We can tell the truth about pregnancy without scaring women to death – in fact, it’s crucial that we do Emily Ooster
TThere is an inherent tension here between two basic facts about childbirth. On the one hand, it has happened billions and billions of times over the course of human history and has been successful in a wide range of environments, from Neolithic caves to state-of-the-art hospitals. On the other hand, in many cases it is objectively dangerous.
This tension is palpable in much of the modern popular discourse on birth. On my Instagram feed there are images of unmedicated home births in a bathtub, surrounded by flowers, and a caption about how birth has become too medicalized. Some commentators are quick to note that the medical assistance in their case was lifesaving. To put it bluntly, yes, people have been giving birth at home for millions of years, but many of them have died.
I struggle with this tension in my writing about pregnancy. I’m an economist and have written two books designed to help women navigate their pregnancy experience by giving them a better understanding of what the data says. In the first part, Expecting Better, I cover a largely uncomplicated pregnancy. I talk about the decisions that arise when everything goes well – for example, whether to eat sushi and how to write a birth plan for an uncomplicated delivery. In the second, The Unexpected, I discuss complicated pregnancies. With my co-author, Dr. Nathan Fox, we talk about miscarriage, preeclampsia, stillbirth, gestational diabetes, postpartum depression, and other tough stuff.
These are issues I care passionately about, largely because I don’t think we discuss complicated pregnancies enough. Perhaps 50% of pregnancies are affected by at least one of the complications covered in the book – that’s half of pregnancies, but more than half of people who have been pregnant. In many cases, until this complication happens to someone, they have no idea it could happen. They feel alone, sometimes rejected, scared.
A core problem with lack of discussion is that it leads to a lack of treatment or preventive activities. The top pregnancy organization in the US, the American College of Obstetricians and Gynecologists, recently urged more discussion about preeclampsia, a serious complication that affects 5 to 8% of pregnancies. The risk of preeclampsia can be reduced by approximately 20% by using baby aspirin from the second trimester of pregnancy. This treatment carries virtually no risks, so it is becoming increasingly clear that pregnant women with any risk factors – older age, higher weight, high blood pressure and many others – should be treated. If people are not aware of this risk, they are less likely to seek treatment. Even if they are offered treatment, if they do not understand the condition they may be reluctant to take it up.
A lack of attention to these complications leads to a lack of information, and without a basic understanding of what happened to them (or not). happens for them) during their pregnancy, patients are not able to focus on their condition as much as possible. When this book came out, a mother told me in interviews, “I had postpartum hemorrhage with my second child, but until I read your book, I didn’t really understand what that was, let alone how to treat or prevent it.” ”
I want to shout this information from the rooftops. I want to tell everyone I know that, yes, your uterus can fall into your vagina (or even partially come out of your vagina), and that if that happens, there is help. And yet: I see the danger in focusing too much on these complications. If 50% of pregnancies are affected, then 50% are not. Where should we draw the line between ensuring pregnant women are well informed without scaring them to death? After all, everything often goes smoothly. Giving birth at home in the bath can may be a good option for some people. And I would hate it more than anything if someone decided not to start a wanted family because he or she was worried about pregnancy and birth.
We need to find a balance between giving women the information they need, telling the truth about the risks and not creating unnecessary panic. I wish I could say I knew for sure what this balance looks like. What I do strongly believe is that keeping information hidden and only spreading it when necessary – or never – is not the right answer. We need to find a balance between giving people information and allowing them to put the risks into context. So they can take comfort in the hope – and likelihood – that everything will work out, but be prepared if it doesn’t.