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YOUR BODY, YOUR BABY, YOUR CHOICE:
For example, our grandmothers and greatgrandmothers may have accessed medical or midwifery care, but their pregnancies would have been overwhelmingly social rather than medical experiences, and neither their bodies nor their babies would have been subjected to the intense scrutiny and complex decision-making that 21st century pregnancy, labor, and birth bring. The medicalization of pregnancy begins in the earliest days and weeks, with a series of choices and tests offered at regular intervals over the next nine months. Today’s parents need to make important and unprecedented decisions; for example:
Even today the complexity of these choices is increasing, as researchers seek more ways to prevent common (and not-so-common) problems for mothers and babies. This is a worthy aim; however, like many technological advances, the new drugs and treatments associated with these preventative measures can also have side effects for mother and baby. And because of the delicate balance of the pregnant woman’s body, and the extreme vulnerability of her unborn baby, obstetric drugs and procedures are particularly liable to cause long-lasting side effects, many of which have been discovered only in retrospect. These include the use of X-ray on pregnant women from the 1930s, which was discovered to increase the risk of cancer in exposed children only in 1956; the use of diethylstilbestrol (DES), prescribed for threatened miscarriage from 1938 to 1971, which has been found to increase the risks of reproductive problems including infertility, miscarriage, premature labor, and clear-cell cancers in exposed daughters, with effects even into the third generation; and the recent use of misoprostol (Cytotec) for induction in women with a prior cesarean, which was discovered to dramatically increase the risks of uterine rupture only after it had been in use for several years. Moreover, many – in fact, most – obstetric drugs and interventions have not been tested for long-term effects, apart from birth defects, on exposed offspring. It is now more important than ever for modern parents to be closely involved in decision-making and to carefully consider the choices that their care providers offer. This means making sense of complicated information not only intellectually but also with hearts and instincts. Today’s parents also need ready access to obstetric technology when necessary, to get the most benefits with the least harm for mother and baby. Accessing the best care and least harm may involve parents’ asserting their wishes and desires over conventional care or “expert opinion.” This can be very challenging, especially when it is the first encounter with the medical system. However, it is important to remember that it will be the parents, not the health-care professionals, who will live with consequences of these choices, so it is extremely important for parents to speak up for themselves and their babies. The Nocebo Effect “Nocebo Effect” (as opposed to the Placebo Effect) refers to the unintended negative effect of a medical diagnosis or treatment. It is particularly relevant to maternity care, because the mother’s emotional well-being is so often neglected, as we have discussed. Michel Odent comments, “The nocebo effect is inherent in conventional prenatal care, which is constantly focusing on potential problems. Every visit is an opportunity to be reminded of all the risks associated with pregnancy and delivery.” In addition to increasing worry for pregnant women, the nocebo effect may contribute to adverse outcomes by increasing the levels of stress hormones.13 High levels of stress hormones in pregnancy increase the risks of prematurity and low birth weight, and they can cause damage to the developing brain that leads to conditions such as ADHD and learning difficulties, with possible lifelong effects on offspring. The nocebo effect reminds us how important it is to guard emotional well-being in pregnancy and to choose caregivers who will increase joy, rather than reinforce fear and worry, at this time. Odent, who emphasizes the importance of joy in pregnancy, recommends that practitioners “create such interactions that a pregnant woman feels even happier after a prenatal visit than before . . . or at least less anxious.”13 This is an excellent rule of thumb with which to evaluate maternity care and caregivers. We can help to counteract the nocebo effect through activities that give joy and physical pleasure: for example, regular massage in pregnancy will reduce stress and may even reduce the risk of giving birth prematurely. Rest, relaxation, and regular exercise are also very useful, and tuning in to the baby will often give reassurance when worries arise.
Sarah Buckley, MD, is an internationally known and widely published authority on natural birthing and parenting choices. She has published numerous articles in Mothering magazine and Midwifery Today. She lives with her husband and four children. Visit www.sarahjbuckley.com. |
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Women’s experiences
of pregnancy and
birth have changed
enormously in the past few
decades.
Which care provider will we choose?
Reprinted with permission from Gentle
Birth, Gentle Mothering: A Doctor’s
Guide to Natural Childbirth and Gentle
Early Parenting Choices. Copyright © 2009
by Sarah J. Buckley, MD, Celestial Arts, an
imprint of Ten Speed Press, a division of the
Crown Publishing Group, Berkeley, CA.