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Monday, March 14, 2011

Your (Fearful) Pregnancy, Week by Week

Consider yourself warned.
If you want to witness fear-based obstetrics at its finest, check out this book.

Seriously, one reader commented that it was the "most fear-based book I've ever's the only book I've ever put into the trash in my whole life."

Wow. Was it really that bad? I wondered at first. I checked it out from the library and decided to find out for myself.

The first thing that really struck me was the little callout box on the cover: "The Only Best-Selling Guide Written by a Doctor - Millions of Copies Sold!" I was immediately skeptical. To the unsuspecting pregnant woman, that's supposed to mean, "Everything written in this book is true, because it was written by a doctor."

There was also a nifty quote featured from Dr. Elizabeth Warren (should I know who that is??):
"The primary book I recommend...I know I can trust it. It's organized, up to date,  and provides women with terrific information."
Surely you're joking.

As far as being up-to-date, that's only as good as the copyright date, so there's not much I can say about that. I had a good chuckle when she said it was "organized" - in that case, I think either Dr. Curtis (the author) or his editors were smoking something, because that's one thing I noticed about this book: it seemed very willy-nilly and strange in that respect. In one paragraph we're talking about testing and procedures to baby's presentation to bug spray and its bad side effects. Then we jump from TB and lupus (even Mad Cow disease! As if you didn't have enough to worry about while pregnant!) to "How much does having a baby cost?" I thought my head was going to fall off.

I don't want to sound crazy or all conspiracy theorist, but I think this book is full of lies. (Lies! They're all lies, I tell you!) Or at the very least, it's lying by omission.

Why do I think that?

Lie #1: When it comes to the biggies, like VBACs and cesareans, Dr. Curtis (who's first name is Glade, which makes me automatically think of a stinky bathroom and a can of air freshener) spends little time discussing the risks of repeat cesareans. He also spends blessed little time emphasizing how those risks can essentially be mitigated by having a VBAC. Not surprisingly, he prefaces elective cesarean as "patient choice," but most of us realize that the mother agreeing to a cesarean simply because her doctor made it sound like she was going to spontaneously explode without one doesn't exactly equal "choice." At the end of the day, we know that many women have little, if any, choice in the matter at all.

Dr. Curtis makes a glaring discrepancy by not really mentioning how repeat cesareans can impact future pregnancies, which is probably why conditions like placenta accreta are on the rise. Curiously he mentions a product called ON-Q, a system of medication delivery that administers pain medicine to just the incision, rather than the entire body. While it sounds interesting, I wonder how many hospitals use it -and the words "Ask your doctor about it at one of your prenatal visits" makes me think of a drug commercial (shameless product plug here!). Is he basically saying, "Just in case you have to have a cesarean - and many women do! - you should be preparing yourself for it. You know ... just in case."

One thing I can't stand is the assumption that just because you want a natural birth/VBAC/something other than the "norm," it "might" fail. It's like tearing you down before you even begin. Conversely, I also don't really like the idea of saying "I will have a vaginal birth!" because really, you don't know that either. It's important to have confidence in yourself, yes; but we can't be too presumptive, either.

Lie #2: He sets you up for more pessimism and failure later: "but you might need another c-section anyway" (with regards to a diagnosis of CPD). You might as well add, "So you should just skip your stupid, lofty plans for VBAC and just have another section." Again, we hear "Not all hospitals permit VBAC nor are they equipped for it." If they're not equipped to handle a VBAC, then why are they delivering babies at all?

Lie #3: You can't eat anything more than ice chips in labor. I think even the recent studies were published by the time this edition came out (2008), yet they're still promoting starving a laboring woman. If your hospital insists on nothing by mouth, know that they're basing their findings on a very outdated study done in the 1940s that suggest women who have food and drink in their stomachs *might* aspirate it should they need anesthetic. I'm hoping, as I'm sure you are, too, that methods of anesthesia administration have improved dramatically since that time, and that your risk of aspirating is even lower than it probably already was then. Should you experience a long labor, light food and fluids (notice I didn't say turkey dinner with dressing and four gallons of pop) is going to give you essential energy to stay strong throughout. Dr. Curtis doesn't mention any studies (or anything else, for that matter) other than hospitals won't let you eat and drink (and really, some do, by the way) except that "it's for your own safety." (So don't worry your pretty little head over it, okay?)

Lie #4: "Avoid anxiety-inducing TV programs." Unless he's talking about Law & Order, I'm assuming he means all those insipid "reality birth" shows that are cropping up. I can't argue with him there, except for a different reason: I haven't seen one episode of "A Baby Story" that's even remotely realistic. Ditto on "One Born Every Minute" and all the others. So yeah, you'd be best to stay away, but not for the reasons he's thinking, I'm sure.

He also suggests "be careful of what you read on the Internet." You know, because those crazy bloggers that talk about natural childbirth all day (and give this book bad reviews) might give you some empowering information that might convince you that you can have a different experience than what Dr. Curtis thinks you should have. Seriously? I will admit, there's a lot of crap out there on the 'net about birth - both natural and medicated - that should be taken with a grain of salt. But there's also a lot of good information out there, and anyone who wants the trust and respect of their readers will provide reputable links that encourage you to read up on your own. Most blogs I read will have a blog roll of other birthy links for more info, and they come from some very well-respected, trusted midwives (and other sources). You're going to have a lot of pro- and anti- information thrown at you, but I really hate how he almost makes it sound like all the crapola and nonsense comes from pro-natural birth sources. 'Cause we all know there's some real shi!t-slinging going on from the other side too, don't we? (cough)

As far as natural birth philosophies, he does mention the big ones: Bradley, Lamaze, and hypnobirthing, to name a few. But it's almost like there's an invisible asterisk beside the paragraph that seems to say, "You can try these, but don't expect them to work." Some of them, according to Dr. Air Freshener, are best taken "before you get pregnant." Why? I'm completely puzzled over that one. So you'll be sure and forget everything you've learned by the time you give birth?

Lie #5: Diet is everything! Ok, it doesn't really say that, (actually, I think it says "Be vigilant about the foods you consume") but I swear - almost every time I flipped through this book my eyes fell on something about weight. Food. BMI. Desserts. Most of us realize that we shouldn't necessarily eat like there's no tomorrow when we're pregnant. But there's a hazy theory surrounding that: I'm not saying it's a good idea to eat with reckless abandon, but you need to enjoy yourself while pregnant, too. He actually says something like, 'At parties, you should avoid the dessert table if you think you're going to overeat.' You know, hide behind that big potted palm tree in the corner, you pregnant woman, because you don't deserve to have even one ounce of cake/cookies/or anything. If you sneak one hot dog or forget to microwave the cold cuts, it will go on your permanent record! (There's even a handy chart towards the back, so you can neurotically keep track of every ounce gained.)

We are not robots. Obviously cravings will overtake many of us while pregnant, and weight gain is just one of those things. Some women eat a reasonable amount of food and watch their diets and still gain a lot of weight. Others do not. Because if you're just harping on diet because of the "big baby" scare, well don't even go there, Dr. Curtis.

I'll admit - when I gave birth to my youngest, I was heavier than I'd ever been. And he was my largest baby, at 8 pounds 7 ounces. Woo. That's huge. Right? While you probably shouldn't be eating yourself into a food coma at every meal, neither should you feel like Dr. Curtis and the Pregnancy Food Police are going to come knocking on your door - with Heidi Murkoff bringing up the rear.

Lie #6: Vaginal exams are necessary. He goes on and on about how important they are to "assess" the pregnancy towards the end, such as baby's station and positioning, etc. etc. I will admit, during VE's two of my doctors were able to tell that my babies were not in the vertex position. (even with external palpitation, one doctor was also wrong) Aside from that, though, unless you're 35 weeks and in preterm labor, most people argue that they don't really tell your doctor anything. They sort of make him (and you) feel like he's doing something, and he is, all right: if you're not progressing, it gives him more of a reason to badger you into scheduling an induction because you're one day shy of your due date with no cervical changes whatsoever. You're already thinking about lupus and Mad Cow disease, who needs that on top of everything else??

Lie #7: Homebirth is dangerous. Dr. Curtis, bless his heart, devoted probably what amounts to an index card-sized space to tell you one thing: That home births are incredibly dangerous. (Actually, he prefaced it in the form of a question: "Are home births safe?" His answer: "NO!"in bold letters, just like that.)

I'm of the belief, like many people, that they are not safe for some. And perfectly safe for others. If you have access to good, quality care and are well-informed about the subject* then perhaps yes, home birth is safe for you. But for him to assert his opinion, essentially, as fact - well, that's just wrong. This book is more supposed to inform women about pregnancy and answer some of their questions, not start a firestorm of debate on whether you personally think it's safe, Doctor. Because there are many physicians who disagree with you on that one.

(*As for as being well-informed, I suppose that goes back to all that natural birth crap you read on the internet, right? Honestly, this is one of those murky areas that even the best natural birth/home birth advocates take issue with. This is your right as a childbirthing woman, and only you can discern whether you've gleaned enough - or the right - information in order to make that decision for yourself and your baby.)

Dr. Curtis goes on about how ACOG says this that and the other as far as the safety of homebirths, which is a dicey subject in and of itself. However, ACOG also says that it's safe for some women to have VBACs after two cesareans, but I don't see him jumping on that bandwagon. Know, ladies, that sometimes doctors like to pull out the ol' "ACOG says this!" about some things, yet completely ignore what they say about other stuff.

His pitiful, anemic take on home birth is probably the biggest stick-your-finger-in-someone's face judgmental BS ever, probably because it's written by a doctor who happens to think he's your boss, and that his opinion is the be-all-end-all on the subject. Let me tell you: whatever your stance, you deserve better than this!

At least he does suggest a birthing center, but you'd be hard-pressed to find one, depending on where you live. I live near an international border, 20 minutes from a major city, and there are no birthing centers where I live. That, in and of itself, severely limits your choices, and if you're also like me and live in a semi-rural area, you know that your choices are even more scarce. This is what Dr. Air Freshener, and many others like him, don't get.

This book is billed as "authoritative." Honestly, I'd call it more authoritarian than anything else.


Chavelamomela said...

Great post! Thank you once again for making me laugh (and roll my eyes) at the absurd "information" that the mainstream medical establishment is trying to convince women to believe.

I will take issue with one item of yours: #4. While I agree that most TV-versions of labor and birth are totally inaccurate, there have been several recent labors on tv that actually were pretty cool and accurate.

1. The Office - Pam had a pretty good labor. Not too quick, normal amounts of pain and discomfort that she worked through with movement, distraction, etc, followed by a non-interventionist hospital birth.

2. "A Baby Story" - while I agree with you that in general, the show is more like "An Interventionist Birth Story" with an occasional MW birth in a birthing center, they did show 1 week of homebirths last year - and I was actually one of those homebirthing women - and they did an EXCELLENT job of portraying our homebirth in an accurate fashion.

Here's a link if you're interested:Part 1

Part 2

Part 3

part 4

Part 5 (Bonus) (out-takes)

Pregnancy week by week said...

thanks for gave this book name.that help to laugh pregnancy women.pregnancy women have some disturbances in her mind. the story helps to relax and give pregnancy week by week activities.