B.R.A.I.N.: A Helpful Way To Guide Your Decision-Making
During pregnancy, there are many routine tests, procedures, and assessments done on to ensure that you and your baby are maintaining good health. If you are in a high-risk category, there may be even more tests, procedures, ultrasounds, or specialist visits than usual. Many times, you are informed of these procedures or tests the day-of your appointment; your provider may even use terminology like “I’m going to check your cervix now” or, “you’ll be getting the TDaP shot today,” which may make you feel like you aren’t given an option or a chance to voice your opinion before the procedure is done. However, regardless of what situations you find yourself in, whether you have a high or low-risk pregnancy - even in the labor and delivery room - you have the right to pause and ask for the benefits, risks, alternatives to any procedure or test being suggested to you, the right to trust your instincts, and the right to say “no, not now.” You can remember to exercise your right to informed choice and to ask these questions, by using the helpful BRAIN acronym.
BRAIN Acronym: Benefits
Unless there is a life-threatening medical emergency occurring, with insufficient time to make decisions about your care, you always have the right to ask questions about the tests, procedures or assessments being done on your or your baby, regardless of how “routine” they are or seem to be. The ‘B’ in the BRAIN acronym reminds you that you can ask about the benefits of the test, procedure or assessment. Some questions you may ask:
How does this test/procedure/exam benefit me?
How does this test/procedure/exam benefit my baby?
If you are feeling anxious or unsure about a procedure, knowing the benefits for you and your baby may help you to feel more confident.
BRAIN Acronym: Risks
The ‘R’ in the BRAIN acronym reminds you that you can ask about any potential side effects or risks to you or your baby as a result of any procedure or test. Almost everything comes with some level of risk, and if you are concerned about the potential negative side effects of anything, you have the right to ask. The fact that a test or procedure is “routine” or that “everyone gets it” does not necessarily mean it comes with zero risks, and you have the right to know what they are. Some questions you may ask:
Are there any risks to my own health if I were to go through with this test/procedure/exam?
Are there any risks to my baby if I were to go through with this test/procedure/exam?
If I decline this procedure, what are the risks associated with that, if any?
Knowing the benefits AND the risks of a procedure allow you to make an informed decision that you feel comfortable with.
BRAIN Acronym: Alternatives
The ‘A’ in the BRAIN acronym reminds you that you can ask about potential alternatives to whatever is being suggested to you. Depending on your care provider or the care environment (birth center, hospital, etc.), they may or may not offer alternatives to any procedure or test for the sake of their own ease or office policy. If they do not offer alternatives, you have the right to ask if there are any, what they are, what the benefits and risks associated with the alternatives are, and weigh your decision based on that information. Some questions you may ask:
If I decline this specific method of testing/treatment/procedure, are there any alternatives and if so, what are they?
If I were to chose (alternative treatment) what are the risks associated with it, if any? What are the benefits?
Discussing alternatives with your care provider, as well as the benefits and risks to declining the original test/procedure, can help you feel confident in knowing your options, and make the best possible decision for yourself and your baby.
BRAIN Acronym: Instinct
The ‘I’ in the BRAIN acronym reminds you that you are not merely a computer that intakes information and generates a response, but a thinking, feeling human being with intuition and instinct. Yes, if your gut is telling you to do, or not to do something, you have the right to listen to it. If your care provider has given you the benefits, risks and alternatives to a certain test or procedure, but you still feel uncomfortable about something, you have the right to make a decision based on what your instinct is telling you. For example, if your doctor tells you that there is limited evidence on alternative ways to diagnose gestational diabetes outside of the routine glucola test, but your instinct is telling you to choose an alternative method, you have the right to consider alternatives. Some things you might say:
“Thank you for answering all of my questions, my gut is telling me _________, so I am going to decline the exam.”
“I understand there are risks associated with this, but after considering the benefits and alternatives, my instinct is telling me this procedure is right for me and my baby.”
The beauty of being human is that we are all have an innate sense of intuition, and hopefully your care provider and support team understands and supports the idea that YOU are the best person who can make decisions for YOU, and for your baby.
BRAIN Acronym: No, or Not Now.
The ‘N’ in the BRAIN acronym reminds you that you can say no, or not now. “No” is a full - and a valid - answer. You have the right to decline any procedure, test or exam being offered or suggested to you or your baby. You may choose to decline after considering the benefits, risks or alternatives, or you may solely rely on your instinct alone. Either way, you have the right to decline or delay. Some things you might say:
“No, I don’t want to have my cervix checked.”
“No, I don’t want my baby to receive erythromycin eye ointment.”
It can feel like “no” is an intimidating answer to give, and you may feel nervous that you will receive pushback from your care provider. This is why it’s important to remember the other aspects of the BRAIN acronym, so you can feel confident saying “no” if that is what your instinct is telling you to do. It also helps to have a team of support people by your side who can help you feel supported in your decision-making and help you come to a decision that is best for you and your baby.
The BRAIN acronym can come in handy not only during pregnancy, but also during labor and delivery. Hiring a doula is one way to ensure that you have someone on your support team who can not only help you remember to ask the important questions about your care, but also help you get the information and education you may need in order to make those decisions. You have the right to informed choice, and the BRAIN acronym is a simple and easy way to remind you of questions to ask, so that you can have the utmost confidence in the decisions you are making for yourself and your baby.