(Maria Fabrizio for WPLN and KFF Health News)<\/p>\n
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.<\/p>\n
\u201cEverything that I did not want to happen had happened,\u201d she said. \u201cAnd I just remember that feeling of being just so utterly defeated.\u201d<\/p>\n
Her cervix wasn\u2019t 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\u2019s amniotic fluid sac, another intervention used to move labor along.<\/p>\n
Conley agreed to that step, reluctantly. But looking back, she said she didn\u2019t feel comfortable with many of the decisions that day. And Conley doesn\u2019t feel that her providers were fully hearing her.<\/p>\n
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. \u201cHow were you treated?\u201d she said. \u201cAnd how many decisions did you feel like you got to truly make?\u201d<\/p>\n
The QTip:<\/strong><\/p>\n Even in a fast-paced medical setting, it\u2019s OK to ask: \u201cWhat happens if I do nothing right now?\u201d<\/p>\n The Acronym To Remember: B.R.A.I.N.<\/strong><\/p>\n Birth doulas, including Conley, often advise clients to use the acronym B.R.A.I.N. to ask questions of their medical providers:<\/p>\n What are the benefits<\/strong> of this intervention?<\/p>\n What are the risks<\/strong>?<\/p>\n What are the alternative<\/strong> options?<\/p>\n What does my intuition<\/strong> tell me?<\/p>\n What happens if I do nothing<\/strong> right now?<\/p>\n \u201c\u200aIt\u2019s essentially a framework for talking to your healthcare provider when you\u2019re coming to a decision or a pivot point,\u201d said Margaret Buxton, a certified nurse midwife and vice president of clinical operations at Diana Health<\/a>, a network of women\u2019s healthcare practices in the South.<\/p>\n Listening to your intuition is particularly valuable, Buxton said: \u201cYou do experience emotions in your body, not just in your head.\u201d Checking in with your intuition or gut can help you decide and ultimately feel more comfortable with a choice in front of you.<\/p>\n \u201cWe know that people who feel seen and heard in their healthcare visits, their anxiety goes down, their stress level goes down,\u201d she said. \u201cAnd their ability to process information, think and listen, all of that improves.\u201d<\/p>\n When All Else Fails, Remember \u2018N,\u2019 for \u2018Nothing\u2019<\/strong><\/p>\n If you don\u2019t have time or energy to go through all five questions, you can ask the N in B.R.A.I.N.: \u201cWhat happens if I do nothing right now?\u201d<\/p>\n 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.<\/p>\n Of course, there are moments when a medical emergency takes precedence. \u201c\u200aIt\u2019s pretty clear when it\u2019s not a good time to talk, because people are ripping cords out the wall and they\u2019re running you down to the OR,\u201d Conley said. But generally, \u201cthere\u2019s time for you to get to a point where you feel pretty comfortable and confident that this is a good decision.\u201d<\/p>\n B.R.A.I.N. Won\u2019t Replace a Compassionate Provider<\/strong><\/p>\n Some patients feel uncomfortable questioning a doctor\u2019s authority, because of the power dynamics in the room. \u201c\u200aMedicine was really set up to be top-down,\u201d Buxton said. \u201cThere\u2019s an expert, and there\u2019s a recipient.\u201d<\/p>\n Others fear being dismissed or not taken seriously. Research has shown that medical professionals are less likely to prescribe pain medication<\/a> to women than men for the same symptoms and that Black women are three times as likely to die in childbirth<\/a> than white women.<\/p>\n That\u2019s why it\u2019s 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\u2019t, find a different person to oversee your care.<\/p>\n \u201cWe 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,\u201d she said. \u201cIt\u2019s definitely harder to have those conversations with an abrasive provider who is not interested.\u201d<\/p>\n People and Policy<\/strong><\/p>\n Medical professionals are both legally<\/a> and ethically<\/a> required to obtain \u201cinformed consent\u201d from patients before most procedures. This means they have to give you accurate and complete information about the recommended treatment, typically in writing.<\/p>\n And nearly two decades ago, the American College of Obstetricians & Gynecologists\u2019 ethics committee recommended that doctors go a step further<\/a> and engage in shared decision-making, which involves discussing \u201cthe benefits and risks of available treatment options in the context of a patient\u2019s values and priorities.\u201d The Centers for Medicare & Medicaid Services has also started requiring shared decision-making<\/a> as a condition for paying for a limited number of treatments.<\/p>\n <\/em>Katherine Ruppelt<\/em> at Nashville Public Radio contributed to this report.<\/p>\n HealthQ is a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable healthcare system. It\u2019s a collaboration between Nashville Public Radio and KFF Health News.<\/em><\/p>\n<\/div>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" (Maria Fabrizio for WPLN and KFF Health News) 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. \u201cEverything that I did not want to happen had happened,\u201d she…<\/p>\n","protected":false},"author":0,"featured_media":16340,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-16339","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/16339"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16339"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/16339\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/16340"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16339"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=16339"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=16339"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}