Supporting you make a decision
Tools to help you make an informed decision
The BRAIN tool
When deciding how to give birth, a structured way to make your decision may be useful to use. The BRAIN tool is a decision-making tool to help you approach making decisions about your birth options and can be talked through with your doctor or midwife (1).
‘B’ stands for benefits and allows you to think about the benefits of a decision.
‘R’ stands for risks where you can think about the risks of a decision.
‘A’ stands for alternatives - are there any alternatives to the decision you are making?
‘I’ stands for intuition. This is about how you feel and what your ‘gut’ instinct is.
‘N’ stands for nothing and allows you to think about what will happen if you decide to do nothing or wait and see what happens.
The decision you make regarding an induction of labour, or not, is completely the decision of the person giving birth. Alternative options should be discussed with you, and you can always say no to things offered to you.
Maternal satisfaction with induction varies. Some will have positive experiences of an induction of labour, but for others it may not be positive for their birth experience (3).
Common concerns people may have before induction of labour include a fear of delays or fear of being alone. Delays will vary depending on your hospital (hyperlink to risks of induction). Birth partners are encouraged during induction. How long and how many birth partners you may have depends on where you get induced (inpatient or outpatient), and what stage of the induction you are in (in the induction suite or labour ward). Talk to your team about any concerns you may have for clarification.
There is little to no difference seen with uptake of breastfeeding at discharge in those who have an induction of labour compared to other birthing methods (4).
After your due date (40 weeks)
Your likelihood of going into spontaneous labour varies according to how far along the pregnancy is. As your pregnancy progresses you are more likely to go into spontaneous labour. (2)
You can choose to wait and not be induced. If this happens, you may go into spontaneous labour or you might not. If you don’t go into spontaneous labour by 41 weeks of pregnancy, there are some additional risks. These include:
A higher likelihood of a caesarean birth
A higher likelihood of baby needing to spend time in the neonatal intensive care unit (NICU).
An increased likelihood of stillbirth
An increased chance of your baby dying just after they are born (neonatal death).
If you do not go into labour by 42 weeks of pregnancy, the risks listed above increase further. If you choose not to be induced, you may be offered extra monitoring of your baby.
This monitoring cannot reliably predict any changes that happen after the monitoring ends but can help to see how the baby is in that moment and even help with decision making for birth options. Complications that happen to the baby cannot be predicted or prevented with monitoring.
References:
Palmer, Jane. ‘BRAIN Decision Making Tool for a Better Birth Plan’. Pregnancy Birth and Beyond, 21 Mar. 2020, https://www.pregnancy.com.au/brain-decision-making-tool/
Inducing Labour: Guidance | NICE. 4 Nov. 2021, https://www.nice.org.uk/guidance/ng207/chapter/Recommendations.
Harkness, Mairi, et al. ‘Experience of Induction of Labour: A Cross-Sectional Postnatal Survey of Women at UK Maternity Units’. BMJ Open, vol. 13, no. 5, May 2023, p. e071703. bmjopen.bmj.com, https://doi.org/10.1136/bmjopen-2023-071703.
Induction of Labour in Women with Normal Pregnancies at or beyond 37 Weeks. https://doi.org/10.1002/14651858.CD004945.pub5. Accessed 17 Aug. 2024.
