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Prenatal Care... Necessity?


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  #1  
October 15th, 2010, 03:57 PM
Melliesbelly's Avatar Mega Super Mommy
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(I also posted this in Pregnancy as well, but since I'm really intent on having a natural childbirth, I figured this would be a good place for it as well, and to go into a bit more detail)

First... No judgment!

I'm just curious, honestly. This is my first pregnancy, and I don't really know what to expect. I've read so much recently about natural and unassisted births, and it's leading me to question everything I've thought up to this point about pregnancy and childbirth.

So, my question is... Can you care for yourself just as adequately as a doctor/midwife can during pregnancy? Diet and exercise is paramount, or so I've read, but that sort of thing is something only you can really control. Of course, you can't give yourself an ultrasound , so there's that... But, assuming you are a healthy individual with no history or family history of anything to the contrary, then u/s is more of a luxury than anything else, maybe...?

I keep going back to the fact that women have been getting through pregnancy since the dawn of time, and are fully equipped to deal with it all on their own. I don't know. Hm.

I'm just sort of thinking aloud here. Please chime in with your thoughts.
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  #2  
October 15th, 2010, 04:42 PM
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Personally I wouldn't recommend it. I had some bad experiences before my successful pregnancy w/ Ethan. My first pregnancy was molar & was diagnosed at 8 weeks during a routine ultrasound. That means there are serious genetic abnormalities w/ the embryo, in my case 2 sperm entered the egg. The embryo develops into a mass & can turn into cancer. It had to be removed surgically & if I had not been under standard medical care it could've been very dangerous to my health & future fertility. I had no symptoms out of the ordinary.

I also had an ectopic pregnancy. That could've killed me w/o treatment. I often wonder how many young women died from internal bleeding due to an ectopic prior to modern medicine.

My point is that yes, women have been giving birth forever & long before modern medicine. However, a lot more women & babies died. In my opinion, prenatal care is important for your health & the baby's. It is worth the time & effort to find a provider that you like & are comfortable with. One that supports your decisions & looks out for your well being. There are medical professionals out there that will support your wishes for an intervention free pregnancy. Their job is to make sure all does go smoothly & catch any potential problems before they become life threatening. It is your decision, but forgoing all prenatal care is not something I'd be comfortable with.
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  #3  
October 15th, 2010, 05:00 PM
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I thought that a lot of it was unnecessary just to make the doc feel better..... until everything started going wrong. I'm very grateful to have the ob that i had.

I was hospitalized with preterm labor, ended up on bedrest, hospitalized again. Had blood pressure issues etc. I truly believed my ending would not have been as happy, had i not had regular care. You just can't plan for these things. Luckily with bedrest and treatment, my son was born healthy at 39 weeks.
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  #4  
October 15th, 2010, 05:19 PM
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Sure. I know women that UP or shadow care. I would definitely have the early u/s for peace of mind and the level II u/s to detect or rule out anomalies.

Other than that, you can check your own BP, perform a urinalysis, check baby's heart tones, palpate your fundus/check fundal height, weigh yourself, check your glucose levels. You can have your labs done. You're limited in the same way a homebirth midwife is limited (no access to ultrasound).

There wasn't anything done at my OB/CNM visits that I can't do myself. I only recall having maybe two urinalyses done with my first two when I was seen at a clinic. My CPMs with ds1 and ds2 did it at every visit.

I prefer midwifery care because I like the relationship and care I receive, but I'm fairly capable of managing basic prenatal care. If there's a problem you get checked out. If you experience signs or symptoms of pre-e you should see a doctor. Same for things like preterm labor.

I can't say I would be comfortable UPing with a first baby. I know some do, but most of the UPers I know already have children and some pay a visit to their GP a few times throughout the pregnancy.
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Last edited by Aeterna; October 15th, 2010 at 05:24 PM.
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  #5  
October 15th, 2010, 05:23 PM
horseradishmayo's Avatar Platinum Supermommy
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i do think it's important to have blood work done at some point during pregnancy. i had no idea i was extremely anemic until i got my blood results back from the lab. i was very tired (way too tired for the 2nd trimester - like i could barely keep my eyes open). now that i am taking iron i feel great and have way more energy.
had i not known i was anemic and something bad happened because of it i would feel so guilty.
that and having your urine checked for protein, to avoid pre-eclampsia are pretty important. pre-e is pretty serious and if i had it i would not want to find out the hard way.
u/s are definitely not necessary and you can check your own blood pressure. listening to the hb with a doppler isn't really important either... as long as you are keeping track of kicks.
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  #6  
October 15th, 2010, 05:35 PM
us_four's Avatar Kristian... mommy of 2!!!
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i would not recommend having no medical assistance. since this is your first baby, you really do not have the experience and know what to expect throughout this pregnancy. keep in mind that every pregnancy is different so even if you are getting advice from your mother or a friend it is all different. you may want to get the ultra sounds to see if your baby has any genetic problems and also can detect if you have any problems as well. the doctor or midwife can tell you if you need to be on bed rest or pelvic rest.
i really hope whatever choice that you make is the best for you. also i really hope that you have fantastic healthy pregnancy.
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  #7  
October 15th, 2010, 05:43 PM
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Wanted to add, prenatal care should be standard/necessary, but you can manage your own care. Women that do this are very in tune with their bodies and very informed and educated about pregnancy and childbirth. They have to be.

You can buy everything you need to manage your care. Urinalysis (checks ketones, protein, glucose, leukocytes, blood, etc.) test strips aren't cheap, but if you're doing it according to a normal prenatal visit schedule then it shouldn't be too bad.

If you're managing your care (similar to how a homebirth midwife would) you're more in tune with what's going on and what to watch for (bleeding, preterm labor contractions, high BP/visual disturbances/headache/swelling, consistently measuring small for dates--could point to low fluid, consistently measuring very large for dates or a big jump in fundal height--too much fluid.)
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  #8  
October 15th, 2010, 06:16 PM
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My first was ectopic. I had none of the risk factors that would have made it more likely.

Things happen - usually when you're not prepared. If you want to let your body do it's magic without all the fiddling, I might suggest a Midwife and homebirth. Aside from the odd thing (for example, here in Ontario, it's law to have the eye ointment...though I think even that can be circumnavigated with the right paperwork) you have the right to refuse routine procedures like ultrasounds and blood tests. I believe Midwives are fully covered under BC health care too.

A Midwife will support you in a natural birth and promote informed choice - she can tell you about what procedures are available and explain their purpose, capabilities and limitations before you decide whether you want them or not. It is possible to have your cake and eat it too.

Congrats on your pregnancy!!!
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  #9  
October 15th, 2010, 08:00 PM
moon~maiden's Avatar Cheryl~ birth truster
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well, I do think care is important BUT I do think a minimal approach is ok. With my first I did every test and 3 ultrasounds. With my second we had a homebirth, and we did no genetic testing, no GD testing, no group strep test. We did only one ultrasound at 23 weeks, we decided to do that because we wanted to make sure baby was healthy enough for the home birth. If we had detected there was an issue that would require immediate care for baby (such as a heart issue) we would have chosen that, so we wanted to know. There is a lot of over management going on now. I do understand your line of thinking. With my home birth midwife, we hardly did anything other than my blood pressure, testing urine for proteins and such and they did hands on feeling of my belly and measuring. We mostly talked, but a lot of the info we discussed was important and helped her assess how I was doing. It is extremely important that for a home birth, mom is low risk.

There are plenty of women who do not do any ultrasounds. While they are very common now (and usually over used) they are not as safe as most would have you believe. This is why I decided to only do one in my last pregnancy. My midwife strongly advises against any, but we chose to do the one. Here are some articles on ultrasound safety. http://www.justmommies.com/forums/f3...nd-safety.html (Some articles on ultrasound safety) As you will read dopplers are considered even less safe than ultrasound because they use constant waves, where ultrasound uses pulsing waves. Although the doppler is usually shorter. My midwife only used the doppler in labor and only very quickly.

My best advice is to stay away from an OB and go with a midwife. Find a local natural mothering group and ask them for recommendations on someone good, and minimal. Participate in your care (SO IMPORTANT) and don't be afraid to decline things if you don't want them.
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  #10  
October 15th, 2010, 09:02 PM
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Ditto to what Cheryl said. My two cents: Yes, women have been doing this for hundreds of thousands of years, HOWEVER, midwives have always existed as well. It might have been your old Granny, or the eldest lady in the neighborhood, but women were generally always assisted by one or more knowledgeable women during their pregnancy and birth. Also, to echo AmandaEliz, a lot more women and babies died. So I would not go unassisted.
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  #11  
October 15th, 2010, 09:24 PM
Melliesbelly's Avatar Mega Super Mommy
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Thanks so much for all the input. You ladies are truly wonderful, and I appreciate all the information given about EVERY view.

Cheryl & Vespertina, thank you especially for providing a differing viewpoint and making me feel a little less crazy for considering, and wanting to learn more about, moderate to minimal prenatal care (in terms of a OB) and less u/s. I really am interested in finding a midwife who can help guide, but isn't too pushy.

Oh, and thanks so much for the congratulations. I'm really, really excited about this baby, and no matter what, I want what's best for him/her. I want to be a good mom.
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  #12  
October 16th, 2010, 04:49 AM
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The ladies here really know what they're talking about, so stick around! I'd post a better response, but it looks like anything I may have said was already posted.
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  #13  
October 16th, 2010, 06:34 AM
moon~maiden's Avatar Cheryl~ birth truster
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make sure you stick around, ya hear?
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  #14  
October 16th, 2010, 05:09 PM
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I think going unassisted and going natural are different. I think you can go with a natural approach to pregnancy and birth and still see a midwife. I would agree to steel clear of obs. I would find a midwife that you like and that has the same views about labour, birth and pregnancy as you do.
If you decide to go unassisted there is no reason why you can't have access to an ultrasound if you would like. You would just see your family doctor who would order it. As long as you are informed and educated-- no problem.

Even after having 3 children I don't think I would be totally comfortable birthing my babe all alone! It's nice to have some backup!

Christy
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  #15  
October 16th, 2010, 05:18 PM
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To be truthful, women have been doing this forever, yes, and they have also been dying from preventable causes in pregnancy too. Pregnancy and childbirth used to be the number 1 killer of women. I have no desire to go back to those days, even if I do tend to villanize obstretic care. Minimal prenatal care is OK, but I do (personally and IMHO) believe that being watched by someone trained and experienced in pregnancy is important. There is a reason these people train/apprentice or go to med school. It's because prenatal care isn't just as easy as dipping a paper in some pee and taking blood pressure.
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  #16  
October 18th, 2010, 06:18 AM
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I have had my number of clients who had an unassisted pregnancy. I normally don't recommend it because things can go wrong, but I support it.

Yes, you can check your own BP and can even buy urine sticks to check for protein, keytones, etc. But you have to actually know what you're looking for. Books can't tell you everything. I thought I had everything all down after reading over 100 books, and then when I started apprenticing with a Midwife I was shocked at how much you would learn actually doing things on a daily basis.

If you aren't comfortable with using a OBGYN then I would suggest a Midwife who better suits your needs.
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  #17  
October 18th, 2010, 08:42 AM
Isaeph's Avatar Jennifer the Momma
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I think it's a very individual choice, one that only the mom and dad to be can make. However, I think if one chooses to go UP, you must take every opportunity to educate yourself. So skip the crap books like "What to Expect" and dig deeper. I just finished reading "Childbirth Wisdom" by Judith Goldsmith. It's about tribal birth practices long ago. It talks about how complication-free their pregnancies and birth were and why...and it also talks about the few complications they did deal with and how things were remedied to the best of their abilities. It was a really eye opening book.

Check out the Trust Birth Initiative created by Carla Hartley. I think it's trustbirth.com It's a fantastic resource and it was one of the things that convinced me that I COULD do it on my own with #2. I'm getting ready to enroll in her midwife courses in the spring...she's my birth hero. I've had 2 unassisted births now and am 28w into my second unassisted pregnancy. To be honest, the ONLY things I learned from the medical establishment during my first pregnancy was 1, braxton hicks can start very early (mine started at 6w w/#1 and the nurse felt one at my 8w appt), and 2, I want to never birth in a hospital again. I have very low risk pregnancies. The only complications I've ever had were the ones that the hospital caused during L&D with #1. With #2 I saw my ob for the first tri and then we moved and I saw a team of 5 mw's at a birth center. I did not like their approach at all and felt like my experience would be slightly better than the hospital, but not at all what I wanted, so I stayed home to give birth (after MUCH prayer and research).

If you do decide to go the mw route, interview them and ask LOTS of questions. Titles don't make midwives...and I'd be personally reluctant to see a CNM because of my own experience with them with #2. Just my two cents. When I am a mw myself, I will support the educated decisions that my clients make and do my best to further educate them on their choices and be as hands off as possible...and that's the way I think it should be.
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  #18  
October 18th, 2010, 09:55 AM
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I've heard of many people on JM who do their own prenatal care and then just pay for their ultrasound and when they're ready to deliver go to the hospital or their ob or MW or just stay home and do a UA birth. Those people are low in numbers but it is done and you have to really really educate yourself.
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  #19  
October 18th, 2010, 11:35 AM
Aeterna's Avatar Super Speshil
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Quote:
Originally Posted by Sk8ermaiden View Post
To be truthful, women have been doing this forever, yes, and they have also been dying from preventable causes in pregnancy too. Pregnancy and childbirth used to be the number 1 killer of women. I have no desire to go back to those days, even if I do tend to villanize obstretic care. Minimal prenatal care is OK, but I do (personally and IMHO) believe that being watched by someone trained and experienced in pregnancy is important. There is a reason these people train/apprentice or go to med school. It's because prenatal care isn't just as easy as dipping a paper in some pee and taking blood pressure.
I always hear these sort of arguments. How women died a lot during pregnancy and childbirth. Infection was one of the most common causes of maternal death. Before doctors realized that washing hands protects patients from infection. The other leading cause was poor diet. Rickets was quite common during the 'olden days.' Insufficient amounts of vitamin D led to rickets and this led to poor development of the pelvis. Proper hygiene and better nutrition are to thank for better outcomes for mothers and babies. In other industrialized countries we don't see the rates of high risk pregnancies like we see in the U.S., which many believe is due to the standard American diet. I would not be surprised by that. Why is it that the majority of women in the Netherlands are cared for by midwives and the vast majority have uncomplicated pregnancies?

Obstetrics is the study of what to do when pregnancy goes wrong. It's left for the 20% that fall in the high risk category. Low risk pregnancies don't require a lot of management.

The dating ultrasound is not necessary if the woman knows when she ovulated and women that typically UP/UC are very familiar with their cycles. The level II ultrasound is not seen as truly medically necessary by all. Many insurance companies don't cover it. There are many in the NCB and homebirth community that completely forgo ultrasounds all-together.

What my care consisted of at an OB/CNM group practice:

Dating ultrasound
Level II ultrasound
Weight check
BP check
OGTT (which is not supported by evidence based medicine or data)
Measure fundal height
Fetal heart tones
GBS test

*I only had a urinalysis maybe twice with dd1 and dd2.

My care with ds1--seen by a CPM:

BP check
Fundal height
Heart tones
Checked for swelling
Urinalysis
Had glucose checked via glucometer at 31.5 weeks

Ds2:

Weight check
Fundal height
Heart tones
Swelling
Urinalysis

With both CPMs they of course asked lots of questions and went over basic stuff like diet and what to look out for. Typical stuff. They both offered the GBS test, but it's not something they stress. Many homebirths forgo it.

For low risk pregnancies that's what it typically looks like. Only when symptoms appear does it deviate from that routine. One of the most common pregnancy complications is PIH and pre-e, which is usually first seen in a rise in BP, which is then followed by a urinalysis. UPers are usually very in tune with their bodies and they know when to seek medical attention. Many consult with midwives if they turn out to have PIH. If it goes from PIH to pre-e then it only makes sense that they transfer their care to an OB since pre-e is out of the scope of practice for UPers and homebirth midwives.

I'm just not seeing why it is argued or believed that managing one's own care is somehow impossible or unwise to do if the individual is educated and informed. Now, I will say that I do advocate for the level II u/s to diagnose or rule out any problems the baby may have. I think this is a smart thing to do. I know quite a few homebirthers that opt out of ultrasounds. I wasn't one of them. I had many with ds2 because we needed to be sure he was good and healthy since ds1 had very serious and fatal heart defects that went undetected on u/s. Had ds2 presented with a CHD or another issue I would have had to rethink my homebirth plans.

Just taking a look at the DDCs here pre-e is one of the most common complications, followed by impaired glucose tolerance (which I don't take as a true complication). Then there are those that experience incompetent cervix, preterm labor or pPROM. A pregnant woman is considered low risk until she presents with signs or symptoms of a problem. How a pregnancy is managed changes from basic care to more maintenance after a problem develops. Prenatal care for the 80% that are low risk is pretty basic stuff. Perhaps I've missed something, but how complicated is it?
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Last edited by Aeterna; October 18th, 2010 at 11:40 AM.
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  #20  
October 18th, 2010, 12:01 PM
Sk8ermaiden's Avatar Platinum Supermommy
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I've seen a lot of people talk about how none of the things that used to kill people off in childbirth/labor apply anymore and it's really not based in historical fact. Sure, childbed fever really upped the stats there for awhile, but that's an anomaly in history.

Yes, the basic things checked on with a healthy pregnancy with a midwife are minimal. What you are paying for is their training at spotting when something might be going wrong. There is a good chance - a very good chance - that a woman doing her own prenatal care will have no problems or catch most of the huge ones. But there is also a reason that even among us weirdo "birth junkies" almost everyone will chose an experienced care provider. Experience will trump our basic and cursory knowledge (because that's what it is compared to someone practicing 17 years) almost always. You are paying for the small chance that you will need that knowledge and experience. I also think a small part of it is "fresh eyes" too. A lot of things that might seem small and unconnected to the mom add up to something big and wrong to someone trained in it.

The thing that sums it upthe most I think was the midwife who was talking about being "backup" for an unassisted birth and the mom retained placenta and nearly hemmoraged to death. EVERY woman I've met who went/is going UA believes that she would know exactly what to do in the situation. The mom in the story did too. What the extremely distressed dad said to the midwife on the phone was "we thought we knew it all from the books, but it is nothing like the books." Obviously things that go wrong in pregnancy are a lot less dramatic, but they can have the same results. The 4 years or so I have spent researching birth does not give the the qualifications and know how to diagnose many of the things that could go wrong in my pregnancy.

I fully support the right of women to go unassisted, but when someone asks for opinions on whether it's a good idea, I do share why I don't believe it's a good idea. It's just my opinion, although it has been shaped by being a part of the natural birth community, and hearing the stories of unassisted moms.
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