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Because has been branded to mean ‘doctor attended hospital birth’, the first question people may as when a woman announces she’s pregnant is ‘has she seen a doctor yet?’
Therefore, here I would like to explore the many assumptions implicit in that question.
First of all, the obvious: the question is not ‘has she found a midwife yet?’ or ‘is she seeing a midwife or doctor yet?’ It is simply, ‘doctor’.
When should a woman go to the doctor? What should she expect? How much of what she may encounter is actually beneficial? Why or why not?
The expectation is that as soon as the rabbit dies, a woman needs make an appointment with a doctor to ‘begin prenatal care’. This is a bit of a misnomer. ‘Prenatal care’ is actually something only a mother can do. She’s the only one who can make decisions about what she eats, what stress she is exposed to, how much she exercises and whether or not she stops smoking. In other words, how she CARES for herself PRENATALLY. All a doctor can do is monitor, test and give advice; perhaps even educate. Still, the mother is the only one who can choose to accept or reject the advice. So, technically, going to the doctor immediately is the initiation of prenatal monitoring and testing, not prenatal care. This is a redefinition of the verbiage, intentionally.
Who wants to be monitored and tested? Of course I want to be cared for! This actually puts doctors in a bad place. I believe it is one of the reasons obstetricians are the most sued profession. They have set it up so that in the minds of the birthing families that they (the doctors) are responsible for outcome, because it is their medical care that determines outcome. It isn't true of course, but they need to foster that belief to maintain the monopoly on birth. The double edge sword is that then some women believe they are not responsible for their decisions. We see this in the language: "And then my doctor decided I needed...", "My doctor made me...", "then they gave me...".
The manipulation of language modifies the meaning, thus in the minds of many, implies something it is not. This is a technique used in rhetorical persuasion, as are logical fallacies, which are contained in the question ‘has she seen a doctor yet’.
The slippery slope: this asserts that if we got to the doctor, we will get the very best care, our baby will be healthy hence we must go to the doctor as soon as possible.
I've already discussed previously the abysmal outcomes in the U.S. which disprove these assumptions.
The hasty generalization: this would be the assumption that ‘everyone knows to be healthy you have to see a doctor as soon as possible’.
Again, this is not supported by outcomes.
Post hoc ergo propter hoc: this fallacy assumes causation, i.e. that one thing is because of another thing because it happened after the first thing. For example, birth is safer now than it was 100 years ago because we see doctors in pregnancy.
Birth is safer now than 100 years ago, but due to many factors unrelated to obstetrical care. Again, previously discussed here.
Ad populum: This is an emotional tactic that equates one thing with another. The example here might be that if you are a good mother, you go to the doctor immediately.
However, just because the entire concept isn’t what it might appear at first glance doesn’t mean it’s worthless. In pregnancy, women do need to be educated (although that happens more through the woman’s own efforts than through prenatal visits), may need sound advice, and should be monitored to a certain extent.
The first prenatal visit establishes ‘baselines’. It is important to know what your normal blood pressure is, what your normal heart and breath rates are and what your normal temperature is. It is important to check your blood sugar level through a finger prick or urine dipstick (which also tells if you may have a urinary tract infection) to determine if you could have diabetic tendencies (which is different from ‘gestational diabetes’ which we’ll get to in a minute). It is important also to find out if any sexually transmitted diseases are present, and to have your health and family history recorded, as well as the that of the father of the baby. It must be determined if you might be a victim of abuse or if you need public assistance to get nutritious food.
All of that can be done by a midwife, a nurse, or essentially anyone, even a group of other pregnant women.
Doctors are required for genetic screening, ultrasounds and glucose challenge testing, which round out the first prenatal visit. (Well, technically, a CNM can and does do this things too, but likely will explain the procedures and honor a woman's decision to decline a routine test or procedure that is not relevant to her individual situation.) What do those three tests tell you and how might it change your care? In other words, what good are they? What’s more, if anyone can do the rest of the stuff and doctors are only necessary for these, why is the first question people as is ‘has she seen a doctor yet?’
Ultimately, what this comes down to is, how comfortable is the mother with the possible loss of a healthy child due to the tests, and is she comfortable with aborting a fetus that has chromosomal abnormalities? She also must consider that healthy babies have been aborted because tests said they were abnormal, but they weren’t. Then there is the stress that testing adds to the pregnancy, which is addressed in The Tentative Pregnancy: How Amniocentesis Changes the Experience of Motherhood (Katz-Rothman).
What does early ultrasound tell you? It tells you that you are pregnant, which you already knew. It can tell you about ‘how much’ pregnant you are, which you also probably already knew. If not, does it matter if you know that you are due at the end of April or the beginning of June? Nope. You are still 'due' in sometime in the spring. It doesn't matter how many times your 'due date' changes with each ultrasound; your conception date doesn't change. You are the same amount pregnant whether a proclamation of an estimated GUESS DATE is made or not. Only about 5% of women actually give birth on their 'due date'. The rest will give birth within the 2-plus weeks or so on either side of it. Gestation can also be determined by cervical changes and size of the uterus, measured by fundal height (where the top of the uterus is). Fundal height also allows assessment of fetal growth as the pregnancy progresses.
It can detect certain abnormalities in the placenta or fetus. Then again, it can 'detect' abnormalities that aren't there too. Let's see, I've known women who were told the baby had Down Syndrome, which it didn't; women who were told they had placenta previa, which they didn't; women who were told they had too much fluid, which they didn't; women who were told they had to little fluid, which they didn't; women who were told their babies were too big, only to discover after surgery, they were normal or small; woman who weren't told they had twins, when they DID. You get the picture. (Pun intended.)
Is there anything that you need to know at this stage of the game that justifies the use routine use of a technology that has been implicated in a number of problems for babies, including more than 3000 annual miscarriages of healthy babies per year?
The cruel irony here is that many women get early ultrasounds to verify they are pregnant (which they already know) or to assess viability of a fetus because they have endured infertility.
The FDA has even urged caution.
And while some would argue that the warning is against ‘keepsake images’ I would argue that routinely used, without a true and clear medical indication, it’s the SAME TECHNOLOGY used for the SAME PURPOSE. The only different is the location of the machine and technician. I admit, it is a very cool tool. I’ve seen some amazing pictures, and it IS useful in some selected medical situations, but I am talking about the risks of non-medically indicated routine ultrasound.
Please remember, x-rays were used on pregnant women to determine fetal position for years before it was determined it was unsafe. Ultrasound hasn’t yet been proven to be safe despite wide usage, and there is a lot of evidence that it might be causing problems. If there were a probability that there was something wrong with my baby that could be fixed I would weigh the benefit and possible risks and might decide to take the risk. If the problem could not be fixed, or there was no problem, why on earth would I take the risk of CREATING problems for my child?
“…no benefit has yet been established for glucose testing during pregnancy…” (A Guide to Effective Care in Pregnancy and Childbirth, pg. 77)
This test is wrong up to 70% of the time.
Think about that. 70 out of 100 times, it will be worthless. If a test is wrong far more often than it’s right, and the results lead to care that is does not improve outcomes, and the very test itself makes women (thus their babies) sick, WHY WOULD YOU DO IT?
What all of these do is add stress, and a previous post spoke to the detrimental effects of stress in pregnancy.
So, if the assistance that midwives provide (or women provide for each other) is proven to improve outcomes, but the few tests that require doctors provide little to no benefit to healthy women (with much risk), I ask again, why is it that the first question women get asked is, “did you see your doctor yet?”
That would be a logical question to ask a sick or injured person, not an expectant mom. Pregnancy and birth are normal, physiological functions! Just as with any normal, physiological function, they are not without risk, but we don't assume impending danger in every normal function.
I slept well last night. Tonight, or tomorrow night, or the night after, I could succumb to insomnia, or a circadian rhythm disorder, or a deadly sleep apnea. No one asks me if I saw a doctor because I slept well last night, but they certainly should ask if I'll be seeing a medical sleep specialist if a problem develops.
I digested my food without incident yesterday. There is every reason to think I will today, and tomorrow. But at any moment I could choke and die. I could develop diarrhea or I could become constipated. I might become nauseated or contract some food borne disease that could kill me in a matter of days. I didn't call the doctor today just in case one of these situations befall me, but I would if and when I did get sick, and I'd expect every test that might determine what the problem was.
My heart beat probably 90,000 times today. I didn't call a cardiologist. I even did things that caused my heart to beat faster than usual and raised my blood pressure. A cardiologist doesn't monitor me during sex or when I ride my bike, though people die of heart attacks doing those things every day.
I walked today. I didn't break my leg, so I didn't call an osteopath.
I breathed easily today. I didn't have an asthma attack, nothing accidentally obstructed my airway, and I didn't fall into coughing spasms. I might, but I didn't. So I didn't call a pulmonary or respiratory specialist. I would if I needed to, but I didn't.
The human body creates a human being from two single cells without a single thought or an ounce of effort on the part of the mother; just as easily as she breathes, walks, digests and sleeps. The human body knows how to birth that being without incident, and how to create food that is specific to that particular infant's needs.
Mothers need to know how to take care of themselves. They need to understand that THEY take care of THEMSELVES and that this pregnancy is not something happening 'out there' that is all about what someone else does or doesn't do, or about machines and tests that may or may not apply to them, or that may or may not be safe or effective. It's about what they are doing that has a direct effect on what's going on inside.
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