The decision is yours - Decision making during labour and birth
I am so lucky that this is my job and that I get to meet so many parents, and the one thing that strikes me time and time again is the importance of a parent feeling in control during labour. Of them feeling listened to, respected and believed.
Those woman who say to me “you know what Vicki, my birth experience was a million miles from what I had planned or expected but I was calling the shots, I was in charge and the final decisions were made by me” are able to speak much more positively about the birth of their babies than women who felt that decisions were taken away from them, or that they were not heard or consulted.
Of course during labour and birth there are absolute “blue light” emergencies, where baby and mum need medical decisions making immediately and there is no time for discussion. But they are rare, really rare, and we are so very lucky to have a health service waiting to pick us up when things go wrong. But the majority of the time there is at least a 5/10 minute window where things can be discussed, where parents can be involved in the decision making, where they can call the shots.
I teach a tool for decision making in every single antenatal course I run. It’s an acronym to help parents work through their decisions, work through their choices and feel in control.
The Acronym is BRIAN (it’s more widely used as BRAIN in the outside world, but there is something that niggles me about only using our brains during labour and birth, I want people to think more openly about their bodies, their hearts and their “gut feelings”. So….BRIAN).
It stands for:
This is how it could work......
A woman is in labour. She had been labouring well at home for a good few hours, with contractions getting slowly closer together and more intense. She is hoping to go to her local midwife led centre and have a water birth. She decides it’s time to go in and so she and her birth partner travel the 25 minutes to the centre. When she gets there the contractions seem to have slowed down and dropped in intensity, the midwife who greets them asks to perform a vaginal examination to see how far along labour is (how far dilated the woman’s cervix is).
So a decision to be made, does this woman want a vaginal examination at this moment?
Benefits of agreeing to the examination – The midwife can let the woman know her cervix is opening well and that labour is indeed well underway. This could give the woman a boost that she is working well with her body and everything is heading in the right direction.
Risks of agreeing to the examination – The woman could feel physically or emotionally uncomfortable laying on the bed to have the examination. The midwife could report that the cervix is not opening very far which could lead to the woman feeling anxious that things are not going well which could in turn slow labour more.
Instincts - At this moment, right now, does this woman want to consent to a vaginal examination? We are all different, and it’s important to remember that. Some women want/need lots of support, lots of reassurance and some women need more space, more time to be left alone. What is her gut feeling right now?
Alternatives - There other ways of telling how labour is going. Perhaps the midwife could watch and listen to how the woman is coping through a couple of contractions. They could check for a natal cleft line (a purple/brown line that extends from the anus up the line between the cheeks of the bum and reaches the top once a woman is fully dilated - it is thought to be an accurate measurement of dilation in about 80% of women), or check fundal height instead.
Nothing – What happens if they don’t check now? What if this woman waits 10 or 15 minutes, allows for the stress of the journey to the centre to subside and for her to start to relax into her new surroundings. She can ask these questions.
At a postnatal reunion I remember some parents telling me that knowing they had choices, that the final decision was always theirs, made a huge difference to their birth experience. They laughed because they said they couldn’t remember what BRIAN stood for, but they knew it was important, that they were in charge!
Until next time, sending positive vibes to you all x