This has been a busy, busy week at Chez Parker. We've had a ton of fun things going on, a week long baby shower, for example! - that I'll talk about later. It's not all doom and gloom, but this has been on my mind this week, so I thought it was best to just get it off my chest so I could move on.
So...
I had my (hopefully) last ultrasound on Monday. The midwives recommended it as a final check to make sure the placenta was completely out of the way of the cervix (I had a low placenta placement), and also as a quick position check of the baby. I've mentioned before that I came a little, um, pre-padded, so it's been difficult to figure out how the baby is positioned. They were pretty sure he was head down, but might as well double check while we're as the ultrasound appointment.
I have mixed feelings about ultrasounds. The are amazing, but there aren't a lot of long term studies on their effects. My goal in this pregnancy was to avoid having a lot of ultrasounds and I ended up having three. Which is about two more than I intended, but I digress. Ultrasounds are also fairly misleading. They are good at diagnosing some things, but really bad at diagnosing others, and almost no distinction is made between the two in the medical community. For example, ultrasound weight estimates of a fetus are notoriously bad - off by up to two or three pounds in either direction - yet techs still routinely perform "weight estimates" and doctors use that information to make decisions about care during pregnancy. Everyone even acknowledges that weight estimates are bad! So why are we using this bad data to make crucial decisions about pregnancies?
We met with the ultrasound tech and she quickly confirmed that the baby is head down. Though, frankly, I could have told them that given the number of kicks I get in the upper left quadrant of my belly and the rock that's been sitting on my pubic bone and bladder for the past few weeks... She also confirmed that my cervix was long and closed (meaning we're still baking - no early dilation or labor) and that the placenta was not even visible on the ultrasound, meaning it's completely out of the way and in no danger of blocking the cervix. This is extremely important given that we are planning a birth outside a hospital. Having a placenta partially or fully covering the cervix means no exit point for the baby and necessitates a c-section.
So, good news all around.
But then the tech starts measuring the baby's head and femur (for size estimates), measuring the amniotic fluid levels and tells me that at 35 weeks gestation, the baby is measuring very large at over seven pounds. (At 35 weeks, he should be around five or five and a half pounds.) Since babies gain a half pound or more each week during the last month of pregnancy, this implies that I will have a 10+ pound baby in the end. Here's where the rant comes in.
I didn't ask her to do any of those things. That was not the information our midwives wanted and nowhere on my ultrasound order did it say "check weight and amniotic fluid levels". I came in with no symptoms that would warrant checking those things. I came in for a simple position and placenta placement check. That. Is. It. I'm fairly mad that she went out of her way to tell me, at 35 weeks pregnant, that I had a monster sized baby growing inside me. What am I supposed to do with that information?! I can't slow his growth. That would be dangerous to both of us. I have the healthiest diet of anyone I know, so I can cut out junk food because I don't eat it. So what am I supposed to do with the information? There are three choices:
1. Freak out about having to birth a huge baby and worry about it for the rest of the pregnancy and be terrified when I go into labor.
2. Bail on the homebirth plan and schedule a c-section because I'm afraid I'm growing a baby too big for my body to handle and it will be catastrophic if I try to birth the baby on my own.
Or 3. Ignore the tech, get mad that she is so ignorant and thoughtless as to give me such useless information and move on with my life knowing that those weight estimates are so uncertain as to be worthless information.
I'm choosing option number 3.
The second issue that upset me was the amniotic fluid measurement. First of all, we didn't ask for that. Second of all, this is another area where ultrasounds show their limitations. Amniotic fluid measurements are straight up voodoo, pure and simple. Any physicist (which I happen to be, thank you very much), or mathematician or engineer can tell you that estimating a fluid volume in an irregular space that is occupied by a body of unknown mass and dimensions is at best wildly inaccurate and at worst totally impossible. Particularly when you can't see the entire structure, which you can't in ultrasound. She thankfully didn't make any comments about my fluid levels, but partly because I told her I didn't believe her weight estimate because ultrasound was not an effective or accurate way to measure, and partly because Allen told her to not bother with all the additional stuff she was doing because we weren't interested in the information and didn't come in for that. He told her we wanted the ultrasound to be as short and non-invasive as possible. I'm not sure if she actually cut it short or if she just finished her routine without comment, but either way, I think we offended her a little bit. And you know what? I don't care. I mean, I know she was just doing her job, but the fact of the matter is that she (and other ultrasound techs like her) are part of the problem. They are part of the medical machinery that makes a 40% + c-section rate possible.
These little bits of "information", or really, "MISinformation" contribute to a model of care that is ultimately detrimental to women and babies. The further along I get and the more I see of how the medical community treats pregnant women and infants, the more I think this is fundamentally a human rights issue. There are countless women who are being forced into a model of care that has deleterious consequences on their health and the health of their babies, and because women are so vulnerable at this particular point in their lives, we feel (and sometimes are) powerless to stop the cycle of abuse that is happening. And I won't even get in to the money aspect. That's the shadowy spectre looming over this discussion that I haven't even touched yet...
Again, I'd like to point out that c-sections, ultrasounds and other medical technologies are amazing advances, and when used properly, have saved the lives of many, many women and babies. I know a few, myself, and am thankfully they had access to the medical advances we have in place today. My point is that these things are over-used, and not to our collective advantage. Using faulty and inaccurate data to diagnose and make decisions about medical care would be considered malpractice in any other field of medicine, so why are we allowing it during pregnancy and childbirth?
I don't have a good, succinct ending for this long post. These are questions I am struggling with every day. I'd like to help change the way women and doctors view care during pregnancy, but I am just one voice. And not the most eloquent one in the chorus. But it's clear that something has to change.
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