Expectations while expecting

Pregnancy is a common enough state of being, but if you stop and think about it, it is a unique state of existence- whether on physiological, philosophical or legal level.

I have wanted to blog about pregnancy for a while now- on the rights and responsibilities of a pregnant woman-as a pediatrician, and as woman who is ‘pro choice’ in the American sense of the word.

On Abortion Rights:

I fully support the right of a woman to terminate her pregnancy upto the period of viability. The age of viability is a medically determined goal-post that keeps shifting (it was 28 weeks a while ago, in certain countries it is 20, in some 22) and denotes the ability of the fetus to survive outside the uterus (with appropriate medical support).

I however do not agree with extending the right to terminate a pregnancy beyond the period of viability- even when the ‘rights’ of the potential human are non existent upto the actual birth. I cannot articulate why exactly I feel this way- morality perhaps?

It goes without saying that late terminations should be permitted when the life/health of the woman is at stake, or when the termination is sought for humane reasons- like birth defects which are fatal or incurable.

On harmful choices made before the baby is born

This includes smoking, drinking and substance abuse during pregnancy. All of these affect the fetus inside the woman, during its development inside the uterus and also its life once it is born. While I believe women should not be subjected to excessive ‘policing’ while pregnant, I have seen first hand the disadvantages some babies are born with, and this informs my views on this issue.

I think appropriate support should be extended towards women in order for them to make better choices and modify their harmful behaviour antenatally. Still, I  think children born with disabilities/disadvantages resulting from maternal alcohol/smoking/substance use should be able to sue their mothers in court.

A landmark claim in the UK is currently being filed to determine if compensation can be claimed from a woman (on behalf of her child) for drinking heavily during pregnancy, causing her child to be born with developmental problems.Obviously, fetuses do not (and should not) have rights, but children do, and all children were once fetuses, so it will be interesting to see if the law can ‘punish’ a woman for ‘poisoning’ her child when he was a fetus.

On choices made during labour:

I’m conflicted on this. Sure, it is the woman’s right to choose et al, but most obstetric decision making in labour is anyway centred first on the woman, and only switches to fetus-centered mode if there is no additional risk to her.

I’ve attended lots of deliveries as a pediatrician to resuscitate babies who were born in suboptimal condition BECAUSE the mother made an anti-cesarean choice in a desire to go ‘all natural’. In the quest for ‘autonomy’ over her method of delivery, I’ve seen a woman’s baby end up severely disabled for life- and it was heartbreaking and enraging, to me, as the baby’s doctor to know that the baby would have ended completely and totally FINE , if not for the C-section refusal.

Decision making goes hand in hand with taking responsibility for that decision, and while I’m sure there is a lot of guilt and horror on a woman’s part when avoidable damage is caused by her decision, the fact remains that it is primarily the child who has to live (or die) with the consequences of that decision.

I’m not sure how I feel about  seeing such children also empowered to take their mothers to court over cases where multiple healthcare professionals advise strongly against/for  an intervention and are over-ruled by the woman in question. I’m worried how punitive it can potentially become. I think holding the woman legally liable in unwarranted because the intent to harm is absent- that happens collaterally.

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I must clarify that these stances of mine are applicable only to normal pregnancies- and if there is any threat to the woman’s health from pregnancy or labour at any point, right up until the baby is physically outside her body, she (the woman) should come first, no matter what.

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10 thoughts on “Expectations while expecting

  1. As a mom who has gone through labor, I really cannot understand the stubbornness behind wanting your labor to unravel precisely in the fashion you constructed in your head. Especially when the cost is a child’s quality of life. I can understand a desire to have a natural birth but C-section is not some kind of failure at parenting.

    My only instructions during my labor were to keep me and my baby as safe and pain free as possible. Long live epidural!

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    • Well, I think that particular way of thinking stems from probably a sense of optimism and invincibility- that’s some what understandable? The truth is that it is literally science/modern medicine that makes childbirth ‘safe’- it is inherently fraught with danger for both mother and baby.

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  2. I’m pro choice, for me termination is upto the mom, until the time the baby is born . If i decided i didnt want to have a baby after the 20 week ultrasound then i should be able to abort, if i decide after 25 weeks then too it should be my choice, my body , mu choice. I should decide if i want to be an incubator or not right until the end. having said that i dont think i could go thru with an abortion ( yes yes i know , i’m a wimp)
    As for having babies at home, god the mess. I have OCD and love a clean home i dont want to waste my sheets on the ensuing bloody mess thank you. i did want the dr to try for a natural birth since I don’t want the pain and associated issues with a C-section, but then i agree it’s a medical decision best left to those poor souls who went thru the torturous medical course. but i did insist on an Epidural even when the dr was a nice sweet man who felt natural was best, he did try to dissuade me that my labor was really fast and i could manage without drugs, but then, could manage is a relative term, i didnt want eventhe possibility of labor pain. 🙂 so i got my way , pain free birth in a numb state 🙂

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    • “I should decide if i want to be an incubator or not right until the end.”

      In theory, I completely agree that if there was a humane way to do this, it would be perfect.

      In practice, I routinely care for babies who are born early- and that influences my stand 🙂

      At that stage, getting the fetus out of the body is not going to terminate the life of the fetus, and once outside the woman’s body -both medically and legally- it will be entitled to rights of its own.

      The other option is create a law that allows a doctor to actively cause the death of the fetus inside the womb at ANY point in the pregnancy- and I do not see this POV gaining much support from the people who will have to do these procedures. (I’m no obstetrician, but I would not support such a law as well).
      One reason for this is the nature of the procedures themselves- essentially injecting drugs to stop the fetal heart- which seems a bit cruel and not the kind of thing people went to med school to learn how to do.

      Having said that, I totally see your point, and I wish science would catch up to the point where women didn’t have to be ‘incubators’. In fact, that’s when I think I’ll have my first kid!

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  3. I had midwives deliver me, who were fantastic. They believe that pregnancy is a natural state and not a medical condition. My midwife practiced for 30 years and delivered thousands of babies and only once did her patient have to have a C-section. My feeling is that it should not be the first option, there are other options like having a chiropractor come to manually move the baby, water birth, and also changing positions during labour. I find that too many times doctors want to push C-sections.
    For my first prenatal care, I went to an OB, who at 5 months pregnant told me she was planning to give me a C-section if my baby weighed more than 7lbs. She did not even ask me my family background and that every baby in my family was 9lbs+. So I switched to a midwife and it was the best decision I ever made. I took charge of my own care, and I delivered my 9lb4oz baby naturally, with no medication, within 4 hours!

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    • @madhmama

      While I respect your choice to go with a midwife, I will have to point out some assumptions you are making while you made your choice:

      1. “They believe pregnancy is a natural state”. Proof should take precedence over belief. I can believe that pregnancy is whatever I want it to be, but the fact is that before modern medicine intervened, the #1 cause of death for women was pregnancy. Also infant mortality percentage was in the double digits. Those stats have since then come down to much less than 1% in developed countries.

      2. Realize that just like you believe the doctors and hospitals may have a hidden agenda to push C-section, midwives may also have a hidden agenda to push natural, hospital-free births despite the pregnancy warranting a hospital birth as they are also running a business.

      3. Someone I know also gave birth to a 9lb baby naturally. The baby suffered injury at the shoulder and as a child needed physical therapy to regain complete use of the injured arm. I am glad you and your baby are fine, but when a doctor suggests something, it would always be better to find out why. What is the average size of a woman’s pelvis? What percentage of natural deliveries with big babies go on without any need for intervention? How can we make a better decision about natural vs C-section?

      As for me, personally, I would go with someone who is more informed about my pregnancy and has the equipment and experience to deal with any adverse situation that may arise. And hospitals and doctors certainly fit my bill for those reasons.

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      • @ you should watch the movie “The business of being born“
        It is a common misconception that midwives do not have experience. Midwives in Canada are highly respected and are in place of doctors.
        A lot of women face extreme difficulties during birth because doctors intervene TOO MUCH, especially by giving them all these drugs to “speed up labour“. All of our friends in Canada have had midwives. And by the way – it is a free service. Medical care in Canada is free – so it is not about a business, like the U.S. medical system is.

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    • Well, I’m sure it’s very different in North America, but here in the UK, low risk pregnancies and deliveries are always managed by midwifery services , which are a part of the NHS.
      A doctor only gets involved if there’s a medical reason to do so, the midwives make referrals 🙂

      To me, that does seem like the best of both worlds.

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      • I am not against the choice of midwives. But I would definitely recommend a more logical thought process to arrive at a decision than an emotional one. If a doctor suggests a C-section it automatically does not translate into “doctors are bad”. If a midwife recommends natural birth, it automatically does not grant them sainthood.

        There seems to be a lot of focus on how to birth a child rather than the result – having a healthy child. And I see the focus driven by a lot of misconceptions – using drugs is uniformly bad across the board, OBs and hospitals are not considering your best interests, they just want to make money, etc while not having enough data about the midwives themselves and understanding that midwives have higher number of natural births because people with high risk pregnancies don’t go to them in the first place.

        There also seems to be some kind of perceived moral superiority associated with unassisted births. My colleague was proudly going on and on about how his wife labored for 24 hours without any kind of pain relievers or assistance and all I could think of was why? Did they have a better child because of it? Did they become better parents because of it? Did they get more points in whatever game they were playing because the labor was longer?

        In North America, atleast in my experience, there were no midwives associated with my hospital. It is a decision a individual has to make – midwife OR hospital. UK certainly seems to be the best of both worlds.

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