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April, 2001
1) Community News Check out our sponsor! Go to There are some really great articles featured at the Pregnancy Community
right now! Check them out if you haven't already. If you missed the really great article on Questions and Comments said to
Homebirthers by Kim Wildner, you can read it online: Coming soon: What is Evidence Based Care?
NEW!! Directory for childbirth educators, doulas and lactation consultants.
If you need to find a class or doula near you, go to the new directory. New
names are being added all the time, so check back often. If you know someone
who should be listed, tell them about the Mother's Nature directory. Listing
is FREE! Have a question, comment, story or article you would like to share with the
Pregnancy Community? Email me! Quote of the month: 2) ~Chat with Birth Guru, Henci Goer Tuesday at 12 pm EDT
Pregnant or planning to be? Henci is a childbirth educator and labor
doula, however, her specialty is the medical literature. Henci can help
you make informed decisions; avoid unnecessary procedures, drugs,
tests, and restrictions; and evaluate whether you are receiving care
that is in line with the obstetric research. This chat is held the 2nd
and 4th Tuesday of each month. Henci Goer is the author of The Thinking Woman's Guide to a Better Birth.
This is a must-have book!
Check it out here: This information is intended to encourage parents to further investigate
non-medically indicated testing before making a decision for their particular
situation. The intent is neither to encourage nor discourage the use or
non-use of a particular intervention. All technology has a proper place
where it can make the difference between life and death. Unfortunately, the
misuse of technology also holds that same power, yet pregnancy/birth
technology invented specifically for sick women is often indiscriminately
applied to healthy women with just such consequences. I've seen the
after-effects of this far too often. This page is for the women who have
cried "I wish I would have known! Why didn't anyone tell me?! So, what tests are useful and which are harmful? There is no blanket
response to this. Not only does each intervention have a legitimate purpose,
but my above position must be clarified at the outset...Parents do have the
right to question routine technology and require proof applicability to their
own pregnancy, but with this right comes a huge responsibility. Parents who
refuse a test or procedure without justification, or who refuse testing in
medically indicated situations, are doing themselves a disservice, as well as
disrespecting their caregiver.
One problem here is that many women are being labeled "high risk" less
judiciously than the tests are being ordered. "High risk" these days can mean
too young, too old, too many babies, too few babies, previously infertile
(Even when it has been the husband's infertility or no certain known cause as
in my own case...go figure!), previously too fertile (meaning a history of
twins or other multiples), previous cesarean (even with a non-repeating
circumstance and plenty of scientific proof that a past cesarean is not a
risk factor), too long of a labor, too short of a labor, breech...the list
goes on and on. Included in this list are preventable complications that were
actually caused, either indirectly or directly, by the tests or treatments
resulting from the tests. I can't even list them all, but some will be
touched on as we take a brief look at each test. Some have gone so far as to
call pregnancy itself a dangerous condition! There is so much data to refute
this (covered on my other pages and links from my pages) that I won't even
try to change that belief here. Suffice it to say that it is a belief...an
opinion...that cannot be substantiated. Yet many women's pregnancies and
births are managed under this delusion.
I also want to point out before I get into specifics, that if you are
pregnant and reading for the first time that a procedure you have consented
to may carry risks, don't beat yourself up! We do the best with what we
have, and when we know better, we do better. Guilt would only be useful if
you could or should make different choices in the future. Much of what I
teach and write comes from personal experience and this is no different. It
took me 5 years of heartache and concentrated effort to conceive my daughter.
I was anxious. I had miscarried my first pregnancy the year before. I was
also in the midst of midwifery training, which meant I was learning about
plenty of things that could go wrong. Even though I knew in my head that the
odds were overwhelmingly in favor of a healthy baby and wonderful birth, a
part of me still wanted proof that there was still a baby in there. I used a
hand-held Doppler for 15 minutes at a time once or twice a week from the time
I thought I might be able to hear something, right up until labor. Yes, I
knew it was ultrasound and yes, I knew there were some concerns. But what I
didn't know is that the hand Doppler u/s is continuous, whereas the
ultrasound used in pictures is intermittent.
Because I learned this after the fact, there was nothing to be done about it.
I feel no guilt because I didn't know better. Now that I do, should I ever
be blessed enough to get pregnant again, I will ask that a fetoscope be used
unless there is a specific reason to use the Doppler. My daughter does not
have any problems because of my carelessness...that I know of. But the
deleterious effects noted with u/s exposure are at a cellular level. I won't
know if her eggs were damaged for many years. Still, I didn't know. Now I
do.
Does that mean that this tool is never useful? NO. I own a Doppler and have
used it with clients. With their permission or at their request. I have
used it when a fetoscope was not adequate to hear heart tones as clearly as I
felt I needed to hear them. I would permit use in my own labor if I were in
a comfortable position, say in a tub, where a fetoscope was not feasible.
I'm not sure I'm convinced that u/s is a big huge danger to our children, but
as I parent I want to know that there is a concern so that I can make an
educated decision. I choose to err on the side of caution. When there is
substantiated proof that this is an absolutely safe tool to use in the
absence of medical necessity, great. Until then I feel it is my duty as an
educator to let mothers know what I learned too late.
Finally, I expect the reader to delve into their own subjects of interest
further. There are whole books written on prenatal testing (see the
suggested reading at the end of this article). I can only raise some tough
questions here...the rest is up to you.
Ultrasound (U/S) But this is where common sense must prevail. Just because it's 'cool'
doesn't make it right for every woman. What are some common medical
indications where the use of ultrasound is justified? Bleeding in the third
trimester (Some contend that u/s in the 1st trimester contributes to
miscarriage. [1, 2] If u/s is being used because a miscarriage is threatening
I have to wonder why they are ordered...an u/s cannot prevent, but may
contribute to, the miscarriage, so why are they done so often for this
reason?), breech, twins, polyhydramnios (too much fluid) and ogliohydramnios
(too little fluid). Some conditions with questionable advisability are in the
"we're just checking to make sure everything is okay" category. The "just in
case" philosophy assumes that there is a higher probability that something is
wrong than that something is right, which isn't the case. Not to mention the
fact that very often the parents are stressed out for months over 'possible'
problems that simply don't exist and never did. A case that illustrates
this...
One friend was told very early in her pregnancy that her placenta was
covering the cervix. (if you are pregnant and don't know these terms, please
take a good childbirth class!) She was told she needed to have a cesarean
and plans were made accordingly. Now, the problem with that is
this...imagine (or actually do this) if you were to take a balloon and with a
marker and color a circle near the bottom where you blow it up. Not directly
on the neck, but where it starts to get the wider, rounder shape. Now, blow
it up. What happens to the circle? It doesn't actually move, and yet it
does seem to. It 'migrates' up. So do placentas. Placentas also tend to
gravitate to areas of better blood flow. So, when my friend actually was ready to deliver, her placenta was right
where it was supposed to be. Fortunately, she gave birth really quickly and
there was no time for surgery, otherwise she would have had abdominal surgery
with a five times higher mortality rate (than vaginal birth) for no reason at
all!
Although there are suspected risks to ultrasound, it is used with abandon.
There is no hard evidence that the rise in ADHD, neurological disorders like
autism or even cellular changes that could reslut in things like leukemia are
a result of ultrasound, but neither is there solid proof that they aren't.
If I were bleeding near term or suspected a multiple birth you can be sure
I'd look at the risk benefit ratio and agree to use this technology that
could save my baby's life or necessitate a change in birth plans. Would I do
it just to get an early baby picture or to detect a possible problem that I
would refuse to abort for? Not a chance. But that's just me.
An even bigger problem with ultrasound is that if something looks
'suspicious', which happens more often than not, this leads to others tests.
There is a domino effect here, as many prenatal tests have high
false-positive rates (meaning there isn't anything wrong, but the test says
there is) or are just plain not accurate in either direction (meaning they
may not detect the problem they are testing for a large portion of the time
either). http://www.mothering.com/ultrasounddefinition102.htm http://www.mothering.com/ultrasoundrisks102.htm 1. A. Saari-Kemppainen, O. Karjalainen, P. Ylostalo et al., "Ultrasound
Screening and Perinatal Mortality: Controlled Trial of Systematic One-stage
Screening in Pregnancy," The Lancet 336, no. 8712 (1990): 387-391. Gestational Diabetes Testing First of all, pregnant women should never go more than 2 hours without food
because of the delicate blood sugar balance of pregnancy (low blood sugar is
one of the reasons for pregnancy nausea). A short explanation of the
physiology of a pregnant woman...
Protein may be the building blocks of creating a baby, but glucose (sugar)
makes a baby grow. It is a recent phenomenon that processed sugar has been
introduced into our bodies beginning just after birth (it is a main
ingredient in infant formula). Our bodies already don't respond well to the
huge amounts of the stuff we pour into our bodies daily in the form of soda,
cakes, candy and simple starches. There has been a huge increase in
childhood diabetes and adult onset diabetes (One source says a 500% increase
in the last 30 or 40 years...hmmm...just when breastfeeding fell out of
favor...interesting!). Our poor pancreas'!
Anyway, in pregnancy our bodies produce less insulin so that more sugar is
available to grow that baby bigger, under the assumption that sugar is a
rarity in your diet. But it isn't. It's consumed in large amounts in the
Standard American Diet. So, let's ask the obvious...if a pregnant woman is
starved for hours and then given pure sugar to drink, will it show up in her
blood test? Hell, yes! Does that make her diabetic? Hell no! But she will
be treated so. She will be put on a restricted diet that can lead to
pre-eclampsia. I've seen it happen so often I can predict it before a women
finishes her pregnancy/birth story.
Again, that doesn't negate it's usefulness completely. If a women has a
family history of diabetes or if she shows sugar in her urine dip stick test
regularly (or even in a finger poke) and it isn't resolved with diet, there
are ways to make the test more accurate and do it without starving her.
Symptoms associated with diabetes would also put up a red flag for a
caregiver. In these instances, having the test could help a mother modify
her diet to avoid complications.
And here a word about diet. The diet I've seen recommended to pregnant women
with high glucose readings makes them sick. It is low/no sugar, but it also
is low calorie, many times low protein and low salt. Pregnant women need
these things. Again, we come back to common sense. It's pretty simple. If
you are pregnant, don't eat sugar. Eat whole grain bread, not white. Eat
fruit, don't drink it as juice. Stay away from pure sugar like cakes, candy
and pop all together. Eat brown rice, not instant rice. Eat as though you
are growing a body that your baby will use for a lifetime...because you are!
www.diabetes.org/diabetescare/supplement198/s60.htm
The American Diabetes Association's new recommendations that low risk
pregnant women not be screened for GD.
www.virtualbirth.com/archives/gdhgoer.html Chorionic Villi Sampling, Alpha-Fetoprotein/triple test and Amniocentesis
As the cells are dividing to become what will be the baby and what will be
the placenta, little root like structures, the chorionic villi, form.
Thousands of babies were born without appendages because the cells that would
have developed into fingers were removed to test for chromosome abnormalities
early enough to abort. The irony is, in many of those instances, the mother
wouldn't have aborted even if her baby had defects, but the test caused the
certainty of one.
Fortunately, this one has fallen out of favor. In it's place are the other
above mentioned. The reason I even included it is because women assume that
if a test is recommended, it must be safe. Think again. CVS was used for a
couple of years before anyone put two and two together. Many women of my
mother's generation were given x-rays in pregnancy and labor and told it was
completely safe. Twenty years down the road it's discovered that radiation
can cause reproductive damage...not only to the mother, but to her female
fetus...born with all the eggs she will ever produce. DES and Thalidomide
are other examples. [Note: all of my lab books and medical texts are at my
office, which is not where I am composing this web page. I'm writing from
memory, but will cite references and check spelling once I get my books.]
Many mothers ask "What's the harm in having the triple test? It's just a
little bit of blood." Agreed. But consider this true life example...
Another acquaintance of mine figured just that; no big deal. She had it
done, even though she was not in a high risk group and would never consider
abortion. Her doctor told her that her baby had Down Syndrome and wanted her
to have an amnio. She did refuse that after learning there was a higher risk
of losing her baby from the amnio than there was that it would show a
problem. But, she was now a 'high risk' mother. She was pressured to have
more tests, more ultrasounds and genetic counseling. She was referred to an
OB specializing in high risk and told she could expect a cesarean. I still
don't understand the logic in that...put mother and baby at greater risk of
death even though surgery could not prevent nor cure the suspected problem.
This mother went through months of stress, which is known to have a
detrimental effect on pregnancy for nothing at all. Her baby was fine.
I could give innumerable examples, but I won't. For one, I think that people
already take case examples of inept physicians and let that color their
attitudes about all doctors. That's not fair. Sure, some doctors may order
unnecessary testing, but not all of them do. And, while the doctor may order
it, without the parent's consent, the test cannot proceed. And I guess this
is as good of a place to put this next statement as any. Doctors order all
this testing because they are the most sued people on the planet and they are
covering their butts with all these tests. Are they sued most because they
are inept? Some. Most, though, are sued because we, the public, expect them
to be infallible. There not. They are people. A mother cannot smoke a pack
a day and then sue the doctor because her baby dies due to an abrupted
placenta. But they do. And they expect the doctor to pull a miracle off
even though it was a predicable outcome due to the mother's own actions (Not
to mention plain common sense.)
It's up to the parents to determine if their doctor is using the tests as
medically indicated or inappropriately. A solidly respectful and
non-authoritarian relationship with excellent communication is the only way
to know. Again, it's up to the parents to develop that trust. And remember
this quote from Maya Angelou: "When people show you who they are...believe
them."
Ultimately, this means when you get a red flag, a feeling in your gut,
listen. If you have respectfully approached your caregiver with reasonable
requests and solid evidence in support of why you want certain things in your
birth plan, and you get responses that include disrespect, anger or
ultimatums, run! I have know people to fire their caregiver two weeks before
delivery because their requests were met with a dismissive, or even hostile,
attitude. You pay these people a lot of money to help you, not to humiliate
or harangue you.
So what is a parent to do?
In a healthy, normal pregnancy the first step is to educate yourself and take
responsibility for yourself. Prenatal care isn't what happens at your
doctor's office, it's what you do for yourself between visits. Your
caregiver doesn't have squat to deal with if you don't take care of yourself
and your baby.
Ask questions. When your doctor says you need a test, you have every right
to ask what it's for, how accurate the test is and what information will be
gained by doing it. You should also know before-hand what the next step
would be if the test does uncover a problem. Of course, the flip side of
that is, if the test doesn't reveal anything, is that the end of it? Or will
more testing be recommended? If an intervention will be suggested for any
condition found, are there risks or side effects? Are there alternatives,
including a wait-and-see attitude? If the treatment is not successful, what
would the next step be? Is the problem you are looking for a serious one,
and if so, how serious?
Always be polite and respectful. A physician who is requesting tests for a
true medical indication will have no problem with you wanting to know more
about it. The more you know, the more likely you are to comply. In that
same vein, do your homework. If you are going to initiate dialog and be a
partner in your own care, you can't expect your midwife or physician to do
all the work.
In the end everyone wins with this scenario. If you know that you have done
everything possible toward a safer birth, and you have been able to feel some
autonomy over this major life transition, you will be willing to give your
power over to your physician in the case of a real emergency. After all,
that's what you hired him/her for. Obstetrics is a surgical specialty and
you want a specialist if your plan becomes something other than the normal
birth you envisioned. Unexpected outcomes are even easier to deal with
because there is no room for the 'what if' game if you've considered every
angle in advance and made your own best decisions.
Copyright 1999, Kimberly K. Wildner Suggested Reading: |
