Monday, October 10, 2005

Close only Counts in Hand Grenades and Horseshoes

I'm embarassed to link to USA Today, but they had a fair article yesterday on the differences between Near-Term and Term babies.

They're not quite full term, but they're not that premature. They're "near-term" babies, born roughly four or five weeks before their estimated due date.

They typically have normal Apgar scores, used to evaluate newborns' physical condition. Their birth weight is in the normal range. They usually go home with Mom. Most people think they must be healthy.

And generally they are. But research suggests that appearances might be deceiving in some cases. Though near-term babies on average are healthier than preemies, they may not be quite as healthy as full-term babies.

I feel like I've read about this somewhere before -- heck I probably blogged about it and forgot! Anyway, as interesting to me as the relative immaturity of near-term babies, is the motivation for studying them:

Pediatrician Marvin Wang says he became interested in studying near-term babies a few years ago after an obstetrician colleague asked about the merits of scheduling cesarean sections before the 37th week of gestation, when babies are considered full-term.

It's rumored that some celebrity moms have asked to deliver their babies via C-section a month before their due dates to get a head start on slimming down, says Wang, co-director of the newborn nursery at Massachusetts General Hospital.

He says celebrities aren't the only mothers asking for C-sections before 37 weeks. Indeed, research suggests that "patient-choice" C-sections are on the rise. Wang says comments he has heard suggest that some might be scheduled too early so Mom can fit maternity leave into her work schedule.

What needs to change in our culture for people to accept birth as a process we can't control? The same mindset that leads some women to ask for an elective surgical delivery at 36 weeks' gestation is the same one that leads other women to sue when an unhealthy baby is delivered.

There are no guarantees in birth. Quite the opposite in fact. Birth is an unpredictable and sometimes risky proposition.

But so much is made of our ability to control reproduction -- its prevention and occurrance, the starting and ending times of labor, the pain associated with labor, early determination of the gender and genetic profile of the baby -- that the "natural" (i.e. unpredictable, unforecastable) aspect of pregnancy and childbirth is forgotten.

This reminds me of a family in the town where I grew up. They had a pet cougar. They had raised it from infancy and had it declawed. Their yard had a high fence, through which you would see the adults wresting with the cat in play. You would also see them rubbing it, much as you would a cat. Then one day it saw the neighbor boy running in his back yard, jumped the fence, and nearly chewed off his leg before they got the boy away. I babysat him. His leg is scarred for life.

Now this could have happened to the boy anyway. If he was hiking in the west, say. It would be sad no matter the circumstance. But it was more shocking for the friendly situation suddenly turning violent, the animal you've petted and fed suddenly ripping muscle from bone.

We need to keep in mind that pregnancy may be profiled and measured, labor started and stopped, but the process still has teeth and will occasionally bite people. There is no way to avoid it. Premature babies will be born; congenital defects will happen. But we can avoid creating bad situations by respecting reproduction's wild and natural origins.


Blogger I am a Milliner's Dream, a woman of many "hats"... said...

This is a great post, (again) and I still can't wrap my head around why people--the medical folks willing to do Cesarean's without good medical reason, and the women who want those elective Cesareans--are unwilling to let things happen in Birth's own time. Why not trust birth and the women's body and only intercede if necessary? Oh, I know, I'm preaching to the choir...but what is so hard to understand about this?!

3:00 PM  
Blogger Kim said...

I am horrified by this. Not by the vanity of the women, that sickens me. I am horrified that there are doctors out there who will agree to these asinine requests.
Every single birth is a miracle, not something to be penciled into your Palm Pilot. How sad. After reading yours and Hannah's blogs, I bet if I had a doula at my last birth, I would have been able to do the Vback. I'll be making sure my daughters know that doulas are out there (I don't think I'd be a good one, being da mom! LOL)

2:40 AM  
Blogger Julie said...

I agree, it's both sickening and horrifying. I just don't get it.

11:50 AM  
Blogger alicia said...

The illusion of control over reproduction, from timing of conception to planning births to fit an artificial schedule, is a pervasive and sick part of our culture.

9:41 PM  
Blogger D.P. said...

Wow . . .I don't understand this, and I gained 60 pounds with my son (and went a week past my due date!)

9:00 AM  
Anonymous Anonymous said...

Aren't doctors the ones who are most guilty of altering nature's time table to suit their own schedules? the routine administration of pitocin, "accidental" breaking of waters--maternity wards are full of stories of doctors who "get the show on the road" in order to make golf games or flights to vacations.

Why all this vitriol towards patients? After all, it's their bodies?!

10:46 PM  
Blogger cathyf said...

The flip side of this is the utter ignorance and stupidity of doctors when it comes to due dates. I used to hang out at a large site for breastfeeding moms, and the amount of sheer stupidity I read there was amazing, especially considering that this is not complex medical stuff but pure common sense. No, not every woman ovulates precisely 14 days after LMP, and a baby born 37 weeks past LMP could be significantly premature. Or that woman who is still pregnant at 41 weeks past LMP may still be barely at term.

I don't know how many times I tried to explain that if the only time you had sex since your last period was in the last 5 days, and you think that your period is late and you are pregnant, that you can't be both late and pregnant. You may indeed be pregnant, but you won't be late (and you shouldn't expect a positive pg test) for another 9 days or so.

I constantly told women to lie about LMP if they knew when they ovulated. I told them to take the ovulation date and subtract 14 days, and tell them that. And once it is inscribed on her chart it will become Holy Writ. Yeah, lying to your doctors, nurses, midwives, etc. is generally bad form, but sometimes it's the difference between life and death for your baby.

If you have a mom whose cycle is 9 weeks long, and she gets to "45 weeks," goes into spontaneous labor and gives birth to what appears to be a not-at-all-overdue baby, a stuck-on-stupid OB who can't see beyond the LMP will simply be amazed and confused. But a doc who thinks elective c-sections at 36.5 weeks are a just fine-and-dandy idea could very well kill the poor 31.5-week preemie.

cathy :-)

12:51 PM  

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