Archive for 12 June 2009

How to talk to pregnant friends (part 2 of an occasional series)

Here’s a conversation I had recently with a pregnant friend (37 weeks at the time). She’s doing the standard OB-hospital route, although she has hired a doula and is planning a natural birth, and she knows I had a homebirth with a midwife. We were sitting on the T when she brought this up.

Friend (casually): So, when you saw your midwife, did she, like, do exams and stuff?

Me: Sure, yeah, she examined me–she’d palpate my belly, listen to the heartbeat, all that stuff.

Friend: But did she do pelvic exams?

Me: Oh. Uh, no. I think like way into labor she checked my cervix once, but she asked first, and then it was only about five hours before I had the baby. Why? Are you getting pelvic exams?

Friend: Oh yeah, and yesterday the doctor couldn’t even find my cervix–which is fine. But it hurt!

Me (thinking very very fast): Wow, well, that’s no fun.

Friend: No, it was awful! I was like, gee, if there’s this much pain just from her fingers, then. . . 

Me: So wait, what was her reasoning about why she needed to give you the exam?

Friend: Well, you know, she was doing the Strep B test and I guess she figured she might as well check my cervix while she was down there. . . 

Me: Huh. Well, you know these exams really don’t tell you anything right now. 

Friend: Oh, right, I know–I could be walking around at 3 cm for three weeks.

Me: Or you could be completely closed at your last exam and start labor that night.

Friend: Right, sure. But I’m going back on Friday and I just know they’re going to do another one.

Me: So, you don’t have to agree to these exams, you know, since they don’t really tell you anything, and since they’re so uncomfortable.

Friend (uncertainly): Yeah. . . 

Me: I mean, you could just say, “No thanks, I’ll skip the pelvic for now, I’m good,” or something like that.

Friend (even less certainly): Uh huh. . . 

At that point we had to get off the T, and we never really picked the conversation back up.

This was a really hard conversation for me, though, and it represents on a small scale my problem with the medical approach to birth (vs. the midwifery approach). First of all, there’s the issue of trying to justify an invasive, physically uncomfortable procedure which has no clear benefits. Then, there’s the psychological impact of these cervical checks–right away they put the woman in the passive role of patient and the doctor in the more powerful (and clothed!) position, and then beyond that, if a woman hears that her cervix is completely closed, she may start to doubt that her body will ever begin labor naturally.

Furthermore–not to be too cynical here–after reading hundreds of Internet birth stories, I can say that many women who have become accustomed to routine cervical checks at their 37-, 38-, and 39-week appointments report that at the 39-week or 40-week appointment, the cervical check is suddenly, sharply, much more painful than before. When they question their doctor, he/she typically says something like, “Oh yeah, you were at a 3 but I stretched you out to a 4 so don’t worry, we can get you admitted to the hospital and induce labor now,” or “Oh, don’t worry, I just swept your membranes so we can hustle this baby along.” These procedures are now even more invasive, and are often performed without a woman’s knowledge (much less consent!), because the woman has been conditioned to relax passively while the doctor just does his/her thing inside of her.

As you see, I didn’t say all of this to my friend, but her extreme reluctance to even consider declining a procedure–or, for that matter, even just asking the doctor to explain her reasons for the procedure–suggests she would not have been open to this line of thought.


12 June 2009 at 9:32 am 1 comment

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June 2009