Why plan?

One of the things that is often discussed is whether or not a woman should make a birth plan. There are a few different schools of thought on this. One is, “Women don’t need any plan other than, ‘Go to hospital; have baby.'” Another is, “Birth can’t be planned, so you shouldn’t even try.” Another might be, “You can plan if you want to, but it won’t turn out that way so you’re wasting your time.” There are also some more positive constructions, obviously.

Some people are consummate planners — they have the Day Planner in which they put everything, and are super-organized, and know how they’re going to spend every minute of every day for the next year. They may even be called “obsessed.” Others are the polar opposite — even trying to figure out what to eat for supper that evening, or what to wear the next day to school or work is too restrictive on their “freedom.” Most people are in the middle.

Apparently, my father-in-law was (and still is) very much a planner when it came to family vacations. He would literally have the whole time planned — they would leave home by such-and-such time, and drive so far, eat in this town, drive some more, get to the destination by suppertime, eat, and go to bed. And every day of the vacation was similarly planned. Spontaneity was not smiled upon. There may be some slight variations allowed (You want to play ping-pong instead of foosball? Okay), but in general, he had his plan and it was followed.

When I got married, I paid a lot of attention to a lot of little details about the wedding. I planned a lot of things, obviously — you have to do that when you’re organizing a medium-sized church wedding. If you want to stop in at the Courthouse, not so much needs to be planned; but if you’re going to have a couple of hundred people in attendance (and to feed!), you’ll want to be prepared. For all of you who have ever planned anything, whether a vacation or a wedding, or anything that you thought of more than week in advance, I ask you, “Why plan?”

Are the same thoughts screeching through your head that are screeching through mine? “What?? ‘Why plan’?!? Is this person an idiot? Of course these things have to be planned!! I have to know how much food to buy, or clothes to pack, or money to take… I’ll have to take off work or get somebody to watch the kids or….

What if I said, “Well, you can plan, but you know it’s not going to work out the way you plan, so you’re just wasting your time!”? After all, nobody who gets married plans on having the groom pass out, or the flower girl showing off her pretty panties, or the ring bearer picking his nose, or the flowers getting lost, or the cake getting crushed — but all these things happen in weddings every day. Nobody who goes on vacation plans on having a car wreck, or the alternator going out in the middle of nowhere, or getting a stomach bug the whole week, or having the luggage get put on the wrong plane, or finding out the hotel has lost your reservation — but all these things happen, too.

The fact is, there are things that happen that are not planned, but that doesn’t mean that having a plan to start with is a stupid idea. In fact, it’s usually stupid not to plan. The inspiration for this post came from reading this article, “Homework is the Mother of Prevention,” which I first saw on The True Face of Birth.

This Australian author begins by saying that she was not known to “be prepared,” and in fact ended up quite sick when she went to Latin America, completely unprepared because she refused to read any of the travel literature.

But when I was pregnant I managed to break the bad habits of a lifetime. My motivation was hearing about the many apparently normal, healthy pregnancies that spiralled out of control in the labour ward, ending in unplanned and invasive medical interventions. I was told that labour is just like that — unpredictable, chaotic, terrifying. A bit like my Latin American adventure. But while friends and family didn’t hesitate to censure me for my haphazard approach to overseas travel, the opposite was true of my careful preparations for labour. If I had a dollar for every time I was told that birth plans were futile, since things would never come out the way I expected, I could almost have doubled my baby bonus.

I strongly urge you to go read the full article, because it has many salient points. But just to sum up what I’ve already said — just because life is ultimately unpredictable, that doesn’t mean you shouldn’t plan.

Pregnant women already attract unjustified scrutiny and criticism. No woman should ever be judged for the decisions she makes while in labour, given how indescribable and unexpected that experience really is. But how a woman handles her preparation is another matter entirely, and maybe a lack of preparation deserves scrutiny. To just “wait and see” when the stakes are so high is simply negligent — both for the mother’s health and for her baby.

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A quiet hospital birth story

Since I tend to focus more on the negative aspects of hospital birth, I’d like to balance that perspective a bit by linking to this beautiful birth story, told by the family physician who attended the birth. Here is the opening paragraph, to whet your appetite:

I attended an amazingly beautiful birth last week. This is the second birth for this couple and I attended their first as well. This couple does an amazing job of taking over and creating their own atmosphere in the hospital—to the point that the nurses and I feel almost bad intruding on them, yet they are so sweet and pleasant that you want to be with them. It’s hard to describe, but basically there is like a bubble of personal space around them.

“It hurts…but it feels right.”

Read this amazing story of a woman who had a home birth, although her pelvis was “too small” for any baby to fit through. Told by the doula and apprentice midwife who attended her birth.

When I had checked Allison, it seemed as though the very outlet of her pelvis where the base of my fingers rested barely had room for more than three of my fingers. Joanne said that she estimated at the widest part, her pelvic outlet seemed to be not more than 6 cm (that’s bone, plus think flesh, then try to get a space 10 cm wide and get a head through there!).

[…]

As labor progressed through the afternoon, she became deeply focused between contractions (instead of watching a movie, talking, eating). Allison started to do all sorts of things that had her midwife and I exchanging some strange glances.
She looked like she was doing an instructional video for the The Labor Progress Handbook! We knew that she had never read any doula or labor progress books or seen these positions anywhere, so our mouths dropped open as she proceeded to do things like the double hip squeeze (pressing in on the top of the pelvis with a contraction, widening the outlet), the lunge and then she went into doing the lunge with one foot up on a chair and a huge, low, wide, squat with every contraction for hours. She’d hang on her husband and go lower and lower and wider and wider, saying, “Owwiee! This is wooorking!”

[…]

She’d smile and say, “Well, it hurts, but I want to do it. It just feels right.” She was amazingly in touch with her body and so instinctual about everything she did!

Go read the rest of the story!

Post hoc, ergo propter hoc

If I remember my Latin correctly, this phrase means, “After this, therefore because of this.”

Many times, it is tempting and easy to use this logical fallacy to say that this or that was the cause of the reduction in deaths or disease. This happens all the time — even among people who should know better.

Take maternal mortality, for instance. This CDC document covers maternal mortality from 1915 to 2003. If you go to page 7 of the pdf file (p. 2 of the publication), you’ll see a graph that shows maternal mortality. Apologists for obstetricians are quick to point out that maternal mortality dropped in the 20th century from a high of nearly 1000 deaths per 100,000 live births to single digits by the close of the century. (However, the fact that maternal mortality is beginning to rise again, despite even higher obstetric intervention is not allowed to be mentioned. [But to be fair, some of the numerical rise is due to better reporting — which means that the double-digit figures are more accurate (but still underreporting), and also that single-digit figures were quite inaccurate.]) Pro-birth control folks are quick to point out that maternal mortality dropped after birth control pills became available and common. (The fact that there was a precipitous decline even before birth control began is not breathed.) Pro-abortion folks are quick to point out that maternal mortality dropped after abortion became legal. (The fact that most of the drop of maternal mortality happened well before legalization of abortion, and the fact that many deaths caused by abortion are ignored altogether or attributed to other factors or otherwise not officially linked to abortion, is verboten.)

Post-hoc fallacy, all of it.

Legal abortion has contributed somewhat to the official maternal mortality rate dropping, but if you’ll follow the links above you’ll see that much of the “official” drop is due to inaccurate reporting. Birth control has undoubtedly contributed somewhat, since women who don’t get pregnant are not counted in maternal mortality statistics. Obstetrics has contributed somewhat, since there are some women who are truly safer in the hands of high-risk specialists. But for any of these to claim the total credit is total bull. And post-hoc fallacy. It doesn’t take into account a great many other changes and advances in this world.

Look again at the graph on page 7 (and page 13 & 14 show the actual numbers, year by year). See how that there were fewer deaths at the beginning of the reporting period (1915) than in subsequent years, until the mid-to-late ’30s? Birth moved to the hospital during this time — at the turn of the century, most babies were born at home, with midwives attending; wealthier women could afford a doctor to attend them at home; but hospital birth did not become near-universal until the late ’40s or early ’50s, although it trended upwards from the early 1900s on, reaching the half-way mark somewhere in the ’30s.

Let me insert here, for lack of a better place, that I’m intentionally ignoring the huge spike in 1918, because I think a large part of that may have been due to influenza. I remember one of the Trivial Pursuit questions in the original game said that there were more deaths due to flu in that year than were due to World War I (either just in the U.S., or worldwide), so I’m assuming that a lot of these deaths were partially attributable to that.

So, from 1915-1933, birth was becoming more common in the hospital, but the maternal mortality rate was lowest in 1915, and did not drop below that level until 1934. If obstetrics made childbirth so much safer, the mortality rate should have steadily declined as birth moved from near-100% in the home (if home was so very dangerous) from before 1915 (I’m assuming it’s the earliest year data was collected) until the mid-30s. Instead, we see that it actually rose and fluctuated above the 1915 number. So, as birth moved to the hospital, more women died. (This website has a lengthy discussion of this time period, as well as numerous historical quotes from this time period, which show that obstetricians were aware that more women were dying under their care than under the care of midwives at home. Their answer? “We need to eliminate midwives, so that we’ll have more women to practice on and improve our care” — not a direct quote, but my paraphrasing of their arguments.)

While you may say that I’m engaging in post-hoc fallacy by linking increased maternal mortality to hospital birth, I don’t think so. The doctors of the time noticed it, and correctly attributed it to their poor handling of birth, but just assumed that they needed to make birth more surgical and standardized and sterilized, to surpass the midwives’ safety records. However, the average doctor’s training on births was appalling. Some of the critics of the day noted that the average doctor would start “delivering” babies after having merely seen perhaps only half a dozen births in med school, and maybe not even participating in any. Also, this CDC document includes the following quotes:

Inappropriate and excessive surgical and obstetric interventions (e.g., induction of labor, use of forceps, episiotomy, and cesarean deliveries) were common and increased during the 1920s. Deliveries, including some surgical interventions, were performed without following the principles of asepsis. As a result, 40% of maternal deaths were caused by sepsis (half following delivery and half associated with illegally induced abortion) with the remaining deaths primarily attributed to hemorrhage and toxemia (2).

The 1933 White House Conference on Child Health Protection, Fetal, Newborn, and Maternal Mortality and Morbidity report (13) demonstrated the link between poor aseptic practice, excessive operative deliveries, and high maternal mortality.

Going back to the first CDC document, you’ll notice that the year after that White House report was issued, the MMR dropped below the 1915 level for the first time. In the link I provided that had the quotes from obstetricians of the ’20s, you’ll see that one of the most influential OBs of the time recommended 100% episiotomy and forceps births — whether this was done under general anesthesia which can be dangerous and deadly unless performed under modern standards, or under twilight sleep (possibly dangerous, but haven’t heard any deaths directly attributable to it), I don’t know, but either of these could possibly have increased the death rate even without further medicalization of birth. But doctors assumed that with sterilized equipment and sterile hospitals, that these would be safe. They were wrong. Many women died due to infected incisions — incisions that they would not have gotten had they remained at home, uncut. Antibiotics were not first available until the mid-’30s (sulfa drugs), and then penicillin was introduced in the ’40s. You’ll see that after this time, maternal mortality began a steep and steady decline, so that by 1949, the MMR dropped below 100/100,000 for the first time. It was also around that same time that safe blood transfusion became possible, which also undoubtedly contributed to the reduction in deaths from maternal hemorrhage, since excess blood loss could be ameliorated by pumping in donor blood to keep these women alive.

Let me insert here that the MMR of many Third World countries is currently around the MMR for our country about 100 years ago. I think that is important, because if you look at what life is like for them now, and compare it to life in the U.S. in the early 1900s, you’ll see a lot of similarities — clean water, electricity, quick transportation, improved sanitation, drug knowledge and availability, etc., are things we take for granted that just weren’t there 100 years ago, nor are they widespread in much of the world today.

The thing that really prompted me to undertake this post was really a post by a vaccination blog that I read recently. If you go there, you’ll see a couple of graphs which show that mortality from various diseases (such as diphtheria) was in steep decline prior to the onset of vaccines. Yet vaccine proponents like to just zoom in on the rates for the year or two prior to the vaccine’s release, point to the drop after the vaccine, and say, “LOOK! That’s what the vaccine did!” When in reality, many times the decline in mortality actually slowed down after the vaccine’s introduction.

I’m not saying that vaccines are horrible and ineffective, but I do question the fear-mongering numbers that the vaccine proponents base their numbers on. Nor am I saying that obstetricians haven’t saved the lives of numerous women or children, because I believe they have. But I am saying that it’s a shallow assessment of what caused maternal mortality rates to fall — or infant mortality — or any other mortality, to point to one single factor that happened a century ago and say, “After this, therefore because of this.” I’ve seen doctors do this many times. They say, “Maternal mortality fell 99% in the 20th century, and hospital birth rose to 99%.” True enough. But obstetricians are not responsible for the entirety of that rate, which is what they seem to claim.

Here is a post which sums it up quite nicely: Who to Thank for Public Health Miracles. While obstetricians can rightly claim some of the reduction in maternal mortality, it’s a slap in the face to the many millions of people who contributed in less glamorous or less noticeable ways to the tremendous improvements we have in 21st century America. To put it bluntly, it took more than obstetricians to move this country from conditions not unlike those of current Third World nations to where we are now. A lot of other folks deserve most of the credit — from doctors who pioneered blood transfusions, safe anesthesia, and antibiotics; to lawmakers and others who spearheaded legislation and grass-roots efforts for clean and safe food and water; to men who made automobiles common, and quick and safe roads possible (both contributing to less horse manure in the streets and quicker transports to hospitals); to a whole heckuvalot of sewer workers and street sweepers and other “invisible” people who help make and keep this country clean. Let’s give credit where credit is due. Yes, obstetricians deserve some of the credit — but not nearly so much as they heap onto themselves! Sure, they can give blood transfusions, but obstetricians weren’t instrumental in creating safe blood transfusions, and other doctors could give them just as well. Yes, obstetricians can perform surgery with the patients under anesthesia or awake without pain, and with infection most likely able to be controlled, but they did not pioneer the anesthesia or analgesia, and had nothing whatever to do with the creation of antibiotics. They can do surgeries and properly prescribe drugs, but so can a lot of other doctors. And the fact that they can wash their hands in clean water and scrub their hands with disinfectant soap was not the invention of an obstetrician, but the work of many scientists and engineers who created the soap, as well as the machinery and the process by which nasty things are taken out of sewage and pure water is recovered and flows through our plumbing system.

Credit where credit is due — obstetricians are able to perform what they can by standing on the shoulders of a lot of “giants” as well as a lot of regular folks as well. To try to say that the 99% reduction in maternal mortality was the result of obstetrics alone is shallow, shallow, shallow! (Not to mention haughty, self-serving, and a lot of other negative adjectives I could throw out.) But it’s easier to say that than to say the truth, and try to tease out how the other factors (clean food, water, electricity, machines, antibiotics, blood pressure drugs, anesthesia techniques, etc.) contributed to the overall decline.

I will say this, I’m glad to live in a country where we have obstetricians. I just hope never to have to actually need one! 🙂 I know that birth is safer in America than it is in a lot of other places, and part of that safety is due to obstetrics. But not near the 99% that they claim it to be.

Why do pregnant women eat ice chips?

This was a question that directed someone to my blog.

There are two reasons that spring to mind, and the first is the stupid practice of not allowing women to eat or drink anything while in labor, on the extremely tiny chance that they will need an emergency C-section under general anesthesia, and the theoretical risk of the unconscious woman vomiting and then inhaling the vomit, which could cause harm or even kill her. I know of someone who died in this manner during a tonsillectomy, so it is possible, but is very, very rare, and only happens when they haven’t properly made sure the airway stays clear. Proper anesthesiology practice is to assume that people have something in their stomachs; and even when people fast, there is always a small amount of liquid or bile or something in the stomach which could theoretically be vomited up. If you know you’re going in for surgery, then restriction of foods makes sense. If you’re not, then you probably have more risk of having general anesthesia from a car wreck driving to the hospital than you’d have from an emergency C-section once you got there.

But if the question is in regards to pregnant women not in labor eating ice just because they want to, then I would suggest getting a blood test to check for anemia. A former coworker was told by her doctor that her craving of ice chips was actually a symptom of anemia (she wasn’t pregnant at the time). This woman was cold-natured anyway, and if she had had her way, the building would have been kept at 80 degrees at least, all the time. When she was at her worst with eating ice, she would sit at her desk, huddled under a blanket with a space heater by her feet, freezing away… while eating ice! I’d never heard of an ice craving indicating anemia before, but the doc indicated that it was fairly common.

So, if you’re pregnant and craving ice, you may be anemic. Anemia is fairly common in pregnancy — the woman’s blood volume increases quite a bit during the nine months, and if she doesn’t have enough iron, then the extra blood dilutes the iron she has, which manifests as anemia. One problem is, that vitamins or other pills containing iron may cause constipation, which tends to plague pregnant women anyway. Another problem is that iron pills may cause nausea. If you can get iron in a liquid form, or slow-release, or in pills containing a little bit at a time, these may help. Of course, you can always try to eat foods with a lot of iron in them, which I tend to prefer in theory; but if your iron is really low, you may need to “kick-start” with supplements.

Bed Dystocia

Ok, I’ve found a new favorite magazine — the Journal for New Zealand Midwives. I’ve only read three articles, and each on is blog-worthy. Keep your Good Housekeeping and Ladies’ Home Journal, and give me a good pregnancy or birth article any day!

If you scroll down to page three of the Journal, you’ll read an article called “Active Breech Birth: the Point of Least Resistance.”

In it, the midwife tells of a conference she attended in which symphysiotomy was discussed — that is the cutting of the cartilage between the mom’s pubic bones — ouch!! It was in the context of vaginal breech birth, and the dreaded complication of head entrapment.

Gruesome you may say – but it was actually very affirming for me as it re-emphasised the importance that the woman’s position plays for giving birth to her breech baby to avoid what I term ‘bed dystocia’.

[“Dystocia” refers to difficult childbirth — long labor, slow birth, etc. — “labor dystocia” is a fancy way of saying that labor isn’t progressing according to the doctor’s wishes; “shoulder dystocia” means that after the baby’s head is born, the shoulders are stuck.]

Bed dystocia occurs when the baby’s progress is halted due to, firstly, reduction of the woman’s lumbar spine curvature (lordosis), secondly, the backward tilting of the pelvis and, thirdly, entrapment of the sacrum by maternal weight, all of which can occur if the woman is lying on a firm bed.

I strongly recommend reading the whole article, and would quote the whole thing except I daresay that would be a breach of copyright! 🙂 But the article continues on to discuss the pelvic diameter in “active” birthing positions (such as a supported squat), compared to the lithotomy position described above. It says that while the symphysiotomy “primarily increases the transverse diameters by 1 cm,” so-called active birthing positions increase the transverse diameter 1 cm plus they increase the antero-posterior diameter by 2 cm. So, while doctors will continue to insist on unnatural birthing positions that put mothers and babies into the worst position possible (but it is the easiest position for the doctor), they are then forced to rely on even more medicalization in order to free the breech baby’s head should it become entrapped.

In other words, doctors don’t know squat!

Defiant Birth

I read about this book in the New Zealand College of Midwives’ Journal, and it intrigued me — Defiant Birth: Women Who Resist Medical Eugenics. Essentially, it is a book about women who either give birth after having been pressured to have an abortion because of a fetal anomaly, or refused such testing altogether. While the person writing this review criticized the book for not including any stories of women choosing an abortion, the whole point of the book is one of defying the medical community and giving birth to babies that most women would abort and most doctors would encourage to abort. The whole point of the book, evidenced by the title, is that it is about women who refuse to kill their offspring for medical reasons.

It is my opinion, based on years of being on pro-natural- and pro-home-birth lists, that women who tend towards natural (meaning, unmedicated, not just vaginal birth) and/or home birth tend to avoid prenatal tests and screens, including ultrasounds, which may indicate a problem with the baby before it is born. Also, women who are so strongly pro-life that they would refuse an abortion regardless of the prenatal diagnosis would be more likely to decline any testing. [If any of you know of any research done on this topic, please let me know, because I’d like to know if my opinion is accurate or not.]

The down-side of refusing tests is that if there is a problem (which is, fortunately, rare), then it is not known prior to the birth, so the parents cannot prepare for a child with disabilities or one who needs medical care. Many parents, and it is especially the mothers who write about it, talk about being grateful for knowing of their child’s circumstances prior to the birth. One reason given is that it made the time of pregnancy more special for them, knowing that it would be the bulk of the time they would have with that child. They made more effort to bond with their baby prenatally than they otherwise would have. While it was difficult for them to continue the pregnancy knowing that their baby could die at any moment, and would most likely be stillborn, or die soon after birth, they found joy where they could, and loved their babies as long as they did live. Another reason given is that knowing the condition beforehand gave them the opportunity to better prepare for the baby’s birth (and sometimes immediate death) — either by having a birth plan with specified medical care, a team of specialists to help the baby live, or being able to mentally and emotionally prepare themselves for the grief of losing a child.

The downside of having the tests is that there are false negatives as well as false positives, and if you receive a negative result (that is, that your child is not affected) and at birth you find out that he or she is affected, then you will been given false assurance that everything is normal. If you have a positive result (that your child does have something), then your pregnancy will be much more stressful than it otherwise would have been. While some of that stress may be related to finding out everything about a certain condition, there is undoubtedly stress just in dealing with that condition. One of my friends had a positive result from a screen she had in early pregnancy, and although she chose not to have an amniocentesis to confirm or disprove that potential diagnosis (because of the risk of miscarriage, and the certain knowledge that she would not abort her baby even if he did have something), she did have a more stressful pregnancy with him than with his older brother, because of the worry that the test raised. It was needless worry — the baby was just fine — but it was many months of concern, nonetheless, even though she knew that most of the positives from this screen were false.

While most abortions done for a negative prenatal diagnosis (that is, the baby is said to have a certain condition which will result in his death in utero or soon after death, or will survive with disabilities) are accurate, a small percentage of healthy babies are aborted, or the condition was not as bad as it was thought to be, when the fetus was given an autopsy. If you have been given a difficult diagnosis, and are thinking of having an abortion, please get a second or even a third opinion. While it is rare, I have read of women who have been told that their babies were missing organs (kidneys or even the brain), and after the baby’s abortion or birth, it was discovered that the diagnosis was wrong. Since most of these diagnoses are done by ultrasound, it all depends on the sonographer’s skill and equipment. But even highly-skilled doctors can make mistakes.

I’ve mentioned it before, but I’ll tell it again — a woman on one of my lists was told when she was at or near term that the ultrasound showed her fetus didn’t have Down Syndrome nor have any heart problems (and this was a 90-minute-long Level 3 ultrasound), and the baby died just a couple of weeks later, of the heart problem she supposedly didn’t have, and she also had Downs. The woman said she was glad that the incorrect diagnosis was given, because although she was falsely assured, it at least kept her baby from multiple surgeries which would have done no good, but which she would have been pressured into having her get “just in case.” She would have been pressured into inducing or having a C-section, and the baby’s short life would have been spent in operating rooms and in pain, to no avail. As it was, her entire life was spent in the comfort and safety of her mother’s womb.

Often when such a diagnosis is given, the woman is immediately pressured to have an abortion. Perhaps the word “pressured” is too strong in some cases — it may just be asumed that women will have an abortion (or pre-term induction), rather than carry the baby to term. Here is one such case — the woman had her first ultrasound at 31 weeks, and it was discovered her baby had anencephaly. Immediately after the diagnosis…

My doctor had proceeded to tell us there was a room upstairs to start an induction. She never asked me or had said go home, rest, make an informed decision when you are thinking clearly. I don’t blame her, I had free will, but she now knows how important it is for her to tell patients they have a right to make an informed logical decision regarding inducing early or carrying to term.

The induction didn’t work, and after three days of waiting for contractions to start, she finally decided just to go home and continue the pregnancy, and carry the baby to term.

Our reaction to our son was that of complete awe. He was anencephalic and he was indeed beautiful. He had so many resemblances to our family, it was uncanny. He had my husband’s thin lips, his wonderful cheeks, chin, and nose. His eyes were a bit bulgy, that is due to the orbital bones not forming correctly, but the same deep brown eyes all my children share.

Then there is this story, in which the mother had declined the quad screen because of the level of inaccuracy in it, and wouldn’t have an amnio because of the risk of miscarriage, but she did have an ultrasound, where it was discovered the baby had so many problems, that she just kept hearing them say “and… and… and…” They counseled her to have an abortion, which she naturally refused being very pro-life, but eventually consented to an amniocentesis, because the after-birth care her son got might depend on the answers an amnio would give them. [As an aside, I will point out that when her husband left the room while they were prepping her for the amnio, they pressured her to have an abortion, saying that it was her decision and not her husband’s. As if the only valid “choice” they perceive would be to have an abortion.] The results for the amnio were that the baby did have Down Syndrome, and they counseled her again to abort, because that, combined with his other ailments, meant that he would not live much past birth. When she declined yet again, they offered her a pre-term induction. After it was explained to her that she would be induced before the baby was old enough to live, she said, “That’s the same thing as an abortion,” and told them “no” once more. Good for her! Read the rest of this amazing story here. While her adorable little boy does have Down Syndrome, he defied the prognoses and instead of dying within the first few hours or days of life, is now one year old.

I’m not saying it will be easy to be “defiant” in the face of such pressures. Women “over a certain age” will be strongly pressured and coerced into having tests and screens to see if their babies are affected. All women, regardless of age, will be pressured into having an abortion or pre-term induction if the test results indicate that the baby has a defect. Sometimes even minor, correctable defects like a cleft lip or cleft palate will send some women to an abortionist. But when the baby has a genetic condition or severe heart problems or anencephaly, the pressure to abort will be very strong. It is almost assumed that you will abort — by your doctors, and perhaps your friends and your family — such as what happened to a woman whose blog I happened across. She is currently pregnant with a daughter with congenital diaphragmatic hernia, which may kill her soon after she is born. The woman needed support, and her mom and dad both told her to have an abortion. But she is choosing to let her daughter live as long as possible, and is going to love her as long as possible. I admire her.

If you have been given a poor prenatal diagnosis, you need to consider all your options. There are many support groups, especially on-line, that you can talk to as you go through this. Abortion is not the only answer. Even if you think you cannot raise a child with a disability, there are many families who will adopt special-needs children. Here is one such organization with over 200 families waiting to adopt a child with Down Syndrome. Over on the Real Choice blog, there is a list of websites (below the list of posts, in the right-hand column) that are geared towards helping families when they have been given a negative diagnosis — some are for specific ailments, like Trisomy 13 or Trisomy 18; while others are for all conditions, including being pregnant with cancer, and how to support a friend who has been given a poor prognosis for her baby.