Wednesday, June 12, 2013

medical 'progress' in pregnancy and childbirth

Now I am almost at the end of my pregnancy and I've learned a lot about the state of modern pregnancy and child birth. I feel now the responsibility to put here what I've learned.

Although I had an inkling of this tendency before, now I know for sure that our society leans toward science, technology, and what it calls "progress." We often assume this is good. Take the polio vaccination, for example. It basically wiped out what was once a disease which hurt many, many people. We often think of medical progress in terms of the polio vaccine. However medical progress often (especially in the United States) comes in the form of unnecessary interventions. There seems to be an attitude in the US that goes something like "well, let's just do it just in case," or "it won't hurt to do more, so let's do more."

But it does, in fact, hurt to do more. I've seen this first hand throughout my pregnancy. Pregnancy and childbirth are a great place to see the effects of this kinds of medical progressive thinking because this is a unique kind of medical need. Ideally, and in most cases, women's bodies are capable of handling all of pregnancy and childbirth without intervention. Yet, we go to doctors "just in case." We go to make sure that we're healthy and handling the pregnancy well, and we have them attend births in case something goes wrong. Yet, if nothing goes wrong, you really don't need the doctor at all, for anything.

Even though we don't really need the doctor, as I haven't, they seem to want to make themselves useful. So, they spend a lot of time telling you about the very, very minute risks you may be facing. Some of those risks include: gestational diabetes, a too-big baby, group B strep, placenta previa, a breech baby, toxoplasmosis, blindness from maternal gonorrhea or syphilis, a baby without the ability to clot blood, the list goes on. The likelihood of being affected by any ONE of these things is very, very low. For example, about .01% of babies get toxoplasmosis - a disease contracted from eating undercooked meat (like deli meat). So doctors tell you to COMPLETELY avoid all deli meats, any raw meats or cheeses (including soft cheeses like brie), hot dogs, or any meat that's been sitting out for more than a few hours. Yet, there is a lot of evidence that says it's very important for all people to eat varied diets with lots of different kinds of bacteria in it. We may be over-sanitizing our gastrointestinal systems.

Take another example. Every single baby is given a gel antibiotic ointment on their eyes at birth. They give this to babies in case their mothers have gonorrhea or syphilis. I don't mind saying here that my doctor tested me as part of a routine battery of tests at the beginning of my pregnancy and I don't have these diseases. So, there's really no reason to rub my baby's eyes with a gel which makes it difficult for them to see and may slightly traumatize them. But it's so routine to do this to ALL babies, that in some states the hospital can report you to child services for refusing to put the ointment on your baby's eyes. I put my preference for no gel on my birth plan, but I still don't know if I'll meet resistance for this preference at the hospital or if the nurses will follow my wishes. It is just so assumed that all babies should get this gel, "just in case," that it is almost assumed to be child abuse NOT to opt into this unnecessary intervention. Really, there isn't a huge downside, the baby will just be a little disoriented by it. But, there hasn't been large studies on the effect of the widespread use of this eye ointment, so for me it is riskier to use it than not to use it. I know I don't have these diseases and therefore don't need the ointment. What I don't know is the long-term effects of this ointment.

Another intervention I have been running up against is this idea of a "big baby," medically called macrosomia. Pregnant bellies are supposed to measure, on average, how many centimeters as you are weeks along, plus or minus 2 centimeters. During most of my third trimester, I've been measuring about 3 centimeters larger than the week I am in. Keep in mind that it is normal to be within 2 centimeters of your week. For example, if you are 33 weeks along, your belly should measure between 31 and 35 centimeters. At 33 weeks, I was measuring 36 centimeters. Really only 1 centimeter above the "normal" range. It is also important to note that Patrick and I were both above the 95th percentile for our gender when born. So, genetics tell you that it's likely that this baby will be on the large side of the normal range. Very far on the large size. Yet, at a few of my doctor's visits, the doctor expressed mild concern about the size of the baby. Enough so that she ordered another ultrasound to see how big the baby is. But in most cases, you bear a baby that your body can handle! Your body is a very capable machine! When I went home and looked up online what doctors do about big babies, they often suggest to women that they need a c-section because their bodies can't handle the size of the baby. Even though ultrasounds have been shown to be as much as 4 pounds off in guessing the baby's weight! I have not faced this from my doctor, but what an absurd way to approach childbirth! There is so much to be gained from a vaginal birth in terms of the baby's health outcomes, but so much medical progress thinking leads to a third of babies being born by c-section.

I haven't even gotten into the interventions associated with child birth. It is considered progress to numb yourself from the waist down, getting a catheter shoved into you, being hooked up to an IV, told not to eat or drink for as much as 24 hours, and pushing the baby out by being told by a computer screen that it's time to push. Why is this progress? I can't even count the number of times I've heard "oh, just take the drugs and sit back." These drugs are not without risk! Babies born to mothers who've had an epidural are more drowsy and full of the drug. They often have a hard time taking to breast feeding. What else might be the risk to these babies, we don't know! Why do we avoid all drugs like saints for nine months just to shoot up like addicts at the last moment? Why are we told there is no risk to the baby? Epidurals do effect the baby, and often can lead to more intervention. What if the baby's heart rate goes down due to being drugged up, the medical staff freaks out and orders a c-section? Or they give you pitocin to move your labor along more quickly and it effects the baby's health and again they send you to the operating table? That's what's happening. There's no other way to explain this insanely high c-section rate.

The final example I have to discuss is the very widespread belief that women should not eat or drink anything for the entirety of their labor, just in case they need to get general anesthesia. It is important to keep in mind that this is VERY RARELY used in childbirth, due to the need to have the mother awake during the process. More often, as with c-sections, a local anesthesia is used. So, ALL mothers are told to not eat or drink anything for sometimes as long as 24 hours just in case of this very, very rare situation. What might you feel like doing the equivalent to running a marathon and not eating or drinking for the entirety of this physical feat?   Why might mothers be challenged by this unnecessary rule? Again, the "just in case" thinking of medical progress just doesn't line up with the needs of MOST mothers.

I try to remember that my body is built to do this. It'll be nice to be in a hospital just in case something *naturally* goes wrong. But I don't want the hospital itself to be the source of something going wrong, due to unnecessary intervention. I will try to be vigilant, have Patrick aware of my concerns and be my advocate and the advocate of our baby. It is sad that this irrational and unnecessary thinking pervades our medical system. It is frustrating going into childbirth and having to be a warrior against intervention. What kind of message does this send? It tells the woman "you can't do this" or "you are incapable without our medical help." When in fact she is much more capable than any doctor at growing and delivering the healthiest, most robust baby. I am happy that I know this, but so many women unfortunately do not have access to the kinds of information that I do as a sociologist and a college-educated person. It is the responsibility of society to change this kind of thinking for better outcomes for our babies and pregnant mothers. 

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