Saturday, January 7, 2012

Pregnancy care is all wrong.

We're doing it wrong when it comes to prenatal care. I've never understood why, at the very beginning of the pregnancy when there is so much opportunity for learning and preparation for growth (literally AND figuratively!) prenatal appointments are often skipped entirely during the first trimester, once a month at best during the second trimester, and once a week or even more often in the final few weeks. To me, this is completely backwards from how it ought to work. If I were in charge of pregnancy "policy" for our country (oh, what a different prenatal and birthing environment we'd have...) I'd have the highest frequency of appointments at the beginning of the pregnancy, and then leave the huge, tired pregnant lady alone to prepare for her labor in the third trimester, unless she specifically requests more appointments or there is a problem that requires monitoring.

It makes sense! Pregnancy is the beginning of a lifelong journey, and no woman comes out "the same" after becoming a mother. Not to mention, the fact that a brand new LIFE is beginning. Mothers (and fathers!) should be learning as early as possible about bonding and attachment, nutrition for both mother and baby, safe baby care, and self-care. The first trimester is the absolutely crucial time when cells are multiplying rapidly, organs and bones are forming, the brain is forming, and every part of the embryo is excruciatingly new. This is the time to be particularly conscious about complete nutrition, proper vitamins and minerals, getting enough rest, drinking enough water - and yet, it's the time when many women are barely able to keep any food down, they are exhausted and sore, but they may not even be talking about the pregnancy with supportive friends or family out of fear of "something happening." The first trimester of pregnancy has many challenges, but there are many care providers who won't schedule patients for prenatal appointments at all, or maybe just once, during this critical time period.

On the other hand, we live in a culture that is obsessed with controlling every aspect of birth, right down to choosing when and how, and this obsession is reflected in the care that pregnant women receive as they near their due dates. When I was pregnant with Bug I had appointments every two weeks starting in the third trimester, then every week starting at 36 weeks. Every regular appointment at the OB office ended up leading to me being sent to the OB ward at the hospital for some reason or another, "just to check" on something, so one appointment each week became two or even three appointments each week. In reality, unless there is a health condition that is being monitored, there is no need for a woman to have that many appointments in the weeks leading up to the birth, unless she specifically WANTS the extra time with her care provider. Certainly the time could be well spent talking about the birth plan and helping the mother and her birth support team prepare and plan, but I don't often hear about those kinds of appointments from women who see an OB for pregnancy care. I do, however, hear about an extraordinary amount of women being sent for non-stress tests, ultrasounds, cervical exams, stripping of membranes and other such methods of controlling the end of pregnancy. It seems to me that instead of spending so much time, energy, and money creating this anxiety over when the baby will be born, we should be letting third trimester moms get a little extra relaxation time, or maybe prescribe a nice foot rub and a hot cup of herbal tea.

At the end of pregnancy, as long as you can catch baby's normal heart rate (this can be done very easily with a simple fetoscope, no need for an ultrasound or a doppler) and baby has regular periods of movement, there really aren't going to be any huge developments. The baby is already completely formed and there are a few very important things going on - lung development and brain development, as well as a layer of fat to help with temperature regulation, to name a few. The critical time period of cell division and tissue formation is long over. While it's still incredibly important to stay well nourished, hydrated, and rested, at the end of pregnancy a mother can't help but to sit and look at her belly and think about the life inside of it and how it will affect the rest of her own life. At the beginning of pregnancy it's a lot easier to push those thoughts aside, to brush them off with the thought that it's still going to be quite a while before the baby actually comes. In our culture we are trained to think of pregnancy as something that we should attempt to push aside and ignore as much as possible until it becomes too much to ignore. When you consider, however, that the critical framework for development is from birth to 3 years, it might seem that we should put more energy and effort into educating people who find themselves nine months away from raising our next generation.

No comments:

Post a Comment