​One of the most crucial things we do as doulas is help parents make decisions. It's not as glamorous or often discussed as giving massages, squeezing aching hips, or whispering words of comfort and encouragement (not that any of those things are particularly glamorous). But it's one of the most important things we do.

Decision-making happens frequently during pregnancy. Choosing a care provider, a place to birth, which breast pump to buy through your insurance, what kind of birth preparation class to take, what sorts of things to register for, and so on...the decisions to be made sometimes feel endless.

But during labor, things are different. No longer is there a stretch of weeks or even months before baby is on the way - things are happening right now. Add to the urgency of time the fact that most laboring families are not necessarily calm, cool, and collected the way they might like to be when making decisions. Parents often don't even understand the implications of the options their care team is presenting.

That's where we come in.

In our prenatal visits and birth classes, we often use a tool well-known in the birth world. In fact, it's a tool now used by many who encourage healthcare literacy as a helpful way to approach decision-making with care providers. This tool comes in handy no matter where you're birthing, but we find it's often especially helpful for clients who are having their babies in a hospital setting.

The tool is an acronym: BRAIN. When a question comes up in labor, or a procedure or medication is suggested as the next step, our first suggestion is always to stop and take a breath. Sometimes these situations can be nerve-wracking in labor. So give yourself a moment rather than responding quickly and impulsively.

Once you've gotten a nice breath or two under your belt, take some time to go through the acronym letter by letter and ask some questions. 

B: Benefits The first question to ask is what the benefits of the suggested procedure, medication, or change to the situation would be. Remember to consider benefits both for you and for your baby. We've found that usually care providers answer this question even before you have to ask it, because their suggestion is made with the intention of giving you and/or your baby a certain benefit. But if you have any additional questions about the benefits, ask them!

R: Risks Next to ask is, what are the possible risks to you? To your baby? Usually in a medical setting the answer to this question reads more like the side effects listed on a drug label. While this is good information to know, there are other indirect considerations to think about which sometimes fall outside the realm of the care provider's role in that moment.

For example, sometimes our clients ask their nurse or anesthesiologist about the risks of an epidural. Usually we hear care providers mention things like the possibility of a drop in blood pressure, headaches, nausea, itching, etc. 

However, I've never heard a care provider mention the increased risk of a longer pushing phase, the increased use of medication to augment a labor slowed by epidural (pitocin), or the increased difficulty of breastfeeding after births involving an epidural (probably due to the IV fluids that accompany the administration of an epidural). These are things we discuss with our clients if they're considering an epidural, along with the benefits including "therapeutic rest" if labor has been long and hard. 

If you ask about the risks of your care provider's suggestion and receive information from the drug label, also ask if there are any other indirect risks they know of. (And check in with your doula too, to see if they have any other information that might help you as you make your decision.)

A: Alternatives Ask your care provider if there are any other alternatives that can be tried first before proceeding to the suggested procedure or medication. There may be something less invasive or more temporary that might help address the issue at hand. 

​Often care providers and medical staff are much more comfortable with medications and medical technology in birth than parents are - primarily because they're around those things all the time. They see highly medicalized care help families every day. But most expecting parents aren't in that boat. Our clients are often surprised that their care providers suggested something more invasive when there was a less invasive alternative. Understanding where your care provider is coming from can be really helpful in this case. And of course, if your care provider suggests an alternative or two, make sure to use your BRAIN when exploring those options as well.

I: Intuition What does your gut say about this? How are you feeling about the situation at hand and the proposed next steps? Studies have actually shown that the intuitive, ancient part of our brains (the part that gives us those gut feelings) often works faster than the more analytical part of our brains. Here is a fascinating article on the subject.

It's important not to discount the sensations in your body we refer to as a gut feeling because what it can mean is that some part of you already knows the answer. It may just take a while for the rest of your mind to catch up and figure out the "why." Pregnancy, birth, and parenting involve a LOT of intuition. Don't leave your intuition at the door when you enter the birth room.

N: Nothing Also known as, "What if we wait an hour?" This question can help you determine whether your care provider feels the situation is an emergency or not. If the answer to "Can we wait an hour?" is "Sure, I'll come check in later," you know you have time to think things over. But if the answer is, "Waiting isn't an option - we need to make a decision now," obviously that gives you a different picture.

​If the care provider's response to waiting an hour is positive, sometimes parents are surprised they were being asked to make a decision earlier than necessary. It's important to keep in mind that care providers are often on a schedule and juggling multiple patients at once. Sometimes the timing of things has more to do with their patient load than with your particular situation, which is another reason why it's important for parents to be asking these questions. This question is especially powerful for parents who want to minimize medications and medical technology in their births. 

You should be able to take your time in making your decision unless there is a medical emergency at hand.

After you've had a chance to ask your questions, request a few minutes alone without your care providers in the room to consider your options. (If you have a doula, it could be beneficial to have them in the room with you as you talk things over. But if for any reason you'd be more comfortable having the conversation alone, by all means let your doula know.)

Once you're ready, let your care providers know you've considered your options and made a decision. If you are choosing to accept your care provider's recom-mendation, often the conversation will be fairly straightforward. But if you're choosing instead to try an alternative or wait a while before trying anything else, sometimes care providers can feel that their expertise is being undermined or that someone is convincing you not to accept their recommendation. This is a very human reaction!

To help diffuse any tension if this happens, speak from your HEART when communicating your decision to your support team.

H: Hear "I hear what you're saying and I understand why you recommended this..."

E: Empathize "...and I know you want the best for me and my baby..."

A: Affirm/Assert "...but I intend to wait a while longer before considering x, y, or z." OR "...I would rather try this alternative instead."

R: Reassure "I will let you know if anything changes."

T: Thanks "Thank you so much for your time and for taking good care of us."

These kinds of conversations can be difficult, especially if any medical concerns are present. These tools will give you an anchoring point when making decisions in labor and beyond.

​Remember to use your BRAIN and HEART!

​Megan has been serving growing families since 2014. She is an Advanced Birthing From Within Mentor and doula based in Orange County, CA. She is passionate about providing holistic guidance for her clients, helping them cultivate resilience and openness on their journeys to parenthood. In addition to offering birth doula support, she also teaches birth and parenting preparation classes. Megan practices in partnership with her wife, Marlee, who is also a birth and postpartum doula, childbirth educator, and lactation counselor. Together they serve families of all shapes and sizes with respect and compassion. Find out more about her by visiting Hero Birth Services, or her Facebook page. 

I cannot say how much I enjoyed Bryna's contribution. Isn't there enough of a language gap in the birth world? Dilation when we could say open, and effacement for thinning? What about other terms, such as advanced maternal age (which perhaps is a step up from geriatric pregnancy!)? Or fragile pregnancy? Often these terms serve to make the distinction between doctor and patient. What about words that make the distinction between doula and parent? I hope this gets us thinking!

I’ve worked in the birth world for 10 years, this year. At first, I had what I thought was “burnout” or getting tired of being so emotionally and physically available for clients -- which causes a sort of cynicism and laissez-faire attitude toward one’s responsibilities. I went to work for a couple of weeks thinking this -- visiting clients and being as helpful and present as ever, I realized how happy this work continues to make me, and how capable I feel -- without cynicism. So, if I’m not burnt out, what am I?

I can’t figure it out -- and I’m still sorting through my feelings on this, but let me lay out for you what I’ve discovered so far:

Our language as birth workers, as a general whole, sucks. I’m sick of it. I am so tired of “trust the process” and “it’s not stronger than you, it IS you,” and a thousand other cliches we fall back on as birth workers. As doulas, lactation consultants, midwives, and other affiliates in this world...if I hear about one more person “re-centering” I might scream!

Is there a place for self-care and energy work? Sure. Is it imperative we learn the language and speak circles around our clients? No. No. No. When you tell a client that their “energetic blockages might hold back their labor” you are not giving them information. You are disempowering them, at best, alienating them at worst.

Maybe your particular client needs to move past a fear, a worry, or whatever the heck before they can go forward -- we have all seen this happen. Once, I had a parent hang out at 6cm for HOURS until we FaceTimed their blissfully sleeping kid at Gramma’s house. Baby came within the hour. Was it their “energetic blockage?” Maybe. Or maybe they just needed to know their kid was ok. Or maybe those are the same thing -- but which one uses the flowery language?

Why do we feel called (even saying “feel called” makes me twitchy) to use this flowery prosaic speech when we discuss birth? Some of us use it our whole lives! What difference does it make? What harm could it possibly cause?

I’m working on that part.

I suspect it does make a difference and it can cause harm. I’ve made an active shift away from the “birthspeak” this past year or so. Working to actively remove the embroidery from my words, I am seeing more and more that it’s elitist, exclusive, and I think, harming our communities.

Even if you say “let’s do some yoga breaths” and go on to explain the concept and action in an easy-to-grasp way, you’re reminding your client (who needed to ask you for an explanation) of somewhere they don’t have access -- whether by financial or social exclusion. You have also brought forward a lack of knowledge in a way that isn’t necessary. This can cause more feelings of exclusion. Perceived or real, exclusion is exclusion. You have already lost a little bit of common ground with your client. This is harmful. I won’t go into microaggressions here, because they’re much better explained here and you can see the impact on those who have experienced them here.  These things can add up, and diminish your client’s self-efficacy, or pride and feelings of capability.

Perhaps the internal dialogue of your client then goes like this: “How can I be a good parent if I don’t even know what a yoga breath is?! Once she explained it, it was so simple -- just breathing in my nose and out my mouth! There’s too much to learn, I’m too overwhelmed…” 
 
Was this your intention? Of course not! Is it sometimes the unintended consequence of BS? You betcha. That sentence above is taken directly from the experience of a former client of mine, describing their experience with one of their childbirth educators. BS can impact us all.

Something else to consider as potentially harmful -- a lot of the language is appropriated from other cultures without thought or permission. Co-opting other cultures’ sacred rites & rituals because it feels “more spiritual” is not okay -- especially if you don’t know the significance of the words you are using. Think about it. Think about the things that you do every day as a birth worker -- do you really need that “Namaste” email signature?

I discovered soon after training as a Doula that I wanted to pursue Midwifery. I was told by many my Doula experiences would translate into my midwifery training and the experiences of supporting Mothers in the hospital would be immeasurable. I focused intensely on how to interpret a woman’s body language during labor. I knew from experience that most women did not communicate their emotions or physical discomforts throughout labor. I knew that I needed to get good at feeling what she needed. I did not realize the extent of this intuition that I developed until my experience while interning for my midwifery clinical requirements. 

Our family decided that I would take an opportunity to travel abroad to volunteer at a birth home in the Philippines for my clinical experience. I was a bit nervous about the language barrier, even though I was assured that most of the mothers spoke English to a point which we could communicate. I planned to learn basic phrases before I set out. Of course life was busy, and a lot of other preparations became a higher priority. So I landed in the Philippines without even knowing how to say hello. I know, bad planning on my part. Luckily I was met at the airport by an American and was never in a sticky situation where I needed to speak Tagalog (the language spoken by Filipinos). From the airport I was taken to the birth home where I met the other American Interns and the Filipino Midwives. Again no need for language skills there either. 

The next morning I was integrated into the prenatal check up routine, and that’s when it all came and smacked me in the face. I quickly realized I needed to learn how to communicate with these women if I was going to assist in their care. So where am I going with this? Well after a few weeks I was ready to start attending births as student under supervision, and again I was nervous about communicating with the mother. How would I know what she was feeling? Up to this point my training had focused on the physiological changes to observe that would help me assess the stages of labor, the health of the mother, and fetal well-being. My first birth was a bit of a blur, but the second birth I settled into a very familiar role as this Mother immediately connected with me. 

Reflecting I can recall the moment when I understood not a single word she said to me but I could feel everything she needed from me. My Doula heart took over the emotional and physical care of this mother as she labored hard and just needed to feel safe in her moment of vulnerability. I did not need to speak in her language to support her. I was able to express that I was there for her by not leaving her presence. With sincerity in my touch I think she was able to feel safer and more relaxed. I helped her with breathing patterns and movement, only through demonstrating it myself first. These unspoken instructions quickly helped her gain control of her labor and gave her confidence in her ability. Holding her hand through contractions, reassured her I was not leaving. Simple nods from me seemed to confirm to her that everything was normal. No words were required between us; it was a dance of sharing a common goal to bring her baby into the world safely and peacefully. 

It’s now been almost 3 months since I have been here in the Philippines and I have since learned many useful Tagalog words to aide me in communicating with woman in the prenatal as well as labor and birth. Like sakit and pwerta, go look them up. Now more than ever I realize the value of my Doula experience, and how it will always be a part of me as a Midwife. The ability to communicate without words extends across many roles in life. I’m very grateful for my experience here and the woman that have allowed me to stand, rock, moan, and cry with them as they birthed their babies. They have given me more than I have given them, and I will hold it close as I move forward to serve many more.