"pre-pregnant"

[cellio]

The Washington Post reported yesterday that new federal guidelines ask all females capable of conceiving a baby to treat themselves -- and to be treated by the health care system -- as pre-pregnant, regardless of whether they plan to get pregnant anytime soon. amergina posted a link to the 30-page report from the CDC, which I haven't gotten to load yet but I'm caching the link for future reference.

Recognizing that this is (currently) a limited recommendation, I am still fearful of where this could go. It's a small step from "recommend" to "require"; even if the government doesn't formally require, will doctors follow the recommendation to stay on the right side of malpractice claims and future federal action? Will many (or most) pharmacists refuse to fill prescriptions for drugs to treat actual ailments for fear of harming a hypothetical fetus (even if the woman says "if impregnated I will not carry to term")? Will restaurants and bars start refusing to serve alcohol to women? Will employers keep women out of jobs with environmental hazards? No, not immediately, but we shouldn't ignore it any more than we should ignore other dangerous trends oozing from Washington (and Washington's handlers).

Women are not incubators. It is hubris for anyone not directly involved to expect women to restrict ourselves for the sake of children we're not necessarily even planning to have. If, heaven forbid, I come down with some serious illness, I want the best treatment available -- regardless of what it could do were I to become pregnant. [1] I will listen to my doctor's advice about things like alcohol, diet, and exercise for my own sake (that's part of what I pay him for), but acting on it is my decision alone, morally speaking, and it's insulting to say "think of the baby!" rather than "think of your own health!". ('Cause, I suppose, we aren't smart enough to want to take care of ourselves, but we're programmed to love babies. Bzzt.)

By all means -- make patients aware of the effects of their choices and treatment options on hypothetical future children if they care about this. That's being a good doctor. So long as we stay in the space of recommendations from doctors to patients, we're fine. But I fear the slope before us -- that it will not stay between doctors and patients, and that it will not stay as mere recommendations. And I don't know what the best way to prevent a slide down that slope is.

[1] Ok, I am not personally capable of becoming pregnant, but that is irrelevant to my point.

Comments

[jhayman.livejournal.com]

Pre-Conception Health has been around for about 15 years. My health unit has had an active preconception program for that long. It's important because about 50% of all pregnancies are unplanned. That includes people actively attempting to prevent a pregnancy (the field use effectiveness of birth control is much less than the theoretical, and none of them are 100% effective).

The vast majority of birth defects occur during the time BEFORE a woman knows she is pregnant. Ergo, those unplanned pregnancies often occur in a woman who is smoking or drinking. Or taking recreational drugs, binge drinking, making poor lifestyle decisions. IF the offspring is affected, the child, the woman/family, and society all take a hit.

OTOH, Folic acid use prevents neural tube defects. Period end of story, the research is in. But it needs to be taken a minimum of 3 months prior to conception. That's why it's in your cereal products. Few people are really B Vitamin deficient, but that's added to your cereal products too. Or Vitamin A and D in your dairy products.

Given all the above, the obvious conclusion is that women who are of child-bearing age AND SEXUALLY ACTIVE, need to acknowledge they COULD become pregnant and make decisions based on that. If you cannot abide the notion of a aborting a pregnancy, then you take the consequences of your lifestyle or you change it. The recommendations suggest changing the lifestyle factors known to impinge on fetal health or cause birth defects.

There have been health recommendations from the CDC and every other health agency for years, including the ones you object to. They are ignored. How many people really follow the exercise and diet recommendations? This one will be ignored too. Very few of them have become law (only immunization and there's an out for that as well), so I do believe that your reasoning is specious.

[cellio]

I think it is perfectly reasonable, nay, meritorious, for doctors to say "if you would carry a pregnancy to term, even if you aren't planning one actively, I have some advice for you". Doctors are supposed to advise patients on their health in general and on factors they haven't thought of.

My fear is that, in the current political climate in this country, the zealots will attempt to compel rather than advise. See magid's comment below about someone already denied care because of fertility. Is that a fluke, or the leading edge of a trend? Too soon to tell, but I am concerned. I would be thrilled for this to turn out to be needless concern.