Transforming care so that shared decision making is standard practice must be a multi-stakeholder effort, with women, clinicians, hospital administrators, payers and policy makers doing their part. Childbearing women and their advocates have a critical role in demanding this kind of care. Women can “vote with their feet” by choosing providers who engage them in shared decision making and honor their right to informed choice. But they can also advocate for system changes so that shared decision making becomes the standard.
Effective maternity care with least harm is optimal for childbearing women and newborns. High-quality systematic reviews of the best available research provide the most trustworthy knowledge about beneficial and harmful effects of maternity practices, yet these valuable resources are grossly underutilized in policy, practice, education, and research in the United States. Practices that are disproved or appropriate for mothers and babies in limited circumstances are in wide use, and beneficial practices are underused.