Book Review: Making Informed Decisions on Childbirth: One Scientist’s International Perspective by Sofie Vantiers

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AIMS Journal, 2021, Vol 33, No 3

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Making Informed Decisions on Childbirth: One Scientist’s International Perspective By Sofie Vantiers Published by Sofie Vantiers 2016 ISBN 978-1532812989 286 pages At time of writing, the paperback is £10 on Amazon Find this book on Amazon

Review by Georgia Clancy

Sofie Vantiers is, by her own admission, not a specialist on the topic of pregnancy and birth. She does, however, have a PhD in geophysics and scientific research experience, which she says has given her the confidence to carry out an exploration of the medical literature surrounding maternity. In Making Informed Decisions on Childbirth: One Scientist’s International Perspective (2016), Vantiers seeks to pass the knowledge of this personal exploration, as well as her own and others' experiences, on to expectant parents.

The book, which is an interesting and accessible read, is written as if a friend were recounting their childbirth story and uses the author’s personal knowledge of pregnancy and birth as a launchpad from which to explore a myriad of topics. With the goal of facilitating informed decision-making, Vantiers discusses topics such as pregnancy and birth preparation, the tension between respectful care and ‘best’ care, consent, interventions, pain relief, gestation time, medicalisation and what happens after birth. The author references scientific and academic literature, but also offers the reader her own thoughts on many ‘what if?’ scenarios along the way.

Vantiers herself favours a ‘natural approach’ to childbirth and takes a cautious approach to medicalised practices:

I am not an advocate of ‘natural is always better’. Rather my motto is ‘natural is safer in the long-term unless significant benefits outweigh the possible unknown risks’. In other words, if the most recent (bio)medical research shows only a marginally better outcome or no difference at all for a certain intervention, don’t use it! (p.7).

Just as it is worth cautioning against the use of interventions in birth, it is also worth cautioning against the privileging of natural childbirth ideology, which can make women who do not, or cannot, fit in^[1]to this discourse feel like failures if they have medicalised care. Indeed, Vantiers herself acknowledges that she would have asked for an epidural if her labour had been slow and the pain had been set to continue (p.32), highlighting the subjective nature of decisions in pregnancy, birth and motherhood and how perspectives can change depending on the circumstances.

In lieu of being an ‘expert’ in birth in the traditional sense, Vantiers strives to provide relevant and current references to support her writing and thus offers the reader a springboard from which to engage in the scientific literature itself. Her discussion and consideration of scientific evidence is based on her time living in the UK, US, France and Belgium. Peppered throughout the book are musings from Vantiers’s husband and stories from her “international group of friends and family” (p.5) stemming from eight Western countries.

The stories from Vantiers’s friends and family have clearly had a profound effect on her perspective, though unfortunately we do not find out much about this group, such as whether their experiences represent distinct or diverse communities and so in turn how their experiences might relate to the experiences of others. Vantiers focuses on the difficult births of two friends in particular, one in Canada and one in France. Whilst these stories help to bring the writing to life, they are, of course, individual experiences, which may or may not be indicative of practices in particular countries, and are infused with the author’s own thoughts. Rather than adding to the ‘international perspective’ of the book, they serve to highlight some of the complex and often competing ideologies and practices of birth which women must navigate and negotiate whilst on their own maternity journey.

The overwhelming take-home from this book is that women will encounter a myriad of choices and options during pregnancy and birth and that Vantiers feels that it is “always better to be prepared for the worst and hope that it doesn’t happen” (p.25). Whilst equipping yourself with information is empowering for some, the expectation that women should be doing this may be overwhelming for others at a time when they are undoubtedly already doing the best they can. Indeed, the onus must not just be on women to learn how best to work the system, but also on the system and those working within it to improve. There may be limitations on how many different situations women can mentally prepare for and the technical information they can consume in order to continuously be making informed decisions about their care, especially if they are already in labour experiencing pain and fatigue. This is why a key element of a well-functioning maternity service is to support informed decision-making, so that women can feel in control of their birth and positive about their experience, regardless of how plans might change.