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  Just call off the pregnancy police

It’s tough being pregnant these days. Apart from the nausea, heartburn, swollen ankles and constant pummelling from within, practically every aspect of your life is under scrutiny. You mustn’t eat too much because it could increase the baby’s risk of obesity and diabetes, but nor should you diet – for the same reasons. And you can forget exercise in case it triggers a miscarriage.
Just thinking about it all is enough to raise your blood pressure, except that pregnant women mustn’t get too stressed because that too is bad for baby. Time to chill out? Not so fast: a glass or two is strictly off limits, and so are innocent-sounding spa treatments in case you overheat. Even lying down in bed could cut off the baby’s blood supply.

Recently the British charity Sense about Science carried out its own preliminary research and evaluated newspaper coverage of pregnancy from 2006 to 2011. It identified no fewer than 138 different factors that allegedly influence the outcome of pregnancy, adding ice cream, night work, sun beds, per fluorinated compounds in plastic food packaging, hair dye and pet shampoo to the list of things to avoid.  Worse, because some 30% of these reports gave no clues about the source of the cited, there was no way expectant parents could properly assess the risks or judge the quality of the science.

Then there’s disagreement between doctors whether to delay clamping the umbilical cord to allow more of the blood in the placenta to flow into the baby’s body, and when to intervene in pregnancies that run over 40 weeks, or if labour is slow.
Not surprisingly, when I found myself pregnant for the first time three years ago, I felt overwhelmed, not just by the media but from the offerings of doctors, antenatal teachers and friends. Even complete strangers seem to think it’s acceptable to advise me on the wisdom of drinking a glass of wine or carrying a suitcase up a flight of stairs.

I was so incensed that I set out to look for the truth behind the old wives’ tales, alarming headlines and possibly problematic guidelines. What started as a 14-part blog for New Scientist during my last week of pregnancy developed into a two-and-a-half year obsession with the science of bumps, birth and newborn babies. Eventually, my book, Bumpology, was born.

What I discovered frequently amazed me. I learned how wrong the still popular notion that babies are born “blank slates” really is: newborn babies have some concept of who their mother is, of what a human face looks like, and some appreciation of numbers and language. I discovered the evidence is weak for many things that pregnant and breastfeeding women are told to avoid – including exercise and peanuts (increased risk of peanut and other food allergies) – often contradicted by later studies or meta-analyses.

I was also angered. Shortly after starting to write the book, I became pregnant with my second child, and began to revisit much of what I had been told by antenatal teachers first time. I realized that much of it was misleading (some plain wrong) and I began to appreciate the power that the words “increased risk” can have over our decision-making. For example, when I sailed past my due date in my first pregnancy, I tried everything to kick-start labour, from pineapple to curry to sex, because I had been told that if I was induced I was at increased risk of having an epidural or a caesarean section.

I had also been warned these interventions would, in turn, increase my risk of tearing, decrease that chances of bonding with, and/or being able to breastfeed my baby. Quite apart from failing to find evidence to support the idea that curry, pineapple or sex induces labour, I also discovered that if you study pregnant women who are 2 weeks overdue, you find that they are actually less likely to need a C-section if they opted to be induced rather than waiting for the baby to arrive.
And although there is an increased risk among pregnant women generally of having an instrumental delivery (involving forceps or a suction device called a ventouse) if you request epidural anaesthesia, the absolute risk is very small indeed: 20 women would need to have an epidural for one additional instrumental delivery to take place.
I also felt short-changed by antenatal teachers who glossed over the uncomfortable realities of natural birth: 85% of women will experience some tearing; you can end up so constipated that the lining of your anus may be damaged; while 36% of women anticipate suffering severe pain during labour, 65% report experiencing it; and when your milk comes, your breasts will become so hot and swollen that you may fear someone has replaced them with a sack of boulders.

What’s more, all of this is perfectly normal, and there are things you can do to alleviate the suffering and reduce chances of infection. I wish, for example, that someone had told me how common tearing is – that it isn’t so bad, but that if you feel swelling, heat or discharge from the wound you should insist on speaking to a doctor. And I wish someone had warned me what might happen if I got constipated through not drinking enough, and told me that it is normal for your breasts to become engorged, and that lying in a warm bath and massaging the milk out can help.

Birth support
I strongly believe women should have the birth they want, but they need support and solid facts when they make their decisions – and they need to appreciate that labour does not always proceed smoothly. For example, according to the voluntary organisation Birth Choice UK, in 2010 just 42% of UK women had a normal birth without medical intervention (including epidural anaesthesia). Some experts argue fewer women would undergo unnecessary medical procedures if they were in a midwife-led unit. One unit, at the City Hospital, achieved a normal birth rate of 54%, so it seems steps can be taken to increase women’s odds of delive

ring naturally, but there will always be a significant number who need medical help.
This is not a choice, and it is irresponsible to suggest that women have a huge amount of control over what happens to them during labour. I don’t want to scare pregnant women, but I believe that we need greater honesty about what labour entails so people are more open to the possibility of medication, or to the idea they may need medical assistance without feeling like failures for not living up to a fantasy of what birth should be like.

I say this because at least one study found that women who plan natural birth and end up requesting an epidural say it made their childbirth unsatisfying, even though it relieved pain and they gave birth to a healthy baby. Among the reasons given were a sense of failure, and misplaced concern that an epidural might have harmed their baby. The study also suggested that those women who went into birth with their eyes open were the ones who achieved their goals of natural birth.

It’s time for society to reconsider the effect of this advice, moral judgement and scaremongering on pregnant women and new parents. Having a baby can be one of the greatest joys life bestows, but it is hard work. We can do without unnecessary guilt, anxiety and doubt – but not without the facts.

Ref: NewScientist, 19January 2013, p.29

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