An article in the Washington Post ("Forever Pregnant Guidelines: Treat Nearly All Women as Pre-Pregnant" by January W. Payne May 16, 2006; Page HE01) and a similar article in the Wall Street Journal have caused a stir by recommending that physicians encourage all women of child bearing years to consider themselves "pre-pregnant."
Among other things, this means all women between first menstrual period and menopause should take folic acid supplements, refrain from smoking, maintain a healthy weight and keep chronic conditions such as asthma and diabetes under control.
Generally, this seems to be good overall medical advice and, other than the folic acid part, would be applicable to men as well. Yet it has caused some concern in the blogosphere. I have a hard time getting too upset about it, in part because of this statistic:
The U.S. infant mortality rate is higher than those of most other industrialized nations -- it's three times that of Japan and 2.5 times those of Norway, Finland and Iceland, according to a report released last week by Save the Children, an advocacy group.
Better preconception and early pregnancy care could decrease the infant mortality rate. Susie over at the Suburban Guerilla has some stories about her experiences as a midwife and the lack of knowledge she encountered. I was at the other end of the spectrum. I had pre-conception checkups before each pregnancy, and a full quota of prenatal medical visits. At no point did anyone discuss nutrition with me, other than to ask if I understand what a good diet was. I said yes, and that answer was accepted without question. I learned more from reading the "What To Expect" book than I did from the docs.
The general state of health knowledge, especially where reproduction is concerned, is poor in this country. If you ever want to have some really wicked fun, talk to a group of high school or college women and casually mention that many standard antiobiotics will interfere with birth control pills and anyone who uses the pill for contraception should use an alternative method while taking antibiotics and for some weeks afterward (ask your doc for details). Every time I've done this at least 3/4 of the women will be so startled they nearly fall out of their chair.
Any kind of life planning that would include some basic health information could only be an improvement.
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I dunno about "has to be an improvement" -- there was a first-person account of a woman being given inadequate treatment for her epilepsy (among other things, causing dangerous and precipitous weight loss) strictly because she was of childbearing years. Her immediate health was being set second to her doctor's presumption that she couldn't be trusted in her assertion that her one (11-year-old) child was enough. She was still "pre-pregnant" in their eyes, and could waste away before they'd give her a better medical option...
True, but if you are certain that the one child is enough there are measures you can take to ensure that there aren't any other ones.....
One big jolt I got when expecting my first child was when I had a bad case of the flu and told the doctor I hadn't been able to eat for 2 or 3 days. She said not to worry the baby would be fine -- it would just sap nutrients from me. That wasn't really my point but it did put into sharp relief my secondary status as far as the ob/gyn was concerned. The idea of exceptions "for the life and health of the mother" in many treatments is comforting but, other than dire emergencies, we're supposed to put the kid first. I do know people who found themselves unexpectedly pregnant who had to choose between carrying the child safely and taking psychiatric medications. That would be a tough choice, but if they had planned in advance they could have tried alternative meds that were maybe not as good but safer for the pregnancy, and offer a short-term solution. I think that's part of what this program is hoping to do -- remind people that unless they are celibate or "fixed," pregnancy is a possibility until after menopause.
I've posted this in other forums, but
a few years ago I saw an absolutely
fascinating program on TLC or TDC that
showed how the fetus is equipped with all the necessary survival skills, much like a parasite (no I'm not comparing children to bugs) controls its host. It showed how the fetus can control the mother's heart rate, take calcium from her bones and otherwise live off her body if need be. It sure changed the idea of the fetus as "helpless" and also proved that the phrase "for the life of the mother" isn't just some empty
words because the fetus would kill the mother in order to ensure its own survival.
It was real eye-opener.
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