May 9th, 2005

Finally finished the Simkin, nearly done with Goer

I have these stacks of pregnancy and childbirth books all over the apartment. Oh, and like that was a surprise to anyone. Given the amount of reading I do on a topic of passing interest, imagine what poor R. has to listen to nearly every day. A previous boyfriend described me as picking 5 important books on a given topic in an effort to become an instant effort. It's not too far off, altho I never consider myself expert -- that's just my bar for minimum knowledge. Reading about this topic has been very hard. I had done a little in the past, but felt put off it for two reasons. I like to talk about what I'm learning, and talking about pregnancy and childbirth when not pregnant triggers a couple of borderline hostile reactions. Gosh, you must really want to get pregnant. Must be your clock ticking. And, you aren't pregnant, how can you possibly understand anything about this topic. Oddly enough, while gender influenced what people said, it didn't entirely determine it.

Then again, once I did start reading about pregnancy and childbirth, I hit a whole other kind of difficulty, which I believe I would have encountered independent of hormonal weirdness of being pregnant. There is a lot of bad craziness associated with this topic. Some of it is the de-emphasis of the independent woman's needs in favor of the as-yet-unborn, very dependent offspring's hypothetical needs. A lot of it is the definition of what is a "need" vs. what might be nice. Dumb example (one of my favorites from early on). Got hayfever? Don't take anything, 'cause it might hurt your baby. Throwing up all the time? Try dramamine. Why can you take dramamine for nausea and vomiting, but not for hay fever? It works quite well on both, and you can split the tab a lot to reduce dose which, in theory, ought to reduce risk (which with dramamine is virtually non-existent anyway). Another one: don't take aspirin while pregnant. Why the heck not? One baby aspirin can be durned effective for a headache (has been for me for years, once I got a whole lot of lifestyle and psychological stuff taken care of) and minor aches and pains, and is probably the single most-tested analgesic in pregnant women. There was a huge trial to see if prophylactic baby aspirin would reduce the risk of preeclampsia (didn't have a discernible effect, but also did a fab job of proving safety in pregnant women).

Infuriating, but I am fortunately not under 24X7 surveillance, so if I want to blow off the dumb advice, it's easy enough to do so. Not so easy to blow through some of the other bad craziness. A lot of my friends have already had their babies, and over the years I'd heard their stories. I've gone back and asked again, to hear more details now that I recognize more of the words. Quite a lot of them talked about "the cascade" -- interventions in pregnancy that lead to more interventions and end in a c-birth (and often line mom up for c-births thereafter, given the difficulty to finding health care providers willing to participate in a VBAC). And of course if you read health news as painstakingly as I have for the past 3 or 4 years, you can't really miss the periodic stuff about how episiotomies are a terrible idea. So when I started to learn the hairy details about risk introduced in a low-risk labor because of fear that something might possibly go wrong later, I had some warning. Didn't really make it easier, but did mean I skipped the otherwise likely response of, oh, it can't really be this bad, can it.

It turns out it is so very much worse. The only good news is I can actually read this stuff now -- and keep reading. I still rant and rave and say harsh words about what should be done to the idiots who came up with this stuff, but I no longer have to put the book down or away for days until I can screw up the courage to find out more. And with the ability to keep reading, and face this bad craziness without having to turn away, comes a great calmness and confidence that while pregnancy and childbirth cannot be controlled, decisions made early on in the process with a view to downstream consequences can strongly influence outcomes.

Quote for the day, for all those decades of doctors (and, I am sorry to say, some midwives), some of whom are still practicing now, and think that pulling on the cervix (or really, by extension, pulling on anything, like, say, a baby that might pull on the cervix because you haven't f-ing let the kid rotate because you are in such a bloody rush to "progress" you fail to respect the biology of a slower second stage) might be a useful thing to do:

"No, no, don't tug on that. You don't know what it's attached to."

I'll save the comments on books about breastfeeding, not to mention newborn care, for a later post.