Gina Conley, an Army veteran in Aberdeen, North Carolina, knew she wanted a low-intervention birth for her first child. But her plan started to go off the rails as soon as she got to the hospital.
“Everything that I did not want to happen had happened,” she said. “And I just remember that feeling of being just so utterly defeated.”
Her cervix wasn’t dilating quickly, and Conley said her midwife insisted that she take Pitocin to speed up the labor. Later, when she was nearly fully dilated, the midwife asked to break Conley’s amniotic fluid sac, another intervention used to move labor along.
Conley agreed to that step, reluctantly. But looking back, she said she didn’t feel comfortable with many of the decisions that day. And Conley doesn’t feel that her providers were fully hearing her.
Conley went on to become a birth doula, in part to help other women have better experiences than she had. Her work is not about helping people avoid medical interventions, she said, but helping them engage in shared decision-making, a collaborative approach in which medical providers and patients talk through options and make a choice together. Studies show that patients who are involved in their medical decisions report higher satisfaction with their care and, in some settings, better outcomes. “How were you treated?” she said. “And how many decisions did you feel like you got to truly make?”
The QTip:
Even in a fast-paced medical setting, it’s OK to ask: “What happens if I do nothing right now?”
The Acronym To Remember: B.R.A.I.N.
Birth doulas, including Conley, often advise clients to use the acronym B.R.A.I.N. to ask questions of their medical providers:
- What are the benefits of this intervention?
- What are the risks?
- What are the alternative options?
- What does my intuition tell me?
- What happens if I do nothing right now?
“ It’s essentially a framework for talking to your healthcare provider when you’re coming to a decision or a pivot point,” said Margaret Buxton, a certified nurse midwife and vice president of clinical operations at Diana Health, a network of women’s healthcare practices in the South.
Listening to your intuition is particularly valuable, Buxton said: “You do experience emotions in your body, not just in your head.” Checking in with your intuition or gut can help you decide and ultimately feel more comfortable with a choice in front of you.
“We know that people who feel seen and heard in their healthcare visits, their anxiety goes down, their stress level goes down,” she said. “And their ability to process information, think and listen, all of that improves.”
When All Else Fails, Remember ‘N,’ for ‘Nothing’
If you don’t have time or energy to go through all five questions, you can ask the N in B.R.A.I.N.: “What happens if I do nothing right now?”
Doing nothing provides an opportunity to pause, talk through options with people you trust, and feel more active in the decision-making process, Buxton said.
Of course, there are moments when a medical emergency takes precedence. “ It’s pretty clear when it’s not a good time to talk, because people are ripping cords out the wall and they’re running you down to the OR,” Conley said. But generally, “there’s time for you to get to a point where you feel pretty comfortable and confident that this is a good decision.”
B.R.A.I.N. Won’t Replace a Compassionate Provider
Some patients feel uncomfortable questioning a doctor’s authority, because of the power dynamics in the room. “ Medicine was really set up to be top-down,” Buxton said. “There’s an expert, and there’s a recipient.”
Others fear being dismissed or not taken seriously. Research has shown that medical professionals are less likely to prescribe pain medication to women than men for the same symptoms and that Black women are three times as likely to die in childbirth than white women.
That’s why it’s important to find a provider you trust before a planned medical event, like childbirth, Conley said. Pay attention to how they respond to questions in appointments and whether they actively listen. And if they don’t, find a different person to oversee your care.
“We need to choose a provider that we can truly trust to share their expertise with us in a way that is not going to push us away from our personal preferences,” she said. “It’s definitely harder to have those conversations with an abrasive provider who is not interested.”
People and Policy
Medical professionals are both legally and ethically required to obtain “informed consent” from patients before most procedures. This means they have to give you accurate and complete information about the recommended treatment, typically in writing.
And nearly two decades ago, the American College of Obstetricians & Gynecologists’ ethics committee recommended that doctors go a step further and engage in shared decision-making, which involves discussing “the benefits and risks of available treatment options in the context of a patient’s values and priorities.” The Centers for Medicare & Medicaid Services has also started requiring shared decision-making as a condition for paying for a limited number of treatments.
Katherine Ruppelt at Nashville Public Radio contributed to this report.
HealthQ is a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable healthcare system. It’s a collaboration between Nashville Public Radio and KFF Health News.