shared decision making

  • What is BRAIN?

    What does BRAIN stand for?

    I am going to teach you the shared decision-making process called BRAIN: “Using your brain” B-R-A-I-N. What is BRAIN? BRAIN is a tool for making informed choices in pregnancy, labor, and childbirth!

    The result of using BRAIN is an empowering birth experience where you are calling all the shots. You can use the BRAIN acronym for making decisions during pregnancy and birth, empowering you to be the decision-maker for your birth.

    This simple mnemonic question-asking tool gives you information, helps you evaluate your options, and get a grasp on what you want. These are all essential parts of a happy birth experience.

    what is the brain acronym?

    What is shared-decision making?

    During pregnancy and labor, many things come up along the way. Your birth is a journey, and its path unfolds in front of you as you move through it. You need to know how to get the correct information to say yes, “consent”, or no, “decline” to navigate the path that is unique to you.

    Technically speaking, healthcare professionals need to explain the risks and benefits of any procedure beforehand to obtain a parent’s consent; this process is called ‘informed consent.’

    In reality, what often happens is you sign a paper when you are admitted to the hospital, maybe skimming it over, saying that you give the hospital and medical staff permission to treat you. This paperwork is your “informed consent” so that they don’t have to inform you of every single thing they are doing and ask for your permission to do it. 

    Some providers are good at walking through informed consent continuously through their care. However, it is also just as common to only have procedures, tests, medications, treatments, or examinations with no explanation or other options offered. 

    So how will you handle this? Even if your provider thoroughly explains your options, how will you know how to process it? How will you know what to decide? For this reason, it becomes crucial that you AND your support person (partner, doula, mother) know how to gather information and make a decision for consent or to decline. 

    Making informed decisions using BRAIN

    Shared decision making comes down to asking the right questions. However, at the moment when you are in the middle of labor, and you are deciding to consent to or decline vaginal exams, monitoring, IVs, medications, and other procedures or interventions, what are you going to do?

    It is essential to know that in labor, you are going to need help asking questions and communicating what you want. For this reason, it is essential to have at least one, but ideally, two support people with you. Your support team may include your partner, mother, friend, sister, doula, or whoever you can trust, feel safe with, and take care of you. Plan on having people who already help you feel empowered.

    Using BRAIN in labor and birth

    B – Benefits

    First, ask about the benefits of what your provider recommends or wants to do. Asking about the benefits helps you understand why the medication, procedure, policy, test, or whatever it is, is beneficial.

    Ask, “What is the benefit of this procedure? What problem will this solve? How is this going to help me, my labor, or my baby?” 

    Knowing this information will help you understand the point of view of your provider and why they are recommending the intervention. Knowing why things are happening the way they are and why they might need to change is essential to shared decision making.

    R – Risks

    Once you know how the intervention is going to help you, you need to know what the potential risks are. You will want to know if a procedure or medication has adverse effects by asking the following:

    What are the risks of this procedure? Are there any side effects for me, my labor, or my baby? What if it doesn’t solve the problem, what is next?  

    Once you have the risks and benefits of the action, procedure, or intervention, you can think through and start to process what the best decision is for you, your labor, your family, and your body.

    Consider this, “Do the benefits outweigh the risks for me? Or do the risks outweigh the benefits?” 

    This time in your life is important. You and your pregnancy are unique, and you deserve to make appropriate decisions based on that. It’s ok to feel differently than your provider, and sometimes you will. You have the right to decline or consent to any procedure, test, or treatment.  If you do not wish to take the risks involved, you do not have to.

    However, you must communicate your needs and your decisions in a clear, concise, and respectful manner. If your refusal has serious risks involved, you may be asked to sign a document called an AMA that acknowledges that you are “choosing to go against medical advice.” 

    Doula support informed decision making

    A – Alternatives

    Often you might be surprised to find that there are 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. Having options is a crucial component of shared decision making.

    So you can ask, What other options do I have moving forward for me, my labor, or my baby? 

    After knowing the alternatives, you may want to talk through the risks and benefits of those alternatives. If you prefer one of the given options, you can request to try that first. You may be amazed at how far this question can take you just by knowing what is available that is not initially provided.

    I – Intuition

    One thing to check in on, and perhaps the most important thing, before you make a decision is:

    How do I feel about this option? What does my gut say? Is my higher power trying to tell me something? 

    If something about what is going on doesn’t sit right with you, then you need to ask more questions. Even simply asking for a few minutes alone to pray or talk with your support team about it will help.

    It is necessary to check in with your heart to come to peace and confidence with your decision. Regardless of the outcome, taking that moment to check in with yourself emotionally and spiritually will significantly impact your feelings toward the decision you make.

    N – Nothing

    The last step of the BRAIN acronym can be an impactful one:

    “What if we do nothing? What if we wait one hour? a day? a week? 10 minutes? How long do we have before a decision needs to be made?”

    Asking this question will determine the urgency of your choice, and it is my favorite question in childbirth. It is my favorite because it will help you identify the real necessity or non-urgency of an intervention.

    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. Their reaction may be an annoyance or nonchalant. They might say something like, “well, it’s just going to take more time”, “we’ll just have to wait”, “we’ll check back with you in an hour and probably do such-and-such then.” These are signs that will let you will know that the procedure might not be necessary or urgent.

    On the other end, when you ask the same questions, and you see the opposite reaction, it might be time to re-evaluate. A concerned look, fear, or if your provider suddenly becomes very serious, strongly advising you otherwise, you will sense the urgency. That should have weight in your decision.

    Gathering all this information will help you feel confident in your consent or refusal. You and your care team will know that you were aware of the situation and made a conscious and educated decision. ‘What if we do nothing?’ gives a clear picture of the seriousness (or not) of the situation.

    Why is BRAIN an essential part of shared decision making?

    Why does it matter what I think or feel? I don’t have a medical degree.

    Even if you don’t know anything about pregnancy or birth, the information you gather from using BRAIN will help you to stay part of the decision making process. You might learn in the moment what is happening, what all the terms mean, and why it might be needed. Ultimately, even if you agree to everything your provider recommends, you are more likely to be satisfied with your experience if you participate in the process. The significance of parent satisfaction with informed consent during pregnancy and birth has reliable data to back it up.

    As an informed participant in your birth, things don’t just “happen to you” for unknown reasons. By asking questions and expressing your thoughts and needs, you actively participate in your medical care. Being a passive patient can leave you feeling doubt or regret after all is said and done.  When you use BRAIN, you approach your birth with confidence, empowerment, and appropriately command respect.

    So, there we have it. BRAIN: benefits, risks, alternatives, intuition, and what if we do nothing. Use this simple tool, and you can make the best decisions for yourself and be the driver of your birth.

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