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Decision-making in Labor

Use your B.R.A.I.N for decisions big and small

by L. Antonia Hernandez, CD (DONA)

A pregnant couple discusses their options on a yellow couch.
When the unexpected happens, deciding on your next steps may feel overwhelming. The B.R.A.I.N. decision-making framework provides a helpful way to navigate situations and decisions that pop up in labor and birth.

The lives we live are beautiful, challenging, and uncertain; we’re all just doing the best we can with what we have.  Having a baby is no different. When you give birth, you cannot control how fast contractions come, what your blood pressure does, or what your baby’s heart rate looks like, but you do have many choices about how to deal with the unknown.

You may not know your choices or what questions to ask right away. That’s okay! We have some handy tools to help you talk through concerns with your birthing team.  When families are empowered to be in charge of the decision-making process during the labor and birth of their babies, they are much more likely to walk away satisfied with the experience.  

Why is decision-making so important?

Before your baby comes, you’ll have made many decisions to ensure a joyful birth. You’ll have chosen your care provider, maybe hired a doula, and taken some form of childbirth education. Even with all of the preparation in the world, you still won’t know what your birth will look like. Each hour, each breath, and each contraction may bring new information that you have to consider moving forward. Sometimes the choice is obvious; other times, there are many good options available to you. It’s important to remember that every choice has a benefit and also carries some kind of risk. Being able to decide for yourself when the benefits outweigh the risks is one of the most powerful ways to prevent a negative birth experience.

“[Birthing people] attribute their traumatic childbirth experience primarily to lack and/or loss of control, issues of communication, and practical/emotional support. They believe that in many cases, their trauma could have been reduced or prevented by better communication and support by their caregiver or if they themselves had asked for or refused interventions.”(Hollader, et.al)

You’ve likely heard stories of people who have had beautiful, empowering cesareans or amazing home births that didn’t go as planned. How you end up giving birth does not matter nearly as much as how you’re treated during the process. It is much more likely that you will walk away from your birthing experience feeling safe and ready for parenting if your birth process was an experience you felt a part of, rather than an uncontrollable event that happened to you.

It is much more likely that you will walk away from your birthing experience feeling safe and ready for parenting if your birth process was an experience you felt a part of, rather than an uncontrollable event that happened to you.

Controlling the uncontrollable

So, how do you navigate the unknown? Being prepared, inviting supportive people around you, and asking questions are great ways to navigate the unknown and be prepared for changes when they happen.

When a new choice is offered to you, some good questions to ask are:

  • What are the BENEFITS of this decision?
  • What are the RISKS of this decision?
  • Are there any ALTERNATIVES?
  • What does my INTUITION say?
  • What happens NEXT? What happens if I do NOTHING?

If that seems like a lot, just remember B.R.A.I.N!

Benefits

When faced with a decision during labor, like if it's time to go to the hospital or if you want an epidural, most options will have a benefit, or a plus side. When making suggestions, your provider will have a good idea of what the benefits are for most people and the statistics that support outcomes. However, even though your medical team has a lot of knowledge about birth, you are the only expert in you. Emotional and physical concerns like “Will going to the hospital reduce my anxiety?” or “I always feel better when I can walk around” are just as important as medical statistics. Check in with your core values and talk your feelings out with your birth team when you have concerns about recommendations from your provider, family, or friends. 

Some good questions to ask your care provider are: 

  • What are the benefits of this decision?
  • Does current research support these benefits?

Risks

Just like all choices have benefits, all choices also have risks, or a negative side. It’s important to know about the risks in order to make an informed decision.

A big part of assessing the risks of a decision is knowing the difference between absolute risk, relative risk, and actual numbers. When you are offered a choice like induction, you may hear something like “risk of stillbirth doubles after 41 weeks.” That is an example of relative risk. “Risks double” may sound really scary, but if you ask about what that means in terms of numbers, you may learn that the chance of serious complications before 41 weeks is 1%, or 1 in 100 and after 41 weeks is 2% or 2 in 100. The risk technically doubled, but 2% is still low, so that should factor into your decision while weighing your options. With a 2% risk, that also means that 98 out of 100 births did not have serious complications. Talking about actual, absolute numbers will make it easier to understand the big picture.

Some good questions to ask your care provider are: 

  • What are the actual, absolute numbers of this risk?
  • Where can I get additional, evidence-based information about this risk?
A person with long curly hair stares at their belly in a hospital window.

Alternatives

Almost every intervention has an alternative. Sometimes birth professionals offer options out of habit or because the evidence supports it, but you may have an idea that is different from what they’re used to. Maybe you’d prefer resting with a pillow and blanket in the bathroom instead of the bed, or you and your partner are more comfortable trying nipple stimulation for oxytocin release instead of Pitocin.

Some good questions to ask your care provider are: 

  • What is the goal of the proposed option?
  • Are there other ways to achieve this goal? 

Intuition

Intuition is probably the most important piece of B.R.A.I.N decision-making. Following your gut is such a powerful way to stay in charge of your birth experience. No matter what the medical evidence says, if your birth includes a procedure that doesn’t feel right, you may walk away dissatisfied with how things went. Except in the event of an extreme emergency, there is usually time to ask more questions and settle any doubts.  With more information, you may end up feeling more comfortable or have the chance to work out alternatives. Even if a choice you make doesn’t turn out like you expected, there is power in being able to look back and say, “It was the right choice for me at the time.”

A good question to ask yourself is: 

  • What’s my gut reaction to this option?
  • Does this decision feel right to me?

Even if a choice you make doesn’t turn out like you expected, there is power in being able to look back and say, 'It was the right choice for me at the time.'

Next/Nothing

Lastly, as you’re weighing your options, it’s helpful to have a good idea of what to expect next. While no one knows exactly how long or challenging a birth will be, it is helpful to try to prepare for what’s to come. Knowing what’s about to happen will help you gather strength and prepare.

Some good questions for your care provider are: 

  • Will there be time to rest or eat?
  • How will this feel to my body?
  • How will this impact my baby?

If you’re still uncertain about what to do, you may have the option of waiting or doing nothing. If you are feeling rushed or like your medical team may be worried, asking for an hour can give you a good idea of how serious the situation is.

Some good questions for your care provider are: 

  • What happens if I do nothing?
  • Can I have more time to make a decision?
  • Can we wait for one more hour?

No one knows you better than you

Ultimately, this is your birth. Your birthing team has experience and knows a lot about labor, birth, and babies, but statistics do not reflect an individual. How you experience labor and birth matters to your long-term health. It is important for your team to honor your values. Labor and birth may be filled with a lot of new information. When you get lost, just remember to use your B.R.A.I.N. Whether a choice seems big or small, that choice should always be yours.

This article was review by Quilted Health midwife Nadia Crane.

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L. Antonia Hernandez CD (DONA)
Birth Doula and Artist (she/her)

Antonia Hernandez is a doula and artist committed to reproductive rights, honoring the perinatal period, and anti-racist action. She and her family live in Tacoma, occupying Salish and Puyallup land.

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