I would like to preface this post by saying that I don’t hate hospitals. In fact, I love that we have hospitals and access to modern medicine! We are so so fortunate for that. What I don’t love, is the current approach to birth in the American hospital systems. I’m going to go into a bit about that today and talk about how you can make sure you are giving true informed consent for the decisions you make during your birth. The fact of the matter is that over 98% of births in the United States take place in the hospital. As we all know, oftentimes they’re overworked and understaffed and if you’re not asking questions, they’re most likely not going to sit and explain all of the details to you. Not always, I’ve seen some stellar nurses and OBs that take the time to make sure that you have full informed consent. But it’s important to prepare in case you don’t end up with one of those gems.

It might surprise you to hear that more than half of my clients are second-time parents, who did not have a doula with their first and experienced birth trauma. For their upcoming birth, they are looking for a better experience, and we spend a lot of time working through the trauma during our prenatal meetings. I often hear that they went along with interventions that they didn’t necessarily want because their provider suggested them and they didn’t even know that they could ask questions, let alone the questions they should be asking. This is where quality doula support comes in, and why having a well-educated doula that coaches you on informed consent is crucial, especially if you decide to birth in a hospital.

So what does that look like?

Obviously, preparation beforehand is extremely important. Even if your doula is an educator, it’s a great idea to take a childbirth class in addition to the support you’re getting from your doula. You should look for one that aligns with your values and goals for birth! Many people opt to take the hospital birth classes, which is fine, but I would encourage you to search online to find one that really aligns with what you’re wanting for your birth! Some of you may be thinking, “well yeah, I took this class… but how am I supposed to remember all of this information to have informed consent?”. You can’t. Especially when you’ve been in labor for 20 hours and you can’t even think straight. I have an easy acronym for you to write down and bring with you to the birth space so that no matter what happens, you can have informed consent!

B.R.A.I.N

Benefits - What are the benefits of the intervention you’re being presented with?

Risks - What are the risks? Make sure you are clear about wanting to hear the risks for both the birthing person as well as the baby.

Alternatives - Are there alternatives we can try first? (The answer is usually yes)

Intuition - What does your intuition tell you? This may sound a little woo-woo, but I really believe that pregnant people have a heightened sense of intuition, especially during birth. What is your gut telling you to do?

Now? - Can we have some time to talk it over and think about it? The answer to this is almost always yes, unless it is a true emergency. If it is a true emergency, there will be many people entering your room and it will be very clear that there is no time for talking. Asking for some time to think about your decision gives you a chance to discuss things without the provider in the room. It can be intimidating to make a choice with them standing there, so it’s a good idea to have some time to yourself to talk things over.

You might be thinking “Isn’t this what a doula is for?” Ehhh kind of. As a doula, it is not my place to speak on your behalf to your providers, or make decisions for you! What I am there to do is coach you and educate you prenatally so that you feel empowered and prepared to ask these questions and advocate for yourself during birth! Now, there is a bit of a caveat to this. Asking for more time to make your decision allows a moment for you to discuss options with your doula. A well-educated doula will be able to give you evidence-based information if you feel like you didn’t get enough information from your provider. Again, it is never a doula’s job to give their opinion, it is only their job to give you unbiased information so that you can make your own informed decision! It is your doula’s job to hold space for you and support you in whatever that decision may be.

I could go on a rant about how American hospital systems are for profit and interventions are overused for this reason… but… I’m not going to go there right now.. haha! The bottom line is, that this is your birth. It is your right to be well informed in the decisions that you make regarding your care. In my opinion, (and maybe I’m a bit biased here), every single person giving birth in a hospital should have a doula. Even if you’re not trying to go unmedicated. Even if you’re planning to have an epidural. Especially if you’re having an induction. Birth is unpredictable. In fact, I’ve only been to a handful of births where things went exactly as ‘planned’ (using that term loosely here). Interventions happen. Sometimes they’re absolutely necessary, but sometimes our body just needs a bit more time to do what it’s meant to. If you are interested in learning more about the American medical system and how birth has been affected by its for-profit structure, I recommend checking out The Business of Being Born. You can find it here.

Thanks for reading! I hope you implement BRAIN into not only your birth but for any medical decision that you make moving forward! Remember that doctors are not authority figures, they work for you, and you have the right to full control over any decisions you make regarding your care.