"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

[amergina.livejournal.com]

The main thing that struck me about the report was that it targets women's preconception health not because the gov'ment thinks that all women are baby-making machines, but because 85% of women in the US will bear a child by the time they are 44. That is... it focuses on improving all woman's pre conception health because the majority of woman will bear a child.

It's not that woman are baby making machines, it's that women tend, overwhelmingly, to make babies. Therefore some recommendations for women to make healthier babies isn't a bad idea.

I think the knowledge is a good thing for women to have. I don't think it should be pushed on people, any more than I think things like the food pyramid should be pushed on people... it's good to know what you should eat, but don't strap me down and feed me.

Or sex ed... giving a kid sex ed doesn't mean that he has to go out and have sex... but it's good info in the event that he wants to have sex.

I think the WP article is kinda written to set hackles up, though. Which is why I posted the link to the report.

[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.

[magid.livejournal.com]

There's a post in shadesong's journal about how she's already been denied medication changes because she's 'pre-pregnant'. It scares me.

[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

[ichur72.livejournal.com]

The silliest part about this, IMHO, is that it treats all women as interchangeable units. The chance of pregnancy is not equal for all women. There are those who can't get pregnant b/c they have had their tubes tied. There are those with prohibitive biological conditions such as Meyer-Rokitansky syndrome. There are those with fertility problems who would dearly love to get pregnant but can't. There are those with conditions such as endometriosis that get treated via chemically induced menopause. Ad infinitum, ad nauseam. And then there's the fact that birth defects are more likely in pregnancies that begin when the mother is a teen-ager or over 40 -- i.e., these pregnancies stand a better chance of presenting problems no matter what the mother does or doesn't take beforehand.

Behaving as if the risk is equal for all women is just silly. Moreover, I also think it is poor medical practice as it encourages doctors and other providers not to go to the trouble of making a careful assessment of an individual woman's situation and making decisions accordingly; instead, just follow the pre-pregnant protocol and turn your brain off.

This strikes me as something that was written up by trial lawyers or written wih trial lawyers in mind.

[paquerette.livejournal.com]

Another issue with this whole bruhaha is that they're trying to blame-shift here. A report recently came out about the US infant mortality rate being one of the lowest in the developed world. The natural birth community kind of collectively went, duh, the US model of care is geared towards keeping doctors from getting sued (sparing you the details, they have a habit of doing things which are statistically more likely to cause problems, but it makes it look like they're "doing something" and has evolved to look better in their favor when legal action occurs) whereas more enlightened places (ie, scandinavia) actually follow evidence-based care.

So I think one element of this is to try to keep people from scrutinizing medicine. 'Have a damaged baby? Did you ever smoke a cigarette, drink a glass of wine, or miss your vitamins a single day since puberty? ALL YOUR FAULT!'

But I also agree that this is a convenient way to set up for harsher control.

[jducoeur]

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?

Hmm; interesting point. Combine this with the American tendency towards litigation, and the corporate phobia about it, and the mix becomes explosive.

Consider: what happens when a woman receives a drug that *does* harm her baby, which she received because she didn't know that she was pregnant? The fact of these recommendations adds a fair possibility that she could sue the pharmacy and win -- the argument being that the pharmacist *should* have treated her as if she was pregnant (since those federal recommendations now exist), and didn't.

As soon as that happens, it's all over. It doesn't require intrusive laws: the chilling effect of such a verdict would shut many doors to women, from companies simply protecting their own asses...

[ladymondegreen.livejournal.com]

I am very afraid of the day when women have to walk up to a bar and say "I'm sterile" before they're served.