Your 5-Step Decision Making Framework for an Empowered Birth

One of the key secrets to getting the birth you want is having the right framework for making decisions about your care. While it’s important to know your rights and your options, sometimes you may be faced with recommendations that just aren’t sitting right with you.

Maybe you’re being told you “have to” induce labour, or you “have to” schedule a cesarean.

Or maybe it’s as simple as being told you’re “not allowed” to have the kind of birth you want to have.

As a first time mom, I hadn’t known my full rights, and that’s part of the reason why I wound up having a hospital birth that ultimately led to birth trauma. Had I known that key piece of information on my rights to informed consent and refusal, then this framework I’m about to teach you would have worked much better than it did the first time I used it.

You need to remember that even when you have these tools, it doesn’t help unless you also have all 5 Elements in place for an Empowered Birth.

However, this framework can also apply outside of birth to any aspect of your parenting journey, and I encourage you to use it whenever you need to make any decision for yourself or your children.

You can watch this video to learn more on how I applied the framework in choosing whether to induce labour when I was told my son’s growth wasn’t on track, in addition to how I later applied it to a parenting choice back in 2020 when my son’s school opened up again for a test run.

(embed YouTube Video Here)

This simple framework is powerful, and it helps you find and create options that you may otherwise overlook if you simply use the old BRAIN acronym as your only tool for making choices that fit your needs, values, and circumstances.

The decision making framework I teach inside my Take Charge of Birth Program can be broken down into 5 easy steps…

Ask Questions

First, you want to ask why this is being offered or why it’s being recommended. You also want to ask what the immediate risk is to you and your baby, so you can determine how much time you actually have to make a decision.

This is why as part of the Take Charge of Birth Program I focus on getting my clients the Right Education. When you know ahead of time what the risks and benefits are to various interventions and what scenarios may come up for you in the course of your care, then you’ll already come to your birth armed with the knowledge needed to make quick decisions.

Remember BRAIN!

Benefits

Risks

Alternatives

Now/Nothing

Beyond BRAIN however is the second question of assessing the risk factors that may influence which choices you decide to make. When determining that level of risk, ask yourself whether this recommendation is due to a complication, variation, or a deviation.

A complication means that the situation needs immediate medical attention and would include things such as developing pre-eclampsia, a baby in distress, or another red flag that could lead to a true emergency. It is helpful to familiarize yourself with possible complications that may come up for you and make a plan of how you would like to proceed in such cases. Often there are several options even with a complication, and making that backup plan does not necessarily mean you’re tempting fate or that things will go wrong. All it means is that you are planning ahead, so that if the unlikely scenario happens, you can still feel empowered in your birth and have the best outcome for yourself and your baby.

A deviation is a situation that might need medical attention down the road. These are the pink flags such as low fluid, gestational diabetes, high blood pressure, or any other condition that develops that may have some level of risk, but could otherwise not be a problem at all. I have coached and supported moms who have had gestational diabetes and they’ve gone on to have beautiful births at home. Likewise, low fluid levels may just mean that you are dehydrated and you can replenish those levels by drinking more water. A deviation is not something that needs to cause alarm, though you may want additional monitoring or to alter your lifestyle somewhat to accommodate for your circumstances.

Finally, a variation is when you aren’t following the textbook definition of what “should” be happening. I can tell you right now that it’s pretty much guaranteed that your pregnancy will be considered a variation in some degree. Maybe you won’t be dilated at 39 weeks. Maybe you will have a suspected “big” or “small” baby. Maybe you’ll just go past 40 weeks, and if that’s the case you will be in good company because the average gestation for a first time mom is 41 weeks and 3 days, and even second time moms tend to go a little bit over 40 weeks. In fact, there’s only about 25% of the population who will have their baby before 40 weeks!

A variation is only classified as such because the textbooks tried to fit women into a narrow box of what kind of labour pattern was “effective”, and what kind of pregnancy was “normal”. Most of us fail to fit in that box. Therefore, if you are getting recommendations to intervene based on one or several variations, then it’s very likely that your care provider doesn’t support physiological birth. That’s a whole other blog post!

Consider the Evidence

Every single test, procedure, or recommended treatment has a body of evidence for it, but what many moms don’t know is that not all that evidence is very strong. In fact, there are many routine practices and recommendations that are based on nothing at all but the assumption that our bodies are defective and need help to birth our babies.

Obstetrics was born out of the industrial age, and our bodies were compared to machines. The male doctors who saw a huge profit in taking over maternity care then decided to convince thousands of women that they could speed up labour and birth with their magical tools and so they invented the episiotomy and forceps. There was a time, not even that long ago, when every baby in the hospital was dragged out with forceps. Your grandmother may even have had such birth experiences.

Twilight Sleep was also something that had been based on very little evidence, though at the time doctors thought it was a modern miracle for mothers to birth without remembering the pain. What’s the takeaway here? Question the evidence!

You also want to take the steps of BRAIN to apply to what your intuition is telling you. For example, you’re being told you have to induce for the safety of your baby, however at the moment you know that your placenta is still functioning, baby is still kicking up a storm, and you know that there are a lot of moms who have their babies at 42 weeks or even a little past that. Knowing those key facts, you may question the need to intervene in a healthy pregnancy as you don’t have a complication that warrants inducing labour.

Consider The Experience

If there’s one thing I can’t stand, it’s when someone diminishes the importance of a desired outcome or experience.

You’ve probably seen the comments in the Mommy Groups about how your experience “shouldn’t be that important compared to a healthy baby”. Well, I’m calling BS on that! Your experience is important and matters greatly to how you perceive your birth.

If you have a terrible birth experience it can impact you so much that you suffer birth trauma as a result.

That trauma can be compounded if you also suffer injuries such as lacerations from and episiotomy and forceps, or recovery from major abdominal surgery. An unwanted epidural can cause long-term back pain. Being told not to push, when your body is taking over, and having your baby held inside can lead to nerve damage. When you are not supported in a physiological birth, and there was no reason why you couldn’t have had one, then you can be unnecessarily harmed physically and psychologically.

There’s nothing gentle about Pitocin. When your labour is induced or sped up with this drug, it is harder on your body. My friend Samantha of BeBaby says it’s like putting a brick on a gas pedal in a car with no steering wheel. You can’t expect the car to just magically get to its destination; it may just as likely crash into a tree.

Furthermore, you may have a deeply held vision and desire for your birth. You may want to breastfeed, have an easier postpartum recovery, and you may want to be in a desired environment that feels safest for you.

Always consider both what you truly desire for your birth and what you want to avoid, and make your decisions carefully. You are not selfish for having those desires or wanting to avoid those things; you are human. You are allowed to choose what is going to be best for you. No one else can tell you what your experience will be.

Explore the Worst Case Scenarios

There is no risk-free way to give birth, just as there is no risk-free way to live.

You can be paralyzed with fear when your care provider tells you that there is a risk of a severe complication or a poor outcome if you don’t do what they are telling you to do, but take a deep breath before you agree to anything.

First of all, your care provider should legally be telling you the exact numbers on those scary risks, including the risks of the proposed treatment options. If they are only speaking in generalizations or telling you the risk “doubles” then that’s not true informed consent.

But let’s pretend for a moment that you were told the actual likelihood of that complication or outcome occurring, and it’s scary but super rare.

If you’re still looking at that tiny chance of having that outcome, consider how you will handle it.

What might you choose to watch out for, so that it’s more likely that outcome won’t happen?

Are there any other worst case scenarios with the proposed treatment or recommendations? How likely are they to occur?

In the end, you are your own best decision maker.

By assessing the actual numbers and likelihoods of certain risks, as well as making contingency plans to deal with them, you will be in a position of power instead of making a choice out of fear.

Any care provider who truly supports you will appreciate you making your own decisions based on what you feel is best, and they will respect you. So if after you’ve made your choice you find that your care provider is hostile or tells you that you are putting your child at risk, or even threatens to call social services, that is your big red flag to fire them. You will also want to report their behaviour because as part of your rights to informed consent and refusal, you should not be coerced or threatened into agreeing to a course of treatment you are not comfortable with.

Create Your Own Options

So what if you’ve weighed all the evidence, considered what you want for your birth, but the options and alternatives being presented to you don’t look that good either? Well, there’s no rule saying that those are your only options.

One of the things that I tell my clients in my Take Charge of Birth Program is that they create their own options, and sometimes they get pretty creative.

For example, one of my friends was told she wasn’t “allowed” to have a homebirth, because she lived too far away from the hospital. There were no birth centers or birth houses in her area, and the hospital was simply out of the question for her!

She did want to be close enough to a facility in case she did need to transfer, but at the same time she wanted to labour in a home-like space.

Her solution?

She chose to set up her birthing space at her parents’ house, so that she could remain in the area with the best midwives and also have the homebirth that was inaccessible where she was living.

Another friend of mine had wanted a vaginal birth after 3 prior cesareans. She had been told by every single doctor in our health authority that she was “not allowed”. So she drove an hour in labour to BC Women’s hospital and birthed her baby there.

Sometimes, when you don’t like the options being given to you, you can create your own. It may require a bit of extra work, and it’s worth it.

Bottom Line: When it comes to making decisions about your birth, you are the only one who will know what is right for you. By using the 5 steps of this framework you will become more confident in how you make those choices, and you’ll come to your birth from a place of power instead of fear. You can also start practicing this framework in other aspects of your life. Hone these skills and notice how they work for you. And let me know how it went. I’m constantly perfecting these tools the more I coach mothers in planning their births and making choices that are best for them.

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