Guilt-Tripping Mothers

I often hear that I can’t tell mothers about ecstatic birth because they might feel guilty if they don’t have one. Just a few blog posts ago, I wrote about the same argument being used regarding research about telling mothers that what they eat in pregnancy is important to the health of their babies later. Not just ‘you are what you eat’ but ‘your baby is built by what you eat’. The author of the article I mentioned saw that as blaming the mothers and objected.

So when I hear good parents being told, “If you had only [insert abc routine technology] then we could have done [xyz intervention] and you wouldn’t be here now.” It annoys me a little. No, it annoys me a lot. Especially when I little bad science is thrown in. I’ve known doctors, nurses, midwives, doulas, childbirth educators and lactation consultants all to be guilty of this. One couple who is very close to me intended to have a homebirth, but ended up in transport. The midwife then proceeded to criticize every recommendation that doctor made that the parents followed with comments akin to, “If you had only done what I said, you wouldn’t be here, and you shouldn’t do what he says because...” WTF?!

What is important is that the parents feel they’ve made their own best decisions. It is not the place for others to insert doubt. If the parents later wonder or question their decision, it is then appropriate to support them in their quest for answers. Part of our growth process is that we do wonder if we might have done something differently. It is still up to the parents to travel their own path to resolution without anyone else’s determination of what might have been right or wrong. As Maya Angelou says, “We do the best we can with what we have, and when we know better, we do better.”

The parents who come to my classes are loving, intelligent people. They research their options and make their choices, and sometimes the choices they make are to opt out of routine intervention and utilize appropriate technology only when it becomes appropriate to their situation. Saying,” If you had only…” is totally about placing blame and making parents feel bad so they ‘follow the rules’ next time. There is no other point to saying it. It doesn’t help in decision making in the moment, it doesn’t change the outcome…it just places blame.

One of these instances might be ultrasound. Some parents have done their homework and are fine with a medically indicated use of this technology, but not routine use. They’ve weighed the risks and the benefits and have determined that if the benefits outweigh the possible risks, certainly they would have one done. To later, after the fact and with hindsight being 20/20, say “You know, if you would have had an ultrasound we would have known this was going to happen and could have done something” is really not helpful.

Ultrasound is a great tool for a lot of things, like determining fetal lie if there is a question as to how the baby is positioned. Palpation is adequate for most cases because, well, babies move for one thing. Assuming the possible risks of ultrasound to tell you something that may or may not be the same tomorrow means the risks outweigh the benefits. IF palpation suggests a fetal position that might be corrected, then the benefits may outweigh the risks. But palpation is accurate more than 85% of the time, so to say afterward, if this baby is one of the other 15% (or if this baby has moved INTO a breech position after correct assessment via palpation...and how would one know that?) is just not helpful.

In other cases, ultrasound is just notoriously inaccurate, like in determining a baby’s size (accurate only to TWO POUNDS in either direction) or gestation (accurate to within TWO WEEKS in either direction-yes a month time span). I hear women all the time saying “Well, my due date changed again” after an ultrasound, to which I ask, “How many times did your conception date change?” Due dates don’t change! Babies come out when they are ready, and not all of them will be at 40 weeks.

In fact that is another pet peeve…women being told that such-and-such happened because they were ‘overdue’ when in fact they have not even reached 42 weeks. NORMAL HUMAN GESTATION IS BETWEEN 38 WEEKS AND 42 WEEKS. Babies that come at 38 weeks are not early; they are right on time. Babies that come after 40 weeks but before 42 weeks are not late. They are right on time. 40 WEEKS IS JUST AN AVERAGE. Less than 5% of babies will come exactly on their “due date.”

In a study of 56,317 women, it was determined that there is no advantage to inducing labor before 42 weeks, and in fact, inductions at 41 weeks increased complication rates. (Alexander, McIntire, Leveno, 2000) Notice that the date on that study is 2000 when many women were being induced at 41 weeks; now women are being induced at 40, 39, 38 and even 37 weeks. This is such a problem in our nation’s failing grade on premature birth, that review of this practice is one of the solutions to reducing prematurity from the March of Dimes. (Medical News Today, 2008)

The worst case mother guilt-tripping I think I’ve heard is the doctor who, while walking beside his patient on the way to OR for a cesarean due to a placental abruption said to her, “See, I told you; you should have quit smoking.”

Sure, everyone knows you shouldn’t smoke while pregnant, and yes, he had told her that. But a) he didn’t tell her what the complications might be…just that it causes small babies, which many mothers do not understand means oxygen deprivation and placenta malformation and b) even if he had told her, she didn’t quit. What exactly was the point in telling her, essentially, ‘this is all your fault’ on the way to the OR when she’s scared and uncertain as to whether she or her baby would even survive?

Which brings me back to my original point: there is no point beyond making women feel guilty about something they cannot change. The only reason to say stupid things like this is to make them compliant little patients the next time around.

Alexander J, McIntire D, Leveno K, (2000). Forty weeks and beyond: pregnancy outcomes by week of gestation. Obstet Gynecol. 2000 Aug;96(2):291-4. Retrieved November 21, 2008 from http://www.greenjournal.org/cgi/content/full/96/2/291

Medical News Today, (2008). March Of Dimes Releases Premature Birth Report Card For US: Nation Gets A 'D'. Retrieved November 21, 2008 from http://www.medicalnewstoday.com/articles/129225.php


Ashley said...

I'm so happy to have found your blog. I appreciate the way you look at things and your dedication.

Wildner said...

Why thank you!
Now, if I can just make money at this writing thing, I'd be a happy camper! :-)