Five Common Myths about Pregnancy and ChildbirthMay 01, 2012 11:34AM ● By Russell Turk, MD
The amount of information - and misinformation - available to pregnant women is overwhelming. As a result, many mothers-to-be have a hard time trying to separate fact from fiction when it comes time to have a baby. Below, Dr. Russell Turk, founder of Riverside Obstetrics and Gynecology in Greenwich, sets the record straight regarding common pregnancy and childbirth myths.
Myth #1: VBACs are fringe.
Many women remain under the impression that VBACs (vaginal birth after Cesarean-section) are an alternative, risky choice, but that is an outdated misconception. In fact, the American College of Obstetricians and Gynecologists (ACOG) now encourages physicians to do more VBACs because they are considered safe and are often successful for select patients and in the appropriate setting (in a hospital where anesthesia is available immediately).
However, many physicians have decided that the risks associated with the procedure, albeit very rare, are not worth the chance of a bad outcome and subsequent lawsuit. Others pay lip service to the idea, or put so many restrictions on who will be allowed to have a trial of labor, that in the end, most of their patients end up having no choice other than a repeat C-section.
If a woman is dead set against a VBAC, I do not pressure her into attempting it, but I do make sure all of my patients are educated and up to date about the pros and cons of VBACS -- and C-sections. First and foremost, the most serious risks of VBAC are uterine rupture possibly leading to fetal distress and or maternal hemorrhage. Uterine rupture is rare, occurring less than 1% of the time. Long-lasting effects from complications to mom or baby are even rarer.
Keep in mind that a C-section is a major surgical procedure that involves a longer recovery time and has an overall higher risk of complications compared with vaginal delivery. Yet the C-section rate has skyrocketed in the past decade or so, and here in Connecticut, more than one-third (34.6%) of all deliveries are done via C-section -- slightly higher than the national average. Fewer VBAC trials have exacerbated this trend and has meant that women who have their first baby via C-section are far more likely to deliver subsequent babies the same way.
Myth #2: Pregnant women are eating for two.
Well, yes and no. Many women take this saying literally, and start increasing their calorie intake from the get go, often putting on weight before even seeing their OBGYN for the first time. It is not uncommon to remind patients that the second person you are eating for weighs only a few ounces by the end of the first trimester and less than a pound until about the 24th week. It’s uncommon to see women who don’t gain enough weight in pregnancy.
Obviously, this is not news women want to hear. But it’s simply not true that most pregnant women have to eat a lot of extra calories for the baby to grow. The average American diet contains more than enough calories to gain the appropriate amount of weight during pregnancy. This is important because excessive weight gain is clearly associated with increased risk of C-section, diabetes and other problems. If you begin the pregnancy in a healthy weight range, you should eat about 300 extra calories a day—less if you are overweight to start. Pregnancy is a time when you should eat the healthiest foods possible and try to incorporate whole grains, low fat protein, fruits and veggies into your diet, because the food you eat does pass through to the baby. If the healthier foods you are eating are lower in calories, you can certainly eat more. In this case focusing on increasing protein is typically a good idea, especially in the third trimester.
Myth #3: It’s not a big deal to ask to be induced.
Many women believe that being induced has little impact on the birthing experience, and can appear a welcome convenience for both parents-to-be and doctors. The fact is, if your doctor induces you out of convenience or without a clear-cut medical indication, it may increase the likelihood of a much longer, complicated birthing experience. What’s more, studies show that voluntary (elective) inductions significantly increase the chances of having a C-section.
Being induced, especially if your cervix isn’t ready to go into labor, may lead to a long, drawn out process involving prostaglandin gels and Pitocin. Patients hoping for a more natural birthing experience typically find themselves behind the 8 Ball in terms of reducing their ability to move and walk around in labor because once you are induced you have to be continuously monitored. In many cases that may mean being confined to bed. The majority of women hoping to go through labor without an epidural find this much harder to accomplish if they’ve been induced, although it’s not impossible.
There are many valid medical reasons to induce labor. If it is recommended, I suggest asking why it is considered necessary at this time, and whether continued watchful waiting might not be an option. As an example, OBGYNs used to routinely wait until 42 weeks to induce patients. But nowadays, if a doctor senses a patient is antsy, they sometimes offer to induce them on or around their due date. Instead, closely monitoring the baby and waiting until somewhere between one to two weeks past the due date (provided all is otherwise well with mom and baby) will increase your chances of a vaginal delivery. Another common reason cited for induction is that the baby is getting too big. However, studies show that unless the baby is measuring extremely large relative to the woman’s size, your best chance for a vaginal delivery is to await spontaneous labor.
Myth #4: Most women have to tone down their exercise regimen in pregnancy.
When I became a physician 20 years ago, the conventional wisdom held that pregnant women should avoid vigorous exercise. But we now know that it’s perfectly fine for most women to continue their exercise programs in pregnancy. Over the past two decades the recommendations have switched from allowing exercising in pregnancy to encouraging exercise with relatively few restrictions. The biggest misperception nowadays is that you need to monitor your heart rate. Instead, women should exercise until they’re tired but not completely exhausted, and you need to listen to your body a bit more closely because of physical changes that can occur such as loosening of the joints from pregnancy hormones. Always discuss your specific exercise activities with your doctor, but many strength training and aerobic workouts can not only be continued throughout the pregnancy with minor adjustments but are clearly associated with appropriate weight gain, controlling blood sugar metabolism and lowering the risk of C-section.
Myth #5: The time to discuss a birth plan with your OBGYN is at the end of the pregnancy.
The time to discuss important issues about your birthing experience is early on, during one of your first prenatal visits. The desire for more natural, less interventional birthing experiences is increasingly popular, but some OBGYN practices may not be a good match for women interested in this kind of childbirth. Warning signs of a poor fit include rigid rules during labor and delivery, variation of the physicians’ opinions within the practice, and apparent disregard towards questions and ideas that are important to you and your partner. If you are interested in a VBAC trial of labor and only one of six doctors is agreeable to this, your chances of having that opportunity are small. And if your OBGYN responds the way my sister-in-law’s doctor did when asked about a birth plan (She said, “How would you like it if I told you how to do your job?”), you’ll still have plenty of time to find a more open-minded doctor.
Russell Turk, MD is the founder of Riverside Obstetrics & Gynecology in Greenwich, CT. He is the former chief of service for Kaiser Permanente's northern Virginia area, where he supervised 30 physicians and 15 midwives and nurse practitioners. His blog, Housecalls can be found at RiversideOBGYN.com/blog.