The Reason You Need Your Brain and Your Heart in Labor
Well... ANOTHER reason you need your brain and heart in labor, since the first reason is obvious!
One of the most crucial things we do as doulas is help parents make decisions.
It's not as glamorous or often discussed as giving massages, squeezing aching hips, or whispering words of comfort and encouragement (not that any of those things are particularly glamorous). But it's one of the most important things we do.
Decision-making happens frequently during pregnancy. Choosing a care provider, a place to have your baby, which pump to get through your insurance, what kind of birth preparation class to take, what sorts of things to register for, and so on... the decisions to be made sometimes feel endless.
But during labor, things are different.
No longer is there a stretch of weeks or even months before your baby is on the way - things are happening right now. In addition to the time crunch, there is also the fact that most people are not necessarily calm, cool, and collected during labor the way they might like to be when making decisions. Parents often don't even understand the implications of the options their care team is presenting.
That's where we come in.
In our prenatal visits and birth classes, we often use a tool well-known in the birth world. In fact, it's a tool now used by many who encourage healthcare literacy as a helpful way to approach decision-making with care providers.
This tool comes in handy no matter where you're birthing, but we find it's often especially helpful for clients who are having their babies in a hospital setting.
The tool is an acronym: BRAIN
When a question comes up in labor, or a procedure or medication is suggested as the next step, our first suggestion is always to stop and take a breath. Sometimes these situations can be nerve-wracking in labor. So give yourself a moment rather than responding quickly and impulsively.
Once you've gotten a nice breath or two under your belt, take some time to go through the acronym letter by letter and ask some questions.
B: Benefits
The first question to ask is what the benefits of the suggested procedure, medication, or change to the situation would be. Remember to consider benefits both for you and for your baby.
We've found that usually care providers answer this question even before you have to ask it, because their suggestion is made with the intention of giving you and/or your baby a certain benefit. But if you have any additional questions about the benefits, ask them!
R: Risks
Next up: what are the possible risks to you? To your baby?
Usually in a medical setting the answer to this question reads more like the side effects listed on a drug label. While this is good information to know, there are other indirect considerations to think about which sometimes fall outside the realm of the care provider's role in that moment.
For example, sometimes our clients ask their nurse or anesthesiologist about the risks of an epidural. Usually we hear care providers mention things like the possibility of a drop in blood pressure, headaches, nausea, itching, etc.
However, I've never heard a care provider mention the increased risk of a longer pushing phase, the increased use of pitocin to speed up a labor slowed by epidural, or the increased difficulties with lactation that can arise after births involving an epidural (mainly due to the volume of IV fluids that accompany the administration of an epidural). These are things we discuss with our clients if they're considering an epidural, along with the benefits including "therapeutic rest" if labor has been long and hard.
If you ask about the risks of your care provider's suggestion and receive information from the drug label, also ask if there are any other indirect risks they know of. (And check in with your doula too, to see if they have any other information that might help you as you make your decision.)
A: Alternatives
Ask your care provider if there are any other alternatives that can be tried first before proceeding to the suggested procedure or medication. There may be something less invasive or more temporary that might help address the issue at hand.
Often care providers and medical staff are much more comfortable with medications and medical technology in birth than parents are - primarily because they're around those things all the time. They see highly medicalized births every day. But most expecting parents aren't in that boat. Our clients are often surprised that their care providers suggested something more invasive when there was a less intense alternative. Understanding where your care provider is coming from can be really helpful in this case.
And of course, if your care provider suggests an alternative or two, make sure to use your BRAIN when exploring those options as well.
I: Intuition
What does your gut say about this? How are you feeling about the situation at hand and the proposed next steps?
Studies have actually shown that the intuitive, ancient part of our brains (the part that gives us those gut feelings) often works faster than the more analytical part of our brains. Here is a fascinating article on the subject. It's important not to discount the sensations in your body we refer to as a gut feeling because what it can mean is that some part of you already knows the answer. It may just take a while for the rest of your mind to catch up and figure out the "why."
Pregnancy, birth, and parenting involve a LOT of intuition. Don't leave your intuition at the door when you enter the birth room!
N: Nothing
What if we do nothing? What if we wait an hour before trying this?
These questions can help you determine whether your care provider feels the situation is an emergency or not. If the answer to "Can we wait an hour?" is "Sure, I'll come check in later," you know you have time to think things over. But if the answer is, "Waiting really isn't an option in terms of safety - we need to make a decision now," obviously that gives you a different picture of what’s going on.
If the care provider's response to waiting an hour is positive, sometimes parents are surprised they were being asked to make a decision earlier than necessary. It's important to keep in mind that care providers are often on a schedule and juggling multiple patients at once. Sometimes the timing of things has more to do with their patient load than with your particular situation, which is another reason why it's important for parents to be asking these questions.
This question is especially powerful for parents who want to minimize medications and medical technology in their births.
You should be able to take your time in making your decision unless there is a true medical emergency at hand.
After you've had a chance to ask your questions, request a few minutes alone without your care providers in the room to consider your options. (If you have a doula, it is usually beneficial to have them in the room with you as you talk things over. But if for any reason you'd be more comfortable having the conversation alone, by all means let your doula know.)
Once you're ready, let your care providers know you've considered your options and made a decision.
If you are choosing to accept your care provider's recommendation, often the conversation will be fairly straightforward. But if you're choosing instead to try an alternative or wait a while before trying anything else, sometimes care providers can feel that their expertise is being undermined or that someone is convincing you not to accept their recommendation. This is a very human reaction!
There is a phrase that goes around in the birth community often: “NO is a complete sentence.” Meaning, you shouldn’t have to explain yourself in any way if you want to decline something - you should be able to just say “no” and have your wishes honored.
But in reality, using “no” as a complete sentence usually doesn’t work in your favor. There is a LOT we could talk about here, including systemic oppression. Ultimately, we don’t think that using “no” as a complete sentence during labor is strategic most of the time.
While you are fully entitled to use this strategy if you choose to, you may find that putting a little extra effort into communicating with your care providers (with the help of your doula if you have one - the burden of this extra communication doesn’t have to rest on you!) can make a huge difference.
To help facilitate positive communication with your care providers, speak from your HEART:
H: Hear
"I hear what you're saying and I understand why you recommended this..."
E: Empathize
"...and I know you want the best for me and my baby..."
A: Affirm/Assert
"...but I intend to wait a while longer before considering x, y, or z." OR "...I would rather try this alternative instead."
R: Reassure
"I’ll definitely let you know if anything changes. And if the situation shifts again, I’m open to reevaluating my next step."
T: Thanks
"Thank you so much for answering all my questions and for supporting me.”
These kinds of conversations can be difficult, especially if any medical concerns are present. We hope these tools will give you an anchoring point when making decisions in labor and beyond.
Remember to use your BRAIN and HEART!
If you'd like to learn more about decision-making during the perinatal time, consider taking our Decision-Making Skills for Labor class!
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