Liberated From Prenatal “Care”

Pregnancy Images-8After almost every prenatal visit when I was pregnant with my first child I would cry. The midwives in the only practice our student insurance would pay for were so mean that we ended up switching to the doctors. When I refused what I considered nonsensical testing, they would look at me sternly and say things like, “You’re going to buy yourself a C-section if you don’t do the glucose tolerance test.”

Without telling us why, my favorite doctor in the practice (a young woman with two small children herself) ordered an “emergency ultrasound” when I was eight and a half months pregnant. That’s what she called it: an emergency ultrasound. My face felt tight and when I looked at James his skin was ashen.

When I asked nervously why, the doctor mumbled, “Inter-uterine growth retardation. You’re measuring too small.” She snapped the paper mandate off the pad, turned on her heel, and started to walk out of the room.

“Could it be because I’ve been biking every day?” I suggested feebly to her receding white-smocked back.

After six and a half months of morning sickness, I felt like someone washed the windows. I was happier and fitter and more energetic in the last two months of my first pregnancy than I had ever been in my life.

“I read that women who exercise sometimes measure small or have smaller babies…?”

“Absolutely not.” The doctor left the room. Late, no doubt, for her next appointment though she had spent a total of five and a half minutes with us.

So many medical practitioners, even many midwives, treat pregnancy as an illness. Even the gentlest practitioners want to “manage” your pregnancy. They tell you what to eat, how much weight you should gain, how often you should exercise. They scold you if your pee is too yellow (“You should be drinking more water”) and furrow their brows if your blood pressure is too high (“This is a possible sign of pre-eclampsia. Expect to go on bed rest”).

Many women, especially first-time moms, appreciate being guided through every month of a pregnancy. They believe all the testing and the managing will insure a healthy baby. They believe, like I did, that health care practitioners have the best intentions.

Besides, people in the medical establishment know what’s best for us and our bodies and our babies.

But do they really? Though prenatal visits can be a comfort to parents, a pregnant woman does not actually need to be charted and tested and doctored. Unless you plan to abort a baby if the tests come out questionable, there is little reason to do them. If something is going wrong in your pregnancy, your body will tell you as much and then you can go to a doctor. What a pregnant woman really needs is not prenatal visits, invasive (and often inconclusive) testing, and scolding. She needs to be loved and supported and fed healthy food and given adequate rest and time to be outside and moving her body.

When was the last time your doctor made you a healthy meal or offered to watch your children while you napped or took a walk?

I’m tired of people telling me what to do and how to manage my body. I don’t find it reassuring to pee on a stick and be told there is no protein in my urine. I don’t need a doctor (like my friend’s husband who stayed at our house and ate yellow cupcakes for breakfast every morning) to tell me how much weight to gain. I don’t even need a midwife to remind me to eat salad. I don’t need a midwife’s assistant to palpitate my belly so hard it hurts. And I don’t really feel like filling in numbers on a form that will get stuck in a chart to certify to health professionals I hardly know how many people I’ve had sex with.

We’ve opted not to have any prenatal “care” during this pregnancy. Instead of paying a doctor or a midwife to tell me to take my vitamins, I’ve used that time to write in a journal to Pineapple, to take walks, to work, to watch my daughters’ gymnastics classes, to talk to friends, to volunteer at my son’s kindergarten, and to read everything I can, from thick novels written by my great love Charles Dickens to Ina May Gaskin’s Guide to Childbirth. (Ina May, by the way, thinks the glucose tolerance test is pretty much unnecessary and misguided.)

This personal choice is a threat to a multi-billion dollar industry that treats the prenatal period like a disease. Rejecting prenatal intervention may not for everyone but it’s been an incredibly liberating decision for me.

In the meantime, if you have a doctor who holds office hours outside and takes you walking in the park for the monthly prenatal visit, send me a phone number.

(Photograph courtesy of Koeby Johnson.)

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25 thoughts on “Liberated From Prenatal “Care””

  1. This is very interesting and I agree with you about a lot of things. I think there is little room in prenatal care for differences among women. The standards are too rigid. I gave birth to an 11 lb 8 oz baby in my frist pregnancy after being yelled at for gaining too much weight. My second one was big too- I just grow big babies, but no one wanted to consider that. I too got tired of the constant testing and constant attitudes I encountered in the exam room.

  2. Your description of prenatal care in the USA was an eye-opener for me. I had my babies in France. While the delivery process was not ideal, especially for my firstborn, at least the prenatal care was fully reimbursed and top quality.

  3. I don’t think this is just about medical care during pregnancy; I think it’s about medical care period. Too many doctors and other healthcare workers are the worst communicators on earth — brusque and bossy and arrogant.

  4. After reading your incredibly thoughtful post, I really really wish I could have had a dr. free pregnancy the first time around. I had what felt like and turned out to be an incredibly easy pregnancy, but i was measuring small at 32 weeks which led to numerous unnecessary ultrasounds, hospitalization, bed rest, high blood pressure brought on by stress, etc. At 36 weeks, I’d had it and took myself off of bed-rest and took my own blood pressure at home, which was normal. I had and 8.8 pound 9 apgar little girl on her due date. Afterwards my doctor said she thought i was totally fine all along, but couldn’t risk the what ifs?, aka potential lawsuit…

  5. Well, I was fortunate to have had my babies before some of the now routine tests were being forced on mothers, but I would like to bring up another point of view. It is true that you are intelligent enough to manage your pregnancy just fine, but what about the majority of the women your doctor sees who don’t even know that they should abstain from alcohol while pregnant? Or the dangers of diabetes mixed with birth? The reason the survival of infants has improved so much in four generations, is the spreading of some basic information about pregnancy. Like school teacher who have to teach to the lowest level, maybe the midwives and docs are conditioned to have patients who don’t know the basics.

  6. I was just driving home from dropping my three kids off at school and saw my very pregnant neighbor climbing into her car. I wondered if she was going to a prenatal visit. What I remembered then was how totally overjoyed I was when the visits, during the last weeks of each of my pregnancies, became weekly. I had three different doctors deliver my three kids (each a c-section) and I loved all three of these men like uncles, or fathers! I could have spent all day in their offices talking about my body and the fetus, my other kids, different facts and figures, worries and small victories. There was something incredibly SAFE about those examining rooms and I loved each check-point–yes, prenatal tests included–that told me that my pregnancy was on course and that all was well. I am a worrier. I’m healthy and informed and I managed my pregnancies well enough, but boy did I love my doctors and those visits.

  7. I went to a naturopath for my first (and only) and loved the experience. I looked forward to just about every visit – listening to the baby’s heartbeat, getting feedback about my diet, getting my questions answered. I think if I was on my third or fourth it probably wouldn’t excite me quite so much, though.

  8. Although both my pregnancies were considered high-risk, my ob-gyn couldn’t have been more hands-off, respectful, and warm. She never pushed me to do anything I didn’t feel comfortable with. Both my pregnancies went beautifully because we both viewed our relationship as a partnership; I did my job, she did hers. But then unlike many women in this country, I also had great health insurance so I was able to choose the doctor I wanted after much shopping around. So many women don’t even have access to prenatal care, much less high-quality prenatal care. It’s shocking we have such a high infant mortality rate when we’re the wealthiest country in the world. This is one more reason we need health-care reform.

  9. I did my own prenatal care last time after feeling similiar to the author. I relished the attention of my midwives the first couple of pregnancies, but with subsequent pregnancies it felt like a lot to attend prenatals so that my midwives could be reassured that I was fine. So I thought, maybe I will call a midwife is something comes up and I don’t feel fine. It was a liberating plan! My prenatal care involved eating well, doing prenatal yoga, swimiming, taking specific supplements that my body needed (not the standard prenatal vitamin that made me nauseous),and nurturing myself and my relationships. I never missed having a midwife during my pregnancy, never missed the concern about not eating enough protein. I have grown large, healthy babies four times now. If I have another, I won’t doubt my body’s abilities to grow another large, healthy baby!

    It is very sad that women, while creating new people, are not treated with the respect and care they deserve. I reject the condescending tone and attitude that doctors and midwives often take. I reject the notion that I won’t have a healthy baby without midwifery or medical attention during my pregnancy. Or that I can’t catch my own baby for that matter!

  10. “This personal choice is a threat to a multi-billion dollar industry that treats the prenatal period like a disease. Rejecting prenatal intervention may not for everyone but it

  11. I agree with your decision – for you. Being pregnant is fraught with rushed doctors who only have time enough to dispense advice that is “the norm.” So many women forget the logical, intuitive things you mention in this thoughtful post. I applaud you for listening to your instincts and standing up for yourself. But you need real confidence to do that, and so many women are frightened to take matters into their own hands. And still, there are many who are not as knowledgeable and need health guidance to ensure a successful pregnancy. A complicated multi-faceted situation that is highly personal and emotional for sure!

  12. I’ve only had one baby, so I can’t compare–and I was totally that new mom who had 6 zillion questions when she went to the dr. I did go to a practice with midwives. Two of them were great; one not so much. Most of the tests didn’t bother me, except for the ultrasounds–because they seemed so incredibly unnecessary. I suppose it can help detect things like a heart abnormality that could possibly be treat in utero, but all of that measuring of the fetus is really obsessive, especially considering that the inherent flaw in ultrasound is that it is NOT ACCURATE IN MEASURING THE SIZE OF THINGS. They kept telling me that my baby’s head was big (translation: she might have downs). Low and behold, she does not have a big head–the test was flawed.

  13. I feel much the same way–that the visits seemed pretty pointless much of the time especially by my third.

    Having said that, i did want to share (promise I won’t do this every time!) a piece about my stepsister’s giving birth a month early out of the blue. The NICU, hard as it was to be in it, really did assure them a safe healthy start. What we need is more France/England health care for all, so it can be less medicalized… with my first, I had much of my prenatal care in London. The midwife didn’t measure my fundus; she looked with her eyes & said, “Looks great.” That’s the kind of health care I can get behind!

  14. I agree that so much of the prenatal testing pregnant women endure is either unnecessary or not explained well. I remember refusing the quad testing to the disbelief of the medical staff at my doctor’s office. I kept telling them that no matter what the results I wouldn’t do anything differently in my pregnancy. The doctor was fine with that, the nurses, not so much. While I wouldn’t go without prenatal care during a pregnancy, I’m glad you’re bringing this up. Very valuable discussion. Thanks.

  15. As someone with no kids, I find this post fascinating. I’m so totally against the medicalization of women’s health, but I have no perspective in this area yet – though I learn so much reading your experiences. Thank you!

  16. Jennifer – finally getting around to leaving a comment for you. Brilliant post – I have also had almost no typical prenatal care during this pregnancy and only in the end did we hire a wonderful midwife who answers my questions through email when I have them, and doesn’t bug us about regular appointments. When we do have them she comes to us even though we are way off grid, and does little more than check my blood pressure and give a few reassuring words. I feel lucky to have found her…and I am so glad I have allowed myself to trust my own body and instincts more closely this time around.

    Wishing you a wonderful birth when it comes…41 weeks tomorrow for me.
    .-= Melanie ´s last blog ..The Lancet Commentary: Kids Should Skip the Seasonal Flu Vaccine =-.

  17. What an awful experience! I can see why you want to be liberated this time around. We were fortunate enough to have very sensible and thoughtful doctors and nurses through my first two pregnancies, who went out of their way to consider my hormone-heightened feelings.
    .-= Katherine´s last blog ..The Melbourne Cup

  18. This is so important, though I daresay you’re preaching to the choir a bit on *this blog! I did some things during my pregnancies and early childhood years that in hindsight, I would have skipped, but the doctors, they like things their way. If only I’d been more pro-active and bold back then!
    .-= Kris Bordessa´s last blog ..News? Ha! =-.

  19. I understand this completely. I just fired my midwife a couple weeks ago because I was tired of being over tested even though I’ve had an extremely low-risk, healthy pregnancy.

  20. I know what you mean about being tired of being over-tested, and it’s sad to me that so many midwives do this too (sometimes they are required to by law but so much of it is unnecessary.) I bet you feel much better now that you don’t have to deal with the stress of the testing. Are you planning an unassisted birth, Serena?

  21. A question for the moms who have foregone prenatal visits: Did you have trouble finding a midwife who would attend your birth without them?

    I am early in my pregnancy and just finished my first prenatal visit with a midwife I used to like, and came out worried and teary (for no reason, nothing is wrong, but the focus was finding problems), and wanting nothing whatsoever to do with this negative energy. I’m not sure I’m willing to go for a totally unassisted birth, though, I would like someone there trained to help in an emergency. Advice?

  22. Dear Saoirse,

    First of all, I’m sorry you came out of that visit crying and I can TOTALLY relate to how you feel. Those early pregnancy appointments seem unnecessary for so many reasons and I think you should follow your gut feelings and not be part of that negative energy.

    Here is my advice, for what it’s worth. Since you are in early pregnancy, take some time for yourself and then — in a month or two or even three — start looking for a new midwife. No midwife will turn you down (I don’t think) just because you sign on with them late in pregnancy. That happens all the time because people move or change their minds about midwives.

    If you lived in southern Oregon I could give you the names of midwives who would be happy to attend your birth even if you forego prenatal visits so I think you will be able to find someone where you live (where do you live? I would be glad to ask around if you let me know) but it may not be easy. I had to do a lot of interviewing and I talked to a lot of people before I found the right ones. And some midwives in my area are still upset with me for having the gall to have an unassisted birth.

    But I think–hope–that most midwives would just want to be there in the capacity and way that you need them (though they may have some requirements because of their certification) and it’s really important that you find a midwife who makes you feel listened to and taken care of. It seems like the one you thought would be that person is definitely not it.

    Does this help at all? I hope so. I’ll be thinking of you. Early pregnancy was so hard for me (I was so sick and exhausted and emotional). Hang in there.
    .-= Jennifer Margulis´s last blog ..An Exclusive Interview with Frugal Kiwi =-.

  23. I feel the same way and though it was rather unplanned, I feel so liberated not having had to deal with unnecessary poking, prodding and testing. My husband is not nearly as happy with this as I am, however. We’ll be expecting baby 3 any day now. I’m looking forward to a lovely UCbirth. Though I’ll have to pretend it was unplanned… I know hubby won’t be happy to know I plan to have our little one at home, lol.

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