As discussed in one of our earlier posts (here) it is important that you have ALL the information to make decisions that are right for you and your baby – using BRAIN can help. It happens frequently during birth that laboring women feel under pressure to make quick decisions, without knowing about alternative options or implications, or having the time to process.

A useful tool that many doula and birth workers talk about and recommend is using the BRAIN approach, which stands for: Benefits, Risks, Alternatives, Implications (Intuition), and Nothing.
Every time you are at a decision point before and during your birth (e.g., should your bag of waters be broken artificially, should you start Pitocin, is it time for an epidural), using the BRAIN approach can help you make with a decision that is informed and takes into account your comfort:
– What are the benefits of doing this procedure, intervention, or action?
– What are the risks associated with doing this procedure, intervention, or action?
– What are other alternative to this procedure, intervention, or action?
– How do you feel about this procedure, intervention, or action? Are there possible implications, that will follow or options that will be eliminated?
– What happens if you do nothing now and wait?

The benefits of most procedures and interventions tend to be more obvious – if you get an epidural, you will not have contraction pains. However, risks, alternatives, and implications may often not be quite as known or explicitly called out. To stay with above example:

An epidural increases the risk for mom to develop a fever or increased blood pressure.
An alternative to an epidural could be to use the tub, change positions, or have water injections in the back.
Implication of an epidural is that you can no longer change positions. You’ll also need fluids and monitored more closely.
Lastly, nothing: If you did not choose an epidural, you would continue to feel contraction pains – likely nothing else would happen imminently. However, if you were in labor a very long time and are exhausted, not getting an epidural may lead you to be too tired to push.
Our doulas of Doulas Milwaukee can serve as an excellent resource of evidence-based information of procedures and interventions which will help you assess each decision. Discuss with your doula common procedures and intervention before your birth, but know it is also a source of information when something unexpected comes up during your birth. Doulas can help facilitate communication between you and your care team.

If you don’t have professional support, don’t shy away from asking your care provider and ask your partner to help inquire. If you get a complicated medical answer or are brushed off, ask your provider to clarify what this means in lay terms or get a more extensive explanation. Just because your provider has decided what should happen next does not mean this is the decision that is best for you, or the decision you must follow. If you are unsure or undecided, you can always ask what happens if you do nothing, for right now. It does not mean you cannot change your mind in five minutes or five hours but it allows you to have time to consider your choices and evaluate what you are comfortable with and what is best for you and baby. There are certainly situations in which doing nothing is out of the question and a very fast decision must be made for mom’s and baby’s safety. However, this is probably less common than you think.

*Disclaimer: Any content provided by is intended for informational and educational purposes only and should not be used as a substitute for personalized medical advice by your doctor, midwife, or other healthcare professional. Click return to homepage.

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