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What to Reject When You're Expecting

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For a lot of women in the U.S., the first real experience they have in the world of medicine—seeing a doctor regularly, checking into the hospital as a patient—is during pregnancy and childbirth. That was certainly the case for me during my first pregnancy. By the time I first suspected I might be knocked up, I hadn't seen a doctor in years.

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Like any modern, savvy person does, I went and read what I could about gestating and birthing a baby, as soon as the pregnancy test confirmed the reason why all I wanted to do was sleep and why I felt so barf-y. At the doctor's office, I pretty much let my obstetrician tell me what to do. I trusted everything I read. I believed everything my doctor told me. At least for the first 36 weeks of my pregnancy. In the third trimester, a rogue childbirth instructor with a lot more insight into the process of birth (and my obstetrician's habits related to such) convinced me to seek a different kind of care, which turned out great and left me questioning birth American-style.

Among the things I wondered: Did I really need all those tests? Who's at risk if I refuse them? What options do I have? Do doctors really know everything?

Answering those questions gets very complicated in the American medical system, which receives payment not based on the entire pregnancy-to-birth package, but for each procedure. That means pregnant women are making decisions not just as mothers-to-be but as consumers. Doctors' decisions, no matter how ignoble it may sound, are business decisions in addition to being ones attempting to honor the Hippocratic oath and care for women and babies.

Another shift in routine: no sonograms after 24 weeks.

It's with that cost-per-procedure-based system in mind that Consumer Reports—the not-for-profit group known for crunching numbers and crash-testing cars—issued its report on prenatal care. Cleverly named "What to Reject When You're Expecting," the magazine used studies on birth outcomes and surgical birth rates (among other stats and studies) to conclude that there are 10 overused procedures during pregnancy and birth. The magazine also suggested 10 things pregnant women should do and 5 things to do before getting pregnant—all of which aim for better, healthier, and safer outcomes for mother and baby.

The general advice is to let nature take its course. Avoid early delivery of any sort—whether induced or via C-section. Not all doctors have caught up with recent studies that have found babies born before 39 weeks have higher incidents of breathing problems and spend longer periods in the NICU. It used to be that inducing labor at 37 or 38 weeks was no biggie. But hospitals that have ended the practice of elective inductions before 39 weeks have greatly decreased both the number of babies in intensive care, as well as the length of their stay there.

Also under the "let it go" philosophy is delaying epidurals for as long as possible and allowing (and encouraging) moms to attempt vaginal births if their first was delivered via C-section. Another shift in routine: no sonograms after 24 weeks. These second- and third-trimester peeks into the uterus just get everyone second-guessing due dates and baby sizes, which get increasingly inaccurate as additional weeks of pregnancy are clocked.

Consumer Reports recommends, based on research, a number of things women can do to have better birth outcomes—things like figuring out the due date as early as possible and sticking with it. And there should be a backup plan for different birth scenarios, the laboring mom should be surrounded with support, and her team should plan for for five or six ways to cope with the pain of labor.

I also endorse the other advice, such as hiring a doula or midwife, though I question the magazine's accuracy about how easy and allowable that may be. The report claims "most insurance companies cover midwifery care." I would hope that's true, but it's definitely not true for all insurance companies. Also, midwives aren't available everywhere, and in some places they're only allowed to care for women before she's in labor—not actually attend their births.

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It's weird to think that deciding what to do during pregnancy care is at all related to top-of-the-line juicers or the best riding lawn-mowers. But, at least in the U.S., all three of these things are consumer decisions. Basically, the magazine set out to discover the question it asks itself again and again, even in birth: Do you get what you pay for?

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