What Are Your Rights? Use Your B.R.A.I.N!

Many birthing families have no idea what their rights are as they head into labour and birth. If your care provider schedules you for an induction, for example, are you comfortable with that? Do you know what an induction entails? Do you know that you have a right to question the how and why? The easiest way to compile a list of questions for your doctor or midwife is to use the BRAIN acronym:

B - What are the Benefits of this for me and my baby?

R - What are the Risks?

A - What are some Alternatives/less invasive things we can try, first

I - What is my Intuition telling me is best?

N- What if I choose to do Nothing (or choose not to do anything right now)?

Your care provider should respect your questions and answer them thoroughly and let you make an informed decision based on the answers you receive or the information you choose to research on your own. If your doctor or midwife tells you that they are suggesting A,B,C or D because the risk to you and baby doubles or triples, if you don't do them, ask them for the actual statistics of what "double" or "triple" means. Does that mean that the risk goes from .4% to 1% out of 1000 women? Or does it increase from 1/10 women to 3/10 women? You can see that there is a HUGE difference in what that means (based on numbers) but the verbiage around how it is presented to you is still the same. Using simple terms rather than the actual factual statistics is often a way to subtly coerce you into making a decision that you might not be ready to make. What person wants to risk their baby's life, right? That is what some care providers hedge on when providing you with the risks in words over stats. At the end of pregnancy, almost everyone feels tired, gigantic and ready to meet their baby. So, being offered an induction to get things going is often grabbed onto like an olive branch. However, very few people consider asking about the benefits versus the risks. Even fewer people know that they can refuse an induction.

Another fear mongering tool is suggesting that your baby is large for dates based off of your latest ultrasound results. But, ultrasounds are notoriously inaccurate at guessing your baby's size...and that's what it becomes; a guess based on your baby's head and stomach circumference. Speaking about a big baby - they are chunky...and chunk squishes! So, consider these things when presented with the notion that your baby is going to be large.

If you decide that an induction is right for you, discuss the different ways that you can begin it. One option is with a foley bulb or catheter. It's inserted into your cervix until it reaches the amniotic sac. It's inflated and helps your body secrete hormones to continue dilation. You'll be sent home and asked to come back in once it falls out or in 6-12 hours (care-giver and hospital dependent). When it falls out you're normally 3-4cm and this is when they begin step 2 - synthetic oxytocin and rupture of membranes to get things going. Can you decline these steps? Of course you can. Having begun with the foley, you can wait and see if your body naturally keeps going. If you decide on Synto, you can decline AROM (Artificial Rupture of Membranes), although the doctor will make a strong argument for why the 2 should go hand in hand. So, ask about the risks of AROM - such as infection, loss of too much amniotic fluid, possibility of an amnio-infusion and what are the risks of not agreeing to AROM, at that moment. It is always something you can choose later on - but not necessarily a decision that needs to be made in the moment.

What about eating and drinking while in labour? If you have chosen an unmedicated birth, you can eat and drink as per normal. But, many L&D departments will tell you that you cannot have anything by mouth once you have begun your induction or have chosen an epidural. Ask them why they have this policy and of what benefit is to you. One of the reasons they have this policy is because every intervention you have puts you at a greater risk for an emergency cesarean (and in the off chance you need general anaesthetic, they want your stomach empty to avoid vomiting and aspiration). However, the primary reason for nothing by mouth is because, many years ago, women were put into twilight sleep while in labour and having an empty stomach was safer in that scenario...and since then the policies haven't changed. But, you'll need fuel for this marathon. All that breath work will make your mouth and throat dry...so how can you go 24 hours with barely a sip of water or any food and be expected to keep your energy up?

The long and short of it is to be as knowledgeable and prepared as possible. Don't be afraid to ask questions and advocate for what you believe in, feel is right for you or simply "want".