In childbirth today, women have more choices than ever in history. There are high tech options, surgical interventions, low tech management options, pharmacological interventions, pain medications, augmentation capabilities, natural remedies, and other paths that can be used to help manage complexities of labor.
With all the options, good childbirth education is key to understanding the options available to you. Still, even with a solid foundation of knowledge, every family is going to have their own path to walk as they bring their baby into the world. How a family prioritizes their options are going to be unique to them.
When navigating labor, a mother will make many choices. Having a simple but efficient way to weigh risks and benefits as you navigate labor is of tremendous benefit. So, just remember, when you are faced with a decision in labor, use your B.R.A.I.N.(E.D.)
How does this look in the application? Say you are in labor and your provider suggests augmentation with Pitocin. Go through this list so you can be fully educated and comfortable with your decision.
Benefits – What are the benefits of this particular intervention at this time? How will it change my provider’s approach to my care? What outcome are we hoping to achieve with beginning Pitocin? What will we have as a result of this intervention that we currently are not experiencing?
Risks – What are the risks associated with this option? Explain the risks that Pitocin carries and their effects on both mom and baby.
Alternatives – What can we do instead of Pitocin? Are there natural remedies we can try? What about nipple stimulation? Can mom walk around on the labor and delivery floor a while?
Intuition & Indication – Mom, what does your intuition tell you about this course of action? Never ever underestimate your gut feeling. Your intuition is strong and wise and it’s prudent to heed its warnings and follow its peace, especially in labor. Also ask and consider, what is the indication motivating the provider's recommendation?
Nothing – What happens if we do nothing? If I choose not to go forward with augmentation with Pitocin, what is going to happen? As long as mom and baby are doing fine, sometimes doing nothing is the safest option. This requires patience, but it’s many times worth it.
Evidence – What does the evidence say about this option? For instance, pharmacological augmentation with Pitocin is supported by evidence after a woman’s water has been broken for 18 hours. It is not supported for a woman who is not progressing at the same rate as the Friedman’s curve. What reason is your provider giving for wanting to go down this particular path?
Decision – What is your decision? Own it. The consequences of this decision lie with you and you alone. If you choose to have Pitocin and it leads down a common path of causing further intervention and complication, ultimately you are the one that is going to be living with that decision. Your provider is not, your doula is not, your partner sometimes is not. Responsibility for the decision you make needs to be yours alone and you can move forward with it confidently after weighing all the factors at hand.
Using this acronym is something your birth doula can help you with at each step of the way as you labor. It can be applied to each decision in your pregnancy, labor, birth and postpartum time. For instance, you can use it to decide if you want to move forward with artificial rupture of the membranes (AROM), induction, cesarean, or even epidural anesthesia.
Labor is never “textbook.” It is a very individual experience for each family. Every situation is different the way labor progresses, the priorities that a family places on certain values and the way those two things come together as a baby is being born. There are no wrong choices in birth – just make sure your choices are fully informed ones.
A birth doula can help you formulate questions and think outside the medical box for options.