Calling all mums-to-be! I hope you don’t mind me asking but have you really thought this one through? I know, you’re all excited about the impending birth but do you actually, honestly know what you’re doing? And yes, people might have said this to you before, but you should listen to me. I might not know you, but I’m a doctor.*
Pregnancy and childbirth can seriously damage your health. Trust me – I might turn out to have a PhD in something entirely unrelated to healthcare, but I’ve had children, so I should know. Except I don’t. No one ever went through a list of all the possible negative effects with me (and I went to see the GP loads!). In the interests of writing this post, I’ve just gone and googled a list myself. There are a lot of effects I recognise but hadn’t given much thought to until now, plus there are others about which I knew nothing at all. For instance, I had no idea pregnancy could be linked to a loss of bone calcium. And as for prolapsed uterus – well, I knew it could happen, but I had no idea that it affected as many as 11% of women. 11 sodding percent! And all that’s before you scroll down to the really serious stuff (including, naturally, death). Flippin’ heck! Do these children of mine, currently scrapping over whose turn it is to push down the lever on the toaster, have any idea what I’ve risked for them? Do they heck as like. And to make matters worse, I can’t even change my mind and undo it all. The damage has been done, both to the toaster and to me.
You may say “well, that’s just a list you googled. How trustworthy is it really?” And the answer is, I don’t know. But since no one with greater authority has ever considered it a priority to educate me on current risk assessments, I’m just doing my own not-particularly-reliable digging. And as far as I can see, the outlook isn’t great.
Of course, if when I’d gone to my GP and announced that I was having a baby she’d responded by handing me a long list of established risks and sent me away to “take a bit more time to decide”, it would have rather taken the edge off things. Plus I’d have felt somewhat patronised, not to mention confused. I don’t need to know the details to be aware that pregnancy is not 100% safe, but unless there is a very specific, imminent risk to me, the overall lack of safety is just one out of a huge number of considerations. Basically, while my doctor’s understanding of the physical risks of pregnancy is vastly superior to mine, her understanding of whether or not I’m capable of choosing to have a baby isn’t. If anyone’s the expert on that, it’s me. Thankfully, most medical professionals recognise this, at least as long as you’ve already made the “right” choice and aren’t requesting a termination. Ask to end a pregnancy and suddenly various issues, both real – haemorrhage – and concocted – increased risk of breast cancer, infertility and suicide – become incredibly important, more important, it would appear, than what pregnancy actually is and means.
I realise this is stating the obvious but sometimes the obvious needs to be stated: the difference between having a baby and not having a baby is MASSIVE. This is why miscarriage, no matter how common, is always deeply distressing. And it’s why a “normal” pregnancy, no matter what the side effects, is absolutely worthwhile for anyone who wants a child. At the same time, this is also why deciding not to have a baby shouldn’t ever be dismissed as a decision made on the basis of ignorance, selfishness or convenience. I mean, the person making the decision may or may not be, in general moral terms, a selfish sod. But the alternative – continuing with a pregnancy – is far too significant to be placed in the “too much trouble for you, is it?” box. It doesn’t matter how knowledgeable or mature or morally aware the pregnant woman is. Once you’re pregnant, there isn’t a straightforward get-out clause and there’s never an easy option. No one can make the decision for you.
It bothers me greatly that the publicity given to statistical risks associated with abortion is continually linked to the decision a woman has to make. In today’s Guardian, for instance, a study revealing that multiple abortions increase the risk of low birth weight in subsequent pregnancies becomes, in the eyes of Andrew Whitelaw, professor of neonatal medicine at the University of Bristol, information that should necessarily be shared with women seeking abortions**:
“Birth before 28 weeks exposes the infant to a hugely increased risk of death, brain injury and permanent disability. Thus an increase (after three or more abortions) of nearly threefold in the odds of having an infant born before 28 weeks is worrying,” he said.
But how worrying is it really, at least for the woman facing an unwanted pregnancy? I am not suggesting that this information should be withheld from her – but if it is felt that she needs to be actively informed, what is she meant to do with this information? How is it meant to inform her decision? Is anyone providing corresponding information regarding all the risks involved in not having an abortion? Which pieces of information are considered relevant and which aren’t? And who gets to decide all this?
The trouble is, while continuing with a pregnancy or not is an enormous decision, it’s also a messy one. The factors that come into play – physical, emotional, financial, personal – are so complex that, even if you don’t personally feel up to the job of deciding what to do, there’s no one else who can decide for you. You can’t go back on having an abortion, but you can’t go back on having a child, either. It disturbs me that one decision is considered worthy of counseling while the other – which also has far-reaching consequences – isn’t. I’m not suggesting that no one offers counseling to women seeking abortions, but I am curious as to how and where we’re setting the boundaries of such advice.
I write this as someone who has never had a pregnancy that wasn’t wanted. I don’t know what it feels like to have an embryo inside me which I don’t feel ready to carry to term. Even so, however much I’ve wanted my pregnancies, there have always been moments of extreme doubt and panic. It’s not clear-cut. But if someone had said to me “do you know, you’re increasing your risk of a prolapsed uterus but any future babies you have will be less likely to be born premature?”, it would have made no difference whatsoever to my choices and my feelings. Such things are a drop in the ocean, yet the importance ascribed to some factors and not others reflects a misunderstanding of the complexities of pregnancy – and in some cases, an unpleasantly dishonest leaning towards pushing a specific moral agenda.
I have often wanted to write a post about this, but held back on the basis that health-wise, I don’t really know what I’m talking about.*** But that’s part of the point, isn’t it? I could know more, but I’m not sure how much I need to. There’s no final summing up, no way in which the pros and cons of what I’ve done will be objectively measured, so that I’ll know whether or not I’ve done the right thing. Having children – or not having children – isn’t like that. And to be honest, whatever happens to my uterus in years to come, I’d rather we lived with these messy decisions than keep hunting down the “perfect” choice.
* To be fair, I’m not a medical doctor. I don’t even have GCSE biology. But let’s set that to one side.
** Whitelaw’s position may be linked to the fact that medical abortions appear to carry a lower risk than surgical ones in this matter. If this does mean that one abortion type is ultimately less risky than another, that is important to know (although I am unsure how much choice a woman really has in this – I’d imagine time constraints mean it’s very little).
*** Not that this usually stops me blabbing about anything and everything, if I’m honest.
PS Five minutes after publishing this I saw this. Which is a much better discussion of the Guardian piece. With less personal ranting and more actual facts…