Though everything I read (and everyone I talked to) promised morning sickness would subside at the end of the first trimester, at 24 weeks pregnant with my first baby I was still feeling miserably nauseous.
I was at a prenatal visit. The hospital midwife told me I must take a glucose tolerance test.
Just the idea of drinking a sickeningly sweet sugar solution that contained 50 grams of glucose made me gag.
I explained to the nurse midwife insisting on the test that since the beginning of my pregnancy I had been really sensitive to sugar. Her eyes looked bored as I told her that after reading up on nutrition, I was eating whole grains. My diet consisted of brown rice, whole wheat bread with no sugar added (I’d started reading ingredient labels), lots of fresh vegetables (I’d make James get up with me in the middle of the night when I was so sick to my stomach but paradoxically hungry that I couldn’t sleep. James would sit with me while I ate a plate of raw broccoli, pineapple, and green beans), fruit, plain yogurt, nuts, beans, and fish or red meat when I craved it, even though I’d been a vegetarian before getting pregnant.
I wasn’t eating any sugar, I told her. I was even avoiding overripe fruit.
I also explained I’d had low blood sugar all my life, and that I needed to eat small amounts of food often to keep my blood sugar even.
Granted I was feeling particularly vulnerable and emotional because of pregnancy hormones, but the idea of intentionally spiking my blood sugar and bringing on an inevitable crash made no sense to me.
If a woman develops diabetes during pregnancy the baby can get dangerously large because it is getting more sugar than it needs. But my fundal height—the top of the uterus to the top of the pelvic bone—had been measuring just right. I had even lost weight in the first trimester.
There was no indication that our baby was abnormally big, I had no diabetes in my family. At that time, gestational diabetes only occurred in about three to four percent of pregnancies. I was low-risk and I did not want the test.
The nurse midwife responded I would need to go on a sugar-restricted diet if the test showed I had gestational diabetes.
“But I’m already on a sugar-restricted diet!” I objected.
“You’re going to buy yourself a C-section,” she huffed. “Is that what you want?”
Years later I read Ina May’s Guide to Childbirth. Ina May talks about how unreliable the gestational diabetes test is, explaining that fifty to seventy percent of women will have a different result if they are retested.
The best way for a pregnant woman to bring down her blood sugar levels, Ina May Gaskin writes, is to get up and exercise.
After that upsetting exchange with the nurse midwife, we switched to the doctors in the mistaken belief they would be more competent and logical.
Towards the end of my pregnancy, after spending less than ten minutes with us, the doctor ordered an emergency sonogram.
“For intrauterine growth retardation,” she said offhandedly. “You’re measuring too small.”
I think doctors forget how upsetting the word “retardation” is to a pregnant woman.
I looked at her in confused shock.
After six and a half months of nausea, I felt so good I had started biking long distances every day on the bike path that cut across downtown Atlanta, fast.
“Could I be measuring small because I’ve been exercising?” I asked. One friend who had taken up running during pregnancy told me she had measured small, and I remembered reading that athletes who continued to train during pregnancy tended to have small babies.
“Not a chance,” the doctor said, hurrying away to “help” another patient.
In the waiting room, I couldn’t stop crying. James and I clung to each other. We barely spoke but the worry on our faces belied what we were both thinking: What if there was something wrong with the baby we both wanted so badly and had waited our whole lives to have?
After twenty-five minutes, our name was finally called. The sonogram tech snapped on her latex gloves and squeezed blue goop on my abdomen with the air of someone who knew exactly what she was doing. She looked at my tear-stained face and softened. Then she clucked her teeth in disapproval as she looked at the screen.
“Everything’s fine,” she dismissed. “Baby looks perfect. Nothing to worry about. Now get dressed and go on home.”
Doctors and other care providers want you to do things their way. But often their way is based on habit, fear of liability, or expediency. Unlike homebirth midwives, obstetricians almost never request their patients keep a food and exercise log. They almost never take 45-minutes to review the foods you’ve eaten in the past week, counsel you on good nutrition, and strategize on how best to exercise during your pregnancy. And also unlike homebirth midwives, obstetricians usually don’t know any more about nutrition than you do.
Most doctors practice what one obstetrician I interviewed recently called “reactive instead of proactive medicine.” (Unlike his colleagues, this doctor uses a homebirth midwifery model to interact with his clients.) There is a profound lack of logic in reacting to problems after they arise instead of preventing them in the first place. Yet if the patient rejects a routine test or suggests an alternative strategy, no matter how logical the objection is for this particular case, many pregnancy health care providers will use scare tactics and bullying to try to force the patient to change her mind. They’ll accuse you of being irresponsible, become angry at what they perceive to be your lack of intelligence, label you a problem patient, and tell you, “Don’t do it my way and your baby will die.”
(Doctor and nurse midwife friends who are reading this, this post is not about you. This is a post about your colleagues who have probably treated you the same way when you disagreed with their professional opinion.)
If we had a healthcare system based on good health and good outcomes, instead of good profit margins, our doctor might have taken the time to involve us in the conversation. “I’m surprised by your small measurements,” she could have said. “At this juncture I’d recommend an ultrasound to make sure everything is okay. What do you think?” Probably James and I would have agreed to what turned out to be a completely unnecessary scan. But as partners in health, we could have done it willingly and without the overwhelming and unfounded fear.
Doctors and nurse midwives, it’s time to remember that your pregnant patients are just as intelligent as you are and know just as much, if not more, about their bodies as you do.
It’s time to stop the bullying.
It’s time to start treating pregnant women with dignity and respect.
Jennifer Margulis, Ph.D., is a senior fellow at the Schuster Institute for Investigative Journalism at Brandeis University. She is the editor of Toddler and co-author of The Baby Bonding Book for Dads. Her new book, The Business of Baby: What Doctors Don’t Tell You, What Corporations Try to Sell You, and How to Put Your Baby Before Their Bottom Line, will be published by Scribner in April 2013. Read a Q & A with Jennifer at the Oregonian’s Oregon News Network.