From the category archives:

Managing risk

Alcohol and pregnancy

by Milton on Fri, Feb 26th, 2010

in Managing risk,Research,Week 29

It’s true that drinking during pregnancy is seen as a big taboo, and part of the reason is the lack of information about the causes, risks, and chances of Fetal Alcohol Syndrome along with the rather scary warnings in pregnancy books and on pregnancy websites.

Here are some interesting numbers that I got from this article called “Fetal Alcohol Syndrome and the Social Control of Mothers“:

  1. Only 5% of alcoholic mothers give birth to babies who are later diagnosed with FAS.
  2. Drinking alcohol, while a requirement of being diagnosed with FAS, doesn’t seem to cause FAS by itself.  Other environmental factors needed include smoking, poverty, malnutrition, high parity (i.e., having lots of children), and advanced maternal age.
  3. There is a genetic component to FAS that makes you more or less susceptible to FAS.
  4. Almost all public health campaigns, whether sponsored by states, social movement organizations, public health institutes, or the associations of alcohol purveyors tell pregnant women not to drink alcohol during, before, or after pregnancy… at all… or else.
  5. Women are being blamed for FAS, even though they do not cause FAS, and neither does drinking alcohol (by itself).
  6. Very few women drink at the levels correlated with FAS, even when they aren’t pregnant.

So, the question is, are the FAS campaigns by all of these organizations merely another way for society to blame women for something bad that might happen?  To treat pregnant women as women with some kind of problem that needs to be “fixed” by hospitals, doctors, professional advise, and medication? Why does our society do this to women, and what can we do to help be a little more rational and fair to women and less scared, protective, and controlling?

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I read Jenny McCarthy’s Belly Laughs book a couple days ago.  Wow.  It’s scary to think that she’s encouraging women to act like her, in my opinion.

On the other side of the spectrum, we watched the Business of Being Born last night.  That’s a pretty great documentary.  I think it was meant to be controversial, and to show the worst of hospitals, and I don’t think all hospitals are as ignorant and backwards as the ones depicted (Seattle’s Swedish, for instance). However, I think the fact that more light should be brought to the midwifery traditions and practices is definitely called for.

According to our midwife, that documentary and the book Pushed have both contributed to a surge in business for midwives in the last few years.

Only 1% of births in the United States are done via midwives, and only a fraction of those are home births.  Seattle’s a little different, and actually has between 4-7% of births through midwives.  I think it might be because of the better insurance policies that allow them to be covered.  So hopefully this number will grow.

One of the great and unexpected things about The Business of Being Born is that the film-maker is pregnant during the making of the movie.  Of course, after all this talk about home births and everything, she ends up having pre-term labor and a C-section at a hospital, and had to keep her baby in NICU for 3 weeks.

The reason I think that’s great (in the documentary’s sense, not in the sense that the baby had such a scary beginning) is because every doctor in the movie is like “what if something scary happens?” and this is the answer… you go to the hospital.  Hospitals aren’t inherently bad, it’s just that they are designed to deal with emergencies and dangerous medical conditions.  Most births, however, are not in this category, and could just as easily (and some argue more safely and nicely) be handled outside of the hospital system.  For the 10-15% of births that have complications, it’s awesome that hospitals are there to help, and this fact has a lot to do with the lowering maternal mortality and baby mortality in the last 100 years.

Anyway, it’s just so interesting to think about all of this.  I keep trying to remember how we first started down this midwife/home birth track–I remember being just as pro-epidural as the next person before Esther got pregnant.  We are trained to be afraid of birth.  And, as the non-participatory husband, of course fear is even more justified because all of this is happening to Esther, not me, and therefore the lack of control is scary.

This is merely how I feel now, and reserve the right to change my mind at any point along this pregnancy.

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The description from Baby Center about what Nuchal translucency screening is:

This prenatal test (also called the NT or nuchal fold scan) can help your healthcare practitioner assess your baby’s risk of having Down syndrome (DS) and some other chromosomal abnormalities as well as major congenital heart problems.

The NT test uses ultrasound to measure the clear (translucent) space in the tissue at the back of your developing baby’s neck. Babies with abnormalities tend to accumulate more fluid at the back of their neck during the first trimester, causing this clear space to be larger than average.

The NT scan must be done when you’re between 11 and 14 weeks pregnant. (The last day you can have it done is the day you turn 13 weeks and 6 days pregnant.) It’s usually offered along with a blood test in what’s known as first-trimester combined screening.

Like other screening tests, an NT scan won’t give you a diagnosis. But it can assess your baby’s risk for certain problems and help you decide whether you want to have chorionic villus sampling (CVS) or amniocentesis to find out whether your baby is actually affected.

The NT scan has been performed in the United States since 1995, mostly at large medical centers. Ultrasound technicians (sonographers) and doctors need special training and high-resolution ultrasound equipment to perform it correctly. They must be certified by the Fetal Medicine Foundation in London, the organization that sets the international standards and provides the software that enables a doctor to evaluate your baby’s risk.

I sense that this test is the beginning of many ways that we’ve introduced new ways to worry about pregnancy. The desire to know everything comes from the fear that something scary will happen with the pregnancy.  But, strangely, because of the nature of these results, knowing more in many cases only causes you to worry more.  Not only that, but doing these tests costs money and also increase the chance of miscarriage.

Another statistic, mentioned in last week’s This American Life, which focused on America’s health care system, is that up to 33% of our medical procedures are not needed.  Because we feel like the insurance companies charge us too much, we in turn try to run up our hospital bills with costs to justify the big spending, which in turn makes us a country that spends a lot on health care but isn’t any healthier.

I suspect that the infinite number of blood tests, screenings, etc are a big part of that 33% of things that don’t need to happen.  Less is more.  By avoiding these tests, I will be saving money (our health insurance has a $3,000 deductible and only covers bills 80% after that, so costs are very real to us), we will be avoiding procedures that increase the risk of problems, and in the meantime we won’t have to worry about ambiguous results and statistics and false reasons to worry.

What do others think about this?

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Fear and relief

by Milton on Fri, Sep 25th, 2009

in Managing risk,Week 08

Yesterday, Esther woke up and let me know, casually, that she didn’t feel sick or any of the other symptoms of pregnancy.  Her boobs didn’t hurt.  She didn’t want to puke.  Our sense of right and wrong has recently been inverted… the worse she feels, the better we assume things are going.  It’s a little twisted, I guess, but I hear many of the same sentiments on the baby boards.

Later in the day I got a text informing me that she was going to go to the doctor.  I was at work, and immediately had a sinking feeling.  Perhaps because I had this sinking feeling last time, I was already well trained in the full mental exercise of fearing a miscarriage.  It was the saddest, sinkingest, feeling.  Of remaining hopeful while also gravely afraid of what might happen.

For about an hour and a half, I stirred.  Esther was finishing her client and I had very little information, so I decided to go for a walk, and head up the hill to the doctor’s office. The sun felt good. I wanted to soak up the sun and make it replace the sinking feeling. I distinctly remember feeling that desire for emotional replacement.

I also had this strange new reaction that I never had before. I saw people with kids on the street and had the smallest twinge of resentment for them. The ease that they went about their days. Of course, it’s all an illusion, and I was merely projecting a crazy scenario on an unwilling demographic, and I caught myself and tried to correct the impulse almost as soon as it occurred, but it occurred anyway.  Weird, right?

We arrived at the doctor’s office and after tracking down our new insurance info (we don’t have cards yet, for some reason) I hustled into the ultrasound room where I was immediately informed that the nurse had found a heartbeat and our little embryo was doing just fine.

RELIEF.

Despite my hope, I was actually expecting the worst, and only upon realizing that things were good did I let myself actually consider the thought that this was going to turn out okay. They say that after you can find the heartbeat that chances of miscarriage are 3-5%.  Much better than the 6-week estimate of 10% (or 13% in the case of those who have had miscarriages before). And, our first ultrasound wasn’t scheduled for another 3 weeks… so, in a way, I was really glad that we got to come in sooner and experience the heartbeat and have our most risky statistics reduced just a bit.

Statistics roulette.

I’m so glad there’s a little heart beating in there.  Somewhere in the 131-139 range (both Esther and I heard different numbers from the nurse).  Estimated to be at about 6 weeks, 5 days by length, though that’s about 1 week younger than we had originally estimated from her last menstrual cycle. Totally okay though, cause there’s a heartbeat.

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From 5 to 10 weeks in utero, your baby is developing his or her BRAIN.  This is scary to me.

We are in the 7th week of our journey.  Not even a quarter of the way there, and already there is a brain inside my womb, developing.  This brain will dictate my child’s emotional and intellectual status.  Any damage I inflict on this precious brain could reflect badly on both my child and myself, forever.  Right?

While I intend to have a European pregnancy, allowing the occasional glass of wine and loosened rules about cheese, lunch meat, etc, I am being sure to be strict in the first 12 weeks of this pregnancy. After having a miscarriage 6 months ago, I’m also being careful to follow all the food recommendations- which is pretty easy, since my main craving is for greens and I’m already a fish oil devotee, anyhow.

I am worried about a few of my habits, though.  Namely, I have been taking Claritin every day for about 3 years now.  I developed an allergy to my beloved cat about that long ago, and found that a Claritin a day pretty much eradicated  any problem.

Claritin is classified as a class B pregnancy drug.  This basically means that it is not recommended, but only because no studies have been done.  It is probably not harmful, but should be taken at one’s own risk.

If I stop taking the Claritin, I instantly become super allergic to my poor kitty.  Now, I promise that this kitty will be the last kitty in a the short line of kitties that I have mothered.  I’ve known this for a long time.  Once she is gone, there will be no other kitty until I can fork over $5,000 for a kitty that is completely hypoallergenic.  Fine.  But, in the meantime, I am dedicated to this cat.  I love her little snuggle face!  But, what will taking this drug do to my developing baby?

I’ve cut back my pills to only taking one every other day, and with fish oil.  I haven’t had a doctor’s appointment yet to find out exactly what my doctor says… but have done a ton of inconclusive research.  I feel guilty pangs every time I take that little pill… much like the guilty pang I had the other day at my neighborhood coffee shop when I realized HELLO I AM PREGNANT AND EATING A CAKE THAT IS SOAKED IN RUM.  Geez.

In the meantime, we are addicted to watching Mad Men on AMC and I am always moved by seeing Betty Draper looking fabulous while pregnant, smoking, and drinking unlimited glasses of wine.  It seems that that generation didn’t have issues with ADHD, FAS, or any of the other childhood ailments that plague modern society.  Heck.  That child probably grew up to be a doctor or a laywer.

Whatever.  Claritin can’t have anything on the Demerol that Betty Draper was shot up with during her delivery.  Right?

UPDATE- I spoke with a nurse at my obgyn office this afternoon and got the green light to take Claritan.  Betty Draper, eat your drug and alcohol addled heart out!

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Is it worth the risk?

by Milton on Wed, Sep 16th, 2009

in Managing risk,Week 07

Okay, I admit, I’ve been hanging out on community baby boards.  There are some 2,000 people in my month alone (May 2010)!

It’s pretty addictive to be in a community of 2,000 people who are all going through the same anxiety, excitement, learning, uncertainty, etc as I am at the same time that I’m going through it.  Other than that one major thing we have in common, I would say that I’m in the huge minority as far as being a dude, and then things like age, number of previous children, ethnicity, political views, economic status, etc are all over the place.

I think it’s actually really interesting to participate in the group… unlike anything I’ve experienced before.  Such a high level of interest, opinion, emotion, and yet also so much we don’t know!

The fact that most of us are newbies as far as pregnancy is concerned, and that we’re all equally emotional about it, leads to some seriously interesting conversations.  Some of them are enlightening, and others are scary.

One trend I notice is that there’s a lot of both opinion and sensitivity around the issue of what’s safe for the pregnancy.  Topics like whether or not you should get a flu shot, for instance.  Surprising to me, 50% of the people in the group are going to avoid the flu shot even though almost all medical literature recommends it.  The US Center for Disease Control and prevention, for example, recommends that pregnant women get the vaccine as soon as it’s available.

That particular issue is evenly split.  Others, like whether or not to drink a glass of wine, are more weighted on the side of being “okay in moderation”.  And then there are things like smoking pot that got one unfortunate lady practically excommunicated from the message board for her naive question about whether or not it was okay to smoke pot.

Through them all, there’s the constantly re-iterated judgment on whether or not a particular behavior is “worth the risk”.  Because, it turns out, almost nothing is conclusive.  Everything is a risk.  And some risks are more worth it than others.

Getting in a car and going to the hospital, for example, is a risk.  But it’s deemed worth it because it’s a very difficult risk to avoid.  Our culture deems it okay.  Not getting a flu shot is sometimes deemed worth it because, perhaps, you’re a SAHM (stay at home mom) and you figure you won’t be in much risk of catching a flu from someone.  Or, you believe that the vaccine actually causes you to get sick (a popular anecdote).  Or, you think that there might be long-term unknown consequences (and assume that those long-term unknown consequences are greater than the unknown long-term consequences of getting a flu during pregnancy).  It’s a bit more even, even though the actual risk being deemed worth it or not is probably the main factor in the decision.

Some people love Diet Coke or Diet Pepsi, and for them that risk turns into something of a guilty pleasure.  Same with a glass of wine, or a piece of sushi.  And then there’s the risk of more minor bacterias from cold cuts or hot dogs that are pretty much swept under the carpet because they’re cheap eats.

I’m fascinated by the idea of risk and the way that we justify it.  Pregnancy is one of the scariest gambles we take due to beginning with such a fragile little being with such a high chance of something going wrong, on top of all of our hopes to start or continue growing a family.

I’m very interested in documenting the kinds of risks that face pregnancy, and also judge them on whether they’re acceptable or unacceptable risks, how our culture judges the risk, how emotional the decision is for different groups of people who might be more attached to the risk, etc.  For now, I simply want to bring it up as an area of discussion so that I can become more aware of my own biases, my own desire to ignore certain big risks that I’m personally attached to, and also to my own judgment of others who take risks that I’m not personally attached to.

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