THE BRAIN ACRONYM IS AN IMPORTANT DECISION MAKING TOOL THAT EVERYONE SHOULD KNOW WHEN ACCESSING MATERNITY CARE. IT CAN BE USED TO MAKE DECISIONS REGARDING SCANS, TREATMENT, MONITORING, TESTS, INTERVENTIONS AND BIRTH PREFERENCES.
So let’s look at how to use it in a scenario such as deciding whether or not to accept the offer of an induction.
Benefits- What are the benefits of having an induction at this time? Do you have any indication that baby is not healthy and safe in there? Is baby safer on the outside? This is going to vary wildly for every mother and baby based on gestation, risk factors, the current health of mum and baby, placenta function and fluid levels etc.
Risks- What are the risks of having an induction at this time? Considering similar points to those above, what are the risks of induction to mum if she is unwell or has issues which mean induction is not usually recommended for example, a heart condition. What are the risks to baby if baby is not well or at this gestation? These things are going to vary so much for each family and unfortunately nobody is going to be able to tell you what to think about these factors as everyone has different priorities, situations and also past experiences.
Alternatives- What are the alternatives to induction? Perhaps monitoring of baby using CCG to check movements, scans to check placental function, blood flow to the placenta, steady growth of baby and fluid levels. Monitoring of mums blood pressure or temperature etc. It may be that if it is vital that baby is born as soon as possible that you prefer to opt for a caesarean then attempting induction. Perhaps when weighing up the risks of induction, you feel a caesarean would be a better alternative for you and your baby (you can use the BRAIN tool for caesarean birth too!). Educate yourself about these alternatives so that you have a full picture of your choices.
Instinct- What does your instinct tell you? Mother’s instinct is a really important thing to consider in pregnancy, birth and parenthood. Often the mother will know that something is not ok with her baby before health professionals do. Similarly, she will often feel that all is well with baby despite a professional believing otherwise. So what do you think? What is your gut feeling? Do you feel like all is well or do you think baby needs to be born ASAP?
Nothing- What happens if you do nothing? Could you wait a while? Perhaps the reason that you’re being offered induction as that you’ve reached the arbitrary point in your pregnancy that the healthcare providers now consider you a ticking time bomb. Could you leave it a few days? Is all that happens if you do nothing that you simply remain pregnant? In the case of a so called slow labour, could you agree to wait a few more hours if there’s no indication of any issue with baby?
This tool can be used to consider all choices in pregnancy and birth, from diagnostic tests, rupture of membranes or a vaginal examination during labour, your chosen place of birth or what pain relief you would like to consider.
Remember that all choices are yours no matter what. Your care providers have a duty to let you make choices about your own care including asking for or declining care. Often people have a bit of a fear of people in positions of power like drs etc (white coat syndrome) but they are just people, most of the time they are open to having discussions about your wishes and fears. If you come across anyone who is not respectful of your choices, you are able to ask to deal with someone else and to make a complaint. While these people are of course well trained to deal with issues as they come up, they do have to offer care based on the trust’s policy and not always (or often) based on evidence. The maternity system is not one size fits all and you are the one who gets to decide which parts are relevant to you, based on your knowledge of yourself, your health, your past and your preferences. Who knows you and your situation better than you do? You are the decision maker when it comes to your body and your baby.