"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

[sue-n-julia.livejournal.com]

One of the first anti-inflammatories I was on required a pregnancy test before beginning it. The dr. decided that all she really needed to do was ask -- I would be pretty likely to know if I had a risk of pregnancy (unless, of course, Julia's been hiding something ;> ). It did require that you abort if you got pregnant.

S

[beckyfeld.livejournal.com]

There are a few drugs on the market that are so teratogenic (cause birth defects) or abortafecient (cause abortions) that people who cannot definitively say that they are not pregnant should be tested for pregnancy before starting on them and monthly while they are taking these medications. These include things such as Acutaine, Cytotec, Thalidomide, etc. We in the medical field have been making these recommendations for YEARS. I remember learning about them when I was in pharmacy school. The same thing is true for the routine use of folic acid. The basis for this is that many of these things can affect the fetus BEFORE THE WOMAN EVEN KNOWS SHE IS PREGNANT (that is, within the first few weeks after conception).

In your case, I suspect the drug your doctor wanted to use contained Cytotec (misoprostol), which is sometimes used to protect the stomach against ulcers and is given in combination with an anti-inflamitory which can cause them. Arthrotec is an example of such a drug.

[paquerette.livejournal.com]

Cytotec

Really? Interesting that they're still using it to induce labor. O.O (But I'm guessing, being in the medical field, you know about that controversy)

[sue-n-julia.livejournal.com]

I agree. I was just amused because my doctor figured a lesbian was quite likely to know the risk of being pregnant. But, I got her to switch me to a new drug that I've had a better response to (and could get in more than a 10-day supply at a time).

S

[estherchaya.livejournal.com]

These include things such as Acutaine, Cytotec, Thalidomide, etc.

You forgot to include Depakote in your list. But I'm not bitter. No, not at all.

[beckyfeld.livejournal.com]

Actually, if you want me to get really geeky on you, I'd note that the drugs I listed are FDA Pregnancy Category "X", where Depakote is Pregnancy Category "D". If you are curious, there is a good explanation of what the different category designations are at http://depts.washington.edu/druginfo/Formulary/Pregnancy.pdf

[estherchaya.livejournal.com]

Interesting. I added Depakote, because my doctor had told me it was Category X. Anyway, I don't need you to get REALLY geeky on me. I've got a husband with a PharmD for that. I'm certain that HE never told me it was Category X, but I'm also sure I never asked. I just went with his dumbed-down explanation to me: "It would be really, really, really, really bad if you got pregnant while taking it."

But mostly, I was being bitter, since I now live on Aleve, Codeine, and various other pain medicines, which frankly isn't much better.

[dagonell.livejournal.com]

"(unless, of course, Julia's been hiding something ;>)"

Pregnancy also depends on *where* you're letting her hide it. :D
-- Dagonell