This month on Science & Sensibility as well as on Lamaze International's social media sites, we have been highlighting tools that educators and birth professionals can use when teaching childbirth classes and working with families during the childbearing year. For this month's Brilliant Activities for Birth Educators series, I thought I would share a really fun tool that I use in my Lamaze classes that helps families to understand and prepare for advocating for themselves and gathering information to help in making decisions about their care during pregnancy, labor/birth and postpartum. You can follow along with all of the previous Brilliant Activities for Birth Educators posts by clicking this link here.

Introduction

Regardless of the childbirth class I am teaching, (a full seven week Lamaze series, or one of my shorter specialty classes) I work hard to help my families to understand their rights and responsibilities around decision making and informed consent. I understand that it can feel intimidating to question medical experts on options and to ask for more information. I also understand that this is even harder and more difficult to do so in the throes of labor and in pain. That is why I think that it is important to offer both information and practice time so that families can try the self advocate role on for size and begin to feel confident in in their skills.

Materials

• A BRAIN Hat
  • I purchased a BRAIN hat from IKEA - very affordable at $10.
  • Patterns are available to knit or crochet a BRAIN hat as well
• Scenario cards for practicing, laminated for protection

How to conduct the exercise

I start off this topic by explaining what informed consent is and why it is important for a family to feel that they have all the information they need to make a decision. I talk about using the acronym "BRAIN" to help them through the process. Many of you may be familiar with this acronym, or something very similar.

"BRAIN" stands for

• Benefits: What are the benefits of this action, recommendation, medicine, test, etc.
• Risks: What are the risks of this action, recommendation, medicine, test, etc
• Alternatives: What are the alternatives to this action, recommendation, medicine test, etc (and use the BRAIN for each alternative too!)
• Intuition - What does the pregnant person and their support people's intuition, gut and heart tell them about the proposed action, when they stop thinking and listen deep
• Nothing: What if they choose to not act now, to do nothing, even for a few minutes, or a certain amount of time? "Not never, just not now."

When faced with a decision, I encourage families to use their "BRAIN" and at that time, I pull the BRAIN hat out from a hiding place near me, and put it on. Everyone laughs while I explain what "BRAIN" stands for. I then proceed to be faced with a decision as a laboring person and play both the role of the family and the health care provider as I work through my "BRAIN" to decide what I want to do.

"Who wants to use their BRAIN next?" I ask. When a family volunteers, I pass them the BRAIN hat and a card with a "BRAIN" scenario outlined. They put on the BRAIN hat and read the question out loud. An example of a question they might be facing is recommendations from a health care provider suggesting to artificially break their water to speed up their labor. I encourage them to ask me (playing the health care provider) questions using the BRAIN acronym. I answer truthfully based on what I know the evidence to be, but use language and demeanor similar to what they might expect during a real situation.

After running through the scenario, I ask the family what have they decided to do? I also inquire how did this role play make them feel? We move on as another family volunteers, receives the hat and a new scenario (for example, coming into the hospital when their water has broken, they are GBS negative and they are not having contractions) and is given a chance to work through their "BRAIN" questions. Not all families will step up to volunteer, but even when just a few do, the entire class is witness to the process and gets to participate in the discussion that follows.

I also encourage families to ask for privacy and time to make a decision, after running through their "BRAIN" as long as it is not an emergent situation.

What the families say about this activity

The feedback from families participating in this this activity is very positive time and time again. Not only are families getting a chance to practice inquiring about the "BRAIN" categories, they are hearing about some common potential interventions that may not be based in best practice. Being given a chance to work through the "BRAIN" procedures in a practice situation really boosts their confidence. Class discussion enriches the experience and being led through this activity by their familiar childbirth educator playing the role of the health care provider makes it feel informative, safe and even a bit funny. Often at reunions, families share with me how this "BRAIN" role play we did in class helped them to do the same thing "for real" when they were in labor. I am always glad I take the time to run through this exercise and that I can use the "BRAIN" hat to make it a bit more memorable.

Conclusion

It is important for expectant families to understand their role in informed consent and begin to feel comfortable in acquiring information that helps them to make decisions during pregnancy, labor, birth, postpartum and parenting. This skill practice exercise "Using your BRAIN" helps them to practice these skills and develop confidence in applying them to their own situations. Using the fun "BRAIN" hat helps solidify the message and remind them of the steps they need to take when facing a decision during their own personal experience.

Would you consider doing a similar activity with your classes? Do you think you might enjoy using the "BRAIN" hat to reinforce this learning moment? What type of scenarios might you consider putting on your cards for the classes you teach? Share your ideas in the comments section below.

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