Wednesday, January 2, 2008

Excessive Navel-Gazing

I'm not really sure that I believe in due dates anymore. In fact, let me stop hedging and tell the truth: I don't believe in due dates. I don't! Do you know how many babies are born on their "due dates"? 4 to 5 percent. What other scientific/medical/technological concept has such a shitty accuracy rate?

"Well, Mr. Jones, your vasectomy is complete. You have a four percent chance of being sterile in the future."

"All I have to do is press this button, and four percent of the time, a nuclear warhead will detonate."

"Take new improved Advil! Guaranteed to work on tough headache pain about four percent of the time!"

To me, this means that the medical community just doesn't know enough about pregnancy and gestation to predict a due date with any kind of accuracy. I'm sure there is a due date - a date when my baby is ready to be born, and my body is ready to do the work of labour - but we just haven't learned enough about how to interpret the baby/body signals. And if you think about it, why should we? Why should it matter to me if the baby comes on May 5th, or May 1st, or May 10th, or May 20th? If the baby is ready to be born, and my body is ready to birth it, it doesn't matter when that happens.

(Insert ranty paragraph about women and doctors who schedule optional C-sections just for the convenience of being able to schedule things. One would suppose I am the exact opposite of them, in birth philosophy terms.)

Prehistoric women didn't know their due dates. They didn't know when they conceived. They didn't time contractions. They just obeyed their bodies. What a liberating thought.

So, why are due dates inaccurate? There's some info on it here, but the conclusion I reached myself is that due dates are based primarily on a 28-day cycle. Which is largely a myth. I don't know a single woman who has a 28-day cycle. Come to that, I don't know many who have a perfectly precise, never-varying cycle, whatever the length. But let's assume for the sake of argument that my cycle was unvarying, at only 2 days off from the "norm": 26 days instead of 28. Gestation is counted as 10 28-day cycles, or 280 days. If I had a 26-day cycle instead, that's 260 days. That's a difference of nearly three weeks. Do caregivers panic when a woman goes into labour three weeks "early"? (Yes.) Do caregivers panic when a woman is three weeks "past" her due date? (Big time yes.)

Which leads me into my next navel-gazing topic, interventions. Since starting to "try" and become pregnant - which is a full year ago now - I've been a knowledge addict. I am especially fascinated with All Things Labour, and can't resist thinking ahead to what I consider to be the greatest challenge, and hopefully greatest triumph, of my life: mind and body working together to produce a miracle. But recently, I've come across a labour-related topic about which I don't want to read any more. Inductions and epidurals.

I've read enough to know I don't want either of these things. But even in the hippiest of books, there are chapters about them. It's important to be informed, I figure, and it's good to understand that things don't always go as planned. But I find that reading about the dangers of inductions and epidurals really freaks me out, and I'm having difficulty accepting that my normally obsessively-curious mind just Doesn't Want to Know.

The way I look at it, I'm with a caregiver who is not going to do either of these things as a matter of course. She's not going to push them on me, and she will accept my wishes to avoid them. So that means if we get to the stage where either of them are truly medically necessary - not for convenience's sake, but genuinely for the health and safety of either me, the baby, or both - then the risks and dangers associated with the procedure will have to be accepted. At that point, there is no benefit to me being any more "informed" than I already am about what those risks are.

If I were with a doctor or any other caregiver that I didn't trust completely to sycnh with my values and strive to avoid these procedures - if I felt that I might be part of a bedside battle over whether I wanted/needed them, and had better have my arguing points ready - then yes, I guess reading those scary chapters might be of use, so I could memorize all the stuff the doctor might not tell me as he pushes his own agenda.

Similarly, six or seven months ago when I first started learning the facts about this stuff, the information was incredibly useful as it helped dispel many assumptions I'd had about interventions. But I've got the info now, and I am strong and firm in my goal to avoid all unnecessary interventions. I'm not saying I know everything I need to know about labour - but I am starting to believe that reading about the scary stuff may be doing more harm than good at this point.

It's just so hard for me to reconcile that with my ever-hungry mind. Who would have thought I'd reach the end of my tolerance for knowledge?

No graceful segue this time into the third topic, my dreams and desires for labour itself. It may seem strange, especially to those who have gone through it, that I am looking forward to labour. Not in a "Hooray, it's Christmas" kind of way, but more in the way I looked forward to my marathon. I want to rise to meet the challenge. I want to put myself through something incredibly difficult, and not only survive but earn the prize of a healthy baby. I want to become one with every other labouring woman around the world and across time. I want to win.

I am just starting to put these desires into words, and to work on accepting the hardest thing about labour: that in order to be "good" at labour, you have to let go of your desire to be good at labour. Over and over again I read that a huge part of labour involves losing control. Something I've never been very good at. I console myself that last time I had to deal with labour, I had no idea what was going on, but I coped with it pretty well. I did what needed to be done, despite my ignorance, pain, and fear. This gives me hope that next time around I will be even better, since I will be more informed and understanding of what's happening.

I have been learning lately about the more "spiritual" side of birth, thanks to Birthing From Within. It's amazing how the so-called "little things" can have a huge influence on labour and birth outcomes. According to this book, birth environment can be very helpful or very oppressive in labour. Birth environment includes not only the big one - where you are giving birth - but other things as well, things that my skeptic father-in-law would never buy into: room temperature and lighting, who is in the room with you, how confident or pressured you feel, what kind of sounds you are hearing from the people with you or the outside environment. If you are uncomfortable with anything that is going on, feeling exposed or unprotected or anxious or frightened, labour is likely to slow down. If this happens, the book advises checking out the likely suspects of birth environment and mental atmosphere before jumping into an intervention.

Which brings me to some news. During our visit this past week, my mother finally put it to me straight out that she wants to be at the birth (prior to now, it's just been little side-comments which are completely unanswerable). And I told her I would prefer if she came later. I told her it was important to Chris and I that we have some time with just the three of us, a brand new family getting to know one another. That what I really, really wanted was for her to come a few days later when we needed help adjusting to the new reality.

It was both terrifying and liberating to finally say these things. As of yet, I am not sure how she feels about it or what will be the consequences. She didn't really respond at the time - didn't argue, but didn't say "Okay, that sounds good," either. For the rest of the visit, she didn't bring it up. As my sister points out, she didn't make any snide comments (e.g., anytime the baby was mentioned (which was OFTEN) she could have said something like, "Well, I'm not even good enough to be at the birth, so what do I care,") which would be absolutely typical if she was pissed off, so we take that as a good sign. Then again, it wouldn't be unexpected for her to wait a while, then try another tactic and pretend she has no memory of our conversation. Who the hell knows.

Whew, thanks for letting me get that all off my chest. So much to think about these days.

And in case you're curious, the actual navel itself is still an innie. It has become both wider and shallower, but is not yet an outie. Stay tuned for further updates.

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