Mountains and Valleys

3d ultrasound, doulas, Induction, Drugs, no drugs, delayed cord clamping, eye ointment, birth plans, swaddling, bassinet or crib, co sleeping, breastfeeding, bottle feeding, pumping, carrier, car seat, strollers, baby monitors, sound machines, sleep training, attachment parenting, early entry, wither or not to follow them when they move or enjoy your retirement. From the moment parents become parents to be they are flooded with decisions. At first the endless things to choose from can be exciting but as Week 13 quickly becomes week 36 parents can feel overwhelmed with the choices they feel they need to make.

I recently watched a webinar by Penny Simkin (a founder of DONA International) about something called decision fatigue. It was the first time I had ever heard that term. I instantly had an uh huh moment! This makes so much sense!!!! http://https://www.dona.org/continuing-education/practice-webinars/

Some of you that have experienced this in the past or are experiencing it right now might being having an uh huh moment as you read these words. Decision fatigue is defined as the deteriorating quality of decisions made by an individual after a long session of decision making. It is now understood as one of the causes of irrational trade-offs in decision making.

The New York Times came out with an article discussing a study that was done following judges in Israel. Long story short they found that judges were more likely to grant parole to prisoners in the morning compared to end of the day. There was no difference between the prisoners ethnicity or crime. The prisoner who was seen at 8am was given parole and the prisoner seen at the end of the day was not given parole. Crazy right?! http://http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html

Maybe not that crazy. I know that as a mother my decision making is more patient and thoughtful in the morning compared to the end of the day when dinner attempt #4 ends in me sprinkling Cheerios and cheese in front of my children.

The way decision fatigue works is simple. The more choices you make throughout the day or during an event such as birth the harder each one becomes for your brain to take in and create a thoughtful answer or choice. Eventually your brain will look for a short cut. The path of least resistance. One shortcut is to act impulsively instead of spending the energy to first think through the consequences. The other shortcut is give up and do nothing, surrender.

 

Penny Simkin showed this picture to describe how your brain works when it’s exhausted. Once your brain has become fatigued it will automatically want to take the path of least resistance. Instead of climbing the mountain, take the valley.

We are a society that values informed choice. Most health care professionals and other pre and postnatal care providers advocate for this. But with so many options these days are we asking too much of new parents? Are we setting them up for decision fatigue?

When I was pregnant I wanted to make the best choices for my baby and I. I would spend hours researching the pros and cons of car seats, epidurals and safe sleep. I was lucky enough to recognize when I was becoming overwhelmed but some are not so lucky. I recently had coffee with a friend that is expecting her first baby. She is normally great at making decisions for herself but became overwhelmed when trying to pick a stroller. Sometimes is not just the amount of choices we are asked to make in a short period of time but it can be the amount of options we have to choose from. As my friend researched on line and asked friends for advice she boiled down her choices to a running stroller, a chariot for biking, a light compact stroller for shopping malls and trunk space, a convertible stroller, a double stroller for future babies, a trendy stroller…… How is a new mom supposed to decide between these options! If you were to look in my garage you would see a single bob running stroller, a small stroller that came with my car seat, a cheap umbrella stroller, a double chariot, a double bob running stroller and a wagon! Who needs all of these modes of transportation?! No one.

It’s very clear that decision fatigue plays a role in many day to day scenarios. The judge deciding someone’s fate, shopping for the perfect stroller, even buying a car! There’s a reason you are asked 1000 questions about upgrades when checking out online. They are banking on you taking the valley and choosing options laid out for you that can benefit them.

If we experience decision fatigue day to day imagine how intense this can be for new parents in labour! Before the birth of my first son I had planned on climbing the labour mountain! I researched the shit out of every possible scenario, the pros and cons, made a plan A, B and C. I had goals and made a birth plan but the end result was very different. I haven’t thought about it until now but there were many changes and interventions through my labour process. I wasn’t ever asked to choose between options, or even given options to choose from but the end result was the same. My brain was so overwhelmed I didn’t question anything! I surrendered to what was easiest.

It makes sense that some women go into labour feeling informed and secure in their birth choices but when something goes unexpectedly they are faced with important decision after important decision. There comes a point that your brain may take the valley route instead of your planned mountain route.

For some women they are unaffected by this and are simply happy everything turned out ok! For others there can be feelings of regret and resentment.

So what can we do about this? As a doula and prenatal educator I used to preach informed choice! If you don’t know your choices you won’t have any. This is true. So I would encourage new moms and dads to ask questions and educate themselves so they feel prepared. However it’s important to recognize when you’re starting to feel overwhelmed with choices. When it comes to making choices during pregnancy try to “take a break”. If your brain can only handle 5 website searches a day then respect that. Don’t feel rushed to make every decision about everything possible before baby comes! Amazon won’t stop shipping when your baby arrives.

In labour we aren’t so lucky. There isn’t time to just “take a mental break”. When things don’t go quite as planned you may be faced with decision after decision which can take a toll not only on your brain and ability to make a thought out response but it can also take a toll on your goals and wishes for your birth. So how can we work with this?! Just being aware that decision fatigue is a real thing is step one. Step two would be relying on some really great birthing support! Doulas and other support systems can’t give you medical advice nor can they advise you what to do but they can support you through making choices!

You’ve been “stalled” at 6cm, a Dr comes in to tell you that augmentation is recommended and there are a few options to choose from. If you were overwhelmed and unable to think through your options, as a doula I would see this and ask you “do you have any questions for the doctor? Do you need a few minutes to decide?” Or Would remind you of what your birth plan covered in terms of augmentation.

You don’t need to trade in your goals because your brain is too tired to do its job properly! Prepare yourself for the possibility of decision fatigue and be sure you have some good birthing support. It’s ok to take the valley now and then, heck I do it every day come 6pm when the answer to my sons 1065th question is “because that’s life”. But when it comes to your labour and birth, rely on your support for reassurance, ask questions if you’re unsure and if you feel overwhelmed it’s ok to ask for a moment to decide.

It’s your mountain to climb.