Use your B.R.A.I.N // Ashley Woolsey

the power of knowledge in birth

My ultimate role as a doula is to offer non judgmental support to my clients and provide them with as much information as I can. I do this so that they are equipped to make knowledgeable and informed decisions with confidence. We go over a.lot. at prenatal visits, but I know that information requires repeating when the actual birth comes. Sometimes this means simplifying what the Drs and Midwives are saying in the moment. Especially if  it is a decision that the Dr has already made and I feel valuable information is being left out.

I have chosen to distance myself from the agency that I received my training from for many reasons. But I do feel like there are a few valuable things I took away from them and for that I am thankful. One of those things is the idea of B.R.A.I.N. Using this acronym to asses each step of your birthing and labor process and to help you make those informed decisions. Essentially the idea is that, with the exception of a true emergency, you have time to think over and talk about everything that's happening in your birth. You have the ability and the right to ask for a few moments alone to think about something before a decision is made. And ultimately, you have the right to refuse any and all medical interventions at your own risk.

B.R.A.I.N   

Benefits - What are the benefits of what is being suggested? How can this potentially help my labor process or keep me and my child safe?

Risks - Most, if not all, interventions come with risk factors. So what are those? are they minimal enough to outweigh the benefits? And are you ok with the outcome should those risks become a reality?

Alternatives - What else can we try first? What are some other options that might not be as invasive that might result in the same outcome?

Intuition - What is your gut saying? If your only reason for not wanting to try something is simply because you have a bad feeling about it, that is reason enough. Trust your instincts and ask more questions. 

Nothing - Continue to do what you have been doing up until this point. Give yourself and your body more time before offering any changes or interventions and come back to it at another time. 

Almost always, when I am at a birth, an intervention is suggested with little to no explanation and in a way that seems more like a requirement than an option. It is my job to gently remind my clients of what we talked about during their prenatal and if necessary, further describe the intervention being pushed. It is also my job to work cohesively with the OBs and Midwives and to maintain a good relationship with providers and hospitals. It's a fine line at times. 
OK, so here is what brings me to the whole reason for writing this post. This image came across my feed on Instagram today. 

View this post on Instagram

Riveting photograph from @evarosebirth of a babe with an internal electronic fetal heart monitor called an FSE, fetal scalp electrode —via @thelanguageofbirth

A post shared by TRIBE de MAMA (@tribedemama) on Jan 11, 2019 at 10:22pm PST

This is an internal fetal monitor. It has the ability to give a much more accurate reading on the baby's heart rate than an external one. According to hopkinsmedicine.org "This method uses a thin wire (electrode) put on your babys scalp. The wire runs from the baby through your cervix. It is connected to the monitor."
 
I was once at a birth where, as a team, we were all working very cohesively. Their baby's heart rate was pretty elevated for a solid chunk of time and my clients OB wanted to use an IFM to capture a more accurate reading. In this situation you have parents who are often scared because they are making decisions based around the fact that their baby's heart rate is not cooperating. Almost always, your first instinct is to agree to what you think will help asses or resolve the situation. Especially when the intervention is being presented to you though a doctor. But the truth is that there are so many options in birth and you almost always have the time, and the right, to think your decisions though. In the very least you deserve to be handed the full extent of the information before committing. 

Her OB did not explain what the IFM was or how it worked. She just said she was going to need to use it to get a read on the baby's heart. Again, not so much presented as option and more like a decision that was already in the process of happening. IFM in hand and ready to be inserted.

We had covered internal monitoring at their prenatal, but knowing the chances of them remembering were slim in the moment, I softly reminded them of what was about to happen.

"Remember we talked about this? It is an invasive procedure because it is inserted in your cervix and they have to break your water. But seeing as you sac has already been ruptured it doesn't effect that...." I hadn't gotten to the part about the higher risk of infection, or the fact that for the monitor to work it would need to be attached to the baby's scalp via a small screw *see image below* before her OB SNAPPED at me and in a very violent tone and said

"it is NOT invasive!"

I was literally shocked and taken aback and quickly tried to mend things by explaining that

"I just meant the amniotic sac has to be ruptured in order for it to be inserted..."

When she interrupted me and snapped again saying her water was already ruptured.

This is where that thin lines comes into play and I have to remember that I'm representing my agency and these hospitals and providers are our coworkers. That I need to keep bridges intact. So I step back and let the procedure happen knowing that I tried my best to inform my clients and although the way in which the intervention was handled wasn't ideal, ultimately it was the best one for the situation. I just wish that they had been fully informed beforehand. 

But here is the thing. The whole reason I'm sharing this story. Internal fetal monitors ARE invasive. The dictionary definition of invasive is this " involving entry into the living body (as by incision or by insertion of an instrument)" You are literally inserting an instrument into the cervix and then it is attached to the baby's scalp. All prreeetttyyyy invasive if you ask me.

source

So here we are in a situation where I'm doing my job by trying to inform and educate my clients of what is happening to their body and their baby, and their OB is withholding that same information. Because she is what? Worried that if they are equipped with all the information that they may not be comfortable with the intervention? How is that right? Let me tell you. It isn't. Because not only did she withhold information, she straight up lied to my clients. And she scolded me, another professional, in the process.

After it was all said and done and her medical team left the room, my client felt the need to apologize to me for the behavior of her OB. She felt uncomfortable and like I was being attacked. My client, who's sole job is to focus on herself, and her child, and this labor processes, is now worried and apologizing to me for her OB's behavior. Nothing is OK about this. 

Alright, so why am I sharing this story? It isn't to attack hospitals, or OB's, or even interventions. All of those things are wonderful. Hospitals, and OBs, and interventions save lives, and I have seen some pretty amazing, and beautiful, and supportive hospital births. I have had those births. But I am telling this story as a cautionary tale. Because not all hospitals and not all providers are the same. That information is invaluable and that you have every right to know, and explore, and voice, your options and opinions. This image sparked a memory in me that I had almost forgotten, but it all came rushing back. I still remember the shock I felt and the tone in her voice. I still remember how confused I was that I was being told IFM was NOT an invasive procedure. I felt violated and it wasn't even my body that was about to be entered into with false premise. This kind of things happens in birth all.the.time. If we don't educate and equip ourselves with the knowledge of what birth is, then we are putting ourselves in a position to be taken advantage of. We are unknowingly victims of unnecessary interventions and, in-turn, we are making ourselves even more susceptible to risks. This is in no way meant to be victim blaming because the only person at fault here was her OB, but I do want you to be able to stand up for yourself and know your rights. It's ok to question the professionals. When in doubt ask for a moment alone and use your B.R.A.I.N. Because, as always, your birth matters.