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Writer's pictureJo Morris

Making decisions in pregnancy and birth: use the TBRAIN tool

Updated: Sep 18

Decisions in Pregnancy and Birth 


During pregnancy and birth, you will be faced with a lot of decisions. The first are often where should I have my baby? Do we find out the gender of the baby or not? Should I have screening tests? Others include, do I need to have a sweep? Is an induction necessary? Do I want pain relief or not? Do I need the proposed intervention?  Do I want my baby to have the vitamin K Injection after birth? 


Pregnant lady holding a pregnancy test - Bumps in Bloom

Sometimes those decisions are easy ones, and sometimes they can feel overwhelming and hard to make. You may be presented with lots of options, and have no idea what to do. 


Decision Making Tools 


What are they? They are simply a guiding framework for exploring your options that allows you to make an informed decision that you feel comfortable with. 

So, I would like to introduce you to the TBRAIN tool.


TBRAIN is an acronym and stands for Time, Benefits, Risks, Alternatives, Intuition and Nothing (do nothing). 



Bumps in Bloom - TBrain Free Download Blog Banner



This is a really useful tool that you can use during pregnancy and birth to help you make informed decisions about your care. It can be really overwhelming to go into an appointment and be told that something is happening, or that a scan has found something or the midwives have concerns about the labour and are considering an intervention that isn't listed within your birth plan. Be involved with any discussion about options during your pregnancy or birth. Use your TBRAIN and ask:



T - Time: Questions to ask


  • Does this decision need to be made now (unlikely)?

  • Can I take some time to explore my options before I make a decision?

  • Can I have more time?



B - Benefits: Questions to ask


  • What are the benefits to me and my baby?

  • What does the evidence say? 

  • What is the success rate of the intervention?

  • Does this apply to me as an individual?


R - Risks: Things to consider


  • What are the risks to me or my baby?

  • What does the evidence say? Ask for statistics and absolute risk ratios i.e. 1 in 1000 vs 3 in 1000 risk 

  • What could the possible outcomes be?

  • Are there any long term risks? Consider the impact on your birth experience, mental health and place of birth

  • Does the intervention carry a higher risk of medical intervention?

  • What percentage of people are likely to experience these risks?



A - Alternatives: Explore other options


  • Are there any alternatives? For example: another ultrasound scan

  • Could I get a 2nd opinion?

  • What impact would offering the alternative have?

  • Is there an alternative pain relief method?

  • Can I change my position to see if that makes a difference?



I - Intuition: What does your gut feeling say?


  • Trust your instincts, what does you gut say?

  • Do you feel like you are doing okay?

  • Do you feel like you need some additional support?


Remember - you are the expert of your body and your baby!


N - Nothing: What if you do nothing?


  • What if you take some time to see what happens?

  • What are the consequences of doing nothing?

  • Use that time to change position, go for a walk, have some food or have a wee.

  • Is there additional monitoring that will be offered if I decline an intervention?


Hopefully this framework will help you explore your options and allow you to gather the information you need to make an informed decision that you feel confident about. If you want more information on making decisions in pregnancy, Sara Wickham’s website is an excellent source for that, and she has also written a book on this, which I have recently read and highly recommend. 


I love this tool and have used it personally during my pregnancy and labour. It's my number 1 tool for advocating for yourself in pregnancy and I talk about it in all my classes and workshops.


If you want antenatal classes that cover this in depth and you live in the Warrington, Cheshire, Merseyside area, you can book here.


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