Women Need to ‘Lean In’ to Pregnancy Too

Expectant moms need to ask more questions and do more research

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The women I know do a lot. They run companies, they write books, they chase their toddlers around the house, sometimes all at the same time. They wouldn’t dream of making important decisions — what job to take, what house to buy, what school to send their kids to — without doing the research and thinking it through.

And yet when it comes to pregnancy, these same women often passively accept the conventional wisdom. They microwave their deli meats and switch to decaf. They avoid rare steak, and they do whatever kind of prenatal testing their doctor suggests. Pregnancy is among the most important and meaningful experiences many of us will ever have, and yet we are not asking the questions, not looking for the real facts about it, not participating in the major decisions.

Ladies, we need to lean in to our pregnancies too.

(MORE: Why I Want Women to Lean In, by Sheryl Sandberg)

It’s not just our fault. Being pregnant sometimes seems like being a child again. Everyone has an opinion. Waiters remove your wine glass as soon as you sit down at a restaurant, and look disapprovingly if you ask to have it returned. An older woman in line at Starbucks once said to me, “I hope that’s decaf coffee in there!” (It wasn’t.)

When I was pregnant, it was enormously important to me to make the right choices, but I just wasn’t comfortable assuming those choices were the ones dictated by the “rules.” As an economist by training, I was used to making decisions by getting all the data, and then combining it with an understanding of the pluses and minuses of a choice for me personally. This isn’t how pregnancy seemed to operate, but it’s how it should work.

Consider prenatal testing. When I talked about this with my doctor, she gave me the standard recommendation for a woman of my age (31), which was to do a nuchal scan and a blood test that screened for two hormones linked to chromosomal abnormalities. When I pushed to understand more about how this worked and the tradeoffs I might face, most of what I got was reassurance that everything would be fine, and a vague suggestion that doing more screening than recommended would be crazy.

It’s true that there is a high likelihood that the testing will go well and all will be fine. But let’s not gloss over what the purpose is. The goal of this testing is to determine if your fetus has a chromosomal problem (Down syndrome is the most common).

If you don’t test, you live with the (small but not zero) risk of having a child with a developmental disability. If you test and find you are carrying a fetus with a chromosomal issue, you face a decision about whether to continue the pregnancy. At the same time, more-invasive forms of this testing carry a risk of miscarriage, so you have to weigh any benefits of the test against the risk of losing a healthy pregnancy. One challenge was that the standard books didn’t really provide me with the numbers I needed on risks and benefits. But, much more important, I ultimately realized that a key issue was to evaluate how I, personally, compared the risk of a miscarriage of a healthy baby to the risk of a developmentally delayed child.

This wasn’t an easy or especially comforting thing to think about, but it is the central issue. Glossing over it (What to Expect When You’re Expecting says, “The best reason for prenatal diagnosis is the reassurance it almost always brings”) does a disservice to women. Yes, being pregnant brings a lot of anxiety (wait until you get to parenting!), but that doesn’t mean we should put our heads in the sand.

This decision loomed large at the start of my pregnancy, but it was accompanied by all kinds of others later. Whether to have labor induced, whether to get an epidural, should I have a home birth, and on and on. And then there were the smaller, everyday decisions — the coffee, alcohol, deli meats, exercise, hair dye. But instead of the latest research findings, the pregnancy books give us either nonnegotiable rules or vague platitudes without acknowledging a wide range of personal preferences and values. With a few exceptions (smoking, for example, which my research did reaffirm in all cases was bad), different women are likely to make different decisions based on the same evidence — and all of those decisions can be right.

At the end of my pregnancy, my desk was littered with medical papers, and my computer full of decisionmaking spreadsheets. My friends came to me with questions. I didn’t have all the answers for them, but I did have a way to help them make these decisions on their own. If only their doctors and guidebooks had done the same.

10 comments
IanTina
IanTina



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JenniferDegl
JenniferDegl

I love this article.  Anything that gets women talking about reproductive issues means that more of them will be educated.  My daughter Joy was born at 23 weeks last year.  Due to modern medicine and prayers she is doing great today.  I hemorrhaged at 17 weeks for the first of 4 times because of 100% placenta previa, which turned into placenta accreta (which I believe was caused by 3 prior c-sections). After she came home from 121 days in the NICU, I wrote a memoir called "From Hope To Joy" about my life-threatening pregnancy and my daughter's 4 months in the NICU (with my 3 young sons at home), which is now available on Amazon.  It was quite a roller coaster that I am certain some of you have been on or are currently riding on. My goal of writing our memoir is to give a realistic look at what lies ahead to families with preemies in the NICU while showing them that hope can turn into Joy and that miracles can happen.Please see my website www.micropreemie.netand www.facebook.com/jenniferdegl

Thank you.

mdavisk2
mdavisk2

I think one of the biggest things women need to consider is insurance. Like others have mentioned, most pregnant women can tell you everything about the body's threshold for pain to the amount of calories she needs to ensure her baby's healthy development. The insurance coverage is almost a) an afterthought or b) a shock. 

http://navixmarketplace.com/blog/cost-of-having-a-baby-uninsured-vs-insured/

Knowing what your coverage is for pregnancy, pre-natal care and baby well care after deliver is helpful in knowing what (if any) out of pocket costs you and your family might have to cover.

kaywebs
kaywebs

Great article... but I'm pretty sure consuming alcohol during pregnancy is DEFINITELY out. That's not really something we should "lean into"

edlf
edlf

I receive my counseling from MSNBC.  I wonder if it is possible to lean forward and lean in at the same time.

Hollywooddeed
Hollywooddeed

The pregnant women I know are more informed than ever, do research and learn everything they can about their pregnancies.

I'm so tired of others telling women what they "need" to do.

mischief
mischief

I notice that you do not mention that actually, your chances of having a false positive on the test are considerable higher than your chances of having a baby with a problem.


Indeed, I know a woman whose testing indicated, twice, that her baby had Downs Syndrome.  She told the doctor what he could do with the tests -- the second time, she refused to let him tell him the results until after the delivery -- and lo and behold, false positives both times.

Statistically, the most likely result, to be sure.

JMM518
JMM518

@kaywebs I completely disagree with you.  "making decisions by getting all the data, and then combining it with an understanding of the pluses and minuses of a choice for me personally. This isn’t how pregnancy seemed to operate, but it’s how it should work."

You need to do more research before you make a dogmatic statements.

njmedic247
njmedic247

@Hollywooddeed So if a doctor tells you that a GBS-exposed infant needs antibiotics you feel qualified to look that up on your own and go against the doctor?

SilentBoy741
SilentBoy741

There's no way your friend's mom could do 39 sailors in an hour.