I don’t when it happened, but somewhere along the way, far too many expectant mothers had the rug pulled out from under them when it came to making decisions. Whether it’s a doctor saying “You should give up coffee” or co-workers gasping in shock as she has some wine at the company Christmas party, there’s no end to the do’s and don’ts that she will be subjected to over those nine long months.
Amazing, I know, but a pregnant woman can look at the data and make informed decisions about her pregnancy. In fact, I wish more care providers would do just that – arm us with facts instead of arbitrary rules. Two different women can look at the same data, make two different decisions, and both of them be confident that they made a good decision.
My post isn’t just about myth-busting. It’s about giving you helpful information to guide you during your pregnancy. Here are seven things that pregnant women are told they should or shouldn’t do, and what you need to know to make your own decision.
Oh, and if you choose to place full confidence in a trusted doctor or midwife and just do whatever he/she recommends, great! That’s certainly one acceptable approach. But if you want opinions and not ultimatums, read on!
Myth 1: Sleep on Your Left Side
There are entire threads on the internet about this one, and most start with fear-based questions like “Is it safe to sleep on my right side??” It just goes to show how strongly women have been indoctrinated into the “left is best” camp. It’s not uncommon for an expectant mother to wake in the night, fearful that she’s hurt the baby, simply because she turned onto her back. We are told constantly that we should be sleeping on our left side. Anything less feels like cheating at best, and intentional endangerment at worst. Is sleep during pregnancy really a potentially hazardous activity for mother and child?
THE DATA: A few studies have found only a slight difference in blood flow when lying on your back versus your side. One of these studies pertained only to pregnant women undergoing surgery; the other didn’t give any instruction at all based on its findings. (1,2)
More recently, Canadian doctors Dan Farine and Gareth Seaward acknowledged that “Pregnant women who lie in a supine position may develop syncopal symptoms. However, of those women who become symptomatic, only 2% to 4% have significant aortocaval compression. Even in this small minority of symptomatic women, there is no evidence of fetal compromise. The advice often given to pregnant women to lie on the left side is therefore not relevant.” (3)
CONCLUSION: Let’s face it: sleep is an elusive pipe dream that slips away to near oblivion as your due date approaches. Who cares how or where you decide to sleep – the goal is to just get some! Your body is very smart. If the baby pushes on your bladder, you wake up and go to the bathroom. If you try to lie flat on your back, or wake and find yourself that way, it’s very uncomfortable, and you change positions. Problem solved.
Myth 2: You Can’t Fly in Your Third Trimester
Many seem to believe it’s common knowledge that you can’t fly towards the end of your pregnancy; even my OB warned me about all the hassle I would get, if not outright rejections from the airlines.
An often-repeated rule is that after 28 weeks airlines won’t let you get on a plane without a lot of paperwork from your physician or midwife. For women who are feeling fine and love to travel, or would hate to miss their parents’ 50th wedding anniversary bash, this can be needlessly discouraging. Some women are fearful of being hassled or singled out at the check-in counter if they are visibly showing.
THE DATA: Some airlines (like Delta and Southwest) have no restrictions at all, beyond suggested seating arrangements; others don’t require a doctor’s approval unless you’re 36 weeks or later.
CONCLUSION: Chances are actually really good that you can take that flight, so it makes sense to check and see what’s available before saying no to an excursion.
Myth 3: You Should Give Up Coffee
Firstly, a full disclosure: I’ve been an avid black coffee drinker since the age of twelve. This is a myth I really wanted to debunk. 🙂 From my very first prenatal appointment, the cautions against caffeine started. Many women are told to give it up “just to be on the safe side.” What in the heck does this even mean? Could you harm your baby by insisting upon that latte? Or is the science so up in the air that everyone is playing it safe against some potential, unnamed risk?
Neither is true.
THE DATA: There still isn’t any conclusive medical evidence that drinking a few cups per day will harm the fetus. By that I mean the studies we have are limited in scope, and don’t fully factor in other variables. Just to point out one obvious hole: researchers are not willing to have one group of pregnant women drink no coffee and another group drink 6-8 cups per day (surprise, surprise). In fact, you’d be hard pressed to find anyone, let alone an expectant mother, who drinks that amount! The only control group that did ingest high doses of caffeine for the sake of science was animals (again surprise, surprise). And only then were scientists able to document a possible causal relationship between caffeine and problems like miscarriage and brain development.
The few studies that do show a possible link between miscarriage and “substantial” amounts of coffee in early pregnancy are not conclusive either because you can’t prove it isn’t just a correlation rather than a case of direct cause. Why? Because women who tend to drink more coffee also tend to be (a) older and (b) moderate to heavy consumers of alcohol and/or tobacco. All three are known risk factors for negative outcomes.
Another interesting fact: women who are more nauseated in early pregnancy tend to avoid or limit their coffee intake. And it’s been proven that more nausea equals less miscarriage. So, again, the slightly higher rates of miscarriage for moderate to heavy coffee drinkers could very well be due to the fact that these pregnancies were already doomed, and maybe that’s why the mothers weren’t feeling very nauseous, or even sick at all (4).
In a nutshell, the current (American) recommendation of no more than 200 mg per day is arbitrary.
CONCLUSION: The data we currently have does not preclude enjoying a few cups per day.
Myth 4: You Have to Get Antibiotics for Group B Strep
The Group B Strep question is a classic risk vs. benefit calculation, and yet almost never is it presented to pregnant women this way. Not only do we assume we have to take the test (we don’t), we are told IV antibiotics during labor are the best choice in event of a positive test (not necessarily). Nearly one third of pregnant women will be given antibiotics during labor; that’s a huge number, and certainly worth giving a second look.
THE DATA: First of all, what is the theoretical risk posed by not treating Group B? I’ll use some Canadian research to give you a general idea. Of about 20% of women who tested positive and were untreated, 50% passed GBS on to their newborns. Roughly 49% of those colonized infants experienced zero symptoms. Between 1-2% actually developed early-onset GBS.
While nearly every doctor spends time talking about Group B risk, they collectively fail to educate women about the drawbacks of routine IV antibiotics for mother and baby. Some of these negatives include:
- Increased risk of maternal and fetal yeast infection (happened to me twice)
- Increased risk of breastfeeding problems, including giving up on breastfeeding (happened to me twice)
- Increased risk of labor complications due to the mother’s mobility being limited by the IV apparatus
- Negative effects on your baby’s microbiome, for up to one year, including (ironically) higher levels of harmful bacteria like Clostridium, Enterococcus, and Streptococcus (this happened to both of my sons in their first year). Possible links to childhood allergies and asthma are also being looked into.
- Routine use of antibiotics in healthy mothers and infants can lead to antibiotic resistance, a growing problem in our age. In fact, some of the antibiotics used in labor specifically for “treating” Group B Strep are resistant and ineffective (this particular study is over 10 years old, and the numbers continue to rise).
Jane Sheppard raises an important question regarding the numbers in her assessment of our current Group B Strep protocol: “By CDC estimates, we save the lives of two in 10,000 babies-0.02 percent-by administering antibiotics during labor to one third of all laboring women. We should also keep in mind that this figure does not take into account the infants that will die as a result of bacteria made antibiotic-resistant by the use of antibiotics during labor-infants who would not otherwise have become ill. When you take that into account, there may not be any lives saved by using antibiotics during labor.”
Apparently, mortality from GBS remains the same whether or not antibiotics are given. Less babies get sick, but death rates are not changed.
Routine antibiotics aren’t the only problem; the test itself is flawed. Colonization of Group B is very transient. You can test positive at 37 weeks and then be negative at 39 weeks, or vice versa. That means both missed colonizations and misdiagnosed colonizations. In one study, 9% of women who were tested at 35 weeks came up negative and were not given antibiotics during labor. They were tested again during labor and found to be positive. The same study showed that 16% of women tested positive at 35 weeks, but negative during labor. They were thus put on high-powered antibiotics for no reason.
A more recent study from 2009 showed that most cases (61%) of GBS in full-term babies happened with pregnant mothers who had been screened but tested negative. Yet our current testing system is treated like the gospel truth.
There’s also the fact that despite following all the doctor-approved protocols, women who test negative, and their babies, can contract Group B from the hospital itself!
CONCLUSION: Decision-making would be much easier if we had faster, better test results. Some doctors are even administering a simple blood test on the newborn with promising results.
In the absence of that, you have four options right now:
- Use the universal approach and take the antibiotics. Be open-minded about the possible negative side effects of this high-powered dose of medicine on both you and your baby in the short and long term.
- Use the risk-based approach. IV antibiotics are a reasonable choice if: you tested positive AND one of these three factors is present – pre-term labor, fever during labor or membranes that have been ruptured for 18 hours or more.
- Decline antibiotics if you test positive and take steps in the weeks before labor to encourage the colonization of good bacteria. Consider the Hibiclens protocol during labor as an alternative approach (studies are mixed on this one, but here’s some research on that). Other preventative measures include refusing unnecessary internal exams, refusing a membrane sweep, declining internal monitoring except when absolutely needed, avoiding induction or use of “ripeners” which are applied to the cervix, and not permitting the artificial rupture of your membranes.
IMPORTANT: Do not let a hospital give you the “he or me” routine, and threaten that either you or your baby MUST be given antibiotics. You have every right to say NEITHER, and it will not affect your insurance.
Myth 5: Someone Else Should Take Care of Your Cat
An avid cat lover, I was both scared and saddened when reading during my first pregnancy that someone else should take care of our cats because of a deadly pathogen called Toxoplasmosis.
THE DATA: The risk of having Toxoplasmosis pathogens in your indoor cat’s litter box is statistically miniscule. A European multi-city study done in 2000 concluded “Contact with cats was not a risk factor.” Toxoplasmosis infection is most likely to be transmitted via undercooked meat and contaminated soil, not your cat. Furthermore, an infected cat only secretes the toxin for about 2 weeks, and how likely is it that those two weeks are going to fall during your pregnancy?
Two other things to be aware of. You might have already gotten the illness before conception, especially if you were around cats or spent a decent amount of time outdoors in your youth. Many don’t even know they had it because the symptoms range from unnoticeable to mild. And once you’ve had it you’re immune for life. You can even do a blood test before or during pregnancy to satisfy your curiosity.
CONCLUSION: Obsessing about our pet cats during pregnancy is unnecessary. Don’t eat undercooked meat and wash your hands after digging around in the soil, or changing the litterbox.
Myth 6: It’s Risky to Have a Baby After 35
I’ve conceived at 36, 37 and 39, so this one is near and dear to my heart. People tend to see age 35 as a big risk threshold that women should only cross with caution. Fueling this fear, many OB doctors automatically slap the “high risk” label on you if you’re over 35, setting the stage for undue anxiety and worry throughout the pregnancy.
What about all those statistics showing that women over 35 have a greater risk of problems and complications?
THE DATA: First of all, the risks increase very very slowly over time; it’s not like you hit 35 and all of a sudden you’re a walking time bomb.
See how slowly that line creeps up? And see how low the percentages actually are? (it’s not even 1 percent at age 38)
Take Down Syndrome, for one example. Dr. Sears says “Depending on how they are presented, these figures can be scary. If a doctor says to a mother, ‘At age thirty-five you have five times the chance of having a Down Syndrome baby than you did at age twenty,’ that would scare many senior mothers from conceiving. Here’s how I present the risk factors to my patients who ask. At age twenty you had a 99.95 percent chance of not delivering a baby with Down syndrome; at age thirty-five your chances of not delivering a baby with Down Syndrome are 99.75 percent. Doesn’t that figure sound more reassuring? This is why, in my opinion, the “thirty-five-year-old scare” is too young, forty-five perhaps? Even at age forty-five you have a 97 percent chance of delivering a baby without Down Syndrome.”
CONCLUSION: There’s no reason to worry about conceiving at age 35, or after. Not only do the majority of “risks” that we associate with advanced age increase extremely slowly over time, but our ability to do something about them is close to zero.
Myth 7: Don’t Gain Too Much Weight
The recommendations of how much to gain vary from doctor to doctor, and the amounts have changed drastically over the years. They even have weight gain schedules to follow – so many pounds this week or this month – and I know of exactly ZERO mothers whose patterns follow this schedule!
The obsession with weight during pregnancy not only robs many women of peace of mind, but it can cause real suffering and adverse outcomes for women who already have body image issues.
THE DATA: Statistically, there’s nothing earth-shattering out there when it comes to negative medical outcomes in mothers who gained more than the “recommended” amount. Yes, really.
This may shock you, but I haven’t stepped on a scale this entire pregnancy, and I’m now 35 weeks along. In our weight-obsessed, Western medicine-minded culture, this is unthinkable, but what exactly am I to gain (see that pun?) by religiously tracking my weight when everything else that actually matters looks great according to my health care provider? A study in 2000 concluded “Despite the widespread measurement of maternal weight gain during pregnancy, almost no data have been published assessing the usefulness or negative consequences of weighing women.” (5)
If you can show me a study that proves regular weigh-ins are directly tied to better outcomes for already healthy pregnant women, then I’ll change my tune. Potential complications like diabetes, high blood pressure or multiple fetuses can be easily diagnosed by other means.
The impacts we ought to be more concerned about are for inadequate gain, where the baby’s birth weight can suffer. (6 and 7)
CONCLUSION: You don’t have to follow pregnancy weight gain schedules or regularly track your weight in an otherwise healthy pregnancy. Most women gain more than the recommended amounts with no significant negative medical outcomes. If you’re going to worry about anything, it would be eating too little, or being malnourished.
Other Sources (Not Hyperlinked):
(1) Kaupilla, A.J.I, et al (1980). Decreased Intervillous and Unchanged Myometrial Blood Flow in Supine Recumbency. Obstetrics & Gynecology, The Effect of Lateral Tilt on Maternal and Fetal Hemodynamic Variables. Obstetrics & Gynecology, 77(2):201-3. DOI: 10.1097/00006250-199102000-00007
(3) Farine, D. and Seaward, G. (2007). When it Comes to Pregnant Women Sleeping, Is Left Right? Journal of Obstetrics and Gynaecology Canada, 29(10): 841-842. DOI: 10.1016/S1701-2163(16)32633-0
(4) Lawson CC, LeMasters GK, Wilson KA (2004). Changes to Caffeine Consumption as a Signal of Pregnancy. Reproductive Toxology, 18:625-33
(5) Abrams, B. et al (2000. Pregnancy Weight Gain: Still Controversial. American Journal of Clinical Nutrition, 71 (5 Suppl):1233S-41S. DOI: 10.1093/ajcn/71.5.1233s
(6) Schack-Neilsen, L. et al (2005). Gestational Weight Gain in Relation to Offspring Body Mass Index and Obesity From Infancy Through Adulthood. International Journal of Obesity, Severe Obesity, Gestational Weight gain, and Adverse Birth Outcome. American Journal of Clinical Nutrition, 91(6):1642-8. DOI: 10.3945/ajcn.2009.29008
Oster, E. (2013). Expecting Better: How to Fight the Pregnancy Establishment with Facts. New York: Penguin Press
Adler, D. (2014). Debunking the Bump: A Mathemetician Mom Explodes Myths About Pregnancy. (n.p.): Author