Making Decisions in Pregnancy – Using Your BRAIN

We make decisions all the time. In pregnancy and during labour, you will be presented with many different options, for all aspects of your care. Should I be taking a higher dose of Folic Acid? What about Vitamin D? What is a Glucose Tolerance Test, and should I have one? This can be daunting, particularly if it’s your first time; you have no experience to reassure you, and many decisions in pregnancy have the potential to impact on your health and the health of your baby, so you obviously want to get them right! It’s essential with any decisions in pregnancy that they’re fully informed choices – whether that’s informed consent, or informed refusal. There’s an acronym that can help ensure you are covering all bases; use your BRAIN.

If you’ve attended any maternity or NCT antenatal classes you may already have heard of the BRAIN technique. It can be pretty useful to help you cover all the options and ask the right questions.


Making decisions in pregnancy - the BRAIN Acronym

While you’re pregnant, you’ve got time to research your options and think about what you’d like to do; decisions in pregnancy rarely need to be made instantly. A good Health Care Professional (HCP) will listen to your concerns and answer them, or undertake that they will find out for you. If they feel threatened by your questioning, get a second opinion – if they can’t justify and evidence their reasoning to you then why would you agree to their recommendation?!

But when you’re at the sharp end of labour contractions, it’s easy to feel under pressure, overwhelmed by the choice, and to forget to ask the pertinent questions you need to help the decision making process. This in turn makes it difficult to evaluate your options as effectively as you would normally, potentially leading to snap choices you may regret later. Remembering to use your BRAIN can help.


Because no matter how the procedure/test/medication/option is presented; anywhere along the continuum from “you could try this…” to “you have to do this…”, decisions in pregnancy ultimately rest with you.

Any medical professional whose reasoning starts with ‘because it’s our policy’ or ‘that’s what we usually do’ is not doing their job properly. They should be giving you what you need to make truly informed consent. At all times you are being offered options which are yours to accept or refuse. Even if the way it is phrased doesn’t sound like you have a choice, you do. You always have a choice, even if that choice is to “ask me again in 5 minutes… I’ll think about it then”


The acronym BRAIN works as follows:


The B stands for Benefits: What are the advantages of the approach under consideration? Whether it’s a test, monitoring, pain management, position change, it doesn’t matter – you need to know why your care provider is recommending/suggesting it. What is the evidence base for it? If you’ve got the time, is there RCOG (Royal College of Gynecologists) or NICE (National Institute of Health and Care Excellence) guidance on it you could read? RCOG/NICE always state their sources and sometimes rate the’ strength’ of the evidence for their recommendations, which is helpful. Even if it’s just internal policy, there should be documentation and references to back up the reasons for it.


The R stands for Risks: What are the disadvantages of the approach being considered? Are there any side effects? Is the decision reversible? Will it restrict my choices later on? What happens if it goes wrong? How does this relate specifically to me and my circumstances? You also have to keep in mind the severity of the hazard versus the likelihood. Are we talking an almost certain likelihood of breaking a fingernail or a very very very small likelihood of fetal/maternal death? It’s tempting to ignore very unlikely risks, but if the consequence is catastrophic, it must be taken seriously. As a doctor friend of mine put it in terms of c-section – you may not want one, but how many overcautious c-sections are acceptable to prevent one fetal/maternal death? 


The A stands for Alternatives: What other approaches could we try? Is this the only option to consider (aside from doing nothing – see N later)? Just because this is what most people choose/you’d recommend, doesn’t make it right for me… (you might need to BRAIN all the alternatives too!) e.g. If I’m being advised/prescribed something because there’s a ‘risk’ of high blood pressure, could I buy a blood pressure cuff and monitor my blood pressure instead?


The I represents Instinct/Intuition: What does my gut say about the approach recommended/suggested? This may seem like an unscientific measure, but it’s useful in getting to the core of what is personally important; and determining which path is right for us. After all, giving birth is not an illness, it’s a natural part of life. That said, we’re all different, with our own innate values, beliefs, and preferences to consider.


The N stands for Nothing: What is likely to happen if we do nothing? Can we wait an hour/2 hours/a day/a week? Does the decision have to happen now, or can we wait, see what happens next and revisit later, if necessary?

Medical professionals generally want what is best for their patients. On the whole we can be assured that they really do have the right motivation when caring for us. But while we mustn’t lose sight of that, there is also room for our input in the birthing process.

To make informed decisions, you need all the relevant information. Using your BRAIN is definitely one way to attempt to ensure you get that information at the right time.