The BRAIN: Our Favorite Labor Tool For Making Informed Decisions
Jane’s doula taught her the BRAIN tool, so she knows how to get all the information she needs to make an informed decision.
As doulas, we are very passionate about autonomy in birth. We believe that you being involved in decisions about your birth is a vital part of having a positive birth experience. We don’t just believe – research shows that it isn’t so much the outcome that drives birth satisfaction, but that the person giving birth felt respected and included in the decision-making.
With that in mind, we’d like to share our favorite tool for making informed decisions in labor: the BRAIN. We doulas love this tool so much that we coach all of our clients on it during our prenatal visits. BRAIN stands for Benefits, Risks, Alternatives, Intuition/Intelligence, and Nothing. Let’s explore this tool more in depth, using Jane’s story as an example of how it can work.
B: Benefits
Jane is a first-time mom who went into labor on her own, waking with contractions early this morning. She went to the hospital when things started getting intense, and now it’s late afternoon, and her cervix hasn’t dilated past a 6 in the last 2 hours. Jane’s medical team wants to break her water (also called an amniotomy or artificial rupture of membranes) to help things move along. Jane’s doula taught her the BRAIN tool, so she knows how to get all the information she needs to make an informed decision.
The first thing Jane and her birth team look at are the benefits of the procedure. In her case, they’re hoping that with the bag of fluid out of the way, the more direct pressure from the baby’s head will help the cervix to open and help labor progress a little more quickly. Jane’s medical team reassures her that it is a very common procedure that usually has good results.
R: Risks
The next thing Jane and her birth team will talk about are the risks of the procedure. Jane’s nurse explains that the risk of infection increases after the amniotic bag has been ruptured for many hours, so her doctor may want to start antibiotics or turn to cesarean after a certain amont of time has passed. The biggest risk is that the baby’s cord could slip down past the baby’s head, resulting in an emergency called a cord prolapse, but Jane’s doctor thinks her risk of having that happen is very low. Jane’s doula also notes that sometimes there is increased pressure after the water breaks, which can make contractions feel more intense.
A: Alternatives
Next, Jane and her team will talk about other options they can try that might accomplish the same goal. In Jane’s case, Pitocin can help to increase the strength of her contractions, and maybe help her progress a little quicker. She’s also been lying down for a while, so it might help to be more active. She could dance, do some lunges, or walk some laps around the maternity unit. Additionally, Jane’s doula knows that position changes can sometimes help progress a stalled labor, so she has some labor positions in mind that can help create space in Jane’s pelvis.
I: Intuition or Intelligence
Jane now needs to turn inward and consider how she feels about this intervention. Does she have any strong feelings one way or another? What’s her gut feeling?
Some people prefer to use their intelligence for this. Jane could think about what else she knows about this. Has she heard about other people’s experiences, or read articles on the topic? Jane’s doula has a binder with helpful articles in her bag. If there’s time and Jane feels up to it, she could go over the article on amniotomy.
N: Nothing
Perhaps the most powerful question to ask is this: what if we do nothing? What if we wait? What if we don’t do anything at all? A lot of times, your medical team would rather opt for doing something, and it can be easy to feel pressured during these conversations.
Jane’s nurse, doctor, doula, and partner all assure her that doing nothing is a perfectly reasonable option. Labor may just take more time. That’s no worry, because Jane is feeling like she could use a nap anyway. After some good rest, Jane decides to go ahead with the amniotomy, and her baby is born just a few hours later. Jane feels really happy with her birth experience. Things didn’t go exactly according to plan, but her birth team helped her make informed decisions, and that helped her feel empowered and more in control.
Are you curious how a doula can help you navigate decision-making during labor? We’re happy to go over how we support conversations and advocate for clients in labor. Reach out to chat with us!
Are you in birth-planning mode? Check out this blog post we wrote about creating a more comfortable delivery.
