The BRAIN Acronym for Decision-Making

Pregnancy, birth, and the postpartum time are full of decisions: choosing a care provider for your pregnancy and birth; defining and communicating your birth preferences; making choices about newborn medical procedures, feeding, and care; and more! Each of these choices is affected by a variety of factors!

​As a doula, I love supporting my clients through the process of making their own informed, empowered decisions. I love watching my clients research their options, consider all the relevant factors, and move forward with the best choice for their family and circumstances.
One of my absolute favorite tools for informed choice is the BRAIN acronym.

The BRAIN acronym guides parents through each part of making a choice. For each choice, it invites you to consider:

​Benefits: What are the possible benefits of making this choice?

Risks: What are the potential risks of making this choice?

Alternatives: What alternatives can we consider? (For each alternative, you can go through the BRAIN acronym again!)

Intuition: What is my intuition telling me is the best choice for our family?

Nothing: What if I do nothing?

Let's walk through an example of how to use this acronym. Let's say, for instance, that you're trying to decide where to give birth. The BRAIN acronym works best if you choose a potential decision and work through the acronym, and then do the same thing for each alternative choice. For this example, you may begin by considering the decision to give birth at a birth center. You'd start by looking into the options near you. (In Utah county, you can check out Utah Birth Suites, Two Leaves Midwifery, and Birthing Your Way. The Draper Beautiful Mountain Birth Suites birth center is also right on the border between Salt Lake and Utah counties.)  

Next, consider the BENEFITS of giving birth at a birth center. Perhaps you like the homey feel of a birth center (compared with a hospital). You may appreciate that a birth center offers a large tub, spacious rooms to labor in, and places for your family or friends to wait. During COVID specifically, birth centers are much less likely to restrict the number of support people you can have with you during your birth. There are also fewer routine interventions and procedures done in a birth center (compared with a hospital), and you're more likely to know everyone in the room. You may also want to read this blog post about the evidence on birth centers and  ACOG's Statement on Birth Settings, which lists accredited birth centers as one of "the safest places to give birth." Throughout your research, you'll find other benefits to list as you consider making this choice.

After thinking through the BENEFITS of birthing at a birth center, research the RISKS. Think specifically about your situation and the potential risks of birthing at a birth center. If you have a high responsibility pregnancy (what some may call "high risk"), a birth center may not offer access to medical care you need. If it's likely that your baby or babies will need additional medical care at birth, a birth center doesn't have immediate NICU access. If you are planning to use epidural anesthesia during labor, this option isn't available at a birth center. And you won't stay for 24-48 hours after giving birth, but will head home within a few hours of giving birth. What other risks might be important for you to consider?

After thinking about the RISKS, ask yourself about ALTERNATIVES. Alternatives to birth centers include hospital birth and home birth. Some inns/hotels are also open to having clients give birth there (Aspenwood Manor in Provo is a beautiful option that is very open to this!) Again, for each of these possibilities, you'll want to go through the BRAIN acronym again!

Next, tune into your INTUITION. You are the only one who knows all of the factors in your unique situation. Do the work to familiarize yourself with the options and their benefits and risks, and then trust your intuition. Reflect, ponder, meditate, pray. Talk it through with your spouse/partner/doula/friend/mom/aunt/yourself. And trust that you can make the right decision for your family!

The last letter of the BRAIN acronym doesn't really apply in this scenario: doing NOTHING in your decision-making process about birth location would eventually lead to an unplanned home birth, which isn't a great option. (Planned home birth can be, though--stay tuned for an upcoming post about that!) In other situations, though, NOTHING, can be a worthwhile option to consider. Rather than consenting to having your water broken, you can choose to do NOTHING to intervene. NOTHING can also mean letting NATURE take its course, which is an option you'd want to carefully consider.

I hope that example exercise was helpful! I love that the BRAIN acronym is applicable for everything from choosing a care provider to induction to anesthesia to breastfeeding to potty training to choosing a preschool and beyond! It's a great tool for parenting!

I love that this acronym recognize and invites YOU to be the actor, the decision maker, the researcher (in consultation with care providers, medical experts, and others as needed) in your own story. Whenever there's a choice to be made, ask yourself: What are the Benefits, Risks, and Alternatives to the proposed choice? What is my Intuition telling me? What if I do Nothing?