Use your B.R.A.I.N.
Birth Matters: December 2019
by Laura Maxson, LM
While classes, books, and a written birth plan make a great foundation, it is not always possible to control what is happening in labor. Having a plan in mind for decision-making can be a big help in exploring options and feeling empowered by decisions instead of feeling thrown off course.
Used for decades by parents, doulas and care providers, the acronym B.R.A.I.N. is an excellent tool to discuss and explore situations and options that can come up in pregnancy and labor. The components of B.R.A.I.N. are simple – consider the Benefits, Risks, Alternatives, Intuition and doing Nothing when making a decision. Just having this basic roadmap can be reassuring, especially when unexpected problems seem overwhelming.
Giving birth is nature at its best. Most of those in labor should not need anything more than encouragement and a watchful eye to assure that all is going smoothly. Unfortunately, when it comes to childbirth, that watchful eye has often turned into a bit of Big Brother, with overzealous surveillance and control.
Understanding if an offered suggestion or intervention is reflective of an individual’s personal situation or if there is a broader general policy driving the recommendations can be a challenge. When suggestions are in line with the birth plan and feel supportive it’s all good. However, sometimes a suggestion can seem like a bad fit. Taking a moment to turn over the suggestion with the B.R.A.I.N. components can help clarify why something might need to be done or what other options might be available.
Benefits – What is the expected result of the suggestion? Will the test or procedure give information that will change the situation or treatment?
Risks – What else might happen? Is there a downside? This can be as simple as the intervention might not work, or as serious as leading to an emergency cesarean.
Alternatives – Is this the only solution or is there something else to try that might serve the same purpose?
Intuition – How does this suggestion feel? Is there a basic gut-feeling about the recommendation?
Do Nothing – Would it be possible to just skip it altogether or what would happen if it was put off for a certain amount of time?
Here’s an example. After being at the hospital for several hours in labor with her first baby, a laboring person is found to be five centimeters dilated, not much different from when she arrived. She is feeling frustrated, although all is essentially well. Her care provider discusses the situation and suggests starting Pitocin and breaking the bag of water to get things going.
Benefits are anticipated to be longer, stronger contractions to bring about some welcome progress.
Risks can include an over stimulated uterus resulting in stress to the baby that can become an emergency. Mobility can be limited dealing with the IV line and the continuous fetal monitoring required with Pitocin. The artificially stronger contractions can be more challenging to deal with, often necessitating pain medication. Rupturing membranes can cause complications such as increased risk of infection or cord prolapse, which is a medical emergency.
Alternatives might include going back home until labor picks up – sometimes the hospital environment increases maternal stress hormones that interfere with labor hormones, especially in early labor. While out of the hospital, parents can rest better in their own bed. Sexual activity or just snuggling together can release oxytocin, the same labor hormone as Pitocin, and may naturally stimulate contractions. A visit to the acupuncturist, massage therapist, chiropractor or just a nice long walk (with a few trips up and down the stairs to the beach) can all help build labor.
Or, if staying at the hospital, parents might: walk the halls, request a breast pump to help stimulate the release of oxytocin or negotiate a period of “do not disturb” time – no procedures, no questions, dark room, only gentle touch and murmured words during contractions. If it’s the middle of the night, some might consider a sleep medication to help really get some good rest between contractions before labor picks up.
Intuition might point to doing whatever she can to get things going or confirm that they may have arrived at the hospital too early. What feels like a good fit for this person in this situation?
Doing Nothing isn’t always an option, but often parents can negotiate for more time, then reassess.
Making the decision is going to look different for everyone. An experienced birth doula can be a real help in developing questions to ask and exploring other options that might not have been presented. Different people in the same situation will make different decisions, as it should be when the B.R.A.I.N. is used.