the birth consultants
The Only Tool You Need for Your Birth
Sep 3
/
Jaime Wessler, CPM, LM
Allow me to paint a picture:
You're at a doctor's appointment. You have just gotten some information about some procedure or test. They wrap up their monologue and say,
'Alright! Any questions!?'
If you're anything like me you probably go blank. You know you're supposed to have questions, and you know you probably do. But nothing comes. So you smile and nod politely and say,
'Nope! I think I'm good!'
But after some time to reflect, you find that you have a BUNCH of questions.
You're at a doctor's appointment. You have just gotten some information about some procedure or test. They wrap up their monologue and say,
'Alright! Any questions!?'
If you're anything like me you probably go blank. You know you're supposed to have questions, and you know you probably do. But nothing comes. So you smile and nod politely and say,
'Nope! I think I'm good!'
But after some time to reflect, you find that you have a BUNCH of questions.
The myth of the perfect birth
There are a lot of people out there saying that they have the secret to the perfect birth. They're selling solutions that guarantee that if you just do this, this, and this, you, too can have the perfect unmedicated delivery and look like a goddess.
But I'm going to let you in on the real secret.
There is no secret. The perfect birth is a myth.
The myth of the perfect birth tells us that we have control over it. But if there is one single lesson I have learned as a midwife, birth is very much out of our control.
I want to be crystal clear here, because I realize that may sound like I am telling you that it doesn't really matter what you do in pregnancy or childbirth, because it's going to go how it's going to go. But I promise you, I'm not.
There are a lot of evidence-based ways to have a healthy pregnancy and avoid a cesarean. But, there are also a lot of things in pregnancy that happen despite putting all the perfect pieces in place.
And that's why the one tool that everyone needs for their birth, no matter what their plans are, is knowing how to participate in the decision making process.
But I'm going to let you in on the real secret.
There is no secret. The perfect birth is a myth.
The myth of the perfect birth tells us that we have control over it. But if there is one single lesson I have learned as a midwife, birth is very much out of our control.
I want to be crystal clear here, because I realize that may sound like I am telling you that it doesn't really matter what you do in pregnancy or childbirth, because it's going to go how it's going to go. But I promise you, I'm not.
There are a lot of evidence-based ways to have a healthy pregnancy and avoid a cesarean. But, there are also a lot of things in pregnancy that happen despite putting all the perfect pieces in place.
And that's why the one tool that everyone needs for their birth, no matter what their plans are, is knowing how to participate in the decision making process.
Informed Consent - A Crash Course
There's a lot of talk about 'Informed Consent' in healthcare, especially when we're talking about pregnancy. It's not a particularly hard idea to understand - in order to agree to a thing, people should have the benefit of all the information about that thing.
Seems pretty straight forward, right?
But, I think if we're all - patients and providers - being really honest, true informed consent is really rare.
There are a LOT of moving parts to the problem, and I don't think this single blog post is enough to unpack all of it. But, we can unpack some of it.
So, let's talk about why informed consent is difficult and how you can make sure you get it.
If you just want to jump straight to the tool, open the last bullet ;)
Seems pretty straight forward, right?
But, I think if we're all - patients and providers - being really honest, true informed consent is really rare.
There are a LOT of moving parts to the problem, and I don't think this single blog post is enough to unpack all of it. But, we can unpack some of it.
So, let's talk about why informed consent is difficult and how you can make sure you get it.
If you just want to jump straight to the tool, open the last bullet ;)
How the myth of the perfect birth is told
The myth of the perfect birth isn't specific to one type of birth or one type of provider. It can sound different depending on who's sending the message, depending on what they promise the perfect birth is:
In the natural birth world:
From providers:
In advice about advocating for yourself:
It's not that there isn't some truth to most of these statements:
All of these statements follow a formula: this thing has to happen to get this outcome. And that's just not the truth.
We need better tools.
In the natural birth world:
- If you eat <insert perfect dietary advice here> you won't get <insert some bad thing here>
- Your body can't make a baby you can't birth
- Your baby knows when to be born
From providers:
- Your blood sugar is high so I am prescribing this medication you'll need to take
- Your baby is big on this ultrasound, so you will need to be induced
- Or any way a decision or option is presented in a way that says 'my clinical knowledge means I know best'
In advice about advocating for yourself:
- Know your options
- Avoid the cascade of interventions
- Do your research
It's not that there isn't some truth to most of these statements:
- Generally speaking, yes, waiting for spontaneous labor is a safe a reasonable thing to do.
- Yes, the cascade of interventions is a thing that happens in modern birth.
- Sometimes medication is the right call for high blood sugars.
All of these statements follow a formula: this thing has to happen to get this outcome. And that's just not the truth.
- Sometimes people with good diets get hypertension.
- Sometimes blood sugar can be managed without medication
- And you shouldn't have to become an expert in childbirth to make sure you get safe, honest care.
We need better tools.
Shared decision making and informed consent
It is ultimately your healthcare provider's responsibility to make sure you get informed consent. Period. Full stop.
Also, you're in a relationship with your provider. Meaning that you both bring something to the table. Your provider has clinical skills and knowledge. They can understand lab work and ultrasounds. They have access to professional resources and research. These are important and valuable pieces of your pregnancy puzzle.
But just as valuable to the puzzle is the experience and knowledge you have living as you. Your mental and emotional well being. Your belief systems. Your community.
So we have to take informed consent one step further and understand shared decision making. Shared decision making means that both you and your provider's contribution to the care you receive is respected, considered, and valued.
There are a lot of things that influence the things you choose or decline:
- Your comfort level with the potential risks
- Your own desire to avoid the risks
- Your experiences with other situations like this
- Allergies and other reactions
- Your time management skills and lifestyle
- Costs of different outcomes
- Your confidence and trust in your provider
- Your social support
I could literally go on and on and on. Having a tool to help you consider all of these things along with the professional knowledge your provider has can help you do the mental math on what is going to be the best decision for you. Adding the bigger picture into your conversations with your provider improves relationships and trust and leads to better outcomes.
Also, you're in a relationship with your provider. Meaning that you both bring something to the table. Your provider has clinical skills and knowledge. They can understand lab work and ultrasounds. They have access to professional resources and research. These are important and valuable pieces of your pregnancy puzzle.
But just as valuable to the puzzle is the experience and knowledge you have living as you. Your mental and emotional well being. Your belief systems. Your community.
So we have to take informed consent one step further and understand shared decision making. Shared decision making means that both you and your provider's contribution to the care you receive is respected, considered, and valued.
There are a lot of things that influence the things you choose or decline:
- Your comfort level with the potential risks
- Your own desire to avoid the risks
- Your experiences with other situations like this
- Allergies and other reactions
- Your time management skills and lifestyle
- Costs of different outcomes
- Your confidence and trust in your provider
- Your social support
I could literally go on and on and on. Having a tool to help you consider all of these things along with the professional knowledge your provider has can help you do the mental math on what is going to be the best decision for you. Adding the bigger picture into your conversations with your provider improves relationships and trust and leads to better outcomes.
Enough already - the one tool you need for any type of birth
Ok, Ok, Ok. Enough already. Introducing...
U-BRAIN
U-BRAIN is an acronym where each letter represents an element of informed decision making. It's helpful in any situation, but is REALLY helpful when you're in a situation where you're presented with a time sensitive or urgent decision.
BRAIN is nothing new, and I take no credit for coming up with it. But, I added the U for urgency, because when things are urgent, it's easy to make decisions based on our emotional response to fear. But even with big, urgent decisions you deserve to understand things.
Click the arrows to learn more about each part of the tool.
U is for Urgency
How urgent is this decision? How much time do we have to make this decision?
Feeling rushed is never a good setup for decision making. Sometimes it happens because we only have so much time in an appointment and we're feeling pressured to just give an answer, but there's no reason a decision needs to be made now. Other times it's because you're in labor, and a decision has to be made to prevent something else and there is a time limit on that decision.
As a patient, it can be difficult to know which is which in the moment. And that's why I added the U to the BRAIN acronym. It's a way, before even moving into the rest of the tool so you can understand how much time you have to process a decision. It can also be helpful to slow providers down. This isn't a jab at providers, but when we're busy, it can be really easy to forget that the checklist of items that seems so routine and easy to us is very new and unfamiliar to you.
Questions you can ask about urgency:
How urgent is this decision?
How much time do we have to make this decision?
Feeling rushed is never a good setup for decision making. Sometimes it happens because we only have so much time in an appointment and we're feeling pressured to just give an answer, but there's no reason a decision needs to be made now. Other times it's because you're in labor, and a decision has to be made to prevent something else and there is a time limit on that decision.
As a patient, it can be difficult to know which is which in the moment. And that's why I added the U to the BRAIN acronym. It's a way, before even moving into the rest of the tool so you can understand how much time you have to process a decision. It can also be helpful to slow providers down. This isn't a jab at providers, but when we're busy, it can be really easy to forget that the checklist of items that seems so routine and easy to us is very new and unfamiliar to you.
Questions you can ask about urgency:
How urgent is this decision?
How much time do we have to make this decision?
B is for Benefits
If your provider is recommending something to you, they probably feel like there is some benefit to the choice. But if I've said it once I've said it a million times: healthcare decisions are almost never black and white. Even for benefits. There are plenty of things that work just like they say they do, but information can be presented in a way that makes it seem like a clear yes or no.
A medication may be 99.9% effective at getting rid of a certain bacteria that 30% of people have. That sounds great, right!?
But what if I told you that only 1-2% of those people who have that bacteria actually needed the medication and that 98% of people would have been fine without it? And then there's that .01% of people who it didn't work for at all. It changes the big picture, doesn't it?
Questions to ask about benefits:
What are the benefits of this decision?
What evidence is there for choosing this?
How likely is this decision to work?
A medication may be 99.9% effective at getting rid of a certain bacteria that 30% of people have. That sounds great, right!?
But what if I told you that only 1-2% of those people who have that bacteria actually needed the medication and that 98% of people would have been fine without it? And then there's that .01% of people who it didn't work for at all. It changes the big picture, doesn't it?
Questions to ask about benefits:
What are the benefits of this decision?
What evidence is there for choosing this?
How likely is this decision to work?
R is for Risks
Almost nothing beneficial comes with absolutely zero risks. There are lots of things that have more benefits than risks, but only you can decide how important a risk is to your choices.
Using the example from the last slide, we already identified that you have the risk of being one of the 98% of people who took it but didn't need it, and that a very small number of people won't even get the benefits. But there's no way to know any of that ahead of time. To fully understand if you're comfortable with the risk of taking the medicine that you don't need, you also have to understand the risks of the medication itself. Because, what you learn is that the medication will also kill off your good bacteria. And to understand how important that risk is to you, you have to understand what the consequences might be.
And it builds in that way. Each new piece of information helps you paint a bigger picture so you can be confident with your choices.
Questions to ask about risk:
What are the risks of this decision?
Can choosing this thing cause any harm or complications?
Does this choice affect my ability to make other choices later?
Does this choice increase the risk of other things happening?
Using the example from the last slide, we already identified that you have the risk of being one of the 98% of people who took it but didn't need it, and that a very small number of people won't even get the benefits. But there's no way to know any of that ahead of time. To fully understand if you're comfortable with the risk of taking the medicine that you don't need, you also have to understand the risks of the medication itself. Because, what you learn is that the medication will also kill off your good bacteria. And to understand how important that risk is to you, you have to understand what the consequences might be.
And it builds in that way. Each new piece of information helps you paint a bigger picture so you can be confident with your choices.
Questions to ask about risk:
What are the risks of this decision?
Can choosing this thing cause any harm or complications?
Does this choice affect my ability to make other choices later?
Does this choice increase the risk of other things happening?
A is for Alternatives
In healthcare there is something called the 'standard of care'. It means that for a certain thing, the healthcare community generally agrees that this is the way we should handle it. There may be a really clear reason that something is the standard of care, but sometimes standards have to do with streamlining processes or comfort level with certain things.
To treat the bacteria we've been talking about, the medication is the most effective choice to get rid of the bacteria. But, when you explore the alternatives, you find that there is some evidence for prevention of the bacteria in the first place. So now you need to understand those options and determine if they're a better fit for you.
Questions to ask about Alternatives:
Are there alternative choices to this decision?
Are there other options that may do something similar?
(And then you go through BRAIN for all of those!)
To treat the bacteria we've been talking about, the medication is the most effective choice to get rid of the bacteria. But, when you explore the alternatives, you find that there is some evidence for prevention of the bacteria in the first place. So now you need to understand those options and determine if they're a better fit for you.
Questions to ask about Alternatives:
Are there alternative choices to this decision?
Are there other options that may do something similar?
(And then you go through BRAIN for all of those!)
I is for Intuition
There are also a lot of powerful stories about intuition - people who avoided scary situations because something inside them made them feel unsafe. It can be easy to think of those things like they're magic - like we're psychic.
But intuition isn't really magic at all. These inner warnings that you can't explain is a normal survival response. You're reacting to signs of danger that are so small that you don't really notice them. And your brain could sit there and and logic it all out to you, but sounding an alarm is faster and could prevent something bad.
But, sometimes we have scary situations that we don't fully recover from, and our brain starts to sound alarms about things that aren't actually a threat.
Checking in with our intuition can help us slow down and determine if we're making decisions that are based on our instinct to survive, or as a reaction based on some other experience.
Questions to ask yourself about Intuition:
What about this is causing my alarm to sound?
Can I remember a time where something like this happened and was scary?
If I experienced something like this before, what's the same or different this time?
But intuition isn't really magic at all. These inner warnings that you can't explain is a normal survival response. You're reacting to signs of danger that are so small that you don't really notice them. And your brain could sit there and and logic it all out to you, but sounding an alarm is faster and could prevent something bad.
But, sometimes we have scary situations that we don't fully recover from, and our brain starts to sound alarms about things that aren't actually a threat.
Checking in with our intuition can help us slow down and determine if we're making decisions that are based on our instinct to survive, or as a reaction based on some other experience.
Questions to ask yourself about Intuition:
What about this is causing my alarm to sound?
Can I remember a time where something like this happened and was scary?
If I experienced something like this before, what's the same or different this time?
N is for Nothing
Choosing not to do something is also a choice. This is really valuable, especially when you think about the urgency of the decision.
Back to our medication, if you don't take it, there is a 98% chance that everything will be fine. But, maybe that 2% risk of something bad is hanging out there concerning you. If you refuse the medication, it can also be helpful to know if you can change your mind later, and if so, if there is a point where it's too late to change your mind.
True emergencies are rare. They do happen, but they aren't really that common. Even when there is a clear problem that needs a decision quickly, there is almost always some time to consider the decision. And sometimes we just need a little bit of time to process the situation. Having the healthcare team step out while you take a moment to discuss things with your partner or even just to feel emotional about it can be extremely helpful in facing hard decisions.
Questions to ask yourself about Nothing:
What are the risks of doing nothing?
Is there a chance that this could get better without doing anything?
If I say no now, can I change my mind later?
Are there things that could change the risks we've discussed?
Can we give this a time limit before making this choice?
Back to our medication, if you don't take it, there is a 98% chance that everything will be fine. But, maybe that 2% risk of something bad is hanging out there concerning you. If you refuse the medication, it can also be helpful to know if you can change your mind later, and if so, if there is a point where it's too late to change your mind.
True emergencies are rare. They do happen, but they aren't really that common. Even when there is a clear problem that needs a decision quickly, there is almost always some time to consider the decision. And sometimes we just need a little bit of time to process the situation. Having the healthcare team step out while you take a moment to discuss things with your partner or even just to feel emotional about it can be extremely helpful in facing hard decisions.
Questions to ask yourself about Nothing:
What are the risks of doing nothing?
Is there a chance that this could get better without doing anything?
If I say no now, can I change my mind later?
Are there things that could change the risks we've discussed?
Can we give this a time limit before making this choice?
Who we are
The Birth Consultants are experts in optimal reproductive health with a passion for education. We believe that information is the key to good birth outcomes and positive experiences.
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