Informed Decision Making for Empowered Birth November 24, 2020 ~ Meghan J Paterson
When faced with making decisions while in the midst of labouring all concept of rationale thought and the ability to process what is transpiring can be challenging and rather difficult for the labouring person and their partner. There are various tools that can support making informed choice and decisions a little easier to navigate. One such tool that I can offer as a suggestion is called using your BRAIN! In this context BRAIN is a simple mnemonic question-asking tool that can be used to get the information you need, know your options and support decisions you make to get you to the outcome you are desiring. The result of this can be an empowered birth, using this tool for making decisions in any medical situation you find yourself in can empower you as an advocate for your health.
What is informed Consent or Decision Making?
When information is not given about what or why a medical procedure is being done, you need to know how to obtain information and know how to say yes, “consent”, or no, “decline”.
When care providers find themselves in a situation where they need to pass on information to you they do this in a way that walks through informed consent continuously through your care as events unfold. There could be situations that arise when this doesn't happen.
So how will you handle this? Even if an explanation is given, how will you know how to process it? How will you know what to decide? For this reason, it becomes very important that you AND your support people know how to obtain information, and make a decision of consent or decline.
How to make an Informed Decisions for an Empowered Birth?
Informed decision making really comes down to asking good questions. However, in the moment when you are focused on your labor and you are suddenly faced with vaginal exams, monitoring, IVs, medications, and other procedures or interventions, what are you going to do!? It is quite challenging in such heightened physical and emotional moments to come up with a reasonable question in your head. That is where the “using your brain” tool comes in. BRAIN is a tool to remember what questions to ask. In any moment that you want to know and be included in what is going on medically with you, your labor, or your baby, you can use BRAIN to ask good questions. Now be aware that in labor you are going to need help asking questions and stating what you want. That is why it is so important to have at least one, but ideally two, support people with you. This may include your partner, mother, friend, sister, doula, or whoever you can trust to serve you and feel safe with. Plan on having people who can help you be empowered!!!
With this in mind, let's go over what B R A I N stands for!
B = BENEFITS The first question you’re going to ask is about the benefits. This is a way that you can understand why the medication, procedure, policy, test, or whatever it may be, is beneficial to you. What you will want to ask is, What is the benefit of this procedure? What problem will this solve? How is this going to help me, my labor, or my baby? It will be surprisingly helpful to know this information!
R = RISKS Once you know how the procedure is going to help you, it’s important to know what are the possible consequences. You will want to know if a procedure or medication has adverse effects by asking…. What are the risks of this procedure? What are the side affects for me, my labor, or my baby? What if it doesn’t solve the problem, what is next? It is good to know if an action or treatment could necessitate another action or treatment since the secondary actions may influence your decision for the first. Once you have these two pieces of information alone, you can think through the benefits and the risks for you and your laborand your family and your body. Ask yourself, Do the benefits outweigh the risks for me? Or do the risks outweigh the benefits for me? Different people are going to feel differently and make different decisions for themselves. You indeed may feel differently than your doctor or midwife and that is okay. It is your right to choose to do or not to do a particular procedure, test, or treatment. If you do not wish to take the risks involved, you do not have to. However, you must be able to state your wishes clearly and kindly, and on occasion if your refusal has serious risk involved, you may be asked to sign a document that you are “choosing to go against medical advice”.
A = ALTERNATIVES There are almost always other options, even if the care provider doesn’t openly offer or prefer the other option…you may prefer it. So you ask, What other options do I have to solve this problem for me, my labor, or my baby? Then you may want to talk through the risks and benefits of those alternatives. And if you prefer one of the given options you can request to try that first. You will be amazed at how far this question can take you by simply knowing what is actually available to you when you ask.
I = INTUITION A valuable component is your intuition and what your inner voice is telling you. How do I feel about this procedure? What does my gut say? What is my partner's intuition saying?
If you’re not feeling quite right about something then you need to ask some more questions or ask for 5 minutes to talk with your support partner, centre yourself and allow space and time to assist you. It is important to check in with your own heart and your support team’s heart to come to peace and confidence with your decision to consent or decline a presented medical procedure. Regardless of the outcome, taking that moment to check in with yourself emotionally and spiritually will significantly impact your feelings toward the decision that is made.
N = NOTHING This is for the question, “What if we do nothing? What if we wait one hour? a day? a week? 10 minutes?” This is a super important question and my favorite question in childbirth. It is my favorite because it will reveal to you the true urgency or non-urgency of a procedure. When you ask “what happens if we do nothing right now?” or “what if we wait an hour?”, then you immediately get to see the emotional response of the doctor, midwife, or nurse. If their reaction appears nonchalant or even annoyed with a comment like, “well it’s just going to take more time” or “we’ll just have to wait and we’ll check back with you in an hour and probably do such-and-such then”, then you will know that the procedure is not medically necessary or urgent! So, if you don’t want to do it, it’s not that vital to your health, your labor, or your baby. However, if you ask, “What if we do nothing? or what if we wait an hour?” and you see great concern, or you see that the doctor or midwife becomes very serious, strongly advising you otherwise, then you will know the actual urgency of the medical situation at hand and weigh that in your response. This information allows you to feel confident in your consent, if given, knowing that you were aware of the situation and made a conscious decision instead of a serious intervention being made without you knowing why or later feeling that it was unnecessary. ‘What if we do nothing?’ gives a clear vision of the seriousness (or not) of the situation.
How does BRAIN support me with an Empowered Birth?
When you find yourself in a situation where you don't have a wealth of medical knowledge you generally will give yourself over to whatever your care providers are suggesting you should do. By using BRAIN this process will allow you to make empowered decisions and staying in the loop. You will learn in the moment what is happening, what things mean, and why it is significant or not. Ultimately, even if you agree or ‘consent’ to every procedure the doctor or midwife does, you will be much more satisfied with your experience if you are included in the process.
By having an informed process, things don’t just “happen to you”. By asking questions and voicing your thoughts you actively participate in your birth experience. Opting for becoming passive often leaves you feeling doubt or regret in your mind and heart after the birth of your child.
I hope you find this tool supportive and many blessings on your birth.