Prenatal Care: It Ain't What Happens in 15 Minutes At An OB's Office

Just to interject something else into my near-constant stream of homeschooling posts, I thought perhaps I'd reference the part of my "about me" description that says "I'm also passionate about birth, breastfeeding, and politics, so there are posts about those from time to time." So here's something about birth. :)

After each of my homebirths, we packed ourselves into the family vehicle and went to the county records office so that we could obtain a birth certificate for our new addition. Generally, the workers glance at you, see a small baby in some kind of baby carrier, and immediately ask if you're there to register a homebirth.

One of the question on the worksheet deals with the amount of prenatal care received. This is measured through answering the question "How many prenatal visits did the mother have?" Since I never chose dual care, I answered "zero" after each homebirth.

When I had my oldest, in the hospital, most of the worksheet was completed by a nurse, using our file, and I don't remember specifically what number was listed. At a guess, I would say twelve, plus or minus two. When I had my middle child, I laughed, because I had spent an hour at every prenatal, which totaled many more hours in formal prenatal care. By the time I had my third child, the question made me downright ornery. I had to list myself as having had no prenatal care, a state which most would label irresponsible. The truth was, while I had had no formal appointments with any care provider for the sole purpose of monitoring my pregnancy, I had experienced superior prenatal care through my own self-care.

All women practice self-care, I can hear people commenting. How was what you did any different than any other pregnant woman?

Ultimately, responsibility. When a woman who is having an unassisted pregnancy (UP) takes on responsibility for the care of herself and her baby, she knows that there is, generally, no "back up." If she misses the fact that she's anemic, no one else will notice at her appointments. As an illustration of what I mean, I'll use an anecdote from my own pregnancies.

While pregnant with my second child, I began experiencing what I could only call "woozy sessions." I would feel light-headed and as if I could fall. At first, I assumed it was related to my blood sugar, and would take steps to quickly raise it. When that did not help, I thought perhaps that my blood sugar was too high, and I took steps to moderate my blood sugar levels. I had no sign of issues with blood sugar, however, other than the "woozy" feelings, and all efforts I took had no effect on the way I would feel from time to time. When I mentioned this to the midwife that I had hired, she suggested that perhaps it was related to my blood pressure, but that the only way to know for sure was to monitor it during one of these sessions. She also wasn't nearly as convinced it wasn't my blood sugar, despite all lack of evidence and my statement that I had had low blood sugar at times in the past (when I had not eaten enough), and I could tell the difference in how I felt. Eventually, the woozy times became less frequent, and they disappeared altogether when my son was born.

When I got pregnant with my third child, then, I was dismayed when the woozy sessions began again, earlier than before and more frequent. This time, I had a blood pressure cuff, thanks to both my status as a UPer (someone who has an unassisted pregnancy) and my desire to foist it on my mother once I had the baby, since her doctor had suggested home monitoring of her blood pressure (and yet she didn't buy a machine). I took my blood pressure during a woozy time. Repeatedly. It was clear that it did not originate from blood pressure. I tried all the blood sugar ideas again, to no effect. I drank water, to make sure I was not dehydrated. Again, no effect. I intuitively felt that there was a reason it should be worse during a subsequent pregnancy. After much reading, I began to suspect that I was anemic. During my second pregnancy, as part of the care I received from the midwife, the iron level in my blood was tested. I was not anemic. I have never tested as someone who is anemic. I was, however, symptomatic.

I bought an iron supplement. I began taking it at the recommended dosage. Within a week, the woozy feelings had almost disappeared; two weeks after beginning the supplement, they were completely gone, and remained gone for the rest of the pregnancy. I was functionally anemic. Knowing I was the only expert involved in my pregnancy, I could not simply accept an outsider's explanation. Even though I thought I was taking responsibility for my care in previous pregnancies, I can clearly see now how easy it was to abdicate some of the responsibility.

I highly recommend the book Expecting Trouble to anyone interested in prenatal care and the various forms it can take. The author makes the important point in several ways that prenatal care is not actually about preventing problems. It's about the detection of problems. True preventative prenatal care would be focused on nutrition, exercise, the position of the baby, and preparation for childbirth.

All of which any woman can do on her own. If she does not choose to do so, there's no issue with that, but I think it's vitally important to remember that preventative prenatal care has to begin and end with the woman herself.