What Happens When Pregnancy Doesn’t Go as Planned?

50% of pregnancies involve some type of complication, yet we often don’t know why they happen or how to prevent them. Pregnancy, postpartum, and parenting come with so much uncertainty, and that can be incredibly hard to navigate.

Our expert guest today is someone who, like Dr. Ruta, has dedicated her career to helping people understand what the data actually says. Dr. Emily Oster, PhD—Professor of Economics at Brown University, and founder and CEO of ParentData—joins Dr. Ruta and Allie for a conversation about navigating the complex decisions of parenthood.

Together, they discuss how common pregnancy complications really are, how to sift through endless information, and how to make decisions when there’s no perfect solution.

The Bottom Line: 

• Recognize you will have to live with some uncertainty, and there is no getting around that.
• Structure your decisions so they force you to make choices that are hard.
• Remember that this is hard, and give yourself a break.

Resources:

• Read The Unexpected: Navigating Pregnancy During and After Complications by Emily Oster and Nathan Fox
• Reach out to a Postpartum Support International Specialized Coordinator
• Learn more about pregnancy complications

Disclaimer: This podcast is not intended to be a substitute for professional medical care. The views, thoughts, and opinions shared today are the speakers’ own. **Trigger Warning** Pregnancy complications, pregnancy loss, trauma

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So Glad You Asked with Dr. Ruta Nonacs is brought to you by the MGH Center for Women's Mental Health and the J. Willard and Alice S. Marriott Foundation. 

Transcript

Listener 00:00:00

From a data perspective, how do we help moms navigate the pressure of the ticking clock or the fear of advanced maternal age when they are still trying to emotionally heal from a previous loss?

Dr. Ruta 00:00:11

Welcome to So Glad You Asked, the show where real moms bring us their toughest questions. I'm Doctor Ruta Nonacs, a perinatal psychiatrist at Mass General Hospital with over 30 years of experience supporting the mental health of moms and helping them navigate the emotional highs and lows and the often unexpected challenges that come with planning a family, pregnancy, and motherhood.

Allie Hales 00:00:34

And I'm Allie Hales, a mom of four. I know what it's like to scour the internet wide awake at 2 a.m. with a million questions, wondering if what I was experiencing was normal. That's why we created this show. It isn't just for real moms, it's by real moms. Every episode is a conversation led by you. Your questions, your experiences, your mental health front and center.

Dr. Ruta 00:00:57

And we don't just listen, we provide real evidence-based answers and reliable resources from trusted experts. Because moms don't just deserve support, they deserve solutions.

Allie Hales 00:01:08

One thing I often tell Dr. Ruta is that none of my pregnancies and deliveries went the way I expected. From preterm birth and C-sections to feeding challenges and hip dysplasia harnesses and pelvic floor therapy, I never felt fully prepared. And I've come to realize that the uncertainty doesn't end after birth. It often carries forward into parenting, shaping how we make decisions and how we hold both worry and hope at the same time. Even though half of pregnancies involve some type of complication, whether miscarriage, gestational diabetes, preeclampsia, or something else, we often don't talk about these experiences openly.

We carry the guilt privately while the world around us expects us to just move on or try again. But there isn't a simple reset button. It's complicated, it's emotional, and often it's filled with uncertainty. For me, the hardest parts of pregnancy and parenting have never been just the complication itself. It has been the uncertainty, the constant question of am I making the right decision? Whether it was deciding how to feed my babies, sleep training, or even navigating the after-school chaos of older children, I have always sought out accurate, transparent information that can help me make informed decisions. 

I first discovered Dr. Emily Oster's work right before the COVID pandemic. During a time when there was so much fear and conflicting information, I found myself relying on her data-driven approach again and again. It helped me feel calmer, more grounded, and more confident in the choices I was making for my family.

Dr. Emily Oster is a professor of economics at Brown University, founder and CEO of Parent Data, author of multiple bestselling books including The Unexpected, and co-host of the podcast Wellness Actually. She has transformed the way parents think about risk, data, and decision-making. Today we're focusing on how parents can navigate uncertainty with confidence and make informed decisions that support their mental health. Emily, we are so glad you're here.

Emily Oster 00:03:02

Thank you for having me. I'm delighted to be here.

Allie Hales 00:03:06

So your newest book The Unexpected, so begins with preparation. And just for the listeners who have not read it yet and um who are unfamiliar, what does emotional preparation actually look like when we know that uncertainty is part of the process?

Emily Oster 00:03:21

Yeah, so the unexpected is really about navigating pregnancy after, uh, after complications, um, which there is a wide range, about 50% of pregnancies end in or involve some kind of complication. And so, uh, so this book is really about kind of how do you come into another experience out of that. And I, you know, part of what we wanted to address in the book, and it's co-written with a maternal fetal medicine specialist, part of what we wanted to address was just the preparation for the like details of, you know, what will have happened. The question that all of the data-minded people go to, which is like, what's the chance of this happening again? You know, what can I do to prevent it?

But I really believe there's a very important part of sort of emotionally preparing in advance of any of this and asking, you know, how uh how do I understand what happened before? And so we sort of suggest that people ask some questions, you know, what happened? So trying to understand the details. Why did it happen to me? And I think that's a really important emotional preparation question because people do ask that question. They ask, “Why did this happen to me ?" like, why was I cut-why why'd this terrible thing happen? And Nate, my co-author Nate and I would really like people to reframe that question as asking, you know, why was there something about my risk set or something about, you know, the way the pregnancy went that made me more likely to have this complication? So rather than why am I at fault here or why this like why was I punished, to ask just how can I frame that question to be practically helpful for then moving on to the more practical questions like what can I do to prevent this from happening again? What's the chance of it happening again?

Emily Oster 00:05:05

So, I think the emotional preparation part is really sort of trying to transform what's often an experience of just feeling again, sort of punished or at fault, into like how can I practically prepare myself to move to move forward.

Allie Hales 00:05:20

I think that's great. So my first um birth ended up being it was preterm. and I totally blame, I was like, everything had gone fine until it didn't go fine and I was, you know, wondering like, well, what did I do? Like, did I not, “was I exercising too much?” “Was I like doing this wrong?” like what happened, and I think going into my second pregnancy, I also had that emotional, you know, response of it was my fault and I might cause it to happen again, you know. So I appreciate you having women take a step back and looking at it like, okay, let's look at what actually happened and what we can do and what we can control and what we can't control.

Emily Oster 00:06:01

Yeah. Yeah, and I think that that part of what we control and we can't control is really important because of course there are some complications where it is true that there's something not so much that you did but a sort of characteristic or some modifiable risk factor and we could say, okay, is that something we can change? Which is different from saying it's your fault. It's but it is, you know, here's something modifiable. And then there are many of these cases where the answer we're going to get to is like, there's really nothing that you did, there's nothing we can control. It just is just is a a thing that happened and then you can try and move forward from there.

Dr. Ruta 00:06:33

As a psychiatrist, I just wanted to add something about being able to tolerate uncertainty. Pregnancy and having a child is kind of a huge test in that area. We are learning that being able to tolerate uncertainty is important to resilience and adaptability. From a mental health perspective, being able to tolerate uncertainty is protective. Emily, I first heard your name when my younger brother and sister-in-law got pregnant. They kept talking about Emily Oster and what Emily Oster recommended. My first thought was this: Why aren't you discussing this with your doctor? Given the incredible success of your books, we can firmly conclude that just talking to your doctor might not be enough when you're navigating pregnancy and parenting. Why do you think that's the case?

Emily Oster 00:07:22

Good question. I mean, I think one thing that I would say I always, especially with pregnancy, I should always think of my work as complementary to your doctor rather than a substitute. Um, I think the biggest issue for many people is just the limited time. So people have a lot of questions and rightly, when you are there with your doctor, they are focused on like, let me take these measurements, let me, you know, look like let me sort of think about the medical pieces of this. And the myriad of questions that people have, you know, can I clean the litter box? What's the really the data say about hot dogs? What is this thing about Tylenol? like what, you know, there sort of isn't time to do all of those things and also do the doctoring stuff. Um, so I think that's kind of one issue. 

And then I think the other thing is that that you know, for the most part, um doctors are not trained in the like one of the things I think resonates about my work is kind of like let me really walk you through like why we think some things from data and you know why data shows some things and doesn't show others. Like how do we really think about causality and and evidence? And that's actually just what I think a lot of people like that approach. Maybe that's surprising, but that's true. And that's the kind of approach that lends itself to the type of training that I have relative to medicine. So it's like I am trained in how to read causality out of studies, medical studies, other kinds of studies. That's my job, and I think that that's kind of the the approach that that I think resonates with people.

Allie Hales 00:08:54

A hundred percent it resonates and I like what you said that it's complementary because I mean of course like you know I had some complications with my pregnancies and deliveries like I'm so appreciative of my amazing OB and you know going through that experience safely and everything you know went as well as it could but also like trying to make sense of it all I have turned to your work and it's been so you know appreciated and transformative for me just being able to like make sense of what happened and um I think another thing that I feel like I hear a lot about like my friends ask I've experienced it too is you know feeling like your OB/ GYN your your meetings with the OB/ GYN are quick and then it's hard to get in touch with them. And it can be really frustrating trying to figure out like, well, do I really bug them with this small question? But then I am wondering like, can I take Tylenol or can I, you know, whatever all these things are. And you do a great job with your Ask Me Anything, like I love and you know, with Dewey on Parent Data, like being able to kind of search those like frequently asked questions. But when a woman's feeling like, you know, they need to advocate for themselves and they don't feel like their OB/ GYN is providing, you know, the information that they need to feel confident making a decision, what do you suggest to women to do in that situation?

Emily Oster 00:10:11

Yeah, that's obviously a very tough situation. Um I think there's sort of two pieces. One is the like I don't want to bother them and then a second is like I don't feel like I'm getting the answers that I want. And I think there's a there's a component of preparation for for both of those, you know, you do get pretty limited time with your OB, which means the more one can bring in like, here are the things I'm thinking about, and like, you know, the more one can understand, like, here are the decisions that are going to come up, here are the questions I have about those decisions, the more effective those conversations can be. I feel like a lot of my work is about trying to not give people the answers but give them tools to have those conversations go more efficiently, which is kind of what we need. uh, I think so I think that's one piece of it. 

I think a second piece of it is figuring out at the beginning of the relationship, you know, what is the expectation for how I'm going to get answers when I need them in the moment. And being very clear about what you need and is this doctor a good fit for that? Right. So if you are a person who is going to need to like have your anxiety dialed down, which I understand because I am that person, if you're going to need that a lot, you need to have a provider relationship that is in some way going to accommodate that or you're going to be very upset. And so, you know, like honestly midwives are like it's often easier to get in touch with a midwife. If you're going to have a lot of questions and you have a low, like a relatively low risk pregnancy, that may be a better, that may be a better kind of option. So I think just really being honest with yourself and your provider about what you need in advance is important. 

I think the third really hard conversation is one where like your provider is telling you something you don't think it's right or you don't think it's consistent with something else you've heard. And those conversations are hard because you never want to start them with , " What are you talking about? You're telling me something that's wrong ." Uh, partly because they may not be, and partly because that's a terrible way to come into any conversation with another person.

Emily Oster 00:12:09

So, the phrasing I almost always tell people to try to use is something like, you know, my understanding of the data is, you know, bed rest isn't generally recommended for complications. What's, is there something different about my case that would make you recommend it here? Which is sort of an opening for like, hey, I'm not sure that this is what the data says, but also like acknowledges that there may well be something different about your case that could prompt a different piece of advice. So.

Allie Hales 00:12:38

No, I love that and I love how you described, you know, you give the people the tools to then, you know, advocate for themselves and to make informed choices, which I think is it's just, yeah, it's such a wonderful way to go about it and that, you know, every family situation is different, everyone's personal preference, et cetera, are, you know, unique. Um, I like what you said too about understanding the data because I feel like right now it's a unique time where, you know, we are hearing different things from trusted sources. Like, you know, CDC or you know, our own personal doctors like when you know, there was a time where people might have been more in step with each other, like all the different agencies. There are situations now where, you know, they're at odds. And how do you, you know, if you're not going through the data yourself, like how do you know who to trust or where to go for reliable information?

Emily Oster 00:13:27

Totally. I mean, I think that's a very, there's like seventeen different problems with misinformation right now. You know, I think one is the problem we've had even before the current administration, which is, you know, when you are just trying to scroll on the internet or whatever, things are coming at you that you're not kind of prepared to to evaluate because you're not in a moment of evaluating. I think that always tell people like, if something comes across your feed or your news feed or whatever it is, and it's not something that's decision relevant for you, try not to think about it. Like, you know, you probably don't need to engage with every panic headline because most of them are not relevant for decisions like later. There'll be an opportunity later to engage with that if you are making that decision. So, I think we're just really not very good as people. We're never good at decision making if it comes from a place of like, oh my god, I was just trying to scroll cat videos and all of a sudden like now I think my kids are gonna die 'cause I put them in daycare like— 

Allie Hales 00:14:27

Well, it's funny because I mean, you say it like an over-exaggeration, but like I've I feel like I've gotten there. Like I've been scrolling through.

Emily Oster 00:14:33

That's a real thing. That's a real thing. I'm just trying to read, I'm trying to watch my like professional running people like do it and then all of a sudden there's a thing that's like when you drop your kid at daycare, they think you died. It's like, what?

Allie Hales 00:14:44

I was not ready for that.

Emily Oster 00:14:46

More of the algorithm. And then of course you get stuck because you're watching. you're like, oh man, I'm watching this. and then the algorithm's like, ah, you enjoy reels of X. I don't enjoy it.

Allie Hales 00:14:56

Well, and the other thing I was going to ask you about too is, so you did a like a segment under um ask me anything recently about red light masks, which I hundred percent bought a red light mask. I'm like, look at all the results. They're amazing. Like everything, you know. But I think that's another thing with parenting is, you know, you get in a situation where you're trying to solve a problem. And then you start Googling stuff or whatever, and then your algorithm comes up with, "Oh, well, you want to help your baby sleep, here are like 50 things that you should order to help your baby sleep ." Like, trying to sort through that just feels—

Emily Oster 00:15:27

There is no one more susceptible to marketing than the exhausted new parent. Um, you know, it's just any and we're we're looking for solutions and I think unfortunately there are a lot of cases in which the solution, like maybe there is a solution, but it's just not that's it's not as simple as, you know, purchase this course or purchase this mask or, you know, buy this packet of vitamins or whatever. It's like, here are the things that are hard and here are some ways you can go forward and and I think that's that doesn't lend itself well to the current information environment.

On top of all of this, then you have the kind of CDC now says vaccines are bad. The AAP and the CDC disagree that, you know, there's a lot of particularly much more so around vaccines than almost anything else. There's this really, really like noisy thing for parents, uh, in this moment where they are having a hard time navigating. I would put that almost separate from all of the other things, like that is a real problem. And I don't really know what to do about it. I actually think what we need to do about it is probably quite different than what we need to do about, you know, how do we get people to interact better with the noise online.

Allie Hales 00:16:32

Um, one thing that you've talked about a lot is, you know, you have two choices, like you have an option A and an option B. And there are good things and bad things about both options. And you don't obviously have a, you know, crystal ball and can tell where you're going with either one. And you kind of get, at least for me, like I've gotten paralyzed by wishing for this option C that you've described before. Like, even the other day I was having a difficult situation with my daughter and we were trying to decide between A and B, and I was wishing for that option C, and it was really hard to make a decision between A and B, not feeling like either one was perfect. And, you know, with so many things in parenting, you're making so many decisions. How do you, you know, how do you tell parents to pick, you have to pick A or B, there is no C. like what's that thought process like and yeah, tell us a little about that.

Emily Oster 00:17:24

Yeah, I mean I think the first thing with good decision making is kind of acknowledging the constraints on the choices that we have and recognizing that if you don't make a choice, the world makes one for you. Um and so in in a sense like that's a that's not going to it's not going to make things better to wait. But you're right, it's so challenging to choose something that's that we know has a downside. Right? Like once you sit down, you think about your choices, you're like, I could do this, I could do this, and you know bad things about both of them, it's so hard to to just be like, okay, we're going to choose this, even though we know that it's going to, you know, make our weekends worse in the following way or may or my kids not going to like it or whatever, you know, whatever it is. Like that choice is just really hard to make. I think it's crucial for people to almost like you almost have to force a choice.

So I would tell people in terms of good decision making, you pick the choices, you get the information, and then you need to say like, this is the time we're going to make the decision. Like, I don't know what the, you know, we're going to sit down, we're going to have a meeting. At the end of the meeting, we're going to have a decision coming out of the meeting and then we're going to implement the decision. Like there's a sort of forced choice there. And it is facilitated by recognizing that there's there's no secret option C, and that if you wait and wait and wait, some decision will be made. Will be made for you, you know. I think the hardest, the hardest of these choices for people, I think is is when when I mean there's many hard choices.

One very hard choice people it comes up for people all the time is like, I want to have another kid and my partner doesn't. And it's sort of people are like, how do we solve this? It's like, listen. Like, there's no half a baby. Like, you're either going to have another one or you're not. And if you wait and wait and wait, you're not. Right? That's like waiting and not deciding is choosing is choosing for you. And you really need to force that by recognizing that at the other side of that, someone's not going to have gotten the thing they want. And good decision making is about figuring out, you know, how are we going to sort of make it as right as possible, recognizing that like there's just no, there's just no way to have both of those things at the same time.

Allie Hales 00:19:34

So another question we had was, you know, you've spent your career looking at the data and the numbers and, you know, all these different studies and um there is this gap between how common pregnancy complications are or issues that happen and how isolated women feel when it happens to them. And it's just interesting given, you know, 50% of pregnancies have some kind of complication and yet at least for me, a lot of times it felt like, well, I don't even know anyone else that's experiencing what I've experienced. Like what hap, you know, just what where you feel like that disconnect is or like why why that's there.

Emily Oster 00:20:11

Yeah, I mean, I think there's a there's a few pieces of this. One is almost like the sort of shame aspect and in a lot of case there's a sort of secrecy and then there's a shit like this thing happened but I don't really want to talk about it, you know, people other people maybe don't want to hear, don't hear about it. And so you feel like, okay, I'm not, you know, I'm not interested in kind of sharing this with with people because maybe they'll be uncomfortable in some way. And I, you know, I think there's all of those reasons keep this kind of quiet. The cost of that is a feeling of of loneliness and and confusion and it happens in pregnancy as but it also happens in some of the sort of things that happen after. 

I was thinking about this yesterday because somebody asked somebody, so I do these Wednesday Q& As on Instagram. And somebody said, you know, whenever I start breastfeeding, I feel like intense self-hatred and disgust. What like how do I like what's going on? What's wrong with me? The thing is, there is a thing called dysmorphic milk ejection reflex (DNER), which is surprisingly common.

Allie Hales 00:21:16

I've never heard of that, but that's making sense. 

Emily Oster 00:21:19

In the messages that I like, and so there's a thing. So I said, “Hey, like, this is the thing you have." There is like for some women during letdown, they have like a surge of hormones and it prompts like a lot of feelings, some of which are very negative, intense depression, intense like it just it's a very like can be a very overwhelming feeling. This person has never heard of that, but I promise that when she, you know, Google's support group DNER, she is going to find all of the other people who are in my DMs who are like, "I had that, I had that, I had that, I ..." And that's an example where like somebody is feeling really terrible every time they start breastfeeding, which when you have a baby is not instant gratification. And not getting healthy eating. So I think that's that kind of thing is is so much the cost of of not being public about it, not making it clear to people, you know, what's going on behind the scenes.

Allie Hales 00:22:10

Yeah, totally. Um, another question we had was, you know, when do you feel like data reaches its limit? Like we've, you know, gotten the data and we still aren't sure. like, at what point are we Oh, jeez.

Emily Oster 00:22:25

Yeah, almost all the time. I mean, I think so one of the things I will often tell people is, you know, the data is not boxy. So when you make a decision, it is very rare that the data is going to be so clear in one direction or the other that it's going to say like, this is definitely the decision you must make. There's a couple of examples in parenting where it's like, boy, it's really overwhelming that this is the right choice, but like they're few and far between. Uh, most of the time, the data is one input along with your preferences or other constraints into a good decision. So thinking about data as kind of like there's data and there's preferences and you need to combine them to make the right choice for you is going to be much more productive than thinking as sometimes people do about sort of data and your gut feeling. And people will put those against each other like, well, should I go with the data or should I go with my guts? Like, well, the answer is you should go with both. Because when you say gut feeling, what you mean is preference. You mean like, I feel this thing is really right for me. That's great. You should listen to that and also you should look at the data because those things need to work together, not as two different ways to make decisions. There's only one good way to make decisions, but you need both pieces of it.

Dr. Ruta 00:23:41

Also, something I tell my patients when they're going through difficult decision-making processes, I tell them to ask their healthcare provider to say, if this was your partner or if this was your daughter or if this is your mother, what would you do? Because I do think there is the data and I think there's another layer of clinical experience that sometimes doesn't align with the data. Um, and and I think getting a physician or another healthcare provider to sort of take a stand uh can be difficult, um but sometimes it can be a very helpful piece of information.

Allie Hales 00:24:22

I think too, like what you're saying about, you know, your gut feeling versus the data and how you reconcile both of those things. Like, I'm sure, you know, there's situations where you're kind of overriding your instinct a little bit more because you see the data. And then there's also times when you're like seeing the data, but then you're giving more weight to your instinct. So I think that is like, at least for me with like formula feeding. Like data, like my mental health, everything told me, you know, you need to make this switch, it's going to be the best thing for you, but then emotionally I was so torn up about it. And I ended up, you know, overriding that emotional sense, you know, knowing that what my choice was was safe and everything would be fine. But I think what you're saying with that like kind of give and take, it's complicated, but you're right. Like you have to have both.

Emily Oster 00:25:12

Yeah, and I think you have to sometimes in our decisions it sort of goes back to like when both options are not great. Like sometimes our decisions require us to sit in the end with like, I wish this had been different. Right sort of like for you to say like I wish breastfeeding had been super easy and fun. Like that's what I was hoping for coming into this was like breastfeeding super easy and fun and I love it. it makes me go But well, you didn't get that. And you could and there's grief. You could just say like, I'm grieving the loss of not the loss of breastfeeding, but the loss of like the way that I imagined that it was. And that's a totally valid, reasonable way to feel while also making whatever is the right decision, you know, given the constraints that you have been handed, which for many of us is like breastfeeding is not that fun and really hard and doesn't really work all the time. No, it can be great. Again, it can be great. it's not always great.

Allie Hales 00:26:07

No, that's right. Yeah, that's helpful.

Dr. Ruta 00:26:09

Your comment also gets to something that I often see is that there are things we call complications. I see these uh patients who have had quote “uncomplicated pregnancies,” um but so many things have gone wrong or not the way they expected. And they feel like, well, I shouldn't, I shouldn't be upset.

Emily Oster 00:26:34

No, and people will say, you know, well, I had like, you know, fourth-degree vaginal tearing, but you know, and people are like, well, baby was fine. It's like, but actually, that's like a very trauma-like a very traumatic event that takes a long time to recover from and we shouldn't, you know, we shouldn't minim-minimize them. And I think I totally agree with you, Ruta, the like labeling of things as like, well, this is a bad thing and this is like kind of what you should just be getting over it, does not acknowledge differences across people among other problems.

Allie Hales 00:27:08

It's so powerful to hear that so much of the guilt we carry as parents isn't backed by evidence, it's backed by uncertainty. The truth is, uncertainty doesn't go away after pregnancy. It continues through parenting, from feeding and sleep to school decisions and beyond. So now we're going to shift our conversation from the big picture of risk and preparation to the day-to-day reality of navigating uncertainty in real time.

We're diving into our listener inbox to talk about how to move forward when there are no perfect answers. So we have a written question. Uh, how can I manage the paralyzing anxiety of a future pregnancy after experiencing a miscarriage and birth trauma? Every scan feels like a death sentence until proven otherwise.

Emily Oster 00:27:50

Yeah. I mean, I think first of all, I think just acknowledging that it's extremely common and there isn't going to be a like, here's how you fix this problem. I think the two things there are one, talking to your provider about, you know, is there a cadence of scanning or some other thing that could actually alleviate the anxiety? You know, I think providers are understandably reluctant to do more of that, but also your anxiety is actually something that needs to be treated. So again, going back to like, find somebody who's going to work with you on this, that's a big piece of this.

And I think the second is just, I think Nate talks about radical acceptance.some in in our book just accepting like this is going to be hard and you are going to live with both the grief and the joy at the same time and there is no getting around accepting that bad things happened and then trying to move forward anyway.

Allie Hales 00:28:47

So here's another question. What is one practical tool parents can use when the what ifs about the future start to spiral?

Emily Oster 00:28:55

One practical tool when you are starting to spiral, uh, is to ask yourself, do I need to worry about this right now? Um, and usually the answer is no. There's a tool in general in anxiety that I use a lot with my kids, uh, which is to say like if you're really struggling with a lot of this, to kind of like compartmentalize it in another time, say like, here's a time in the day I'm going to worry about this, or here's a time in the week we're going to worry about this. You know, we have a lot of concerns about our kids, great. Let's keep an agenda and let's put a meeting on where we can have a time where we talk about all of our concerns, and then, you know, when I have when something comes up, put it on the list. And so then you sort of give yourself, give your brain the feeling of like, okay, I've done something about this without giving your brain the kind of, now I'm going to just like go down a rabbit hole of obsession. So a lot of this is about this kind of CBT of like, just moving the worry to another, to another time.

Dr. Ruta 00:29:54

And that's something we use uh a lot with um like patients who have generalized anxiety or OCD and who are waking up in the middle of the night with these questions. We tell them, and it doesn't always work. Write it down, we'll take a look at it in the morning. Um because they do keep people up at night.

Emily Oster 00:30:13

Middle of the night is a terrible time.

Dr. Ruta 00:30:16

It is.

Allie Hales 00:30:36

So. Um, there's okay, another question. There's so much advice about pregnancy online. How can I tell if the information is accurate, evidence-based, and worth trusting?

Emily Oster 00:30:50

I would choose your sources in advance. Um, it's rare that there's a random source that comes across your online experience that is something that you necessarily want to listen to. So I think a lot of this is about saying, here are the sources I'm going to listen to, and you know, I'm going to try not to just listen to stuff that comes across my feed just because it's scary. Um, I think it's also really always worth asking what's the person selling. A lot of this stuff is like what they're selling is fear, then the other side of that is a supplement. Or they're selling is fear and the other side of that is a course or is it this or that.

Emily Oster 00:31:28

And so I think, you know, incentives, incentives matter.

Dr. Ruta 00:31:32

From a data perspective, how do we help moms navigate the pressure of the ticking clock, um or the fear of advanced maternal age when they're still trying to get over and emotionally heal from a previous loss or unexpected event?

Emily Oster 00:31:51

That is very hard. Um, I think that, you know, there's a kind of honesty combined with understanding that is challenging, I suspect, is very challenging to navigate. Because on the one hand, I don't think it's appropriate to tell people like, well, don't worry about it, you know, age doesn't matter because age does matter. It's probably one of our most important things. But at the same time, if you're not, you know, if you're not emotionally ready for this, you're not emotionally ready and it like that's that is what that is what it is.

You know, I often wonder whether there's an opportunity in that intermediate space to do as much as we can to sort of set people up for success when they are ready to try. So, particularly for older people saying, hey, like, what about doing some cycle tracking, what about doing some sperm testing? Like, how can we sort of get into a place where when you do start to try, you're as prepared as possible for it to move as quickly as as it can. Uh, which may be a little bit of an intermediate, like it's productive but it doesn't um it doesn't force something before someone is is ready for it.

Dr. Ruta 00:33:02

I think that's a really good, um, suggestion and, um, often I see, uh, patients who are trying to get pregnant and nothing's happening and they don't actually know how long it takes to get all of these appointments set up and to do all these testing. So giving them something to do while they're getting ready that feels purposeful and concrete, I think is actually really helpful.

Emily Oster 00:33:27

People would like something to do and I think that's that is, uh, when we can give them something that feels like it's moving forward, that that really can be emotionally beneficial.

Dr. Ruta 00:33:37

Economists are really good at presenting data and understanding where it comes from and I love a lot of the discussions you've had with uh Bapu Jena about understanding data and how can doctors get better at presenting data?

Emily Oster 00:33:52

But yeah, that's a good question. I mean, I would like to see more uh more data training in med school. So it's something I think is missing from a lot of the med school curricula is just a deeper understanding of, you know, what makes quality evidence and in particular, you know, we know most doctors are familiar with like there's a large randomized trial of, you know, labor induction. Like, okay, we get that. Like people can read that. That's great. I think that kind of like here's a more nuanced take, maybe it's causal, maybe it's not. that's much harder, that's not really part of the training, and I think there should be more there should be more of that in uh in med school.

There's a second thing which is like how do I communicate data to people? I actually think that's very hard to teach. Um and it's something that one learns mostly with practice and sort of thinking about what are the pieces of what are the kinds of messaging that can resonate with people and help them make decisions uh well, you know, how do I explain small probabilities? This is like a thing I think about all the time and I'm not sure there's like a simple piece of piece of advice. Partly because different people, I spend like a lot of time explaining the same thing fifteen different ways, hoping that one of them will hit for for any given person.

Dr. Ruta 00:35:07

I think that's true. We get no instruction in medical school about, um, you know, really how to navigate this large bolus of data that we're getting. And I also think like with pregnancy and postpartum, there are so few randomized controlled trials. You can't make pregnant women do something and test the option of not doing something. So, a lot of the information we get are these naturalistic studies and we have to think about, you know, breastfeeding's an important one. The women who uh can breastfeed are often ones with more family support and and um more time and we just can't compare that and outcomes to women who don't have those things. Um but you can't force people to breastfeed.

Emily Oster 00:35:58

Right. Yes. But I think that's a good example where actually there is some better data and I think, you know, learning like here is like some better, you know, within this space, here's a kind of better approach to this, and then having people focus on it would be beneficial.

Allie Hales 00:36:13

And I know we're up against time, but one of the things I appreciate about your book as like a sleep-deprived parent or as like a busy parent now with young kids, like I love that you include a bottom line at the end of every chapter. So if I've like just, you know, it's been a minute since I've I just look at the bottom line, I'm like, okay, perfect. So, as we're wrapping up here, I just was wondering if we could get your bottom line on um your advice to parents as they navigate the unexpected.

Emily Oster 00:36:40

Okay, my bottom line is recognize you will have to live with some uncertainty and there is no getting around that, structure your decisions so they force you to make choices that are hard, and remember that this is hard and give yourself a break.

Allie Hales 00:37:06

Love it.

Dr. Ruta 00:37:07

Very wise.

Allie Hales 00:37:09

Always.

Emily Oster 00:37:11

Thank you guys. This was a treat.

Allie Hales 00:37:13

This was amazing for us. you're just the greatest. Again, all that you've done for me, like over the years, you know, I just appreciate it. It's really made parenting much more manageable for me and making my decisions. So, really appreciative of all the work you do. Thank you.

Emily Oster 00:37:28

Thank you both.

Allie Hales 00:37:29

Thank you, Emily.

Dr. Ruta 00:37:30

If you're listening and feeling overwhelmed by uncertainty right now, please know this: you're not alone. Whether you are navigating a complication, grieving a loss, or facing a difficult decision, your emotions are valid. As Emily shared today, the data can guide us, but it doesn't remove the human experience. What it can do is help us to make informed, thoughtful decisions that align with our values and support our mental health. You are not expected to have all the answers. You are allowed to move forward one step at a time. And the fact that you are asking these questions and weighing your options means that you are already a thoughtful and deeply caring parent.

Thanks for tuning in. As a reminder, please note that this podcast is not intended to be a substitute for professional medical care. The views, thoughts, and opinions shared today are the speaker's own. Your feedback and questions drive this show, so feel free to send us an email at podcast@womensmentalhealth.org or leave a voicemail at 617-643-9232.

Allie Hales 00:38:48

You can find additional resources at our resource hub at sogladyouasked.org. This show is executive produced by Dr. Lee Cohen, produced by Mike Brown and Peri Barest, and edited by Mike Brown. This is So Glad You Asked with Dr. Ruta Nonacs and Allie Hales, brought to you by the MGH Center for Women's Mental Health and the J. Willard and Alice S. Marriott Foundation Listen and subscribe wherever you get your podcasts.