Rachael Hutchins:
Hello and welcome to the Aligned Birth Podcast. I am Dula Rachel. I am one of your co-hosts here on the Aligned Birth Podcast. Today, it's just me and I am talking about the power of knowledge in regards to informed and shared decision-making. So today I'm gonna explore crucial aspects of childbirth surrounding informed decision-making. So join me as I uncover the significance of understanding your options, advocating for your preferences and fostering a sense of control. during your childbirth journey. So I'm gonna cover like what is informed decision making and then combining that with shared decision making and why it's important that you have both, that it's not just about gathering information. It's not just being told what something is. That's more than that, especially when it is in regards to things happening to you or your baby during pregnancy, childbirth and afterwards. So we're gonna talk about how to achieve informed and shared decision making. when to use it and why it matters. So let's dive in. Okay, so I'm going to begin by talking about what is informed and shared decision making. The meaning of informed decision making. So just the informed part. So I'm talking about, I think it's optimal to aim for informed and shared decision making, but a lot of people talk about just informed decision making. So the meaning of informed decision making is where you assess risks. and you collect relevant information before you take another step or a step forward or agree to something or, you know, agree to an intervention or procedure or a test informed decision focuses on the risk and benefits involved in the decision making process. So this is really, really important in life. So this is a life skill here. So if you're listening to me talk about this, it doesn't just apply to giving birth. It applies to autonomy over your body for all of your health care needs. In my opinion, I have found that learning about this tool, I've been able to apply it for myself and my own care, for my children and their care, for my husband. Like it's something that we can universally use. And so I think it's a really, really important and impactful and long lasting tool and approach. So a lot of people. say or feel, you know, we hear a lot of this from our clients, um, when they're going through pregnancy and you have doctors or midwives sort of telling you what is happening or giving recommendations, it's easy just to feel like, okay, they're telling me to do this. They're the expert. So it must be what's best for me. And that is not always the case. It's a piece of the puzzle, right? It's not that we don't trust them at all. I trust them significantly. They are the expert, they've had the training, but you are the expert on you. You've known you for your whole life. You know all of your history, you know all of your medical needs, you know all of your individual needs and your experiences and your history. And you have to be your own advocate over those things and remind providers and remind, you know, in all the situations when you're needing to make a decision about your care that you are the expert on you and they are the expert on whatever the... if it's if it's pregnancy or childbirth or pediatrician or whatever it is, like, you can give respect or respect is due and they are the expert on that you're the expert on you. So let's come together. So that's the informed and the shared part of it. So what this looks like is whenever a procedure a test, whether it be routine, or hey, we do this for everybody type of test and you're like, Oh, well, if everyone else does it, then it must be fine. It it's whenever there's something being brought up as a next step that you aren't as familiar with, you've never done it before, it's new territory, you're not sure about it. You want to gather information about it, ask questions until you feel satisfied about what you're going through. Like that you feel like you understand it. So ask questions, gathering information, learning about the relevant risks and benefits and then assessing your unique needs surrounding. this particular next step and then taking time to think about it and then make a decision that is best for you. So it's a collaboration right you're coming together with your in this situation and what I talk about a lot is with pregnancy so I use the term provider and in that way I'm talking about midwives, OBs, doctors, so your nurse. people like that, but it can really apply, like I said earlier, pediatricians, your general care provider, your gynecologist, if you're going for, you're having to go see a cardiologist and it can apply to any situation or scenario. So what it looks like is you are gathering information, you're saying, hey, What is this thing that you're recommending? Why are you recommending it? What are the risks and benefits? Let's evaluate my unique individual needs, medical history, all of that, taking time to think about it. And then like the provider being like, how do you feel about this? And how would you like to move forward now that you have the information? And then letting you make the decision about it. And then that gives you that autonomy and that power over the process. And so it's not saying you're not going to do the thing. It's saying, I'm gonna do it with as much information as I need to make me feel comfortable. So that looks different for everyone. And this is, I run into this a lot in the birth world as far as like people feeling like you need all the information in order to make a decision. And really you need the amount of information that helps you feel at ease and comfortable moving forward and that you've been given time to consider. your options and how you feel about it and then it's on your terms about the decision moving forward. So I think that is a well balanced way to approach informed and shared decision making surrounding your care during pregnancy, birth and postpartum. So like I said, it's not just about like information overload. It's about the whole picture of risk benefits, individual medical needs, history. preferences and then time to make a decision. And then it being on your terms, like you saying, I feel good about this or I don't feel good about this or I need some more time. And then having a provider who is supportive of this formula or this dialogue, right? That is also really important. Cause sometimes if you feel like it's not safe or you aren't comfortable having this kind of a conversation with your provider, then that is, would be considered like. concern or a red flag that provider may not support you overall and that could impact your experience down the road especially if we're talking about childbirth. Okay so that's a little bit about what informed and shared decision-making can look like and what it is. So the how to achieve this, the simplest way I have learned through my childbirth education training, through my doula trainings, through working with many clients in many different scenarios, with all kinds of different prior histories and prior experiences and preferences. This one tool I think is universal and very helpful in achieving informed and shared decision-making and it is the BRAIN acronym. So we lovingly say, use your brain, okay? So what is that? And it's a simple five question acronym or five sequence of five questions that you can ask. whenever you're being offered a next step or an intervention or a test or something like that. So again like in pregnancy this could be the glucose test right like it's very standard lots of people do it and it's assumed that this is just like everyone should do it and don't ask a lot of questions but the reality is that there are options in there it's good to know what's happening to you and what you're putting in your body and why you're doing it. and any risk and benefits and any other options available. So like taking the glucose test during pregnancy, getting tested for group B strep during pregnancy, later in pregnancy doing a membrane sweep or getting induced or in childbirth, like you're in childbirth, maybe wanting to do artificial rupture of membranes where they artificially break your water or using pitocin, getting an epidural or needing a cesarean. And then postpartum, you know, any sort of screenings that happen postpartum or really like a pediatrician care, breastfeeding, navigating challenges with feeding your infant, whether it be providers recommending the use of formula, we can use the brain acronym then, or you're at the pediatrician and they have vaccines they want to do, then you can use the brain acronym like or additional tests they want to run, you can use the brain acronym. So you can see like lots of examples. I've just sort of strung out there for where you can just say, let's take a beat. I'm going to use this. I'm going to use my brain and I'm going to ask questions. And I think it's really important to know too that with the brain acronym and I try it, we tell this to our clients all the time. You don't have to know all the things about all the things because there is so much to know. I've been doing this for almost 10 years and I'm still learning stuff. every single day or learning new ways about the same thing I've been doing for a long time or learning new options available for certain things. There's so much to know so if you are expecting and this is your first time or even if you've done it multiple times you may not know everything and so you can release that fear of like what if I don't know everything and say I'm going to feel confident that I have this one tool that no matter what comes up I can use this tool and feel more confident about the next step. And that's the gold in this, in this tool. So the brain acronym is the B is for benefits. What are the benefits to doing this procedure or this intervention or this test? And you could also flip that and say, what are the benefits to not doing it? Are there any benefits there? What are the risks? So the R is for risk. What are the known risks? to doing it, what are the risks to not doing it? So you can always look at both sides of it based on what's being proposed. Because sometimes you might learn there's no risk to not doing it, and not doing it could become a very viable option, and sometimes it's just more of a wait and see, or let's give it more time scenario, depending on what it is. Okay, so the A is available alternatives, and I add the A because, I mean, I add the available alternatives. because it really depends, like there can be a whole slew of alternatives based on what you're going through, but what are your available alternatives based on your situation, where you are, like based on where you're, if it's like giving birth, where are you giving birth, and what is available in that location, or what's available, like have other things already been ruled out based on my circumstances, so what is truly left as an available alternative, because knowing what your alternatives are, what else can I do here besides what you're recommending first? Is there like a, is there a baby step we can take here or is there just something else I can try first before going to this other thing if you're really not wanting to go to the other thing. So the A is available alternatives. The I is intuition and that's a really, really important one. So what is your gut telling you about what's happening? And I can't say this enough. I've learned through my own personal experiences of being a mama and giving birth and working with so many expecting parents, the value of your intuition is tremendous. So really tapping into your intuition as much as you can. And it serves you. Like if you're more aware of what your gut is telling you or guiding you to and trusting that more, you're going to over time increase your ability to trust and use your intuition as a good decision making tool, it's always there. It's how we access it. And if we, through our life, haven't been taught or we haven't had the confidence to trust our own intuition, then it gets dimmed. And being pregnant and going, becoming a parent, becoming a mother can really heighten your intuition. It's biologically designed that way to where you are more attuned to. the needs of you and your growing baby or the baby you just gave birth to. Like you have an innate knowing and an innate wisdom. It's just being aware of it and learning to trust it or lean into it or be more curious about it. And so I is intuition. And then the N in the brain acronym is now or nothing. So do we need to do this now or what if we do nothing? and I kind of said it earlier, but sometimes if you learn that doing nothing is an option and still safe for you and baby, then maybe that is the answer. And you're like, oh wow, I didn't know that was even an option. Or if we don't have to do it now, can we wait an hour or two or a day or two? And that can look like in labor waiting to artificially break your water. Like if we don't have to do it now, if there's no real need to do it now, let's wait. And that could be an hour or two and then all of a sudden your water breaks on its own or you don't need that intervention or you decide, okay, well I've waited now and nothing has changed. I would like to go ahead and take that intervention. Or in into pregnancy and you're facing maybe a possible medical induction is do we have to do it now or can we wait? Like can we wait a day or two and do some continuing monitoring and let my body have more time to prepare on its own for labor? And then maybe there's no risk there and you learn that through asking this. OK, well, great. Let's do that. So that's the rundown for the brain acronym. And what I think is the most valuable tool and the most accessible tool for preparing for childbirth and parenthood. Please, if you're listening to this and your partner isn't listening to this, share it with them, share it with whomever is going to be part. like alongside you through pregnancy, if they're going to doctor's appointments with you, if they're going to be in the birth space with you, um, if they're going to be in that, you know, postpartum bubble with you. Um, so whether that's your partner or a mom or an aunt or sister or a best friend, share it with them and be like, this is the tool I need. Cause sometimes, especially if it's during labor, you're the birthing person, you are in labor land, right? Your thinking brain is dimmed. So you may not be having the thought. or the awareness and that's good, we want you to stay in that space, but having people around you familiar with using it so that you're not the one having to do it while you're in labor can be really, really beneficial. So share this with your birth support team, specifically like a partner or the person who's gonna be right alongside you through this journey and it can be really, really helpful all along the way. So when to do it, and I've sort of touched on it a little bit already. So thank doctor, your doctor visits, your midwife visits, anything prenatally where you're going in and you're seeing a provider, be it a nurse, a PA, midwife, a doctor, an OB, a GYN, pediatrician, whomever, whenever you're in a doctor's appointment, y'all, I promise, I know how hard it is. I have experienced this personally in my own life when I've gone through like care for myself. Like I've gotten really good at, I got really good at doing it during pregnancy and I got really good at doing it for my kids. But like for myself, I struggled like being in a doctor's office by myself and having something come up and not knowing what to ask for, what to do. And like trying to lean on this brain acronym. So, and sometimes it leaves my brain and I, pun intended, I guess. Um, and I forget what to do. So having it written down or having it in your phone or having it in notes app as a reminder of like, okay. I need to ask these questions and you use this tool if something comes up. But I'm saying all that to say, I know it's not easy at these appointments, especially like you get a little anxious about being there. You kind of want to get out. But also know with your provider, you can always leave a visit and write up your questions and either send it through. If you have like if there's a portal that you use with your provider or you can call and leave a message with your questions or if they do email, you can email them and say, hey, I was just there. You know, I didn't think of these questions while I was in the office, but here they are and still ask these questions if it means you feeling better about making the decision or moving forward. So again, tests I mentioned earlier, some of the times when you would use this is anytime a test is being offered procedures are being offered interventions are being offered treatments. Anytime. And again, it's like if they're like, oh yeah, we do this for everyone. That doesn't mean you don't get to ask questions. that anytime something is happening and you want to know more, use the brain acronym. Another great time is during postpartum. Again, babies here, we do a lot of prep during pregnancy for the pregnancy, for the birth, for the baby, but once all that has settled and now you're in postpartum and you're having your own postpartum care, now you have newborn care, pediatrician care, your own well care down the road, like you can use the brain acronym for all of that as well. Or like I mentioned earlier too, when if challenges come up with your newborn and there needs to be interventions, like they are recommending that baby go to NICU or they're recommending baby be under bilirubin lights because their bilirubin levels are off and they're possibly jaundice or they're wanting to supplement with a formula or any of these things come up, there are lots of interventions that are life-saving and we need them. And so, Again, it's not to say don't do them. It's saying that there are lots of opportunities when interventions might arise and having this tool can help you feel more at ease navigating them so that you feel like you're making the best decision for you and your family if you're feeling, you know, overwhelmed or uncertain. So some of the whys into the why do we care about this? Why should we care about this? I think it really helps build trusting relationships and opens like communication with your provider. So by taking this approach, I believe that providers become more open and more receptive. That's my experience. I know there are stories out there and lots of people have negative experience with trying to talk to their provider. And again, if that's happening, that's a red flag. That's not the provider for you. But for with a good provider, they are going to receive this. And you're kind of saying, hey, I really am invested here. I care about what's happening to me and my baby. I wanna know more, I wanna work together, right? It's saying I want to be a collaboration in this process, not a one way like, you know, we're more authoritarian or dictatorship. We are a democracy here. We are, you know, we are working together to, for the betterment of the health of me and my baby. and this whole process and also it improves how you feel about the whole process right. So I believe it can improve relationships with your provider, it can increase communication, it can open the door, it can set the foundation for a really positive experience and if you try to use this approach and you're shut down that's a red flag. Also, the brain acronym can really help you navigate unexpected turns during childbirth and even during pregnancy. It is a way to say that no matter what comes up, if I use this tool, I have a better chance at feeling better on the other side of this, at having a positive experience despite unexpected turns. And one thing I can tell you for sure about We know a lot about childbirth. We know a lot about how the body works, how the baby works, how the hormones work, the physiology of birth. There's so much to know, but we don't know exactly how your pregnancy and birth and postpartum will go until it's happening. So this tool will help you navigate the unexpected turns along your path. And that is amazing. That is so... amazing and can really improve your overall experience. And that's my goal as a childbirth educator, as a birth doula, is that you have a satisfying experience no matter what comes up, that it's not about doing it a certain way. It's not about saying I'm going to have an unmedicated birth. And then if you don't have an unmedicated birth, then it's not satisfying. It is like you can have you can have the birth that like checked all the boxes off of your preference list. and still not feel good about it because you either didn't feel like you were supported, you didn't feel like people were listening to you, you didn't feel autonomous. And so that's what creates the negative experience, right? And you can have a very empowering medicated experience because you took this approach. So knowing if you are facing some of these unexpected turns that you can use this tool and it can help you feel. more empowered, more satisfied, more in control. And again, it's all about how much you need to know to feel good about it moving forward, not like you have to know all the things. And another big why behind the brain acronym is the power behind the intuition, the power behind how the brain acronym includes and puts a big emphasis on your intuition. The decision-making dance of How much do I need to know to feel more confident about this? What do I need to know? How am I feeling about it? What are my preferences? Have those preferences changed? Trusting your care provider, trusting people who are giving input, such as your doula, or your partner, or your mom. Like this dance that occurs through this whole process is what can increase anxiety and fear, or it can help. You know, help. calm those fears. And so finding that balance is what we're going for and I believe that the BRAIN acronym can help you do that. Aiming for informed and shared decision making can also help. Another big why for informed and shared decision making is your postpartum reflections. So how you feel as you process your birth after you've given birth. So when you're processing your decisions and the outcomes, it can help improve your overall satisfaction with your experience when you're looking back on it and you're like, well, this thing came up that I wasn't hoping for, that I wasn't expecting, and I used these tools, I listened to my intuition, I asked for help, I communicated, I leaned on my team, I felt heard, you know, so I'm... bummed that this happened or I'm really disappointed that this one thing happened, but overall I feel good because I had support through the process and that I advocated for myself and I use these tools. So it's two things being true at one time and it can really help in the processing of your birth when you are able to kind of look back and have these points of like, okay, I really felt heard here. I really felt like I had shared decision making here. I really felt like I took ownership of my birth here. I really felt safe during this thing that happened. So it can really be an important tool as you are processing your birth as well. So there you have it, a comprehensive exploration of informed and shared decision-making in childbirth, a process that empowers parents to take an active role in shaping. your birth experience and your postpartum experience too. So thank you for joining me today on the Aligned Birth Podcast. Remember to subscribe and share and tune in next week where we continue to share all about pregnancy, birth, postpartum, motherhood and beyond.