Use your BRAIN

As a pregnant person, you will be called upon to make a lot of decisions about your pregnancy, labour and birth. And there will be a whole lot of people offering you their advice, opinion, and experience. Here’s one tool to help you navigate all that decisionmaking: BRAIN.

Before I get into what that means, let me take a moment to reflect on how decisions get made in birth. In an ideal world, every decision would be based exclusively on the individual, their particular history and context, their aspirations and desires, and their particular needs: medical, emotional, spiritual, practical.

But this is not an ideal world. In the UK, the NHS is under huge resource pressure. Maternity services are chronically under-staffed. Hospitals are looking for efficiencies, but what is most efficient for a service may not equate to what is optimal for a birthing mother. Above all, hospital trusts are worried about being sued – and since maternity services are the most litigated area of medicine, this is the area where the pressure to have an audit trail can be the most profound.

The simple truth is, in medicine as a doctor or midwife you are far more often sued for what you didn’t do than for what you did – so the impetus to intervene will always be stronger than that to wait and see.

One response to this fear of litigation is to make more and more care protocol-driven. Now I am fully aware of the value of a good checklist, and I understand how in medicine they can save lives. But I also see on a daily basis how thoughtless adherence to abstract protocol can damage and even traumatise birthing women.

So at every point where “protocol” demands a certain course of action, I urge you to use your BRAIN to make a decision. Because no matter what the protocol suggests, you always have the right to make an informed choice at every point in your pregnancy and birth.

B is for benefits. What are the benefits to doing the intervention? What is the evidence to support that supposed benefit? What is the magnitude of the purported benefit, and how much of the time does that benefit occur?

R is for risks. Medical practitioners will rather sneakily want to tell you the benefit of doing an intervention and the risk of NOT doing it, but what we’re looking for here is the actual risks of DOING the procedure. How common are these bad outcomes/side effects/inefficacies? How does that weigh against the purported benefit magnitude and frequency? Remember here that your comfort and emotional well-being is important too, so make sure that plays a part when weighing the risks and benefits – it’s not all just about speeding baby’s arrival.

A is for alternatives. What else besides the proposed intervention could be tried? What other courses of action also have positive results? Do they have fewer side effects or work more often? What does the data say?

I is for intuition. How does your gut feel about what is being proposed? Do you instinctively recoil from what is being suggested? Or does your body feel like, yes, it could probably use this form of assistance? Do you feel like something is wrong and action needs to be taken, or do you feel like you and baby are doing fine and just need more time? I find that a birthing mother who is given the freedom to enter into her birth bubble and operate from her animal brain has very strong and accurate instincts about what is right for her and her baby.

N is for nothing. There are very very very few instances in labour and birth where something has to happen really quickly, and those situations are often completely unambiguous. The most common reason for intervention is a sense that “things aren’t progressing” or “contractions aren’t effective” or “labour is slowing” or “mum/baby aren’t coping as well as they were” – very much judgement calls, and very much with a preconceived notion of how a labour and birth ought to proceed (frequently one that isn’t actually supported by the evidence). So it is always helpful to ask the question, “what happens if we just do nothing for a while, and reassess in an hour (or two or four)?” Doing nothing should always be one of the choices on the table, and I can’t count the number of times that simply backing off and giving a couple time to regroup, rest, and regain their calm, secure, oxytocin-inducing feelings, has ended up giving them the conditions that bring on the progress they were seeking.