Using your “E-BRAINS” to Make Informed Decisions

Written By Leila Walker

Average Read Time: 5 minutes

One of the most helpful tools I’ve learned as a doula is EBRAINS - an acronym for how to ask questions in order to make informed decisions.

This tool can be used whenever you need to make a decision - whether it’s about using a medication during your pregnancy, or a medical provider is recommending a procedure during childbirth.

I even use this tool to make medical decisions outside of the perinatal experience - I recently used it to decide what course of action I should take to tackle my persistent plantar fasciitis!

Let me break down this acronym for you: 

E - Explanation

  • What is this? 

  • What can I expect from the beginning to the end of my experience? 

B - Benefits

  • How might this help? 

  • What are the benefits of this choice?

R - Risks

  • How might this hurt?

  • What are the risks of this choice?

A - Alternatives

  • What else can we try?

  • Do we have any other options to try first? 

I - Intuition

  • What is your gut telling you?

  • What background information are you bringing to this choice? 

N - Nothing

  • What happens if we wait for X amount of time? 

  • What happens if we decline this choice?

S - Side effects

  • What else can I expect from this choice? 

  • What are the side effects of this choice? 

I want to give you an example of how to use this acronym when you’re making decisions in the months and weeks leading up to your labor. 

Scenario: You are debating whether or not to get an epidural. You’ve heard that it can offer quite a bit of pain relief, but you have some hesitation after hearing that you won’t be able to move around after it’s placed. Let’s use EBRAINS to help you make an informed decision about using an epidural in labor!

Explanation: 

  • An epidural is a catheter that is inserted into your spine by an anesthesiologist at any point during your labor. 

  • This catheter allows for a stream of medication into your body to stop the pain of contractions.

  • The medications that are used depend on each hospital, but may include opioids (ex: fentanyl) and anesthetics (ex: lidocaine). 

  • The catheter is taped to your back very securely so that it won’t move around! 

  • If the medication starts to wear off, you are given a button to press to administer a bolus (a small boost of medication). You can’t over-do this bolus, the machine won’t let you press the button more than once every 15 minutes. 

Benefits:

  • You will not feel the intense sensations of contractions any longer. 

  • It can give you a chance to rest, or even sleep, in order to prepare for the later stages of labor and delivery.

  • If a cesarean becomes necessary, many anesthesiologists will use the same epidural for the procedure. 

Risks: 

  • You can no longer get out of bed, and will require assistance to move your body into different positions (remember, motion is lotion for labor - to quote the amazing Britta Bushnell). 

  • There is an increased risk of hypotension (low blood pressure), so the blood pressure cuff will take a reading every 15-30 minutes. 

  • There is an increased risk of fever. This epidural fever can’t be distinguished from an infection, so medical staff will treat you with antibiotics. 

Alternatives:

  • Non-medical comfort measures, such as counterpressure, hydrotherapy, acupressure, and more!

  • Narcotics 

  • Nitrous oxide 

Intuition:

  • While you can compile all the information and knowledge about an epidural before the day of your birth, checking in with your intuition throughout your childbirth journey is going to be the final deciding factor when you make your decision. 

  • You may have planned for an epidural, but then find that other comfort measures are working well and that you’re coping in the way you wanted. Or, vice versa, you may have planned for an unmedicated birth but decide to get an epidural when you realize your pain has turned into suffering.

  • Before you get an epidural, I always recommend asking for a cervical check, if that feels safe to you. It may help your decision-making to know how dilated and effaced your cervix is!

Nothing:

  • The “what happens if you do nothing” question for an epidural means… you won’t have an epidural! 

  • The question here is more for the instances where an epidural is recommended to you. If a nurse or provider asks if you’d like an epidural, you can always respond by saying, “I would like to labor for a bit longer, but I’ll let you know if and when I’m ready!” 

Side effects:

  • You will have a catheter inserted into your bladder to assist you with peeing for the duration of your labor. This typically comes out before or during the pushing stage! 

  • Epidurals require continuous fetal monitoring to make sure that you’re contracting well and that baby is doing OK! If possible, ask your hospital for wireless monitors, so that you can move around without worrying about wires. 

  • Another requirement of an epidural is a saline IV drip. This is to support blood pressure drops, which are common with an epidural. 

  • There is a chance with an epidural of labor slowing down, especially if you get an epidural earlier in the laboring process. This may increase the change that your provider will recommend pitocin to stimulate your body to continue to have contractions and progress through labor. 

  • Some people report that there’s a feeling of pins and needles that lasts in the legs and feet for days, weeks or sometimes months afterward. 

The example above is a great way to think about using EBRAINS to make an informed decision for you and your family. I use this technique at my own medical (and dental!) appointments, so that I can make informed decisions about my body. 


Did you find this article helpful? Have you used a version of EBRAINS yourself? Reach out and let me know all about it! 

Still have questions, or would like support making informed decisions in your labor? I’m here :)

Citations: 

Leila Walker
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