As doulas, prenatal education and support are a vital part of our role. Parents have better outcomes, especially in reporting a positive birth, when they are active participants in the decision-making process. Using B.R.A.I.N is one way to ensure parents have an easy tool to help make decisions.
One of the most valuable tools you can bring into labor isn’t something you pack in your hospital bag. It’s a simple way to think through your options, the B.R.A.I.N. acronym.
The B.R.A.I.N. acronym is an easy-to-remember decision-making tool that helps families ask questions, better understand their options, and participate in informed decision-making.
B.R.A.I.N. doesn’t tell parents what decision to make. Instead, it helps one gather the information they need so they can make the decision that’s right for them. And even when a parent fully agrees with the recommendation of a provider, going through B.R.A.I.N. allows them to understand why something has been suggested. This can help process a change in birth plans in the moment rather than leaving questions and wondering for after birth.
What Does B.R.A.I.N. Stand For?
B.R.A.I.N. is an acronym that stands for:
- B – Benefits – For me? For baby?
- R – Risks – For me? For baby?
- A – Alternatives – What alternatives exist?
- I – Intuition – What is your gut feeling?
- N – Nothing – What happens if we wait or do nothing right now?
These five simple questions encourage conversations between families and their healthcare providers.
Instead of feeling like decisions are happening to them, B.R.A.I.N. helps parents become active participants in their care.
The difference between a positive verse negative birth experience is rarely vaginal vs c-section, medicated vs unmedicated. It is typically, did they feel safe? Cared for? Like an active participant in the decision-making process? Or did they feel like things were just being done to them?
B – Benefits
Start by asking about the benefits. Educate parents about how to ask about the benefits of something.
Why is this recommendation being made? What are the expected advantages? How might it improve the health or safety of you or your baby?
Understanding the intended benefits provides important context. Every recommendation is made for a reason, and it’s helpful to understand what the provider hopes to accomplish.
For example, if induction of labor is recommended, you might ask:
“What are the benefits of inducing labor at this point?”
The answer may vary depending on a specific medical situation, gestational age, or baby’s well-being. In some cases, it is simply a preference.
Perhaps they are offering an induction because many of their patients request one around 39 weeks. When you go through B.R.A.I.N. and realize it’s simply an option, not medically necessary, you might opt to decline.
On the other hand, if you go through B.R.A.I.N. and the benefit is ending the pregnancy to reduce risks associated with preeclampsia, it helps you understand and accept that an induction might be important.
Going through those two scenarios with families can help them understand how the provider’s response could impact their decisions.
R – Risks
Every intervention, medication, and procedure has potential risks or downsides. This is true even when the overall benefits outweigh those risks.
Encourage parents to ask questions such as:
- What are the possible risks?
- How common are they?
- Are there any long-term considerations?
Understanding both benefits and risks helps provide a more complete picture. If we use the induction example above, the risks exist regardless of why you induce. However, when you’re deciding about an elective induction, you might decide the risks are not worth the potential benefit.
On the other hand, if you’re inducing for preeclampsia, even though there are still risks, the benefit of ending the pregnancy safely outweighs any side effects of inducing.
A – Alternatives
In many situations, there may be more than one way to manage a suggestion.
Alternatives could include:
- Waiting and reassessing
- Trying another intervention first
- Additional monitoring
- Choosing a different treatment approach
- And sometimes the alternative is to do nothing
Asking about alternatives doesn’t mean refusing care. It simply helps parents understand what options may be available.
Helpful questions might be:
“Are there any other options we should consider?” or “Is doing nothing an appropriate alternative here?”
At the end of the day, a person is in charge of their body. Asking questions should never be seen as difficult but rather being collaborative in their own care. Helping parents understand that before they’re at the point of making decisions about birth can help them be comfortable asking questions.
I – Intuition
Evidence matters, but so do your values, preferences, and your intuition. Others might be birth experts, but parents become the experts of their own bodies.
It is common to look back at situations and think you should have gone with your gut feeling, but it’s pretty rare you go with your gut feeling and regret it.
Questions families should consider include:
- How do I feel about this option?
- Does this align with my goals for birth?
- Do I need more information before deciding?
- How does my medical history influence this decision?
- How do I really feel? What is my gut telling me?
Your intuition may not always replace medical information, but it deserves a seat at the table. Your intuition is powerful and worth listening to.
N – Nothing
One of the most overlooked questions is:
“What happens if we wait?”
Sometimes the answer is that waiting is not recommended. Other times, there may be time to observe, gather more information, or reassess.
Another helpful variation is:
“Is this something that needs to happen right now, or do we have time to discuss it?”
You can often tell by tone and urgency whether there’s a true emergency happening that needs immediate intervention, or if something is simply a discussion or option.
Using B.R.A.I.N. During Labor
You can use this example with a client:
Imagine your provider recommends continuous electronic fetal monitoring.
Rather than feeling pressured to immediately say yes or no, you might ask:
- What are the benefits of continuous monitoring?
- Are there any risks or drawbacks?
- Are there alternatives based on my pregnancy?
- Ask yourself what your intuition, gut feeling is?
- What happens if we wait or continue intermittent monitoring?
These questions help facilitate conversation between someone and their healthcare provider.
Where Does a Doula Fit In?
One of the most important roles of a doula is supporting informed decision-making.
Doulas do not provide medical advice or tell families what choices they should make. Instead, we help families understand their options, encourage communication with healthcare providers, and provide emotional support throughout the decision-making process.
We can remind a family about using B.R.A.I.N., encourage them to ask questions, or help them process information after speaking with their provider.
This support can help families feel more informed, confident, and involved in their care.
Sometimes people think informed decision-making means avoiding interventions.
But the real goal is making decisions that are based on accurate information, align with individual circumstances, and reflect a person’s intuition and personal preferences.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...