Saturday

thinking about pregnancy

Here is some more info on my decision to forego routine gestational diabetes testing (which is not routine in many other developed countries with better birth outcomes than we have, by the numbers)

ARTICLE 1

ARTICLE 2

Of course, I will have the test if any syptoms of risk factors develop, and maybe even if my midwife just feel really strongly about it and urges me to do it. But at this point, I am leaning toward no.

I have had a lot of screening testing in all my pregnancies, and even more in this one due to my "advanced maternal age" and my recently-discovered thrombophilia gene mutations. I am not opposed to screening tests I believe serve a purpose. But I am trying to have a pregnancy/birth where I feel like I am making truly informed, empowered decisions at every step. Sometimes this may actually involve asking my doctor or midwife for MORE testing. For example, I have read the research and ultrasounds don't worry me, so I have no problem asking for one if I have a concern or worry the ultrasound might alleviate.

But I am not willing to just blindly go along/get along - either direction.

Another example: I wasn't going to be able to have the birth I want with the perinatologists I was seeing because of how and where they deliver babies. So I spoke up to them about this and they were very open to working with midwives at another hospital to make sure I get what I want. I am glad I spoke up and didn't just accept what appeared to be the only option. I feel really good about taking some control over my care, and I continue to feel like I am still in very good hands for both my routine care (certified nurse midwives), as well as for any back-up or more advanced care I might need (my perinatologists).

For my birth, I plan to be assertive about what I do and do not want, recognizing that sometimes I may have to trust the judgment of my caregivers if they say I really do need to have some sort of intervention I would ideally like to avoid, like continuous fetal monitoring.

On the other hand, I may choose one intervention in particular - an epidural - that my midwives don't generally offer, because for 95% of their births, they are working in a freestanding birth setting rather than at the hospital where I will be having my baby.

Bottom line: my body, my baby, my brain, my birth, my decisions. We are lucky to live in an age where good info about pregnancy and birth are available to most women in the U.S., if they know where to look. I am lucky enough to have health insurance that allows me some choice and flexibility in choosing the caregivers I really want, so I know that I can trust their judgment and guidance in deciding how my care will proceed. And I am also lucky enough to have a husband who is equally involved in making pregnancy and birth decisions, but who supports my right to "drive the bus," as it were.

You might make different decisions for your own pregnancy, and I may make a misstep along the way, but at least I'm thinking as I go.

15 comments:

Anonymous said...

"Bottom line: my body, my baby, my brain, my birth, my decisions. We are lucky to live in an age where good info about pregnancy and birth are available to most women"

And yet you routinely berate women who make choices that are not the same as yours. Why is that? For example breastfeeding. You feel very strongly that it is the only way, and women who do not bf are not good mothers. Yet you yourself are choosing to not have a test that could in fact protect your unborn child...cool.

helen said...

I really admire your skills in managing the health care system. I was so nervous during my pregnancy and I think I let a lot of "what if" fears drive me into sometimes not making the best decisions for me. If I am able to have another it will be a totally different experience as I feel much more confident and empowered about the birth process now.

katie allison granju said...

Uhhh...I challenge you to find a specific example of me saying in any context that women who don't breastfeed "aren't good mothers."

And if that's the case, then count me among the ranks of bad mothers, since I didn't breastfeed my oldest son.

And in any case, you are trying to compare apples and oranges: declining a routine screening test of debatable value in the absence of any risk factors or symptoms does not equate with deciding on the primary food/nutrition/immunological source that I will put in my child's body for the first two years.

How a woman chooses to feed her baby is ultimately her decision. I've never said otherwise and never will. I happen to believe that a lot of women make that decision without all the support and knowledge they need to make a truly empowered, informed decision. But if after weighing all the evidence, a woman decides not to breastfeed, that's her business.

However, I will continue to advocate publicly and privately for cultural and institutional changes that will increase breastfeeding rates nation-wide, because baed on MY reading of all the evidence, and based on my own experience as both a formula-feeding and breastfeeding mother, I believe we will have healthier babies and women with higher rates of breastfeeding.

uumomma said...

long sorry!
Hear Hear Kate!
I love what you said and that you backed your self up with information as to why you are making this chose
Personally I think that “anonymous” is just some gross troll.

Anyway, I am at week 16 of what is a very high risk pg. I have had a U/S every two weeks and will cont. to have them till she (yes we know itsa she) arrives via planned c-sec sometime in the beginning of Sept. it is cool to have this prenatal scrapbook.
I have no say at all for this birth...anything, nada! I.e. On Thursday I asked if we could at least let the cord stop pulsing and my Perinatologist said...no Erika you’re a bleeder. To dangerous. She was wonderfully kind and she very supportive I just love her! It does sort of suck still

But Kate I am so happy that you are having the birth you want! YAY!

Continue to make the choices that work for you and you family for us moms who can’t!
But I can and I will say “no” to gestational diabetes testing as well because I can!

you go girl!

Hay Kate, did you/will you vaccinate

Erika

dewi said...

Kate
I hope that by sharing your research and polite explanations to the alarmist anonymous posters it is educating to everyone how to make an informed decision related to pregnancy and birth.

Keep on teaching the masses, you're truly gifted at educating as you learn and make your own informed decisions!

dewi

Laura Linger said...

According to Bill Maher's show a couple of weeks ago, The United States ranks 55th among our planet's nations in infant mortality rates.

55th.

I find that as frightening as I do upsetting.

Laura Linger said...

According to Bill Maher's show a couple of weeks ago, The United States ranks 55th among our planet's nations in infant mortality rates.

55th.

I find that as frightening as I do upsetting.

Whatever we are doing as a country for our nation's children...it ain't working. Perhaps if we shifted our focus away from unnecessary testing and made moves toward guaranteeing quality care for all Americans, regardless of social status or household income, that ranking might change.

Laura Linger said...

According to Bill Maher's show a couple of weeks ago, The United States ranks 55th among our planet's nations in infant mortality rates.

55th.

I find that as frightening as I do upsetting.

Whatever we are doing as a country for our nation's children...it ain't working. Perhaps if we shifted our focus away from unnecessary testing and made moves toward guaranteeing quality care for all Americans, regardless of social status or household income, that ranking might change.

Anonymous said...

and how does that mortality spread out? Is it reasonably well educated married women who take care of themselves and eat reasonably well and aren't bathing the baby in chemicals throughout its gestation? Or is it sixteen year old meth addicts? Or might the statistics include everyone who pops a baby out no matter what? Statistics can be EXTREMELY misleading.

Anonymous said...

Katie-

Glad to read that things are falling into place as you prepare for the arrival of your new baby. I, too, dealt with the added "risk" of a couple types of thrombophilia during my last pregnancy.

Since you are research oriented, thought you might want to educate yourself on the many risks of the epidural (c/s, fever in mom and then antibiotics for the baby, breastfeeding problems, and the many interventions that often follow....)

http://www.icpa4kids.org/research/pregnancy/drugs_labor.htm

http://www.healing-arts.org/mehl-madrona/mmepidural.htm

http://www.childbirthsolutions.com/articles/birth/epidural/index.php

http://pregnancytoday.com/experts/a-epimedcross.htm

I know that there is a ton more out there. You seem very educated on so many other parenting/child issues and I am surprised that you are considering an epidural. I HIGHLY recommend the Bradley classes and at the very least read the books. The hubbies/so is VERY involved and it is an amazing experience.

Clisby said...

Infant mortality varies widely among racial/ethnic groups in the U.S., with the lowest rate among Asian/Pacific Islanders, and the highest among blacks. Whites used to have a slightly higher mortality rate than non-white Hispanics; I'm not sure if that's still true.

I don't know how it spreads out amont economic groups.

Denette said...

Have you decided to have a birth at the hospital with midwives? If you have I would be interested to know who your midwives are. We are doing a homebirth right now, a VBAC homebirth but I would like to know if we have to transfer to hospital what midwives are avaliable.

katie allison granju said...

I am using the certified nurse midwives at Lisa Ross Birth and Women's Center in Knoxville. They have hospital privileges at St. Mary's Hospital, also in Knoxville.

Sarada said...

"Yet you yourself are choosing to not have a test that could in fact protect your unborn child...cool."

Protect the unborn child from what? This isn't some sort of magic test. You give the baby a massive dose of sugar. If you have a particular range of blood sugar level, they give you a special diet to follow. Only, it isn't really a special diet, it's just a healthy diet. In a few cases, you take insulin injections.

The only point is to try and prevent a big baby. This is not a test which is going to prevent anything. It isn't even going to result in a dramatic uterine surgery which cures the child of her spinal bifida.

The baby isn't going to explode if she doesn't have the test. It will be okay, Anon, really.

As for those who are doubting the assertion that we really don't have the best medical system in the world, well, it isn't just among teenage drug addicts. The World Health Organization is very clear that while we might be most technologically advanced, our outcomes are universally worse than every other industrialized nation, and several that we wouldn't really consider industrialized.

Clisby said...

Perhaps there is some confusion about the difference between true diabetes and gestational diabetes. True diabetes is, as one poster on another thread put it, nothing to mess around with - pregnant or not. The condition labeled "gestational diabetese" is way different.