Making decisions in pregnancy: the BRAIN tool
Decisions in pregnancy
During pregnancy, you will be faced with a lot of decisions. Where should I have my baby? Do we find out the gender of the baby? Should I have screening tests? Do I want my baby to have the Vitamin K injection after birth? Sometimes those decisions are easy ones, and sometimes they can feel really really hard. You may be presented with lots of options, and have no clue what to do - you’re not a medical expert after all. But this is your baby, your body and your pregnancy, and you ultimately have the final say.
Decision making tools
A decision making ‘tool’ sounds fancy, but its simply a framework for exploring your options and allowing you to think through a decision. So, I would like to introduce you to the BRAIN tool.
BRAIN is an acronym and stands for Benefits, Risks, Alternatives, Intuition and (do) Nothing.
This is a really powerful tool that you can use during pregnancy and birth to help you make decisions about your care. It can feel really overwhelming to walk into an appointment and be told that something is happening, or that a scan has found something. Using the BRAIN tool to help you explore your options is so valuable at this point.
Firstly, take a breath. Does this decision need to be made NOW (unlikely)? Asking to take some time to make a decision can be so helpful in allowing you to process information.
Benefits: Questions to ask
What are the benefits to me and my baby?
What is the evidence for this? Is it good quality evidence?
What is the success rate of the intervention?
Does this apply to me as an individual?
Risks: Things to consider
What are the risks to me or my baby?
Are there any long term risks? Ask for statistics and absolute risk ratios i.e. 1 in 1000 vs 3 in 1000 risk
Consider the impact on your birth experience, mental health and place of birth
Does the intervention carry a higher risk of medical intervention?
What percentage of people are likely to experience these risks?
Alternatives: Explore other options
Are there any alternatives? For example: another ultrasound scan, caesarean instead of induction of labour.
Could I get a 2nd opinion?
What impact would offering the alternative have?
Are there any alternative therapies or other alternatives outside the NHS? (For example for breech birth - seeking an expert or trying Moxibustion)
Intuition: What does your gut say?
What does my gut feeling say?
What feels right for me?
Consider your own personal circumstances - risk will look different to everyone. Consider the feeling and preferences of your birth partner or support team
Remember - you are the expert in your body and your baby!
Do Nothing - playing Devil’s advocate
What if I do nothing?
What are the consequences of doing nothing?
Is there additional monitoring that will be offered if I decline a intervention?
What if the likely outcome if I do nothing
Can I change my mind later?
Hopefully this framework can help you explore your options, allow you to gather the information you need to make a decision and to feel confident in that decision. If you want lots more information on making decisions in pregnancy, Sara Wickham’s website is an excellent source for that, and she has also written a whole book on this.
Personally, it's my number 1 tool for advocating for yourself in pregnancy and I talk about it in all my hypnobirthing classes. If you want antenatal classes that cover this in depth and really dig into your rights in pregnancy and how to make the best decisions for you, and you live in Stockport, Manchester or Cheshire, you can book here.
