Monday, November 23, 2009

The Bell (Jar) Curve: Let me out of this pregnancy!

(No, no, no!  Once again, I am NOT pregnant!  Happy happy not to be.  Just surrounded by people who are… and, for once, not minding a bit!)

Reproductive technology:  besides helping us get pregnant, and knowing when we have succeeded, sometimes down to the millisecond, it has also made us the most impatient generation of pregnant ladies… well, ever.

I have a friend on Facebook who’s expecting a baby.  She’s 39 weeks and sick of being pregnant, as I discover every day when I log on.  And then there’s Amy, whose blog I read sometimes (Assertagirl), who, when she hit 40 weeks, blogged that her baby was “officially on borrowed time.”

I don’t blame them… I got to 42 weeks with one kid, 39 with two, and those are tedious places to be, believe me (Elisheva had the good sense to be born at 34 weeks!).  Everything’s done that’s going to be done, and there’s only so much nesting you can do when you are so big you could rent out ad space on your sides.

Used to be, in the dark old days, that a woman just “turned up” pregnant, perhaps diagnosed by a fainting spell, or perhaps she just sagely knew after a few weeks with no period.  As a consequence of the pregnancy’s fuzzy beginning, the ending was just as fuzzy:  she had no idea when her baby was due.

Even if she asked a midwife, she’d be told her baby would probably come “sometime around March.”  Forget finding out down to the second thanks to a planned C-section; she was lucky if they could correctly predict the season of her birth.

So after a while, I figure you probably just anticipated giving birth both not right away – and any second.  It was both imminent and distant… a blurry time looming in the sort-of near future.

These days, it’s easy to get sick of pregnancy because we have this myth that everything is supposed to be precise. 

Because we know almost to the second when we conceived, and we know almost to the second when the baby is due, we feel like we should have control.  It’s easy to get impatient:  “Get out of there!  It’s your due date!  You.  Are.  Due.  Get out!”

One of the sadder consequences is C-sections, more more more C-sections.  Especially if it’s an older mama or a reproductive-technology baby to begin with, because then, the stakes are higher.  Who’d want to risk any kind of post-term problem with a premium baby? 

But even if it’s conceived the old-fashioned way, there is a tendency to see anything over 40 weeks as a problem.  Which is a problem.  Why?  What doctors or midwives fail to explain well is that the whole 40-weeks thing is a bell curve

If you’ve ever seen a bell curve, it doesn’t just go up up up and then drop down to nothing. 

Noooo… not so simple!  What the bell curve means is that some women have their babies three weeks “early” – before their due date.  Not many, but enough that it’s normal.  More will have a baby two weeks “early” and many more a week to a few days “early.”  Quote, quote, quote.  None of them are “early”… they’re all on the bell curve.

Remember, we’re not talking prematurity here.  Three weeks is alarming, but usually okay.

And then, HUMP!  Lots and lots of women have their baby within a day or two of their due date.  The most of any other day on the curve!  Yay, due date!  Let’s call those babies “on time.”  In quotes, again, because they are just on the curve, like all the others.

But that still leaves… you guessed it… a heck of a lot of women staring bleakly at the other side of the ski slope.   The ominous “late” side.  OMG, my baby’s LATE!  Who’d want to be LATE?  (okay, I was a late baby… who’da guessed it?)

That’s right.  Up to three weeks late, given the natural course of things.  Of course, that’s only a tiny percentage; the same tiny percentage who had their normal, full-term babies three weeks early. 

By two weeks past the due date, some huge percentage of women, probably in the high 90’s, will have naturally had their baby.  Not “late,” just like those other babies weren’t “early.”  They were all on the curve.

Suffice to say, that doesn’t happen much nowadays.  Few midwives and fewer doctors let a pregnancy go beyond 42 weeks.  Too much risk to the baby, too much risk to the mother.

In most cases, it’s nonsense.  Sometimes, somebody miscalculated early on; wrong or bad guess for a date-of-last-period … ultrasound not as precise as it should have been.  But sometimes, it’s just a baby that needs to gestate a couple of weeks longer; still on the curve, still normal.  The baby’s not stuck, just needs a bit longer to cook.

Those babies are getting induced, they’re getting c-sectioned, they’re getting grabbed out and suctioned and spanked into the world before their time. 

I’ve read that a surprising number of c-sections for post-term babies revealed that the babies were not, in fact, post-term; doctors just had their information wrong, and panicked.  Ditto for c-sections due to alarming large babies.  It can be very tricky to estimate the size of a baby based on an ultrasound at term.

I don’t want to get really technical here, because that totally isn’t my point.

My point is – what’s wrong with us, that we’ve gotten so impatient?

Not that women of my grandmothers’ generation suffered silently through those last weeks.  I knew my Bubby when she had diabetes (“I have Jewish diabetes?”  “No, it’s not a different disease… it’s a meeting for Jewish diabetics.”) and angina; I can’t imagine her suffering silently through anything.

I bet they kvetched, for sure.  But they didn’t clockwatch.  They didn’t start peering up at their cervices anxiously round about 38 weeks, didn’t poke and prod and start chomping down the raspberry leaf at precisely 39 and a half weeks.

Pregnancy shouldn’t be on the clock.  Of course I was as miserable as anybody towards the end, and just as eager for it to all be over, so what kind of hypocrite am I? 

But I did do the smart thing and tell many, MANY people a made-up due date that was a couple of weeks beyond when I was actually due, so at least others weren’t poking and prodding and inquiring over the state of my cervix (at least, not over kiddush in shul).

If I ever become a midwife, or, more unlikely, an OB, I know what I’ll tell my patients when they come to me.  I’ll shake hands, get their information, the date of their last period, their IUI or whatever it was that got them knocked up in the first place.  Then, I’ll pull out my little wheel and spin it around a bit, looking contemplative.

And then I’ll say, “well, it looks like we can expect your baby to come along… hey, how’s spring for you?”

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