Risks and Rewards
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.