Monday, June 27, 2016

Use your BRAIN(ED)

In regards to modern childbirth, women have more choices than ever before in history.  We have high tech capabilities, surgical interventions, low tech labor options, pharmacological (drug) interventions, pain medications, augmentation abilities, natural remedies, and other options that can be used to help manage the various of labor and birth.

With all the options, a birthing family can get easily overwhelmed with the sheer number of options. Quality childbirth education is so important in understanding the options available to you.  Even with a solid foundation of knowledge, every family is going to have their own path to walk as they navigate their labor and birth.  How a family prioritizes their preferences and options - both for birth and for baby care - is going to be completely unique to them.

When navigating labor and birth, a mother will need to make many choices. Having a simple but effective way to weigh the risks and benefits to help navigate labor is of tremendous benefit.  So when you are faced with a decision in labor, remember to use your B.R.A.I.N.(E.D.) (Benefits, Risks, Alternatives, Intuition, Nothing, Evidence, Decision)

What does that mean, and how does it look in application?  Let’s say you are in labor and your provider suggests augmentation (speeding up labor) with the drug pitocin. You can go through this list so you can be fully aware as you move forward with your decision. Remember, each situation is going to be different, and the reasons to move forward with a decision or not are unique to you.

Benefits - What are the benefits to using this particular intervention at this time? How will it change my doctor or midwife’s approach to my care?  What outcome are we hoping to achieve with starting this intervention? What benefit will we have as a result of using this intervention that we currently are not experiencing or seeing?

Risks - What are the risks associated with using this particular option?  In his instance, explain the risks that the use of pitocin carries and its effects on both mom and baby.  

Alternatives - What can we use instead of pitocin that will give us the same effect? What are their risks and benefits? If you want to, are there natural remedies you can try first?  For example, what about nipple stimulation?  Can the mom walk around on the labor and delivery floor a while to try and move things along instead?

Intuition - Mom, what does your intuition tell you about moving forward with this course of action?  Never - NEVER - underestimate your gut feeling.  Your intuition is stronger than you think and it is prudent to heed it's warnings and follow it, especially in labor.

Nothing - What happens if we choose to do nothing? If you choose not to move forward with augmentation with pitocin, what is going to happen and are these guaranteed outcomes? As long as both mom and baby are doing fine, sometimes doing nothing is actually the safest option. This requires some patience, but many times it’s worth it.

Evidence - What does the scientific evidence say about this option?  For instance,  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 whose progress isn’t following the Friedman's curve (1 cm / hour, which is what many hospitals still require despite its many flaws).  What reason is your provider giving for wanting to go down this particular path and is it supported by evidence?

Decision - What is your final decision?  Own it. The consequences of this decision, both good and bad, lie with you alone. If you choose to have pitocin and it leads down the common path of necessitating further intervention and possible complication, ultimately you and your baby are the ones that are going to be living with that decision.  Your doctor or midwife are not, your doula is not, and your husband or partner sometimes is not. The responsibility for the decision you make needs to be yours alone. You can move forward with as much confidence as possible after carefully and deliberately weighing all the factors at hand.

The BRAIN(ED) acronym 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 (breaking the waters), induction, cesarean, or even an epidural.  

There is no such thing as a "textbook" labor. Birth is a very individual experience for each person. Each situation is different in the way a labor progresses, the priorities that a family places on values, and the way those two things come together as a baby is being born.  There are not necessarily any wrong choices in birth - just make sure that your decisions are fully informed ones.  

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