Choices in Pregnancy

March 31, 2018

Most of us don’t think about the choices we have in pregnancy. When we discover our efforts of trying to conceive have been fruitful or we’re completely shocked by the surprise, the next thing we do is go to the doctor. What the doctor tells us kind of becomes our bible for the next 9 months and into the most intimate and transformative event of our lives.

 

In this guide, we will explore some of your choices in pregnancy:

  • Ultrasounds

  • Weekly vaginal exams

  • Stripping membranes

  • Induction of labor

 

Keep in mind, these guidelines for women with low-risk pregnancies. You can always choose what you do with your body, but talk with your doctor or midwife about what is right for you.

 

 

 

Ultrasound scans are optional

An ultrasound scan is a machine that uses sound vibrations to display an image. Typically women get this procedure to confirm their pregnancy, measure how the baby grows, reveal the sex of the baby, monitor the baby’s position, and get an idea of how much amniotic fluid is surrounding the baby. Normally an ultrasound can be done by sliding the doppler across the belly. In early pregnancy, the baby is so small that they need to use a different shaped device that’s inserted into the vagina.

 

Oddly, using ultrasounds became standard practice even though there’s no sufficient evidence showing it to be safe. There are no known side-effects either but there just isn’t enough research to have a definitive answer. However, the FDA did come out with a warning against the 3D/4D ultrasounds that you’d get from companies outside the hospital. The main concern of long or repeated exposure of ultrasonic frequencies is the heat created by the vibrations and how that impacts the baby. There is currently more research being done so stay tuned!

 

 

Vaginal exams are optional

Usually in the last weeks of pregnancy, doctors or midwives want to do vaginal exams to check the cervix. The cervix is part of the uterus. It’s where the uterus opens into the vagina. In this exam, they’re looking for effacement (how soft, thin, and short the cervix is) and dilation (how open the cervix is). Knowing how effaced or dilated the cervix is can be useful information but it does not reveal when exactly labor will begin and it is not a necessary procedure.

 

 

Membrane sweeps are optional

A membrane sweep means manually separating the amniotic sack (bag of water) from the cervix. This is different from breaking the water but there is always a risk of unintentionally rupturing the amniotic sack when doing a membrane sweep. Membrane sweep can urge labor to begin and may be a more gentle option to start with if you’re heading towards an induction. Keep in mind, there could be bleeding and cramping that comes along with this. About 1 in 8 membrane sweeps will bring on contractions within 24 hours, but often times the contractions are more from the uterus being irritated than actually in labor.

 

 

Induction is optional

Induction is the manual start of labor. There are two reasons why someone would be induced: medical and non-medical.

 

Non-medical reasons for induction:

  • Reaching your due date

  • Convenient timing

  • Having a big baby (or small hips)

  • Low amniotic fluid

Induction might become necessary if the baby is showing signs of stress, but you can test for that!

 

A note about big babies - most mothers will not make a baby that’s too big to fit through her body unless she has developed gestational diabetes. (ultrasounds are often off by 1 or 2 pounds when estimating baby weight!) Fontanels on the baby's head enable their skull to mold to the shape of your birth path. In addition, your body creates a hormone called relaxin that makes both your and babies joints and ligaments more flexible. 

 

Medical reasons for induction:

  • Preeclampsia (a combination of high blood pressure, protein in urine, and potential organ failure)

  • Placental abruption (the placenta separates from the uterus)

  • Fetal arrhythmia - if the heart rate is too high or too low and doesn’t change when mom changes positions

 

Have you experienced a struggle with your OB or midwife in supporting your birth choices?

 

You can always use one of these responses:

  • “I’ve had a healthy pregnancy thus far so I’d like to wait a bit longer.”

  • "Is this absolutely necessary?"

  • “How is my baby doing? Fine? Ok, great, I’d like to wait.”

  • “Is there any sign that things aren’t going well?”

  • “What are the risks of waiting?”

  • “I’d like to try some natural alternatives.”

 

Click here to learn about different methods of induction and how to avoid it.

 

Resources:

 

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