Kate Tietje, Modern Alternative Mama, is expecting her sixth child and planning a natural pregnancy. A natural pregnancy is an ignorant pregnancy … literally.
Nearly every single aspect of modern obstetrics is preventive medicine. Nearly every test is a screening test designed to provide women with information they can use to improve their health and the health of their babies. Nearly every intervention is a preventive intervention, designed to prevent poor outcomes for babies and mothers. Natural pregnancy means forgoing information, rejecting preventive efforts and winging it while hoping for the best. If it works out fine, you’re a warrior mama (though the whole point is that you didn’t do a damn thing), and if it works out badly, tough luck for you.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]A natural pregnancy is an ignorant pregnancy.[/pullquote]
Here’s Kate’s strategy for a natural pregnancy:
- No Doppler use
- No ultrasounds
- No blood tests
- No internal exams
- Few (if any) prenatal visits
- No GD test
- No GBS test
Because what you don’t know can’t hurt you, right?
Wrong.
Here’s Kate’s explanation of the advantages of ignorance.
Most of these tests are intended to check to make sure the pregnancy is progressing normally. In most cases, the answer will be yes. The tests don’t actually prevent issues from occurring; they only detect them. Some of the tests come with their own set of risks (from false positives to much more serious risks), and I don’t think that the risk of further intervention is worth “checking on” in a pregnancy that appears to be going fine.
In most cases the answer will be yes, the pregnancy is progressing normally? Duh! In most cases the pregnancy is progressing normally. But what if it’s not? Tough luck for the baby and maybe tough luck for the mother.
What about the risk of false positives? It’s very real risk, but Kate does not mention that there are ways to reduce that risk. Screening tests done on low risk populations have high false positive rates, but when applied to high risk populations they have far lower false positive rates.
For example:
If you were to give everyone (men and women, all ages) a pregnancy test, there would be false positives among the men, children and elderly who couldn’t be pregnant under any circumstances.
If you were to restrict pregnancy tests to all women of reproductive age, there would be far fewer false positives, and you would almost certainly diagnose pregnancies in women who weren’t aware they were pregnant.
If you were to restrict pregnancy tests to all women of reproductive age who have missed a period, have morning nausea and breast tenderness, false positives would be rare.
It is always the case that for those at high risk for a condition, the rate of false positives is lowest.
So when Kate implies that there is a significant false positive rate for low risk women for the 1 hour glucola test for gestational diabetes, she is correct. But for women who have had gestational diabetes in the past or given birth to a very large baby, the risk of a false positive result is far lower.
What is the downside to a false positive test for gestational diabetes? Very little, just a further test with a very low false positive rate. What is the downside to missing gestational diabetes? It could result in the death of the baby. In other words, the downside of a false positive is far less serious than the downside of ignorance.
Each specific test has a different calculus of risks and benefits for each individual. Therefore, lumping all possible tests and interventions together as a “natural pregnancy” makes no sense. Every woman should take into account her specific circumstances in order to make individual decisions about individual tests.
In contrast, Kate’s view is that ignorance is a better strategy than risking any type of false positive test result. It’s like claiming that no one should ever have their blood pressure checked because it’s better not to know than to unnecessarily treat high blood pressure. It’s like claiming that there’s no need to buckle babies into car seats since the overwhelming majority of car trips involve no accidents.
So ignorance can often be dangerous, but knowledge can be valuable even if it doesn’t change outcomes.
Consider the use of ultrasound in pregnancy.
According to Kate:
There is no evidence that routine ultrasounds improve outcomes in low-risk pregnancies.
But they do improve knowledge, providing evidence on congenital anomalies (including some that can be treated in utero or immediately after birth), twins or higher order multiples and placental problems.
Obviously the knowledge of congenital anomalies is important for those who would terminate the pregnancy in such situations, but it is important even when termination would never be considered. Advanced planning for the birth of a baby with severe anomalies can be the difference between life and death. And many people find the knowledge of congenital anomalies or multiple pregnancy valuable even when it isn’t a matter of life and death.
What’s the value of ignorance in these situations? Kate doesn’t offer any examples.
Kate makes a big deal of the potential risks of ultrasound, but there’s no evidence that those risks actually occur or affect babies in any way.
As an aside, my favorite part of Kate’s ultrasound post is this:
Since obstetrics is unfortunately a very non-evidence-based field, it’s important to look beyond what’s “commonly done” and really dive into the evidence.
The claim is simply false based, on a deliberate distortion of one paper, but it’s also hilarious for two reasons.
First, Kate claims that obstetrics isn’t evidence based and then exhorts everyone to look at the obstetric evidence. Which is it? Do obstetricians ignore the existing scientific evidence? Kate provides no examples, not surprisingly, since it isn’t true.
Second, the field of “natural pregnancy” routinely ignores scientific evidence in favor of intuition based on no evidence at all.
Kate tell us that as for herself:
I haven’t had any ultrasounds with my last three babies, and don’t plan to this time, either. I also refuse the use of the Doppler entirely.
What’s the benefit of that? Bragging rights, of course!
I personally see nothing admirable about deliberate, willful ignorance, but, hey, to each her own.
