Every month Science & Sensibility shares a Brilliant Activity for Birth Educators, and since today is Halloween in the United States, I knew I needed to turn to Stacie Bingham for a wonderfully "gruesome" idea. Stacie is one of the most creative childbirth educators that I know. Shared decision making can feel scary and intimidating but this fun idea helps families use their BRAIN to navigate labor and birth choices. - Sharon Muza, Community Manager, Science & Sensibility.

Ghosts and ghouls, mummies and vampires - 'tis the season to be frightened! But as childbirth educators, we know what's really frightening: not having a choice in the decisions surrounding one's birth.

This past week I was able to listen to the Safety Action Series on Reducing Health Disparities: Shared Decision Making & Patient Empowerment, presented by the Council on Patient Safety in Women's Health Care. One of the presenters, LaToshia Rouse, shared how, at 35 weeks, her membranes were stripped during a routine prenatal appointment without permission or discussion. Rouse ended up in labor and her baby dealt with jaundice, blood sugar issues, and required a NICU stay. Her words: 'I wish I had shared decision making.'

According to the National Learning Consortium: 'Shared decision making is a key component of patient-centered health care. It is a process in which clinicians and patients work together to make decisions and select tests, treatments and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values.'

Shared decision making seems to be a popular phrase with medical organizations these days, and that's fantastic. What's not fantastic is that consumers don't know that shared decision making is something they are owed, something they can demand, something they deserve. That's where we as childbirth educators come in.

I ensure the families in my classes are offered unbiased, factual information. When they know and understand what the evidence says, they can seek those best practices for themselves. Let's imagine 'Gemma' knows induction for a suspected big baby is not an evidence-based practice. When her care provider mentions this could be an option for her as she is measuring ahead, she can share, 'I understand ACOG says inducing labor when you think the baby is big isn't recommended; what's different about my situation that you feel it may be necessary?' This benign way of asking a care provider to support their claim is a tool - now the care provider carries the onus for providing rationale around suggesting an induction. And it doesn't end there.

Gemma can look to her BRAIN to practice shared decision making:

• What are the Benefits of having an induction?
• What might the Risks be?
• What Alternatives are Available?
• During this process, Gemma is also checking in with her Intuition, her Inner wisdom, to see what her gut is telling her
• Is this Necessary Now? Or Never? What if I choose to do Nothing?

By sharing this acrostic, we offer an easy way for families to begin a meaningful dialogue with their care providers. This is the first step toward shared decision making.

In my search for something beyond just a piece of paper, I wanted a way for families to carry a brain around in their pocket (or birth bag, or hand). To further provide sensory stimulation (which helps combat some of the sensations of labor), I wanted something that felt nice and smelled good. A waltz around the craft store and I had an idea: I'll make brains out of soap! Instead of a just another stagnant handout (and wow, I do love my handouts), this brain would be welcome at the place of birth -- on a nightstand, held in the laboring person's hand, used as aromatherapy, or simply as the soap in the bathroom.

Materials needed

• Melt and pour glycerin soap base
• Plastic mold in shape of brains
• Alphabet beads
• Essential oil
• Food coloring

Basically, the soap goes into the microwave (easy, right?). Once melted, add essential oil and food coloring to your liking. Spoon the liquid mixture into the molds. Getting the beads in without having them flip around is the biggest problem here - I placed the beads on a toothpick and slid them through the soap, leaving them in a tight bunch to settle into the glycerin. Let the soap cool according to the instructions, and then gently massage the brains out of the molds. Voila! I seal them in clear plastic wrap so they aren't sticky.

Introducing the BRAINs

In my six-week class series, we focus our first three weeks on learning about and building confidence in normal birth. Variations of Normal is the title of the fourth class, and this is when we bring up all the choices families may encounter. I utilize Lamaze's Intervention Intelligence as handouts. We explore these choices and then move into communication strategies, including shared decision making. We practice a few scenarios using the BRAIN acrostic to get people talking. I also throw in non-birth situations, such as a mechanic recommending repairs for your car, and we see using our BRAINs applies to other areas of life. As we are closing, a basket of BRAINs gets passed around and I have each person share where or how the BRAINs can be used (once a partner suggested using the soap to wash out the mouths of people who shared their negative comments or birth stories).

Family feedback

What families have said:

'I loved the way the brain felt in my hand. It was smooth and warm. In fact, it got a little distorted from me squeezing it but it still helped. I wish I had two, one for each hand.' -Stephanie

'Our L&D nurse laughed when she saw my brain on the sink. She asked what the story was behind it. When we told her what it stood for, she got serious and told us she wished all patients would ask those questions.' -Julieta

'My hospital lunch made my whole room smell. I just wanted fresh air! Holding the brain under my nose gave me something to focus on while I waited for the smells to go away.' -Marissa

Conclusion

What's so scary about making decisions? Nothing, when you can rely on your trusty little BRAIN! Consider providing your families with this tool to start their process of evaluating choices - choices that ultimately will shape their birth experiences.

Resources for educators and parents

Reducing Health Disparities: Shared Decision Making & Patient Empowerment, Safety Action Series, Council on Patient Safety in Women's Health Care

Shared Decision Making Fact Sheet, the National Learning Consortium

About Stacie Bingham

Stacie Bingham, LCCE, CD(DONA), resides in California's fertile Central Valley. Her experience in the world of birth and babies began in 2002 when she accredited as a La Leche League Leader. After some time, she realized how women birth affects breastfeeding, and she certified as a DONA International Birth Doula. It didn't take long to see the impact childbirth education has on birth, and that began her journey to LCCE. Stacie enjoys all aspects of teaching and compares being a childbirth educator to the role of stand-up comedian -- engaging her audience with humor and evidence so learning happens in a relaxed atmosphere. Her writings have been published in the Journal of Perinatal Education, International Doula, Leaven, New Beginnings, and Clinical Lactation. Stacie serves on the Board of Directors for La Leche League of Southern California/Nevada, is actively involved in the Bakersfield Birth Network, and is the Kern County coordinator for Postpartum Support International. Always expanding her family through rescue kittens, she resides with her husband and four sons. For more teaching tips, visit her at staciebingham.com

Published: October 31, 2017

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