This is a guest article by Silvio Aladjem M.D.
Webster’s dictionary defines Taboo as something “not acceptable to talk about or do”. I can’t think of a better definition for our society’s attitude towards complications of pregnancy. This is unfortunate, since by ignoring their existence ,we deprive pregnant patients of information which they should have.
Knowledge should never be a taboo, although some may argue with me about that. However, I am a firm believer that knowledge is power. Knowledge took us out of the Middle Ages. brought us the Renaissance, allowed for scientific discoveries, took us to the moon, gave us Cat-Scans, MRI’s and Ultrasound, thus allowing us to improve the care of our pregnant women and their babies.
Why do we, then, not talk about pregnancy complications? We talk freely about any other medical problem. Why not about pregnancy complications? Perhaps a brief look at the history of pregnancy, its myth and superstitions, would be a good point to start. The miracle of birth is still alive and well, no matter what your religion is, where you live or where you came from, what your level of education is, whether you are a woman or a man. In the Judeo-Christian religions it dates back to\how God created the first man, Adam, from dust and the first woman, Eve, from one of Adam’s ribs. Other religions may have their variations, but in all, it was a miracle that happened by divine intervention. Thus the miracle of birth is still, to our days, a miracle and keeps us in awe.
Historically, in the absence of science, superstitions guided our lives. Pregnancy was no exception. If you did not have bad thoughts, for example, that assured you that the evil spirits would not know you were around and therefore nothing would happen to you. Superstitions varied by region, culture, religion, and a number of other intangibles, as well as personal experience. Such superstitions were passed from generation to generation by word of mouths.
Men had little to do with their wives pregnancies. They were never allowed in the area where a woman was in labor. and as such they had never seen a child being born. In fact, in the 16th century, a German physician was sentenced to death, because he was caught dressed like a woman and entered a room where a woman was in labor. When man-midwives physicians in the 17th & 18th.centuries, began to take care of pregnant women, they became physicians without ever having seen a birth.
With the passage of time, certainly mores and attitudes changed significantly. But some superstitions remain. Most women, today, expect a normal pregnancy and delivery, and have no interest in knowing anything about complications of pregnancy. They would deny that they are superstitious, but, really, it is not any different from the historical “have no bad thoughts and nothing will happen to you”. Men now participate in the woman’s labor and delivery, not by their own volition. They were coerced by societal changes dictating what labor and delivery should or should not be. It is what I call the “we are pregnant” syndrome. “We” are not pregnant. The woman is pregnant and the husband or partner is part of the equation, and I think that is the way it should be. In my experience, I have seen many husbands that were not willing to be a part of the delivery. Some, who participated against their will to please their wives, ended fainting in the delivery room or had to leave the area in a hurry.
Pregnancy is, so we are told, a physiologic event. As such, it must be normal, since the very survival of our species depends on it. If it is indeed a purely normal physiologic event, as some claim, why is it that 10-15% of all pregnancies will miscarry? One out of 8 pregnancies will end in preterm births, i.e. before 37 week’s gestation. Hypertensive disorders occur in 5% to 10% 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 and about one in 150 births is a stillborn..
Nature can be sometimes cruel, for reasons that we may not fully understand. Religious scholars have their own theory regarding the will of God, to which we are all subject to. I respect those that feel that way, but I would remind them of the “heal thyself (Luke 4:23) proverb. My God given scientific mind, is not fully satisfied. We, physicians, are meant to cure and avoid disasters. There must be another explanation.
That other explanation is nature itself. It is far from perfect. We are born and eventually die. That’s how it has been forever. In between birth and death, we are healthy, we get sick, we recover and so the cycle continues until our end comes. Pregnancy, is a natural phenomenon, but it is not perfect either. Slowly but surely, over centuries, our lives improved.. We understand more and therefore we can act to better our odds. But if we refuse to learn and discover, or even acknowledge the very existence of complications, we negate to ourselves the ability of avoiding certain events that can leave us in great despair or kill us.
Our societal negation to accept the fact that there is such a thing as a complicated pregnancy, our refusal to even talk about it, helps no one. Certainly it does not help the prospective parents who have been brainwashed that a pregnancy is always a normal event. When something goes astray, they are puzzled, scared, bewildered, hurt, and fail to understand what happened. The woman, in particular, feels that it’s her fault because she couldn’t reproduce like everyone else she knows.
“What’s wrong with me?” confused patients used to ask me. The truth is that nothing was wrong with her. What’s wrong is that nobody ever told her that complications may occur. The problem with statistics is that when it happens to you, it’s not 2% or 3%. It’s 100%. Nothing is rare, when it happens to you. It’s an all or none phenomenon.
Physicians and midwives are just as guilty as the society at large, because they never mention anything about any complication to the prospective parents. One does not have to give them a medical lecture. It would suffice to remind them that the reason for prenatal care is to watch for the possibility that something during pregnancy may not be normal. Why else do we have prenatal care? At least they have the information that something may not always be normal. but if it so happens it’s not a storm. It can be taken care of in the vast majority of cases.
We need to crack this taboo, and we should start talking about what happens, if it happens. That is how nature sometimes works. There is no guilty party. Above all it’s not the woman’s fault. Facing the adversity, understanding what is going on and taking care of it, will do away with the fear of the unknown. Like most ships going through a storm, the prospective parents will reach their destination and be thankful.
SILVIO ALADJE 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