Episode 23: Informed Decision Making

Sometimes it seems like it would be easier for someone else to make decisions for us. But stepping into parenthood requires more of us.

This week we're talking about informed decision making. I give you two different frameworks for informed decision making, ways to think through gathering information for making tough decisions prenatally and during labor and birth. These two frameworks are designed for thinking about courses of action in the modern medical birth context, but tough decisions don't stop once the baby is born -- they only become more complex.

The brave journey of parenthood demands that you / we step into owning our decisions. Only you know your own lived experience, only you know what it feels like in your body, only you know your perspectives on medicine and risk -- and these perspectives are highly individualized.

For every tough decision -- whether or not a medical intervention is the wisest choice, for example -- there really is no one right answer because every person and situation and context is different. And only you know everything you need to know to make an informed decision. Your body, your baby, your birth, your parenthood journey.

Full Transcript

Hello, and welcome to episode 23 of the weekly Brave Journey, free videos, where I Cara Lee, talk about anything related to birth and ,postpartum that I feel like I talk about. What's on my mind and this week what's on my mind is informed decision making. So I'm going to give you two different frameworks for how to think about making informed decisions.

Particularly in the medical context, our modern medical birthing context requires sometimes, thinking about how do we make decisions? And what information do we need to make a decision? So I'm going to give you two frameworks, the BRAIN framework, and then the Three-Legged Stool framework. We'll talk about those in second.

I do want to mention, I am just recording this on my phone today because, um, and I'm sitting on my couch recording on my phone. Generally: I try to set up a tripod and have a nice setting, but I am putting. All of my energy into finishing the Brave Journey Birth Preparation Program. Program, the full program. It's 39, 10 to 15 minute lessons.

It's a full birth prep course. And, um, I have recorded like 32 or 33 of these 10 to 15 minute lessons and I have a few left and then I also need to record some intros and such, but, um, it's getting close. I have all the handouts created and. It's really good. And I'm going to be really proud of it, but it's been a ton of work and that's where all my energy is going.

So this is why I'm just in selfie mode with my phone on the couch, talking to you about informed decision making.

So let's talk about the two different frameworks. And again, this is for making decisions in the modern medical context, this modern medical culture that we are often birthing in.

So these informed decision-making processes start prenatally.

They start when you're pregnant, it starts when you were deciding what tests to have prenatally, it starts when you're deciding how many ultrasounds to have, or whether to do the advanced testing if some concerning things come out of the. So when your prenatal in your prenatals, it really starts when you were pregnant and it continues when late stages of pregnancy when you're facing things like whether or not to have cervical exams later on in labor and, or excuse me, whether or not to have cervical exams later on in pregnancy, um, whether or not to induce your labor, have a medical induction, these decisions start coming up in your late stages of pregnancy before you're even in labor.

And then in labor making decisions is that much harder because hopefully you are in labor land, which is that altered mind, state of labor that is this beautiful gift of the hormones of labor, but it makes it harder to make these kind of analytical decisions.

So two frameworks to think about with informed decision-making.

BRAIN is the first one.

The BRAIN is very commonly talked about. BRAIN is an acronym. It's benefits, risks, alternatives, intuition and nothing. So what are the benefits that usually it's about an intervention? So what are the benefits to this intervention? To this course of action? What other risks to this course of action? There are always benefits and there are always risks.

So what are the benefits? What are the risks? Maybe the risks are small, medium, maybe they're large. What are some alternatives? What are some alternatives that we could try that might have a similar effect? What does my intuition say? And this is where I recommend the body, mind emotion, baby, partner check-in as a way of accessing intuition.

And then can we do nothing? And that's often the option that is not given because our modern medical culture is built around fixing things and acting action. Action, action. And sometimes what labor needs is time. Labor, the normal physiologic process of labor, needs time.

So doing nothing, waiting, ask if that's, you know, always consider that as one of the alternatives. So that's why brain has the n for nothing. Um, benefits, risks, alternatives. What does my intuition say? And can we do nothing? And so that's a way of looking at w. How do I make this decision and how do I weigh these different things?

And then remember only you can make the decision for yourself. Nobody can make this decision for you, not your doctor, not your midwife, you. It's your body and it's your baby.

And this leads me to the second framework for informed decision making, which is the three legged stool. So when you're looking at making a decision, you can look at three different factors.

One is what does the data say? Or the evidence or research? What is the leading research? The second leg of the three legged stool. And remember without all three legs, it collapses. So you need all three of these. So first is data and research only one. Second is your own personal preferences, perspectives, experiences, and particularly your perspectives on risk and medicine.

When you're talking about a medical decision or an intervention decision. What are your own perspectives on risk? What are your own individual circumstances? And only you know those. Only you know. What are, what is your lived experience and what does it feel like in your body. Only you know your perspectives. And what are your perspectives on risk?

It really only you know. And you're the only one who can make the choice. Not your doula. Not your midwife, not your doctor, not your nurse. Only, you know, your own perspectives on medicine risk and your own individual circumstances. So those are two legs of the stool :data and research. What are your own perspectives on medicine and risk?

And then the third is what is the expert opinion in the room? So whomever is there as your medical provider care provider, your midwife, your doctor, what is their expert opinion? And I'm using the term opinion. Now, remember that when you're facing medical decisions, often if you have time, people recommend getting a second or third opinion from different doctors.

And this is because the expertise that they bring to the room is still their own perspective. .And so you hired them because of their glorious expertise and their medical knowledge. That is why they're there in the room as your medical care provider. But it is still only one piece of the three-legged stool.

So you're looking at the evidence or data or research on an issue or a decision point. You're looking at your own perspectives on risk and medicine and your own individual experience and circumstances. And then you're weighing, you're weighing all of that with the expert opinion of your medical care provider.

And they truly are experts, but it is also just their opinion in that context. And so that also includes your nurses, your doctor, or your midwife. You're weighing those as the three legs.

So I just, I really love thinking about people being active participants in their birth. And I love thinking about people making informed decisions when they're looking at medical interventions and choices for, um, actions in their late stages of pregnancy and labor and birth.

And this continues into parenthood. When you're trying to decide how to make choices for your children, as they grow. Um, and it's not just medicine, that it's all these decisions that you'll be facing.

So I want to summarize these two different frameworks. One is BRAIN looking ,at for whatever course of action you're considering looking at; benefits, risks, alternatives, inter what does my intuition say? And can we do nothing?

And then the second framework is that three legged stool weighing the benefit of the research and data on the issue, whatever there is, and whether it's good research or kind of weak. With your own perspectives on risk and medicine and your own individual circumstances with the expert opinion of the medical care provider you've hired. 

Okay. So that's it. Those are my thoughts today on informed decision-making and that's episode 23. I have, um, I'm so excited about this full birth preparation program. I have been talking about it for months and it's finally coming together, um, hours and hours of work I put into it because I want, it's going to be something I'm super proud of and it's going to be something that I know will help people prepare to birth their babies.

So I'm feeling pretty jazzed. But also I just need to finish it and get it done and get it to you. Okay. That's it. See you next week.