Advocacy in the Moment: Using your BRAINS
You're in labor! It's finally the day you've been waiting for--the day you will meet your new baby! You've read and practiced, practiced and read. You are working with your body, allowing your body to do the work nature intended. Contractions are strong, but nothing you can't handle. You've got this!
After hours of hard work, your provider comes into the room. They have been an amazing support for you, working mostly in a hands-off fashion, and allowing you space to labor and feel comfortable in the not-so-comfortable hospital setting. However, this time, your provider looks concerned. You don't necessarily notice the concern (you're so very focused, listening to your birthing body and riding its waves), but your partner, John, does.
John takes your provider aside to chat, not wanting to disturb your space or your birthing rhythm. At this point, your provider tells John, "It's been 18 hours. Three hours ago when we checked her, she was still 3cm dilated. I'm not seeing the progress I want to see here. I'm going to check her and if she's still 3cm, I'm going to break her bag of waters. The last thing I want to do today is a surgery when she's too exhausted to push."
John is surprised, confused, and feels powerless. The strong language your provider used makes it feel like there is no choice. John thinks, okay this must be important. I don't want her to have a surgical birth. That was never our plan. He tells you between contractions that it's important for you to have a vaginal exam and the doctor might break your bag of waters. You trust your partner and your provider to make logical decisions while you focus on your labor.
You are 4cm dilated. Not the "progress" your provider wanted to see. Your provider breaks your bag of waters. Six hours later you are 5cm dilated, but you are diagnosed with an infection. Your broken bag of waters no longer protected you or your baby from the introduction of bacteria to the vagina and uterus. Your provider never told you this was one of the risks of membrane rupture. Your baby has tachycardia (heart beating too quickly) and you are scared.
What if this scenario could have played out differently? What if John had felt confident enough and knew how to ask the right questions to gain all the information about the choices being presented to him? Your provider wanted to perform two interventions. Let's take a look at the choices here:
Artificial Rupture of Membranes
Each and every thing that happens to your body and your baby is your decision. These two interventions are common in the birth scene and can be helpful in certain scenarios, but they can also be harmful or pointless in others. How can you know if the right choice for you is consent or refusal? John could have used BRAINS to gather all the information he needed, relay that information to you, and help you to make an informed choice. BRAINS is just an acronym to help you to remember the questions you can ask your provider. Before you use brains, make sure you have a clear understanding of what the problem is.
John could have asked one or more of the following questions: "Okay, just to clarify, you're thinking my partner is getting tired and you want to rupture the membranes to speed up her labor? And mom and baby are okay? What are the chances of her having a cesarean surgery for exhaustion? How long is an average labor?"
Once understanding the problem (if he agrees there is a problem), John could continue the conversation by asking:
Benefits: What are the benefits of this intervention?
Risks: What are the risks?
Alternatives: Are there any alternatives that might solve the problem you are seeing?
Intuition: What does her intuition tell her? (this would be for the birthing person to decide)
Nothing: What if we do nothing?
Space: Can we have some space to think about it?
It's important to note that for some expecting parents, conversations like this should happen with the medical provider, birth partner, and laboring partner present. For others, the birth partner may have the conversation with the provider and bring the conversation to the birthing person if and when there are decisions to make about having an intervention. This depends on what makes sense for each of you and should be discussed in advance.
What could have been different if John had this discussion with the provider? Let's take a look at an alternative scenario. Your provider comes in and says, "It's been 18 hours. Three hours ago when we checked her, she was still 3cm dilated. I'm not seeing the progress I want to see here. I'm going to check her and if she's still 3cm, I'm going to break her bag of waters. The last thing I want to do today is a surgery when she's too exhausted to push." John knows that despite this authoritative language, you both have choices to make and he needs to get more information.
John: "Are mom and baby okay?"
Provider: "Oh, yes, they are looking great."
John: "Rupturing her membranes may speed labor?"
Provider: "That would be the goal."
John: "What are the risks?"
Provider: "Cord prolapse, infection, increased pain with contractions."
John: "She is doing so well. I've seen her more focused and her contractions are more intense and closer together this past hour. What if we do nothing?"
Provider: "That's an option."
John: "Do we have to check her right now? She's so focused." (you both had spoken about minimizing vaginal exams and you had asked for this on your birth plan)
Provider: "I can come back in a little while."
The provider leaves, and John comes back to support you through the contractions. You ask John what the provider wanted. He tells you. You are so relieved to not have a vaginal exam--all you want to do is focus and not be interrupted. Your intuition tells you things are picking up and your baby will be here soon. Eight hours later, your baby is born. It was a long labor (26 hours!), but you knew you could do it and you did.
Using the BRAINS acronym to help you ask questions during labor is SO important. You don't have to use the whole acronym in every situation (John didn't in the situation above), but keeping the questions in mind can help you to have the birth you want and feel empowered in the choices you make.
Emily McMichael M.Ed., CD(DONA), AAHCC, HBCE, CLC, LLL
Oh, and by the way, your body was made for birth.