Informed choice is not neutral.

“Informed choice” is one of those phrases that sounds unquestionably good.

Who could be against it. Who would argue with being informed. Who would say no to choice.

It is often used as reassurance, sometimes as a shield, and occasionally as a full stop. As if once the words are said, the work is done.

But the longer I sit with it, the more I realise that informed choice is not neutral. It never has been.

Choice exists inside systems. And systems come with values, hierarchies, incentives, and limits. What is offered as a choice is shaped by what a system is designed to prioritise, what it is resourced to support, and what it finds inconvenient, time consuming, or risky.

Being “informed” also assumes something else. It assumes access. Access to information, yes, but also to time, energy, literacy, confidence, and support. It assumes you can ask questions without being dismissed. That you can absorb complex information while pregnant, exhausted, or overwhelmed. That you can sit with uncertainty without being quietly steered toward the most convenient option for the room you are in.

That is a lot to ask of someone at one of the most vulnerable moments of their life.

Informed choice is often framed as a simple transaction. Information is provided. A decision is made. Responsibility is transferred. But real informed choice is rarely that clean. It is shaped by how information is presented, which risks are emphasised, which benefits are minimised, and what is left unsaid entirely.

Language does a lot of heavy lifting here.

The difference between “we recommend” and “your choice.” Between “most people choose” and “this is our policy standard.” Between “you can” and “you should.” Between “98 percent of the time” and “a 2 percent risk.” These distinctions matter. They quietly steer decisions while preserving the appearance of autonomy.

This does not mean people are being intentionally manipulated. Many clinicians genuinely believe they are supporting choice. But belief does not cancel bias, and good intentions do not make a system neutral. Most obstetric training prioritises risk management, efficiency, and clinical outcomes. Language, power dynamics, and trauma informed care are rarely central to that education.

There is also the question of consequence.

Choosing differently often comes at a cost. Being labelled difficult. Having care subtly withdrawn. Needing to justify yourself repeatedly. Carrying the emotional labour of holding a boundary while still being told you are free to choose. Sometimes that pressure shows up as compliance, politeness, or the instinct to appease in order to keep the room calm.

That is not a level playing field.

I think this is why some people walk away from birth feeling like they made the “wrong” choices, even when they technically consented to everything that happened. Consent without context is not the same as agency. Agreement under pressure is not the same as choice.

Informed choice, when done well, is relational. It requires time. Trust. A willingness to sit in uncertainty. It requires systems and providers who are honest about their own limitations, preferences, and constraints. And it requires time that many hospital settings simply do not have.

It also requires us to be honest about what we are actually asking of pregnant people when we say “the choice is yours.”

Sometimes what we are really saying is, “You are responsible for navigating this system on your own.”

That is not neutral. And it is not nothing.

Complicating the phrase does not mean abandoning it. It means treating it with the seriousness it deserves. Recognising that choice is shaped long before a question is asked, and that being informed is not a personal virtue, but a collective responsibility.

Once you start to see that, it becomes easier to ask better questions. Not just about what choices are offered, but about who they serve, and at what cost.

And that, I think, is where informed choice actually begins.