How do we make decisions (especially difficult ones during pregnancy and birth)?

I’ve been reflecting on the complexity of decision making lately.

How do we make decisions , especially difficult ones, and how does this apply to pregnancy and birth?

Let’s debunk some myths first.

I think we naively like to believe that we make decisions in a step by step, rational, logical, maybe even scientific basis.

You know, gathering all the facts, all the “evidence”, making sure it’s process driven etc.

Nope.

Our decisions are first and foremost shaped by our experience and our emotions (fear being a big one and I’ll come back to that in a minute).

Think about it this way: your decision is like the tip of an iceberg. All you see if the decision. What you don’t see is the iceberg below, which is made of EVERY SINGLE EXPERIENCE you’ve had in your life so far.

That’s right, everything you have experienced until now plays a role in your decision making.

People do not make decisions ignoring their experiences, only often this isn’t a conscious process.

Let’s say for example, something really scary happened to a friend of yours during her birth, or you witnessed a very negative experience (this includes stuff you’ve seen/read in the media).

This is what you now associate this experience with.

Being presented with scientific evidence showing that  is not necessarily going to shift this belief.

It takes a lot more work than this, because exploring your own belief system isn’t a quick and easy job.

That is why, by the way, so many women are scared about childbirth-because the media only ever portrays birth as a scary, mightily painful, life threatening like emergency.  This message has been passed onto you and built into your subconscious without you even noticing it.

In an antenatal class I taught, there was  a father who was a medical doctor. He got very heated up when we talked about co-sleeping, stating that it was dangerous.

The thing is, science tell us that when you remove risks factors such as consuming alcohol, taking alertness altering drugs, smoking (and as long as you make sure that the co-sleeping environment is safe and the baby is exclusively breastfed), then having a baby in your bed carries no more risks of SIDS than having your baby sleep on a separate surface-read more about it here (ISIS).

I chatted to this dad during the coffee break and asked him what he had witnessed. He said during his training he saw 4 babies who (allegedly) died of SIDS due to co-sleeping.

So he had integrated this belief through his experience and no amount of evidence was going to change this.

That’s what I mean when I say experiences shape our decision making.

What doesn’t help is that we live in a culture that has put science on some kind of impossible pedestal, and create dogmatic beliefs rather than fluid thinking.

We also completely dismiss emotions, and instinct especially, in favour of “rational” thinking.

Interestingly, evidence even shows that under pressure of time for example, even experts revert to gut instincts when making decisions.

And we are more guided by our experience and emotion than by logic.

I was chatting to male midwife Mark Harris earlier and he reminded me of a favourite topic of his: that everything we see, the world we live in, is an hallucination, because it is the product of the mental construct we have developed as children.

If decisions about where to give birth were based on facts and logic, the majority of women would be planning to have their babies at home or in a birth centre. Not in a hospital obstetrics led unit. Because, for healthy women with uncomplicated pregnancies, there can be more risks in giving birth in an obstetric unit than in the other two settings. The odds of having a straightforward vaginal birth, for the same low risk population, are roughly 90% at home, 80% in a birth centre, and only 58% in an obstetrics unit (this was demonstrated by the birth place study).

And yet most women are scared into believing that birth is inherently dangerous and that they must give birth next to doctors, just in case something goes wrong. Not realising that much of the “going wrong” is actually perpetuated by a risk averse, fear based, maternity system.

Now before you start clamouring that sometimes, thing DO go wrong, let me explain this : my most important value as a doula is to make sure you feel supported in your decisions.

My work as a doula has completely changed the way I perceive the world and people.

As a scientist, I mostly interacted with scientists, and although they were all different, they kind of shared a lot of ways of thinking.

Plus being a doula means I get to discuss people’s emotions and feelings a lot-something you don’t tend to do as much in a day to day science job.

What doulaing has taught me above all, is how amazingly, fascinatingly and wonderfully different we all are.

And that every time I think I have “sussed” someone, they throw me a curveball that goes against everything I thought I knew about them.

Nobody fits nicely in little boxes.

And we should celebrate out quirks.

I have supported women who were terrified of hospitals, and for whom being at home felt like the safest option. I have also supported women who were terrified of giving birth vaginally and for whom having an elective cesarean was the safest option.

See where I’m getting to, here?

We are all SO DIFFERENT. I’m still learning about this and still being amazed by it every day.

What worked for your friend might  not (and most likely isn’t) necessarily the best choice for you.

How does all of this relate to the decision making process?

It means that each person has their own, individual way of making decisions.

It means that the process is incredibly complex.

And it means, when it comes to childbirth, that only YOU know what are the right decisions for you.

It doesn’t mean that you mustn’t look at facts and debunk myths.

But it means that supporting you, REALLY supporting you, without an agenda, through making such important, life changing decision such as how to birth your baby, requires an incredibly sensitive, skilled person, who can help you tease out what you really want, rather than what others have led you to believe what is right for you.

But at the end of the day, because of your personal circumstances, some options are going to feel safer than others, regardless of what the evidence says.

And I fiercely defend your right to make your own decisions, however odd and quirky they end up being.

 

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