Sunday, June 13, 2010

Kegels, Fat Obstetrics, and Fear Factor

I just realized I haven't posted here in almost a month. A MONTH!! I've been diligently working on a post continuing my "mainstraming midwifery" thought process but I keep getting sidetracked. So, a couple random thoughts on recent things I've read:

Are you going to stop doing your Kegels? Apparently the concept that kegels don't work has been around for a while- a quick Google search turned up all kinds of information on how unnecessary and ineffective they are. I wonder, though, if we're tossing the baby with the bathwater? Even if Kegels are not the whole answer, comments I've seen are generally in the vein of "Great! I didn't like them anyway and now I can stop doing them!" Is doing nothing really going to be better than doing something? I'm not a physiologist. I don't know much at all about exercise and muscle-building, but I do know everything I've read about getting in shape suggests that balance is critical. I also believe that Kegels helped me personally, though I never did hundreds a day and I was doing a lot more than just Kegels. I'm going to be watching to see if any more information comes out about this, and in the meantime, I'll keep Kegeling like I always have.

The Navelgazing Midwife wrote a great blog about Fat Obstetrics. I was clinically obese prior to (and during) my first pregnancy, and no one ever said a word about the potential impact it had on complications. Even outside of pregnancy, I had only one care provider tell me my weight might be affecting me negatively. That was a company RN who was doing my annual physical; she told me my high blood pressure (consistently in the 140/90 range) could be due to my weight, and that if I made some simple changes (she suggested walking a mile a day) I could see big improvements in my health. I blew her off- my labs were fine, high blood pressure ran in my family, and I was healthy. Well, except for my recurrent rectal abscesses, which are typically seen in obese middle-aged men, but my doctor said that's just one of those things that happens. Nothing I could do about it, except get through my pregnancy and then have surgery to correct it. After my pregnancy, I decided to make a concerted effort to lose weight, and over the course of 7 years I lost about 50 pounds. I'm (barely) in normal weight range, my blood pressure is normal, and I never did have to have surgery for an abscess because they never came back. Okay, okay, I know anecdotes aren't that statistically useful, but I can tell you that I went from "healthy" to seeing big improvements in my health. I don't judge women who are still struggling with weight because I know it is a struggle, but I don't like the message that we're all medically the same regardless of our weight. Big women deserve respectful, quality care-- but quality care has to include an honest discussion about the impact our weight can have on our health even if we appear healthy. I think Barbara really nailed the issue in her post, and I highly recommend reading it!

Where does Fear Factor come in? Everywhere. I feel like everything I've read lately has been based on Fear. Fear of offending, fear of intervention, fear of losing control, fear of having too much control, fear of failure. Is it possible that we, collectively, are trying to circumvent the necessary processes of overcoming our fears? We seem to look for an easy answer- no more Kegels! Fat is Healthy!- wanting to find utopia without having to slog through the messy realities of change. And this brings me back to the post I'm trying to write about midwifery care and whether or not it's realistic for an OB who supports physiologic birth to work in a hospital setting. That will be coming soon!

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