, while another critiques it. That variability is normal - but it’s why your voice matters.

Asking Questions: Your Right & Responsibility

You have both the right - and I’d argue the responsibility - to ask questions. One of my favourite tools is the B.R.A.I.N. framework (or as I tell my clients: “get your BRA out” 😉):

• B – Benefits: What are the benefits of this intervention?

• R – Risks: What are the risks, short and long term?

• A – Alternatives: What else could we try instead?

• I – Intuition: What is my gut telling me?

• N – Nothing: What happens if we wait or do nothing for now?

Using BRAIN takes the pressure off and turns a vague “recommendation” into a proper conversation.

Antenatal Classes Linlithgow West Lothian

Avoiding Coercion

Your decisions should be made freely, without pressure. Birthrights UK is clear: “Consent is only valid when it is given voluntarily, by a person with capacity, and based on accurate information.”

If you feel rushed or nudged towards a choice, it’s okay to say: “I need more time” or “Can you explain the alternatives?”

The Value of a Second Opinion

Seeking a second opinion doesn’t mean you don’t trust your care team. It means you want more perspective. Another midwife, another doctor, even another hospital can give you a different view that helps you feel more confident in your decision.

Using Reliable Sources

Not all Google searches are created equal. Reliable, evidence-based sources include:

• NICE Guidelines

• Cochrane Pregnancy & Childbirth

• Birthrights

• AIMS

• Dr Sara Wickham

• Dr Rachel Reed – Midwife Thinking

These resources help you check whether recommendations are backed by strong evidence or simply policy habit.

Final Thoughts

Informed decision-making isn’t about being “difficult.” It’s about recognising that your voice matters. Hospital guidelines vary, staff bring their own perspectives, and many practices aren’t based on strong evidence.

So ask questions. Use your BRA. Seek clarity. And remember: it’s your body, your baby, your birth - your choice.

💛 In my antenatal classes in Linlithgow, we don’t just talk about birth positions and breathing - we practise how to have these conversations with your care team, so you feel calm and confident walking into the maternity ward.

About Joy I’m Joy - an antenatal teacher, breastfeeding counsellor and perinatal therapist based in Linlithgow, West Lothian. For nearly 20 years I’ve supported families across West Lothian and Falkirk to prepare for birth with confidence.

Through my small, relaxed antenatal classes in Linlithgow, I help parents understand local hospital policies, ask the right questions, and make informed decisions that feel right for them and their baby.

👉 Find out more about antenatal classes in West Lothian & Falkirk

References

• Public Health Scotland. (2021). Births in Scottish Hospitals, year ending 31 March 2021. Link

• Scottish Government. (2021). Best Start Review – Caesarean Section Rates in Scotland. Link

• NICE (2014, updated 2023). Intrapartum care for healthy women and babies.

• Birthrights. (2020). Consent in maternity care.

• Wickham, S. (2018). In Your Own Time: How Western medicine controls the start of labour and why this needs to stop.

• Reed, R. (2018). Why Induction Matters.