5 crazy things doctors used to tell pregnant women.

I admit I am a bit of a history junkie, especially when it comes to intersection of medicine, culture and childbearing. It's amazing the things they used to tell women. We have come a long way in the last century in caring for women. 

1. Women shouldn't gain weight in pregnancy, unless they are very thin. Then they can gain a little.

In the 40s Doctors commonly told women not to eat any additional calories during pregnancy. In the 1970s a weight gain of 15 pounds or less was preferred. If a woman wasn't thin, she was told not to gain any weight at all. My mother was 130 pounds and 5'3". She gained 10 pounds during pregnancy. Her doctor scolded her for gaining "too much".

Smaller babies used to be preferred by doctors before the evidence showing that low birth weight is linked to an array of long term health issues. (I like to believe that midwives have always loved chunky babies...)

2. Every pregnant woman should get an abdominal x-ray.

Starting in 1920's, x-rays were used on pregnant women to determine pelvic size, fetal size and fetal positioning. Today you can't get a dental x-ray without a 20 pound lead apron draped over your belly. What changed?

The work of Alice Stewart.

Alice Stewart was a Oxford University medical school professor that published an air tight epidemiological study linking x-rays to childhood leukemia in 1956. It was the height of the Atomic Era and because her results were not beneficial to the powerful nuclear industry, she was ridiculed and her work was discredited. But she continued to advocate tirelessly over the years. Her findings were eventually confirmed and additional studies were published showing an increased rate of serious abnormalities in neonates who were exposed to x-rays in the womb. Despite these warnings, x-rays continued to be used on pregnant women and babies continued to be irradiated until the mid-1970's, a full two decades after her original paper. 

3. Don't breastfeed. Formula is superior.

Formula was considered superior because it was more "scientific" and could be measured. It was an era when our culture believed science was superior to nature. The formula and condensed milk producers marketed heavily to pediatricians, which were at that time an emerging specialty. Pediatricians took the role of prescribing the "formula" ratio or constituents, and regulating intake. It was a system that appealed greatly to the science and chemistry based profession as opposed to the old fashioned wet nurse-animalistic-back woods-baby hanging off the breast.....way of feeding.  

Formula was "highly recommended" and touted as "perfect infant food".

Now we know human breast milk is much more than food. It contains prebiotics, probiotics, antibiotics, antivirals, stem cells and hormones. Now pediatricians strongly support human milk for human babies when possible, based on a large body of research showing artificial feeding contributes to diabetes, obesity, asthma, allergy and eczema, and other long term health risks.

4. Babies don't feel pain.

I was recently in a delivery room and heard not one, but two physicians make this claim. Right before a very painful procedure on the baby, the doctor told the mother, "Babies don't feel pain. In fact, they can't fully feel pain until they are 3 years old and the nervous system is fully developed.". Jaw......drop. Really?  These parents could not make sense of this claim. They wanted to believe this doctor, a seemingly bright and compassionate graduate from a top medical school. But, as experienced parents, listening to their baby wail in pain, they could not. 

How could anyone believe that babies don't feel pain? Back in the old days when we used diaper pins on our cloth diapers, if a baby wouldn't stop crying, the first thing you would do was check and see if they were being poked by a diaper pin. Common sense, isn't it?  This elegant article by Oxford university explains it in detail. Not only do they do feel pain, but they feel pain just like adults.

Curious about this myth and where it came from, I did a little research and found that indeed, at one time doctors were taught in medical school that babies felt no pain. Babies were blank slates, with empty minds, tossed in the trash if they didn't breathe immediately after birth. (That is until our hero Dr. Apgar came along and changed that barbaric practice-more on her later!) But in the 1980's there was a surge of interest with 44 studies published on the topic. Finally science caught up with common sense and this assumption was reversed. Ironically, I received an update from the American Academy of Pediatrics into my inbox not long after that "painful' incident in the labor room.  It was an official AAP statement on how to avoid the negative effects of pain in newborns, and that the "prevention of pain in neonates should be the goal of all pediatricians and health care professionals who work with neonates". Now, as to why this young top medical school graduate was taught and now practicing according to such outdated information is beyond me!

5. Smoking cigarettes in pregnancy isn't harmful...ANd sometimes even helpful!

Cigarettes were heavily marketed to both doctors and women in the 1940s and 1950s. Pregnancy books of the time recommended moderation in smoking and discouraged a woman from quitting because it would be too stressful on the body. A common recommendation was to limit cigarettes to 4 a day. Some doctors encouraged women to smoke in pregnancy to control weight gain. It was also acceptable to recommend women to smoke to "calm their nerves". They believed that "hysteria" and "neurosis" were more harmful that cigarette smoke.  By 1964 with the Surgeon General's report on smoking, doctors and the public were finally made aware of the harms of cigarette smoking and began slowly reversing the recommendations. 

A cigarette ad targeting mothers and pregnant women.

A cigarette ad targeting mothers and pregnant women.

Even when new evidence isn't controversial, it still takes an average of 17 years from the time it is published until it reaches clinical practice in mainstream medicine. This is why I recommend you choose a doctor or midwife that is both up on the research and willing to practice according to well selected studies and common sense instead of following hospital policy or antiquated standards of care. Some examples of discredited practices still widely in use are denying women food in labor, inductions for a suspected big baby, banning VBAC, elective inductions and forcing women to give birth in a non-upright position. To get up to date on the latest evidence I recommend Rebecca Decker, a PhD prepared nurse and researcher that publishes her work at Evidence Based Birth. Her articles are very readable and non-biased. Fact check what your provider tells you see if it lines up with the current evidence. You shouldn't have to wait 17 years to get the good care you deserve!

Have you heard any stories from you mothers, grandmothers, great aunts and elder friends about what doctors used to tell them? It's amazing how sharply women will remember their births and the events leading up to them. Ask them! I'd love to hear about them.