Wednesday, 4 September 2013

Keep Calm and use your BRAIN!

This little acronym - BRAIN - is a powerful tool to increase your chances of getting evidence based care. So here goes - your care provider suggests a procedure, such as a stretch and sweep, or an induction, or even an internal exam at 38 weeks, or an episiotomy, or even a Cesarean birth - what do you do?

Sometimes medical decisions are based on outdated policy, financial or convenience factors rather than on what is best for mom and baby. Many parents are not sure how to question their care providers in a way that opens doors of communication rather than slamming them shut. The BRAIN acronym facilitates discussion in a non-threatening way.

What this really all boils down to is making sure that you are making informed choices and giving informed consent. This is a tricky field legally, and particularly in the area of labour and birth where there is a huge emotional component involved and families feel particularly vulnerable. 

Just remember, no one is allowed to do an internal exam or 'adjust' your cervix without your consent - if your care provider asks to do an internal exam and you give permission, and are informed afterwards that your cervix was manipulated or your membranes stripped - that is not informed consent and that is a violation of your patient autonomy. 

Furthermore, no one can inject you with anything or put anything in your drip, or cut into your flesh at any point without your informed consent - and if someone is busy doing something, an internal exam for example, and you say - STOP - you have withdrawn your consent and that person is required to stop what they are doing and withdraw their hand. 

You may be asked to sign a blanket consent when you are admitted to hospital (if you are birthing in hospital) - please read through it and discuss whatever you are concerned about. Perhaps you could get a copy before the time. It really is worth it! I have heard too many stories of women lying in bed for the duration of their labour because they believed that was just how it's done and didn't know they could request otherwise. Or women coerced into unnecessary inductions because of the doctor's leave schedule. For a first time mom, inducing labour drastically increases chances of having a Cesarean birth. If women truly knew the risks of the procedures they are apparently consenting to I think our phenomenally high Cesarean birth rate in our private hospitals would be a thing of the past.

There is much more I could say about this, but you get the idea. When in doubt, use your BRAIN!

Just so you know, I actually have a website dedicated to helping parents make informed choices along their birthing journey. Click here:

When have you used the BRAIN acronym before? Please tell us!

Alternatively, was there a time you would have used the BRAIN acronym had you known about it? Tell us your story!

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