This document provides an overview of pregnancy; the reproductive process through which a new baby is conceived, incubated and ultimately born into the world. Many facets of pregnancy are covered starting with the preparation and planning stages, and moving through conception, fetal development, labor and delivery, and post-partum (or post-birth) stages. The document describes normal, uncomplicated pregnancy in some detail, and also contains information concerning more difficult pregnancies, including pregnancies for women with chronic illnesses and other health complications.
Pregnancy is a unique, exciting and often joyous time in a woman's life, as it highlights the woman's amazing creative and nurturing powers while providing a bridge to the future. Pregnancy comes with some cost, however, for a pregnant woman needs also to be a responsible woman so as to best support the health of her future child. The growing fetus (the term used to denote the baby-to-be during early developmental stages) depends entirely on its mother's healthy body for all needs. Consequently, pregnant women must take steps to remain as healthy and well nourished as they possibly can. Pregnant women should take into account the many health care and lifestyle considerations described in this document.
Though we have tried to present relatively comprehensive coverage of pregnancy, this document should only be considered to be an overview. It will hopefully introduce you to some new ideas, and help you to learn about aspects of pregnancy that you may not have previously encountered, but it does not contain or provide all the information you will need to make informed choices as you go through your own actual pregnancy. Be sure to see your doctor when you become pregnant. Share with him or her any questions or concerns you may have about your pregnancy. Your doctor, and other specialized health care providers including nurses and midwives, will be some of your more important allies during your pregnancy. They are in the best position to guide you through the process and to make authoritative recommendations that will best benefit your baby-to-be's development and future health and welfare.
Vanessa Wainwright, who is 30 years old and lives in Virginia, gave birth to her first son in 2008 and her second son in 2011. She has generously and bravely agreed to let me publish her birth story, in the hope that other women who have had similar negative experiences during pregnancy and birth in the hospital, will not feel so alone.
I had never planned on having children, but this wonderful surprise happened, and I found myself panicked.
I didn’t know where to start.
I didn’t dive into research, I thought about it first. I only knew I didn’t want an epidural, and I wanted to ‘try’ to breastfeed.
I just hoped that I could accomplish both.
I made an appointment with an OB, and everything was looking great. I had an ultrasound to confirm pregnancy.
Then, at my 14-week appointment, there was some protein in my urine sample, and they wanted to send me for tests. They seemed pretty stressed about this protein, though they also told me it was not something that usually happens until later that causes concern.
I didn’t understand what the problem was, and couldn’t seem to ask the right questions to get the understanding. I ended up changing doctors, due to a move. Then I had to change doctors twice more, because one office had made a mistake and could not accept any more January due dates, and the next doctor was concerned so concerned about the protein that he wanted me seen by someone who specialized in high-risk pregnancy. I was still confused.
By this point I was at 32 weeks, and irritated that no one could give me a clear idea what was happening. There was apparently a problem, but it was only a potential problem.
I finally got to see the ‘high-risk’ doctor at 34 weeks. They ushered me in, told me, urgently, that they thought I would deliver early, that protein in my urine put me at risk for developing preeclampsia, that they wanted to monitor me very very closely with non stress tests, and weekly ultrasounds to monitor my fluid levels, and they wanted to give me a steroid shot to help develop my baby’s lungs.
They told me that protein in urine is usually a sign of preeclampsia, but that I did not have any other symptoms and this was most likely a pre-existing condition about which I should see a nephrologist. But, I was still high risk, they said, and had to undergo these weekly tests and monitor my blood pressure. I did everything they asked of me, except take the steroid shot.
As time progressed, I saw other doctors. One time I had slightly elevated blood pressure (about 130/83), and this man wanted to put me on blood pressure meds. By this point, with the help of my chiropractors, I had researched more into birth and knew that this reading did not constitute high blood pressure, I was just nervous (as I was every time) going into the office. I declined the medication.
The doctor asked if I had experienced any headaches or dizziness. I had had a slight headache earlier, and disclosed that to him. He filled out some paperwork and sent me to the hospital for further testing. I waited for three hours in the hospital, asked for food, but was told not to eat.
I finally saw the doctor, and he told me I was sent there for the elevated blood pressure, and an extreme headache. The doctor who sent me to the hospital actually lied to the other, exaggerating what I had told him. I was told later, by yet another doctor in the practice that his colleague was probably angry at me for not accepting his orders (that I needed to go on blood pressure medication), and that, technically, I could be removed from the practice for refusing doctor recommendations. It would have to be discussed at the next meeting they had.
I wasn’t trying to be a difficult patient but I felt pretty sure that nothing was wrong, and that the risk of taking steroids and blood pressure medication during my pregnancy outweighed any benefit they might have.
I was very comfortable with everything that was going on with my body. I had seen the nephrologist, and he told me that, yes, the protein in my urine did put me at a higher risk, but that it was a pre-existing condition, and not a sign that I was going to develop preeclampsia. The protein in my urine just meant that my kidneys were already working harder, and pregnancy made them work all that much harder, and it could cause problems.
He agreed with the other doctors that I should be monitored more often. I didn’t. But I complied. I ended up carrying until 42 weeks exactly, went into labor naturally, and labored for 15 hours.
Then, I started to loose control. I could not stop myself from pushing, and when they checked me, my cervix was ‘swelling’ (I went from 8.5 to 5 or 6 cm). I was told to get on hands and knees and rock. And then, I was told that my baby’s heart rate was going down, and they needed to do an internal fetal monitor. I saw everything I wanted going downhill, and fast. I started to lose confidence in everything I was doing, and I got very very scared for my baby.
They did the monitoring, and their faces looked grim. My husband, who had been my rock for the previous 15 hours, had fear on his face as well. We were not prepared for this. I was told I needed to have an epidural to relax and hopefully that would work to avoid C-section.
I had a choice: Epidural or C-section. I went with the epidural. And it worked. I was able to have my son vaginally. I was very very pleased with my experience at that point. I had my baby, and that was the best day of my life. Even with all the stress caused by the doctors, I was on Cloud Nine. Nothing could bring me down.
I did more and more research, and learned so much that I developed lots of regrets for the way my first pregnancy and birth was handled. I decided to go a slightly different route with my second. I wanted a home birth, but was uncomfortable with my kidney problems, and felt it better to try going with a different practice, and a different hospital.
Everything was wonderful. The midwives saw me and treated me as a normal, healthy pregnant woman. They did not treat me as though I were sick like the other doctors had. I opted out of all testing, aside from what was necessary to my special needs (every so often, a urine test and blood work to be sure my kidney function was still good).
The midwives answered my questions and listened to my ideas. Until something happened. At 24 weeks, I started to bleed. I went to the hospital where they monitored me for contractions, and did an ultrasound. It turned out I had bacterial vaginosis. They prescribed antibiotic cream (I didn’t fill it and took care of it naturally behind their back). I told them afterward and things went back to normal.
But then, my blood pressure started to go up slightly. I had to go in for a special appointment, buy a blood pressure monitor for home, and track my blood pressure every day. I got my blood pressure back to normal on my own by implementing the Brewer’s diet. But then, I started to feel excessively tired. They tested my thyroid, which came back hypothyroid. They wanted to medicate (I declined, as issues with thyroid tend to complicate things in early pregnancy. I was 35 weeks). I also tested positive for strep B. (I later found that I could have declined that too). Then, my nephrologist sent a letter asking that they test my urine a little more often. And unfortunately, my protein went up slightly.
That is when the cascade really happened. I had to start doing regular tests and visits. And the protein in my urine kept going up. A risk, for sure, but at 37 weeks, it was at about 6.5 grams. I was told that they wanted to induce. The midwives had spoken with my nephrologist, and they told me he had basically said he wanted me induced ‘yesterday.’ So, I was faced with another decision. And I had to act quickly. My life was at stake, according to the midwives.
I tried to get in touch with the kidney specialist. I felt just fine, aside from the stress and the worry the midwives were causing me. But I could not speak with him directly. I had to go by what the midwives were telling me, and what the nurse at his office said (that he had given his blessing to induce). So, I went to the midwives’ office, and spoke with the doctor and two midwives (the one who spoke with the nephrologist, and the one with whom my appointment was scheduled).
The midwife actually asked my husband, “At what point are you going to start worrying about your wife’s life?” He had asked some question about the safety of the induction procedures they were discussing. If all went well, they would only have to break my water, but then there was Pitocin. I am terrified of that stuff.
I was terrified, but I was already having contractions each night for the past two, and when they checked me, I was dilated to five centimeters. We scheduled the induction.
In the meantime, I decided to go home and take things into my own hands. I had already started to use evening primrose oil, vaginally and orally. I decided sex was the way to go. I knew it would work. It’s how I started contractions both the previous nights. And at 6:00 p.m., after having sex with my husband, contractions started in earnest.
I wasn’t sure how long it would take, so I tried to rest.
I wasn’t successful.
Every time I laid down, contractions slowed and I got nervous about the induction. So, I walked and paced to keep them coming. By 11:00 p.m. I was ready to go to the hospital. It was an hour’s drive away, so I didn’t want to wait too long.
We got to the hospital, and my contractions slowed again. They were excruciating (unlike my first labor when I could get into a routine and cope).
I could not work through them calmly. But there were long breaks between, when I tried to rest.
We were so tired. My husband and I were struggling to find each other. It was heartbreaking even as it happened.
I was so angry at the doctors and midwives for making this so hard, and for being so unclear. I was in labor for 11 hours total. I ended up having them break my water for fear of it never ending.
I had antibiotics because of the strep B, and I ended up getting a two shots of pain medication to calm me down at the end because my cervix was swelling again. The pain medication did exactly what I needed it to do, and wore off just in time. I delivered vaginally, and was able to feel everything as I pushed my second son out into the world.
I found out later, at my next appointment with the nephrologist that he did not tell the midwives he wanted them to induce me as soon as possible. He could not remember his exact words, but he is sure he would never have said that. He explained to me that he is not a specialist in that field, and was comfortable just monitoring me more closely for any further signs of kidney damage. And that he probably just told them, if they felt the need to induce, he gave his blessing in that he didn’t think it was a danger to my kidneys.
I don’t want to make it out that everything was terrible. There were good points in both pregnancies and births, highlights that I talk about when people ask me about my births.
With my first, I was completely unaware of time. When I asked my husband what time it was, he looked at me pleadingly and said, “Do you really want to know?” I was surprised it had been 13 hours. I was only aware of each moment. My husband and I were closer during those hours than we had ever been before that day. He would repeat the same encouraging words over and over with each contraction, and every time it would be like I had never heard them before, and would calm and sooth me into the tiny break I would get between. I enjoyed this dance. It hurt. It hurt like hell, but it was beautiful and transforming. It turned me into the mom I had not expected to become. I didn’t know I would co-sleep, or nurse so naturally, or hold my baby so much, or even that I would love him so much. It was instinctual. And even the downward spiral during the last hour-hour and a half couldn’t taint it at that point for me. There were a lot of things I didn’t know at that point, but my heart was so full, and it sustained me for years.
It was much harder with my second. I didn’t have the faith in not just the doctors, but in my own body and the process. But at the end, when the medicine wore off and my body said, ‘Turn over. NOW,’ and I flipped over and pushed out my son on hands and knees, feeling him come out, reaching down and pulling him to me, I felt a pride I had never known. It was not the Cloud Nine experience I had with my first—there was a lot of heartbreak at the same time. But I was proud of myself for being able to do what I had done on so little sleep, with so little support. I am still proud of that.
When I talked to my friends and family about the complicated emotions I have around both of my hospital births, to vent or get support, I felt they looked at me like I was crazy. I mean, I had two healthy babies, right? So why all the sadness and disappointment?
But I am sad about the way I was treated during my pregnancies. And I am disappointed that my births were filled with anxiety and fear, even as I feel sort of ashamed for feeling robbed, adding loneliness to a feeling of loss.
I have brushed all these feelings of anger, loss, fear, shame, and sadness under the rug. I still have a lot of healing to do. It’s hard to process my sons’ births without hurting, both because of my disappointment in the experiences I had, and because of the sadness over the experiences I will never have again.
I was never at ease during my second pregnancy. I was always nervous, always tired, always stressed. And when things started to make a turn downhill, I didn’t feel I had any confidence or control.
I went through depression for a long time after having my second child, and never really told anyone. It has been two years now, and it still stings to think about it. I am almost bitter. I don’t attribute all of my sadness, depression, and anger to the ‘healthcare’ I received. But I feel betrayed by a system that makes poor decisions based on fear of what might happen rather than focusing on what is happening.
I have been advised to not have more children, which breaks my heart. Knowing I will never have the birth of my dreams, or as many children as I want, is so hard to accept.
About Jennifer Margulis, Ph.D.
Jennifer Margulis, Ph.D., is an investigative journalist, book author, and Fulbright awardee. She is the author of Your Baby, Your Way: Taking Charge of Your Pregnancy, Childbirth, and Parenting Decisions for a Happier, Healthier Family and co-author (with Paul Thomas, M.D.) of The Vaccine-Friendly Plan. Follow her on Facebook, Twitter, and Pinterest. Watch her in the series, The Truth About Vaccines.