Sunday, December 26, 2010

Obstetric Myth #98- You Are High Risk


Any woman, if tested sufficiently, and stressed enough, can become high risk while pregnant. I truly believe this.

I have talked to women who are high risk for a variety of reasons: previous miscarriage, age, weight, gestational diabetes, prior c-section, high blood pressure, their own choices, their own fears, and many many more. I have also seen many of these women go on to have totally natural births, even at home, and do it seemingly easily.

I also must say, just to be honest and straight forward about where I am coming from, that I find the current obstetric model of "care" that basically involves five minute visits and every test imaginable, laughable and not really care at all. I think it is preparation for birth fear, not trusting your body, and a very sorry replacement for real prenatal care.
(What should actual prenatal care consist of? We will talk about that later.)

First- a story-

I was chatting with a relative the other day. He happens to read my blog and so is always telling the ladies he knows about the benefits of natural birth and the like. He happened to know somebody who was currently pregnant and was "high risk."

Now those two words make me want to grind my teeth every time I hear them. What better way to prepare a woman for her inability to birth without technology than to tell her from day one that she is an accident waiting to happen?

This mama had the sad misfortune of being (gasp) 40!!! Not only that, to top it off she had developed gestational diabetes! Gasp again! Then- (yes she can get more risky) the baby was consistently and persistently breech at 36 weeks. (Breech is another post all together so I won't even touch on that here.)

I was not surprised to hear that the woman's doctor scheduled her for a c-section and she was not sad, she was in fact, relieved. She had just been saved the inconvenience and guilt of attempting a natural or vaginal birth that she had been prepared through her entire pregnancy to believe that she was not actually capable of.

I am not going to tell you that age, gestational diabetes, and baby position don't matter and don't present risk factors. But I will say that the words we use to describe a woman's ability to incubate her child will have a huge impact on how she experiences birth.

Do some of these issues need to be addressed so that a woman can have a safe and low risk pregnancy and birth? Yes- but telling her her body doesn't work is not how we deal with them. Not unless we are more interested in filling beds and maximizing insurance billing and keeping "patients" coming back for more than we are in a positive and safe birth experience.

Now a note on real prenatal care-

There is a big difference between care and testing. You can run tests all day long on various rare conditions and factors. If you run enough of them and if you are LOOKING for something to go or be wrong, it will not be hard to find it.

What does real prenatal "care" consist of? It consists of getting to know a woman. It means finding her normal. It means meeting with her in a place where she lives so that you can see a glimpse of what her life is really like, not just the face she puts forward. It means talking to her. It means education about what it really means to have a healthy pregnancy. This includes talking about good pregnancy nutrition. Care means touching somebody, listening to their concerns, hearing them, and talking to them and sharing wisdom and experience.

It might actually include some tests. Tests are not necessarily a bad thing- but they are a tool for communication, not an end in and of themselves. Let me give you an example- I am almost almost always, pregnant or not, anemic or borderline anemic.

I recently met with my midwife. She tested my levels. They were low. I was not surprised. This is something I knew about myself long before I ever got pregnant. I was not sent for another test or reprimanded. My midwife talked to me about some of the benefits of improving my iron levels. She talked about numerous natural and nutritive ways I could address the issue. She gave me information that empowered me to make better choices. She did not label me or scare me.

How can this and many other similar issues be handled differently? The woman can be scolded. She can be sent for more tests. She can be scared. Seeds of doubt in herself and her abilities and her natural innate human superpower for growing babies can be planted. Women can be "transferred" to another care provider. The list goes on and on.

So, how do you stay (or become) low risk?
1. Don't underestimate the power of taking care of yourself while you are pregnant. Good nutrition and exercise can prevent a myriad of risk factors before they even happen. I am of course a big fan of the Brewer diet. Why? Because it is simply a healthy diet. Dr Brewer told his patients to cut out all sugar and refined carbohydrates. They were to replace these empty foods with nutrient dense ones like greens, fruits, vegetables, whole grains, and protein. They were to drink water and eat WHOLE food. The simple importance of nutrition is often ignored, much to our detriment. Here are some great articles about nutrition.
2. Find a care provider who will actually care for you-
I have seen so many woman who are being labeled high risk switch to a home birth midwife and go on to have a great birth. They can not believe the difference between the five minute test result visit and the one hour "how is your life" visit they get with their midwife. I have also seen women undergoing midwifery care, accidental see an OB and instantly become high risk. Puke.
3. Believe that you can birth and gestate normally-
Many many women have had experiences that undermine their faith in themselves. Maybe you have struggled to get pregnant for years. Maybe you have had one or more c-sections. You can still do this. Those things don't make it impossible to have a normal birth. You may however have to work harder to find somebody who truly supports your birth power and you may have to work harder to believe it yourself. But it can be done.
4. Want to be low risk-
I don't mean this to sound offensive, but yes, I think we have to want to be low risk. As women we are often ignored, marginalized, or encouraged to put others first. The fact that pregnancy is treated like a disaster waiting to happen in our culture makes it a great opportunity to get some much needed attention. (Believe me, I need a break too and pretending I am super woman is not easy 24 hours a day.)

It is easy and even tempting to get some of that much needed attention by talking endlessly about all the things that are wrong with us, all the tests that we failed with the OB and all the aches and pains. It is also kind of scary to attempt a natural birth when all around you you are surrounded by people saying it is impossible. But do not fall into this trap.

You do not have to be high risk to be cared for. You do not have to be wonder woman either. You deserve a break or some help or some love or rest. Ask for it. Take it. Own it. You do not need to have something WRONG with you to deserve this. You need it just because you are doing the important work of growing a child.

The End-

Part of an empowered birth is an empowered pregnancy. This means owning our own health. It means making good choices in not just our foods but the people and information we surround ourselves with.

The term "high risk" is a natural growth from our obsession with the various risks of pregnancy and birth. Are there risks involved? Well of course! But everything worth while has risks. You can choose to believe yourself to be healthy and capable of birthing your baby, no matter what the label.

(Disclaimer- you may very well be high risk. I am not saying that it never happens. I am not a doctor or even a care provider. )

17 comments:

sara r. said...

Your point about women almost wanting to be high-risk really struck me as true.

I had such a boring, uneventful pregnancy. I had only 2 ultrasounds, the last one at 22 weeks. By the time I was 36 weeks along and measuring 'behind', I almost wanted the doctor to recommend an ultrasound to check on the baby's growth, even though I knew that everything was fine. He didn't, and she was just perfect when she was born, although a little on the small side. Even though I knew that ultrasounds are inaccurate, and can cause more problems than they solve, etc...I just wanted a little more than my 5 minutes office visit.

I think that if all low-risk women had midwives, that their desire for attention would be less. After all, midwives take more time to converse and give attention to their patients. Doctors just don't have time for that, so to get more of their "attention", you have to have some kind of issue! It's sad, really. I'll never go to an ob again.

Anonymous said...

I find all extra test ANNOYING and think you are high risk if you allow all the sonograms etc. Something is likely to be wrong at some point in pregnancy and labor that is really a normal for the person, or is normal for pregnancy. My midwife said, "a decel is common in pregnancy and we don't always know about them because we don't monitor constantly, but in labor we suddenly monitor so much and then a normal decel comes and everyone freaks out." She did monitor me in labor, but yet I could be out of bed and pacing as I wanted. She held the monitor to my belly and apologized because my baby was having many decels, and so she watched. No freaking out, no left side oxygen...just calm monitoring. Baby was OP, head tilted, and did have a cord being compressed but until the last 10 minutes of pushing, no O2. Even then, the midwife calmly told me not to vocalize but we need to get the baby out. My 39 year old body birthed a baby OP with head tilted and cord tightly wrapped just fine. No extra help needed, just a trusting and calm midwife to guide when things were wonky. No big deal, but yet everything. Had I been with a different provider, I may have seen the panic button. Much better without it.

Anonymous said...

Awesome post!! My mom had 3 c-sections...the 1st was an emergency c-section with me (however she said that knowing what she knows now about childbirth, it most likely could have been avoided), the next 2 c-sections were pushed/recommended/fear driven as the doctors told her it would be much safer to have another c-section then deliver vbac. After the 3rd c-section she had her tubes tied as she was told it would be unsafe to have any more children. 4 years later, she and my dad decided to have them untied. A few months later she was pregnant, and delivered an almost 10# baby vbac. After him, she had 4 more naturally (yep, I'm the oldest of 8), the 2nd to last being footling breech and a homebirth at that!! With all of the last 5 babies she had gestational diabetes. With the last two she was 40 & 43.
Now I am expecting my first, and am planning a home waterbirth with a midwife - and I am sooo excited (my biggest fear is a hospital birth, because I know that my husband and I would have to put up a fight to have the birth we'd like)!! I know that if my mom can do it, I can too :-)

StandardSpicyWhatnot said...

LIKE!
Especially this part... It is what I have been telling woman for YEARS!
"You do not have to be high risk to be cared for. You do not have to be wonder woman either. You deserve a break or some help or some love or rest. Ask for it. Take it. Own it. You do not need to have something WRONG with you to deserve this. You need it just because you are doing the important work of growing a child."

Penny said...

I was told my many that I was a high risk during my last pregnancy (baby #4) because of a complicated health situation after baby #3 (plus I am over 40 as well). I have an autoimmune kidney disease (in remission) that has caused in the past high blood pressure, anemia, very high proteinuria (we're talking as high as 18 grams), and a stroke.

While I never did find a home birth midwife willing to take me on (babies 1-3 were all home birthed), I did find a birth center I managed to convince that my body knew how to have babies, and that any problems that came up would come up with enough warning before the birth to change plans. Baby #4 arrived spontaneously at 36 weeks, 6 days, weighing 8#6 after a totally uncomplicated 3 hour labor. While the baby did have some subsequent problems unrelated to the birth--problems he would have had regardless of where he was born--I was so glad that his birth was not a medical event of any kind, and that I did not listen to "high risk" warnings that were premised entirely on general principles and not on what was actually going on with my body.

~* Aria *~ said...

I was sooooo high-risk the doctor said that there as no way my baby could be born vaginally and a c-section had a 50% chance of killing me (no large intestine and I have a j-pouch, so somehow no vaginal, and my small intestine is adhered to the front of my uterus, so she'd have to cut through them, which is deadly for me), so we proceeded to plan one with a GI specialty team (to repair my intestine to try keeping me alive) scheduled to be present. Under general anesthesia. So I was to go to sleep knowing I have an equal chance of never waking to see my baby as I did of living.

Do you have any idea how hysterically upset and scared I was? This baby was so very much wanted we even did in vitro to have her, and suddenly I'm going to die?

Anyway my heart and body told me it was all wrong. I went with a midwife and had a homebirth. Daughter was sunny-side up, acyclical, and chin-first, but she was born, and I didn't have so much as a tear.

I believe a large part of the "every's high-risk" crap is that doctors want to protect themselves from malpractice by saying, "Well, we did everything we could and she knew she was high risk," which, sadly, will protect them, even if a bad outcome is a direct result of unnecessary interventions. In our society, there's this idea that major surgery and drugs carry no preventable risks.

Also, as someone else said, I think it's a good point that some woman may WANT to be considered high-risk for the little extra attention they may get. When out of a 10-minute appointment, the doctor will pop in for the last minute or two and not know your name without looking at a chart and you're trusting this person to take the time to get to know your specific situation and yet they don't know your name...desperation can set it. Midwifery would improve matters so much. Midwives take the time to get to know us as people, especially the homebirth and independent birth center ones.

Crystal r said...

I am by a couple of standards high risk. although I do not believe that because I am labled as such that I should fall into line and be dragged from test to test and told I am unable to give bith naturaly. I am a vbac and have been told it would be much easier to just schedual another c section because my baby is going to be a big boy. This is not what I want and have told my doctors this and have been very stubbon that no how big they say he will be I will deliver naturaly no matter what the possible complications may be.

Shannon said...

While I agree with the premise of the blog, I have to say I disagree with the myth being "you are high risk," because high risk IS real. I can attest to that personally. I do think, though, that the REAL myth is that "being high risk means ...you have to have interventions and can't have a normal, NATURAL childbirth experience". Mamas who are told they are high risk should not take it sitting down. Mamas who are told they are high risk should work EXTRA HARD and finding out how to keep that high risk status from taking away from her the desire to have a natural birth. Don't use it as an excuse to the "easy" way out.

My chronic hypertension (regularly known to be in the stroke high levels prior to being regulated) alone (though I do have another condition that places me in the high risk category as well) puts me in the high risk category, but at the same time I AM my OB's worst nightmare. I don't just do things because he says I should (you should have seen the argument regarding whether or not I would accept the flu shot), and I REFUSE to have ANY interventions at my child's birth unless it is ABSOLUTELY medically needed (and he'll have to PROVE IT to me before I agree). And at the same time I use my high risk status and knowledge to motivate me to educate myself to what I can do to better regulate these issues and better ensure I get the NATURAL childbirth experience I have so desperately wanted to have the last 13 years.

And I'm pleased to say that with all the investigation I've been doing, my hypertension has been very well regulated MOSTLY WITHOUT the use of medication (ssshhh...don't tell my OB) down to the level it was prior to ever getting pregnant over 13 years ago and developing pih. It's the lowest it's EVER been and if they didn't already know any better, they would have NO IDEA I was high risk, and there is NOTHING to indicate I will not be able to go full term and deliver a baby without induction this time around. Sure, things could change, but at least I'll be able to say I FOUGHT and didn't use it as an excuse.

So while "high risk" really is very real, it doesn't have to be used as an excuse.

Busy lil' Bee said...

With my #3 (and last) baby, I was truly high risk. I have type 1 diabetes, but I had also just been diagnosed with Graves disease, an autoimmune condition that was sending my thyroid levels sky high. My blood pressure and pulse were both dangerously high, I had Hyperemesis gravidarum from the graves (it causes nausea), which sent my diabetes into a tailspin and meant I could not keep my tablets down.

I giggle now when I hear friends tell me they are "high risk" because they had a miscarriage last year and might have to have a CS. Sorry doc. But no.

I am ever so thankful for the team that looked after me. They were as set on a vaginal birth as I was. We agreed on most things in fact. Especially that an indiction or CS, in fact ANY intervention would be my choice. Of the whole team, only one person believed I needed to fit into her little "box" in order to have a vaginal birth (we disagreed on iron tablets: I refused them).

I had a hospital birth with all my babies, but had I not been so sick, I would have had a homebirth with this one. I am not so naiive to think that it would have been a good idea with this birth, but to all you docs reading this, THIS was a high risk pregnancy. Not the woman who has milk hypertension because you just shoved your hand up her nether-regions without introducing the student looking over your shoulder. But more importantly, a high risk pregnancy is no the same as a high risk birth. And a high risk pregnancy is no reason to assume that a mother cannot obtain a normal vaginal delivery.

mamapoekie said...

I think I should better click away from your blog as this is dislodging so many hurt feelings and I am crying all the way through.
I got labelled with GD too.
I had a happy healthy pregnancy for the first 16 weeks. I was in Cameroon until then. I was radiant, happy, I didn't gain too much weight. My husband and I were on cloud nine.
Then I went to Belgium, to the dreaded hospital where I was being followed, to get a battery of tests... voila. No more happy pregnancy.
The happiness got replaced with worry and dread and fear and testing sugar levels and eventually using insulin and always always fearing the food and being able to join in the fun even less when there were people over or dinner parties.

ANd I completely get the wanting to be high risk, because then at least you get some attention. I did kind of enjoy it. And when I hemmoraged after the induction and maybe needed a transfusion, I did enjoy the close control. I wasn't getting any visits anyways, so at least I had that.

Tattoos n' Diapers said...

Great post! My first pregnancy was bombarded with tests since they diagnosed me with GD (which I was never convinced I truly had). My current pregnancy is fine (though I still had to go through a bunch of tests anyways, since I was previously high risk!).
I couldn't agree more with you!

http://tattoosanddiapers.blogspot.com/

Steph B. said...

I agree they keep claiming patients are high risk when they are not. I just wish there was a consistency among doctors/midwives/hospitals.

I have a seizure disorder, and when I became pregnant I immediately saw my neurologist. He said that I was low risk. I was so excited, that meant I could have a midwife. When I called the clinic (I live in Ontario, Canada where they are covered by our provincial health care) they said they wouldn't take me as a patient because I was high risk, even though my neurologist said otherwise.

So I had no choice and had to see my family doctor, and she also said I was low risk (and had never delivered a patient with epilepsy). I never had any extra tests, or u/s even with a seizure disorder.

My family doctor wanted to induce me because she wanted to make sure I was delivering in a controlled environment. As a family doctor she is given hospital privileges, and has to go through the hospital for scheduled inductions & c-sections. They hospital wouldn't approve an induction because the chance of a c-section was higher than actually having a seizure during delivery.

It just leaves you confused on who has your back. A midwife was supposed to offer the best care, and they claimed I was high risk because I had a seizure disorder (and had been seizure free for 2 years). I was looking forward to having one. However, it was my doctors, and the hospital that knew I was low risk. I wasn't induced because my seizure disorder wasn't going to affect my delivery. As a result, I will not be choosing a midwife in the future, but stay with my family doctor.

It is quite disappointing that there isn't more communication through all parties that end up being involved.

Anonymous said...

I love and appreciate you and what you are doing for women. Thank you so much <3

jentastic! said...

Love what Shannon said, "Mamas who are told they are high risk should work EXTRA HARD and finding out how to keep that high risk status from taking away from her the desire to have a natural birth"

I got the "high risk" label due to Factor V Leiden and a recent episode of pulmonary embolisms. But I know my body better than ANYONE and I trusted my instincts when everyone around me was scared shitless. I worked so hard through my whole pregnancy to fight to just be left alone, despite the "dead baby card" I refused to be induced, and my babe came on his own accord and with no interventions. This is going through a standard OB and hospital, too. I only wish it didn't have to be so exhausting to work through a system that tries to make every woman conform to a cookie cutter standard of pregnancy and birth...

MrsKatherineA said...

I was very surprised to be told I was high risk by a new OB. I was pregnant with my second baby and looking to transfer care and was telling him the details of my first labor and birth. It was a long, hard one that lasted over 36 hours but my daughter was born healthy and with 2nd degree vaginal tears as the only injury to me.

He told me that because the labor was that long that he would consider me 'high risk' for this pregnancy and that he never would have let me labor that long, that he would call for a cesarean. Yes it was what I would describe as hell, as I wanted an epidural and never got one but in the end we were both just fine and I was really taken aback that he thought I was now high risk. He was very patronizing about it, and it all rubbed me the very wrong way. I checked out a birthing center and switched to midwifery care and am so SO glad I did! I went on to have a very quick, easy, wonderful birth with my son.

nshek said...

My midwife told me about a friend of hers that was pregnant and going to an OB. She was 34 when she was conceived and was considered low risk. Half way through her pregnancy she had a birthday and turned 35. After her birthday she was told she was now high risk and needed to have a barage of tests. Simply because one day she was 34 and then next she was 35. The words "high risk" need to be saved for when there really is an issue.

Cranial Soda said...

I wish my OB could read this. Often times I wonder if she views me as a disaster waiting to happen. I'm a little overweight but other than this, am completely healthy and normal. But at every visit, she checks on symptoms (weight gain? you must have GD! uterine doppler studies? you WILL have pre-eclampsia! peeing often? you must have UTI) that could further confirm her suspicions of my high-risk pregnancy and convince me of a C-section. And I'm sick of it!!!

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