Risks and Rewards

smoking-while-pregnant

Pregnancy in our culture has become an endless list of no’s. I actually think if it was at all practical, “experts” would have pregnant women stay home for 9 months completely focused on eating a carefully balanced diet, taking leisurely walks around the block, cleansing their environment of all “chemicals,” and basking in serene thoughts about the miracle of life.

I call bullshit.

I work in environmental health; my job is to analyze risks and probabilities. I could go on for hours (and sometimes do) about how poorly risks and statistics are reported to the public, especially when it comes to health issues. An increased risk might mean nothing or it might mean a lot, but very rarely are we given the context to make that judgement call properly. As a result, people often exert a lot of energy worrying about small risks while blatantly ignoring the huge ones.

As a rule, we fear the unfamiliar more than the familiar: the vaccine more than the trip to the clinic, the radiation from our cell phone more than the neighbourhood pool, the ‘artificial chemicals’ in our moisturizer more than the bacteria in our spinach. In all of those cases the familiar risks we take every day without second thought are the real killers. By magnitudes. The other things are worthy of some attention (maybe), but on an individual basis far less likely to hurt us.

When it comes to pregnancy, we’ve taken this to a whole new level, blowing up small risks into outright bans and sometimes inventing risks that don’t even exist in any meaningful way. The problem is that you can always find one person for whom <insert risk here> seemed to cause something bad to happen and as long as that person exists (or doesn’t, that’s optional) we are all told “why would you take the risk?”

Well no one yet has told me that I shouldn’t get into a car while pregnant and it’s probably the largest risk I’ll take (the lifetime risk of dying in a motor accident in the US has been estimated at 1 in 83). We don’t demand that sacrifice because as a society we’ve decided cars are a risk worth taking in exchange for the convenience they provide.

Here are some commonly heard pregnancy no-no’s, followed by some questioning thoughts. You’ll notice I become fond of hyperbole when I’m all riled up so try not to take this too literally.* This isn’t at all meant to be medical advice for pregnant women – just a few thoughts to mull over and hopefully balance all the fears we’re force fed most of the time.

You have to keep track of a long list of banned foods and avoid them like the plague. THEY ARE THE PLAGUE!

There are very few foods that actually present any extra danger to a pregnant woman – it basically comes down to avoiding listeriosis. It’s the only food-borne infection that really can harm your baby. Luckily, listeriosis is quite rare, enough so that outbreaks make the news (yearly incidence in the US is 3 cases per million population). It is often linked to unpasteurized cheese and lunch meats, so it’s reasonable to avoid those things (but also reasonable not to).

But everything else – the sushi, the raw egg, whatever else you hear about – is of no greater danger to you or the baby while you are pregnant than it was before. And if you pull the short straw and do get sick? Well it’ll suck, but the baby is a very efficient parasite and really won’t give a damn (morning sickness should prove that without a doubt).

You have to be physically really careful or you’ll hurt the baby! No lifting anything, no running, no twisting, no lying on your stomach.

Your baby is in a sealed bag of fluid, within an organ that is attached to you. Do you worry about your organs coming loose when you run or twist? I hope not. So if you’re not doing anything that hurts – a good all-around policy – baby will happily come along for the ride. That being said, John you should definitely still keep doing most of the cleaning around the house.

Pregnant women are also told to avoid anything hot – saunas, baths, India etc. under the belief that the baby will get too hot. But again, let’s remember the baby is in a pool of amniotic fluid inside an organ. Your internal body temperature is highly controlled and you’ll start feeling too hot and move well before the baby even thinks to wake up for another round of spin-around-the-belly. Again, keeping yourself comfortable is a good gauge. Now whether you want to hang out in hot places is another question; heat has become my nemesis in pregnancy and makes my limbs feel like lead.

Oh dear god, no lying on your back! The blood flow, think of the blood flow!

The worry is that the weight of your uterus when lying on your back can block a major artery (the vena cava) from carrying blood to your lower body and harm the baby. Sounds terrifying! But do you think there would be 7 billion humans on earth if simply lying on your back for a minute could harm a developing baby? The thing is, you’re using that blood too. It’s a MAJOR ARTERY. If it gets cut off, you’ll move because it won’t feel very good. Yeah, even in your sleep. We’re well designed like that.

Alcohol – Gasp! The fact that you’re even saying the WORD makes you a selfish monster!

The fear and judgement factor is through the roof here. Cognitive deficits, with fetal alcohol syndrome at the far end of the spectrum, are a real and worrisome outcome affecting children born to women who drink heavily during pregnancy. But as the guiding principle of toxicology says, the dose makes the poison. This hot-off-the-presses large meta-analysis of 34 of the highest quality studies done on the topic sums up the evidence on low to moderate alcohol consumption (defined as up to 6 drinks per week) as follows: “We detected no consistent evidence that mild or moderate prenatal alcohol exposure was associated with attention, cognition, language skills, and visual or motor development.” They in fact found that kids born to mothers who drank a little were doing slightly better on measures of cognition than those who fully abstained, but the mothers who drank a little also tended to be of higher socioeconomic status so those kids might be doing better because of other advantages than access to nice chardonnay.

Making the choice not to drink at all is clearly the easiest way to avoid any and all possible adverse effects of alcohol. But it isn’t the only reasonable choice. I carefully weighed my risks and made a conscious choice to have a little glass of wine on Friday nights because it’s delicious and makes me happy. I also still get into cars.

As living beings, we take risks all day, every day, and are trusted to make the best ones for us. That includes pregnant women and it’s time for society’s hyper-vigilant policing of pregnant women’s choices to end.

* But all of these have been confirmed to me by midwives – so I’m not just making them up.

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Posted on August 29, 2013, in Life and tagged . Bookmark the permalink. 17 Comments.

  1. I’m a vet, so I am aware of the food regulations and risks related to food-borne infections / intoxications, many of which are zoonoses. Regarding the raw egg, I think the situation in Europe is different than in the US (Canada?), because over there eggs are washed in a chlorine solution and then waxed (covered in paraffine), none of which is allowed by European regulation. So at least in Europe Salmonellosis remains a risk (as eggs are packed as they come from the chicken and the dirt around them could be contaminated with Salmonella / Campylobacter from the shell as you crack the egg or sometimes microorganisms could be present *in* the egg, so fully cooked eggs are recommended.
    All meat has to be fully cooked… people are not often aware of this and they relate Toxoplasmosis to contact with cat faeces, but most of the contagions are from eating uncooked meat (in dishes like carpaccio or steak tartare or just a medium steak). As well as to gardening. Actually, only 2-5 % of cats actually excrete oocysts, it is usually very young or otherwise immunodepressed (Leukemia or FIV positive cats) who excrete the oocysts and are infective , so using gloves and washing your hands should be enough precautionary measure.
    As for the sushi… I think it depends. The thing with Listeria is it survives refrigeration and it could be found in refrigerated foods with a high pH, so sometimes it has been found in smoked foods like Salmon. Raw, fresh fish could also harbor Anisakis (but again, in Europe, by law fresh fish should first be frozen at minimum -20ºC for 7 days) which would kill the larvae. But if you get cooked sushi (like avocado / shrimp) I guess it could be ok.
    It’s up to each of us to evaluate the risks, but pregnancy does cause immunosuppression so pregnant women are a lot more *susceptible* to germs that you would normally handle without any risks…

    As for the rest I agree with you, people talk on the media about statistics and risks without actually understanding anything about them or what they mean, which makes it difficult to make an informed decision, but it’s also true that in medicine you don’t really “gamble” and if something is not known for sure, and the means to obtaining that information are nearly impossible (randomized studies) doctors tend to use the precaution principle (specially when there is evidence of the biological mechanism by which a certain harm can happen).

    • Very true, the food regulations in different places will change your risk calculation somewhat. For example, here the regulations regarding sushi-grade fish are quite strict (requiring flash freezing) so the risk of contamination is low.

      But my main point is about weighing risks and benefits, and the risks from most food-borne illnesses (with the exception of listeriosis) on pregnancy are pretty low. Everyone has to decide for themselves which risks they are comfortable with.

  2. You smart, girl. Also, that picture is perfection.

  3. YOU ARE AMAZING. I’m bookmarking the shit out of this because it’s the science-y sanity that I love. Also yes, John, you should probably clean. :)

  4. I keep hearing that a little bit of alcohol won’t hurt you during pregnancy…so when I was waitressing for a table of 5 the other day where one person ordered a bottle of wine and there was a pregnant woman at the table. I forgot to ask the number of glasses so I decided to take them five as she could have a glass or not without it being a Thing. When I put the glass down on the table she shot me the evilest look, “I’m PREGNANT.” (Fortunately the story ended well when she got a virgin strawberry daiquiri.) I was just trying to not be judgemental and let her be her own adult!

    • I for one applaud you, good for you! If that was me I would have given you a giant smile. I probably still wouldn’t have drank the wine to be honest but I would have really appreciated the acknowledgement that I am an adult and can make that choice myself.

  5. “Saunas, baths, India, etc.”
    Nina, you’re my people.

  6. Oh man, so much yes to all of this. I think my biggest issue is not one arbitrary restriction that our society is set, but how much a woman’s body seems to become public property as soon as she’s pregnant. It’s ridiculous that people feel okay shaming a pregnant woman for her choices when all of these things should be between the woman, her partner, and her doctor/nurse.

    Although I think, hopefully, perceptions are changing a bit. I took a physio class in my undergrad, and we had to present research findings at the end of the class, and do a Q and A. One girl’s project was on FAS, and at the end, I asked her if any of the studies had looked at mothers in France or similar countries where it’s normal to consume a little wine in moderation (or similar mothers here) and she just got a blank look on her face as if I was crazy. But at least eight or nine other people jumped in with “that’s exactly what I was going to ask!” so… maybe there’s hope?

    • Yes, I think the pendulum is starting to swing back a little bit. (In fact, I think at one point pregnant women really were expected to lie in a room, hidden away for 9 months!)

      It’s obviously good that we have more knowledge about healthy pregnancy than we did before, but it needs to applied with some rationality/context and those are things the random person at the coffee shop giving a pregnant woman a hard time for ordering a latte likely has NO IDEA about!

  7. i love this. calculated risk is a part of everyone’s life everyday.

  8. Leanne (@SmartyMagee)

    smart stuff, lady. risk assessment is a tricky business and i think you’re nailing it.

  9. I’m so with you on this, NIna (not that I’m pregnant, but as a general principle). I also love that this is your idea of a rant – it’s so civilised! So balanced! My rants are usually rambling streams of barely coherent yelping, so I’m very impressed.

  10. Really interesting given I read this: http://www.dailylife.com.au/news-and-views/dl-opinion/why-we-should-scrap-the-pregnancy-rules-20130827-2snjy.html
    just a few hours before you wrote this post.

    Lying on your back, seriously? Holy cow. Sometimes the rules for pregnant women remind me of the sixteenth century instruction manuals for women I use for work. It seems like nothing is OK.

    If I decide to have kids I won’t be able to take my medication, so i fully intend to have a coffee one a day most days a week….because I’m going to need it.

  11. I am late to comment but I cannot say enough how much I love this. Keep on fightin’ the good, scientific evidence-based fight, Nina.

  12. Yeah that’s how I felt throughout my pregnancy. Too many rules! I broke most of them after weighing the risks :)

  13. I think you should move to Calgary so we can hang out all the time and bitch about how stupid the world has become and make our babies play together. I’d move your way but I know I can’t hack the winters. (At least bitterly cold generally happens under a clear blue sky…)

    • Sounds like a brilliant plan… except for that whole moving to Calgary bit. After 20 years in Vancouver I can actually say I’ve gotten used to the winters here. Mostly. (Don’t hold me to that in March when it has been months since I’ve seen any other colour but grey.)

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