By Silvio Aladjem MD
Pregnancy, by its very nature, is one of the most sensitive times a woman will ever live through. The mere fact that a new life is developing inside her, is an exhilarating feeling that will never be forgotten. As one of my patients once told me: “We are both looking forward to the birth of our baby, but it’s different for my husband. Only I felt the baby’s first movement inside me. I am a mother.”
We all expect our pregnancy to be normal. After all, babies have been born since the dawn of time. No mother thinks that her pregnancy would be anything else but normal and her child anything but a beautiful baby. But what is a normal pregnancy? Can we really assure a prospective mother that her pregnancy will sail smoothly without a glitch? No person, be that a physician or midwife, could, absolutely and unequivocally, assure the future mother, that it will be so. One would be foolish to do so and guilty of deceit, because pregnancies are not always normal, even if most of them are, and they are unpredictable.
The purpose of any pregnancy is that of having a healthy mother and a healthy baby. No one can refute that. The problem we have is, that we can only say that we achieved our goal once a healthy mother goes home with a healthy baby. Otherwise said, we can only tell that a pregnancy was normal when we look backwards, after the fact.
This seems to be quite straight forward. What is, than, the problem?. The problem is, that we never think about a normal pregnancy in those terms. As a result, we expect “de facto” to have a normal pregnancy. Things can happen , we know, but not to us. We are healthy, do the right thing, read the proper books, go to prenatal classes, have prenatal care, and make plans for our delivery and our birthing experience. When something happens, we are bewildered, hurt, and suspicious. Somebody must be at fault.
Since women, and not men, have children, it follows that the woman must be at fault. History does not help either. For centuries, a woman was vilified if she could not give her husband a son. Kingdoms have been lost because of that. Never mind that it is the husband’s sperm that determines the sex of the future baby, not the mother’s egg. In our society, we never talk about complications of pregnancy. “Mary had a nice baby” is a common statement. When was the last time that you heard that “Mary had a stillborn?” But you may occasionally hear that “Mary cannot carry a baby to term”.
As a result, women have felt the pressure of being a good reproducer and feel guilty if they cannot perform as expected. I have seen women having miscarriage after miscarriage, trying desperately to prove that they can reproduce, that they are “normal”, instead of trying to find out what the problem may be. I had husbands telling me that “She can’t get pregnant”, but 50% of infertility problems are because of the male factor and not the woman’s problem.
No one singles you if you have diabetes, and if you do have it, you take care of it and do not feel abnormal. . If a woman has “gestational diabetes”, that is diabetes during pregnancy, she feels guilty, may refuse treatment because “she’ll be ok”, and her first question is “will I have diabetes next time?” instead of asking:”does this mean I will have diabetes all my life?”. She feels guilty of not being “normal”. I have had patients who had to be on insulin during pregnancy, and faked their record of blood sugars levels, just to prove that they do not need insulin, and consequently they were normal. They would not dream of doing that if they wouldn’t be pregnant.
Unfortunately, not all pregnancies are normal. Some have serious problems. But that is the nature of pregnancy. It is not your fault. If your pelvis is too small, it’s the price that humans pay for being bipeds instead of quadrupeds. It’s not your fault. If you should have the misfortune to have a baby with a malformation, it’s a quirk of nature, most of the times. It’s not your fault. Should you have the misfortune of having preeclampsia, the cause of which we still don’t understand, it’s not your fault.
You probably don’t know, but 10-15% of all pregnancies will miscarry. One out of 8 pregnancies will end in preterm births, i.e. before 37 week’s gestation. Premature Rupture of Membranes prior to term may occur in 8% of all pregnancies followed by early labor and/or infection. Hypertensive disorders occur in 5% to 10% of pregnancies. Serious infection of the kidneys occurs in 1% to 2% of pregnancies. Gestational Diabetes is diagnosed anywhere between 2% and 10% of pregnant women. Three to 5% of all babies are born with congenital anomalies.
The likelihood of any of these complications happening to you is low. But if it does, it’s not your fault. In fact it’s not the fault of any of the mothers that may face such hardship. It’s not their fault.
Sooner or later, our society will have to change the “wishful thinking” attitude and accept the reality that complications do happen in pregnancy, even if the vast majority of pregnancies are normal. But beware of falling into a false sense of security that “it’s rare, it won’t happen to me.” If it happens to you, it’s not rare, it’s a 100%. But one thing is sure. It won’t be your fault. Remember that.
SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. He can be reached through his website, www.drsilvio.com.