Use your B.R.A.I.N. (or ask Brian)

My BFF's husband, Brian. Holding a walnut.

If you're expecting a baby or have a new baby at home, you might feel slightly overwhelmed? No? You might feel like it is imperative that you know absolutely everything about pregnancy, breastfeeding, motherhood, immunizations, daycare, and kegels?

I know these are understatements, because every time I meet a new mama or a mama-to-be, I see a wild-eyed, information-starved, overloaded woman who just wants to know everything.

I can relate to the overwhelm and the constant drive to learn more.  A few years ago I worked as a patient advocate for clients living with HIV, and I remember frantically searching the internet for answers, calling pharmaceutical reps so that I could confirm suspicions before confronting doctors, and literally standing in the doorway to keep a doctor in the room until he gave me what I wanted: one more test for my client. This is the Mother Lion behavior, a true testament to one's willingness to find their voice on behalf of someone else. Are you thrilled about being a mother lion? I'll wager you'd say half yes, and half no. And you're right on target. I'm about to give you the skills to be the mother lion on behalf of your child and for your own health as well, and it thankfully involves little internet research, bargaining, bribing, or accusations of wrongfully detaining a physician against his will. Which may or may not be a crime in Colorado.

I recently took a training from CAPPA to become a certified lactation educator, and during that training I learned a very important acronym that sums up exactly what you need to know. Because I'm afraid of intellectual property and all that jazz, I've modified it a bit to become my own.

CAPPA encourages clients to use their BRAIN when they must make a medical decision, so I'll recommend you ask BRIAN. My version comes with a handy cop-out, should you ever need to leave the room. Instead of saying, "I'll have to consult my brain" you can easily say out loud to yourself or to your partner, "I'd like to run this by BRIAN." Hint. Hint.

When confronted with a medical decision (someone suggesting a procedure, medication, or other treatment), ask BRIAN. Well, BRIAN E. And remember, if there are two patients involved (you and baby) make sure to ask the question for BOTH of you. Often mamas defer to what is healthy for baby without asking what she might experience, too. If you want your baby to have the best care available, you must make sure your baby has a mother well enough to deliver that care!

Benefits. What are the benefits of this treatment? This is something the person will likely list for you automatically, but occasionally they do not articulate the benefits because they believe the treatment to be the best option out there, or possibly accept it as common practice. No harm in getting the skinny (with sources, if you're hesitant or want to do your own research).

Risks. What are the risks of using this medication or treatment? This is also something they are likely to disclose, but not always in conversation. Usually these are the items listed on a release waiver, informed consent paper, or literature from the manufacturer of the medication or treatment.

Intuition. What does your gut say about this treatment? This is why you might need a few minutes away from the person offering the treatment so that you can gut-check. Does your gut check matter? Only to you. This isn't some wacky hippy yoga instructor gobbledygook. This is actual science, from a medical anthropologist. People must believe that the treatment/medicine they will take can work. Even clinically tested medications do not work all of the time, and they work less well and less often if the patient has no faith in them. You will actually know how you feel instantly, but it might take you a little while to articulate how you feel. Give yourself a little time, if you can (see N).

Alternatives. Ask what other possibilities exist besides the recommended course of action. Perhaps there are a few that have their own benefits and risks, but if you'd like to be an informed consumer, ask for the names of other medications or treatments so that you can do a little of your own research. This is also a great time to ask the provider why they would select the option they are recommending instead of these procedures. Sometimes it is because they believe the course of action is the best for you, and sometimes it is because they are more familiar with what they are suggesting. If their answer is "I don't feel comfortable performing that procedure myself," you probably don't want them to perform it, either! That doesn't mean the procedure itself is inherently flawed, it may mean you need a referral to someone else.

Nothing. What would happen if you took no action? Are there risks for waiting to do this treatment or start this medication? When will the window of opportunity close? 

Expert. This is my bonus addition. I know it makes Brian a little tougher to remember, but you can write it on your hand if you must! Ask the person who is suggesting this medication or treatment to refer you to an expert on the topic. Even if they are an expert, there is nothing wrong with a second opinion.

Now, to play through in two FUN scenarios to drive the point home.

Pregnant mama is experiencing lots of discomfort during her early labor. Her nurse suggests she try taking a shower. 
What are the benefits of taking a shower?
What are the risks of taking shower (to me AND to my baby)?
What does my gut say about a shower right now?
Are there other things we can do or medications we can take? 
If I don't feel like taking a shower now, will I be able to take it later? What might limit my opportunity to do so?
BONUS: Is there someone who is familiar with pain relief techniques that I can speak with?

New mama is concerned about how much her baby is eating. Her pediatrician suggests offering baby a bottle of formula once a day.
What are the benefits of using formula? (for me and the baby)
What are the risks of using formula? (for me and the baby)
What does my gut say about using formula?
Are there other alternatives to using formula?
What would happen if we do nothing? How will we know when we need to do something or come back and see you next?
BONUS: Is there someone who is familiar with infant nutrition or breastfeeding who I can speak with?

You're on a wonderful journey to be a mother, and no one will expect you to turn around and deliver the next baby! Your job isn't to be an expert about everything you could possibly confront on this journey.

Every time you meet with a doctor, midwife, therapist, nurse, or practitioner of any kind, put BRIAN E. in your bag. It will save you from Doctor Google and information overload.

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