Go ahead and be a BRAT

This week was International Women's Day, with a theme of "Break The Bias." Mission: To assist women to be in a position of power to make informed decisions about their health.

To me, #BreakTheBias means being a BRAT. 

Before my son was born, we took a birth prep class in Amsterdam. Given my mediocre and my husband's non-existent Dutch, it was helpful to have English-based birth prep. The class included couples from across the world, whose common thread was English as a comfortable language. Meeting this community of people having babies at the same time as us was an amazing benefit of the course.  

New friends aside, the advice from the class to remember "BRAT" has stuck with me for years. The use context? Anytime someone is asking or telling you to do something that doesn't feel right or that you don't understand. Especially useful while you are interacting with healthcare professionals over the course of your perinatal journey.

The urging is to consider four things:

• Benefits - What good things could happen if you took the recommendation?
• Risks - What bad things could happen if you took the recommendation? 
• Alternatives - Are there other options that would achieve a similar goal?
• Time - Can the decision wait?

Doctors, Midwives, Nurses, and other healthcare professionals work damn hard to earn their titles and positions. I've had the honor of interacting with a number of healthcare professionals through years working in Healthcare IT, pregnancy/moming, being a human. My experience has been that most of these professionals are smart, kind, and hardworking. I believe (my explicit bias) that these professionals want to make a positive impact on other humans. And they are also humans, with their own perspectives, biases, and personal challenges.

BRAT: Benefits, Risks, Alternatives, Time provides a framework for having a collaborative conversation with your medical support team, and for making informed decisions about your (and your baby's) health.

Benefits

Recommendations usually (and should) start with the good possibilities.

• A glucose test checking for gestational diabetes can reduce worry and enable appropriate treatment.
• If you're feeling anxious, prenatal genetic screening can alleviate concern or give you valuable time to process and prepare a special path.
• A shot of oxytocin after delivery helps with uterine contraction, preventing excessive bleeding.

Risks

Recommendations usually (and should) include disclosure of any known or potential bad outcomes.

• Inducing labor may result in a required C-section.
• Getting an epidural may lead to also needing a catheter.
• Not getting an epidural may result in loud swearing at your partner.

Again, consider: How do the risks resonate with you - what's the likelihood of it happening, the severity if it does, and who is the risk most impacting? What actions can you or your support team take to minimize the risks? 

Alternatives

Not always, but often, there are discoverable alternate paths if the initial recommendation doesn't feel right after your Benefit/Risk assessment. Here's a personal example:  

I went into labor with my daughter at the ancient age of 35, one week after my due date. Those two factors triggered a hospital protocol dictating that I should be on continuous monitoring (involving wearing an external fetal monitor around my belly while laboring, to ensure that the baby's heart rate was strong and stable).

• Benefits? Peace of mind, catch any issues quickly. As a note, we had no known medical issues or underlying conditions for me or baby. 
• Risks? Not really any. 
• Problem for me? Yep - after about a minute wearing the monitor, I felt a huge urge to Get It Off. I found anything touching my skin to be distracting and uncomfortable, and just not what I wanted.

So I asked the nurse for alternatives; she suggested if everything looked good after 15 minutes, we could take it off and just hold it against my belly during the next several contractions, and then intermittently throughout labor. This stepwise approach was much more acceptable for me, while staying in the hospital's comfort zone. 

Time

Sometimes, immediate action is critical. And sometimes not. It's important to discern the difference and ask if you are not sure. For example:

• A close friend had just delivered her 3rd baby. But, instead of her placenta coming out in one piece, it broke apart, causing (a lot of) internal bleeding. Note: this is super (0.2%) rare. She was rushed into emergency surgery and by the miracles of modern medicine and urgent actions of her medical team survived. The decision to move to surgery could not have waited.    
• In (non life threatening) contrast, at one point during labor with my son, the midwife suggested I might like to be on the birthing stool. At that point I was on my side in bed, and as I looked at the small stool on the ground that was about 2 ft away, I simply could not imagine how my body would physically move from where I was to that stool. I said nothing, stayed where I was, and time moved on. 

It Takes a Village

Even with the best personal advocacy, many people do have negative or dismissive health experiences; perhaps more commonly in the last couple years as COVID has necessitated fast shifts in protocols, reduction of in-person support (only 1 parent for a pediatric visit, only 1 support person for labor, etc), and increased exhaustion across our human healthcare professionals and the humans they serve.

Have you felt or heard others experience these scenarios?

• Feeling pushed into a C-Section or Induction date that works for the doctor. 
• Feeling that reported pain levels are brushed off or minimized.
• Feeling that something is just not right and not being heard out, or lacking guidance on how to navigate our complex system to even find the right person to listen. 

I recently asked a new mom friend what advice she would have for other new parents. Her response: "Trust your instincts and feel empowered to advocate for yourself. You don't have to put up with something if you don't want to."

Just as I hope you advocate for yourself and your loved ones, I hope our healthcare professionals continue working to break the Gender Bias in Healthcare. A couple points that bear highlighting:

• When doctors do not believe their patients, this prevents people from getting the relief they need.
• Women who no longer trust medical professionals due to negative situations they have experienced may avoid getting necessary care. 

Let's be brats together.