BRAINS: Use this acronym to navigate medical decisions.
“It is most commonly used in the space of pregnancy and birth, but I believe this can be applied in all medical decisions. “
- Dr. Emma Lengerich
In our current medical system, birth is often looked at something that is inherently dangerous and should be controlled. How do we try to control birth? Through medical interventions. No matter how high-risk or low-risk your birth is, there is a protocol and use of interventions to move birth along and control it. Overall, birth is not looked at as a normal physiological process that should be observed and supported when necessary.
So, what can we do in this current medical system to help us understand interventions presented? The acronym BRAINS is a great place to start.
We can ask:
What are the Benefits of this intervention?
What are the Risks of this intervention?
What are the Alternatives to this intervention?
What happens if I say No or we do Not complete this intervention now?
What happens if we do Something else?
The difficulty with using this acronym is oftentimes we may not recognize that an intervention is even being presented or that we even have the OPTION or SPACE to ask questions due to the verbiage used.
For example;
“The doctor said to break your water now, so let’s get you set up.”
“We are just going to set this IV line now.”
“Your baby is on the bigger size so we are going to get you set up for an induction.”
“You seemed to have stalled, let’s get this Pitocin started so we can help labor progress.”
“We need to check your baby’s heart rate so come over here and sit on the edge of the bed.”
“I’m just going to do a small cut to help give some space so your baby can come out.”
There is a statement of what is going to happen to you and what you should do, but NO space for you to ask questions. It seems like a given..”oh! this is what I should do… I don’t want to be resistant so I will just follow along.”
I want to let you know… it is OKAY for you or your birth partner to stop what is happening and ask questions. Even in an emergency you are allowed to say, “I need clarification.” From here you can consent to the plan, or you can ask for an alternative. An alternative could mean a pause and wait (for eg. “can we wait an hour?”), it could mean no, or it could be picking a different intervention.
I think it is important to start asking your providers questions in appointments. Asking about their thoughts on different interventions such as episiotomy, forceps versus vacuum assisted delivery, intermittent versus continuous fetal monitoring and why they may/or may not decide to use these interventions is important. It not only gives you valuable information, but it can also be a way for you to get comfortable asking questions to providers if this is not something you are familiar with.
BRIANS can be a useful acronym to help you decide treatment options and interventions. Especially if you are at a loss on what questions to even ask. It is most commonly used in the space of pregnancy and birth, but I believe this can be applied in all medical decisions. WHY? Because it is important to know your options and understand the benefits and risks of any intervention or treatment. I believe medical care should always be a two way conversation.
As a pelvic health physical therapist and birth doula, I love discussing and helping you and your birth partner prepare your body and brain for birth. If you are in the Columbus area and are interested in connecting, Click Here!
In health,
Dr. Emma Lengerich
PT, DPT, OCS, CMTPT, Birth Doula
