‘Mental Epidurals’: How behavioural science might help maternity care.

At 12.10am on Sunday 1 st of July 2018, my partner and I welcomed a beautiful baby girl into the world.

It was a roller coaster 9 months culminating in one of the most exhausting, nerve wracking and exciting weeks of my life, including an emergency caesarean. Throughout this joyous (and on occasion very scary) time, the NHS have been absolutely outstanding in the service, resources and support provided. I’ve honestly been blown away.

So, to apply a little of my own expertise in return, I wanted to outline a few opportunities for the NHS by reviewing our maternity care through the lens of behavioural science. I hope this helps to enhance the NHS’s efficiency and the experience of other expecting parents in the future.

“Last month 97 ultrasound appointments were not attended…”

Humans are incredibly social creatures. We’re constantly using cues from those around us to shape our decisions and behaviour — if others do it, ‘ it’s safe’, if not, ‘ it’s risky’. Because of this, referencing the behaviours of others, often known as ‘social norming’, is a powerful strategy to shape our actions.

On occasion though, highlighting the behaviour of others can have backfire effects, particularly if we reference the wrong norm. For example, if looking to discourage cigarette smoking in teens we might think to dramatise how bad the problem is — “3 million youths start smoking every year!” While a powerful statistic, what it inadvertently does is normalise smoking for this audience — “3 million people ‘like me’ are smoking!”

During a routine scan at St Mary’s in Paddington, I noticed a dangerous social norm in reception — it read “Last month 97 ultrasound appointments were not attended at St Mary’s Hospital”. Similar to our smoking example, while well-meaning, the unintended message is “ other people are missing their appointments” — an approach even more worrisome when communicating to those already in the waiting room! An alternative could be “ Last month, a majority…” or “93% of ultrasound appointments were attended on time.”

“This will hurt the most…”

Uncertainty is painful. That uncomfortable feeling you get standing on the platform with no idea when the next train will arrive. It’s the feeling of ‘ message seen ‘ but not replied. We crave certainty, clarity and concreteness and because of this, simple expectation management can work wonders when shaping our experience (from delivering a pizza, to delivering a baby… it appears).

It wasn’t until 12am when sat in surgery after 48hrs watching my partner being poked and prodded, that I connected the dots between expectation management and pain management. Watching her face, I noticed a very different shade of pale after being told “ this will feel like a scratch” when compared to “this bit will hurt the most…”. By providing a concrete reference of what to expect, within an existing frame (a scratch), the doctors offered something for her to mentally grasp. Her expectations were managed, and the intervention was more easily dealt with.

So, can we be creative here? How might we use acceptable (even innocuous) reference points to alter the experiences of quite scary interventions? Might we describe an intervention feeling “ like a hot bulldog-clip on your stomach” or “ like a car breaking sharply with a tight seatbelt “?

If the mind is allowed to catastrophize, it will feel catastrophic.

“Was it ‘Normal’ or ‘Cesarean’”?

Unsurprisingly, language is incredibly powerful. If we were to ask a group of people “ How fast was the car driving when it SMASHED into you?” More will report significantly faster speeds than when asking “ How fast was the car driving when it BUMPED into you?[1]” Choice of words can make people feel comfortable and empowered (let’s be honest, how many athletes are really getting “ athletes foot! “), but it can also make people feel nervous, ashamed and unusual.

Knowing this, you can imagine my ears prick-up when asked on several occasions whether the birth of our daughter was ‘ normal’ or ‘ caesarean’? A turn of phrase that, when understanding the emotional chaos, lack of sleep and natural ‘imposter syndrome’ of early parenthood, risks making mothers feel like a ceasarean birth was abnormal or weird. I think this one is an easy fix. Rather than asking new mothers whether their baby’s birth was ‘ normal’, we should be asking if it was ‘ non-surgical’, ‘ vaginal’, even ‘ traditional’. A simple shift in phrasing with important emotional implications, at a very important time.

A few months on and we’re now happily navigating the roller coaster of parenthood (there are more articles to come…). Again, I want to take this opportunity to thank the NHS for their amazing support and I hope these small observations can help others transverse this incredible and terrifying experience. Importantly, these are not large scale changes to procedure nor recommendations to invest in new expensive technology; they’re simple and modest tweaks aligning with our increasing understanding of human perception and behaviour.

Written: Sam Tatam, Consulting Parter at Ogilvy’s Behavioural Science Practice

Psychologist and former Head of Behavioural Science for Ogilvy Australia, Sam Tatam is Behavioural Strategy Director at Ogilvy’s Behavioural Science Practice in London, a consultancy that combines the gravitas of leading research in cognitive psychology and behavioural economics with the creative expertise of the Ogilvy Group. Tweet him @s_tatam

References:

Loftus, E. F., & Palmer, J. C. (1974). Reconstruction of automobile destruction: An example of the interaction between language and memory. Journal of verbal learning and verbal behavior, 13 ( 5), 585–589.