Attend any childbirth education series and you’re bound to learn the acronym BRAIN. You may not remember what each letter stands for, but you know it’s meant to help you when faced with a decision regarding your birth. During your labor and delivery, it is almost inevitable that you’ll be faced with something unexpected. Maybe your OB wants to artificially rupture your membranes (or, break your water). Maybe the water birth you thought you wanted isn’t giving you the stability you need and your MD suggests you might deliver more easily on dry land. Perhaps you’re a first time mom climbing toward 42 weeks and your midwife is starting to talk induction. Whatever you’re faced with, it’s best to use your BRAIN.
For simplicity’s sake, let’s stick with the AROM (artificial rupture of membranes) example as our intervention example.
B is for BENEFITS
Like my mom always says, “what are the pros?” Ask yourself, “what are the benefits of breaking my water?” It could be that you’ve been in labor for 48 hours and you’re probably fatigued. If your OB suggests breaking your water, you might see the potential speeding up of labor as a benefit since you’ve been at it so long.
R is for RISKS
As with any decision (except hiring a doula!), there are risks. Ask yourself, “what are the risks of my OB breaking my water?” Although artificially breaking the bag of waters at a certain point in labor can be effective at speeding things up, there are known risks associated with it. Once that barrier is gone, the risk of infection for both mom and baby increases especially if manual vaginal exams are performed. In addition, labor might not actually pick up speed. Or, if it does speed up, intensity of contractions will likely pick up as well since the cushion of fluid is no longer present.
A is for ALTERNATIVES
You’ve assessed the benefits and risks and you’re still not sure. Are there any alternatives to consider? If the goal is to speed up labor, what else might we try? Your doula might suggest nipple stimulation, getting into the tub or shower, or going for a walk. Maybe you’ve been walking around and want to try bouncing on a birth ball. Anecdotal evidence alert: I was at a birth once where the OB showed my client the tool (basically a crochet hook) which she wanted to use to break her water. During the next contraction it broke on its own. Sometimes all it takes is a little power of suggestion.
I is for INTUITION
Western culture doesn’t give intuition its due. We talk about having “gut feelings” but most often we prize logic and reasoning above our inner voice. In birth, it’s important to tune in to what your intuition is saying, whether it has to do with an intervention that’s presented or what feels most natural for a pushing position. What does your intuition say about AROM?
N is for NOTHING or NEXT or NO
What if we do nothing? What if our answer is “no”? Let’s say you opt not to allow your provider to break your bag of waters. You may consider one of the alternatives mentioned above. Or, maybe you just say, “nope, we decided we’re not doing that.” Or, perhaps your question centers more on what would happen next if you said “yes”. Will this intervention lead to others?
Part of my job as a doula is encouraging birthing women and their partners to advocate for themselves and ask the types of questions mentioned above. Do not be afraid to ask for more clarification. Do not feel that you’re taking up too much of your OB’s time or annoying your nurse by asking about benefits, risks, alternatives, and what happens next. It is their job to provide you with as much information as you need so that you can make informed decisions.
Now, go. Have a baby. Use your BRAIN.