We sometimes get sick. Obviously we don’t ever deserve it. Sometimes problems occur despite our concerted efforts to do everything right. But accepting the problem (and the help that is offered to resolve it) is sometimes equated with being a failure. Pregnant women seem to be particularly prone to this misguided assumption. How can we be a good mother if our body is judged unable to keep our unborn baby safe? Body shaming 101. We can all visualise what a pregnant body is supposed to look like (thanks, Vogue), even while knowing that the image is misleading and problematic. Yet we still aspire to be that woman. And we just know that she’s going to give birth in a dreamy, unmedicated, unassisted way. As perfect women should. Oh purrrrlease! What a load of crock!

Worse still, some illnesses, eg diabetes, are (wrongly) considered one’s own fault. Everyone knows only fat people get diabetes, right? WRONG!

One of our women rang us recently because she was really hoping we’d tell her that she wasn’t diabetic, that her results were wrong, because she didn’t deserve to be diabetic. Because her diet is excellent and she keeps herself fit and healthy… She’d been ill with flu, and she was sure that this had somehow affected her results. She was sure this misunderstanding would be cleared up if she could just repeat the test. We let her repeat the test. She is still diabetic. Still pretty miffed about it. But she’s engaging with her treatment and her baby will be fine.

We know that pregnancy can affect not only our pancreas’s ability to produce enough insulin (because yes, our pregnant bodies are heavier), but also our body’s ability to use the insulin correctly (because we now have a placenta which wants to provide sweet sugary blood for the baby it is nuturing). Double whammy. That’s why we check almost every pregnant woman.

There are two ways of testing for pregnancy diabetes. Our unhappy mother had her HbA1c measured at her initial appointment and this had come back high. This test measures your blood sugar levels over the last 3 months, and I doubt that a bout of flu 2 weeks ago would affect these results. Not even if she’d fed herself biscuits, crisps and chocolate for a week while poorly. Thing is, unfair as it is, non-diabetics who stuff their faces with junk will not have a high result precisely because they are not diabetic, thus their pancreas produces the correct amount of insulin to keep their blood sugars within limits.  The second way of testing looks at how your pregnant pancreas copes with one specific amount of sugar on an empty, fasting stomach. If you have eaten or drunk the merest mouthful in the previous 10h (apart from water/unsweetened (herbal) tea/coffee) you have to rebook the test. A non-diabetic person will have produced enough insulin to remove that amount of sugar from their blood stream after 2 hours. If the sugar has left your bloodstream because the insulin produced by your pancreas has allowed the sugar into your cells despite your over zealous placenta (which makes you insulin resistant), then your baby cannot have access to your deliciously sweet blood.  This is important because your baby isn’t diabetic and s/he can produce the insulin needed to absorb that sugar. That baby will  grow too big. And giving birth to an excessively chubby baby (nobody wants that!) is only one of the possible problems. We know that poorly controlled blood sugar is terrible for babies. We know that it significantly increases the risk of still birth (seriously, nobody wants that). We know that with the correct care, the risks literally go back to normal.

Not gonna lie, it’s not easy, sticking to the diabetes regime. My sensible healthy (but carbohydrate-rich) diet would become completely inadequate if I were diagnosed tomorrow. I would strrrrugle because I love my carbs. Sure, I mostly eat the good ones, but I’d still need to cut right back. Diabetic chocolate? Purrrlease… I can’t even… I’d probably go full denial if I were ever deemed diabetic. So I have genuine empathy for my poor unhappy client, who doesn’t doesn’t even have the luxury of having a proper full-on meltdown because she has to think of her unborn child. That’s what mothers do.

Raised blood pressure is another thing us midwives regularly diagnose in unsuspecting, otherwise perfectly healthy pregnant women. I’ve lost count of all the reasons I’ve been given for a high reading. Because, like gestational diabetes, it’s considered self-inflicted. Stress-related. If only it were that simple. It would make my life much easier if I could just tell all my women to just chillax! Rather than checking their bloods for signs of liver problems and referring them to our amazing blood pressure clinic for treatment and extra monitoring. We know that a rise in blood pressure can be stress related, but is usually a physical manifestation of underlying health issues that can be very serious. And easily treated nowadays to minimise the risk of serious harm to mother and baby. Like diabetes, it’s very hereditary, and it’s absolutely not your fault if you got landed with those genes. Blame your ancestors!

Our amazing ultrasonographers often make difficult and unpopular clinical judgements about a baby’s size. Both extremes are a concern. Too big and we worry about how you’re going to push it out; too small, and we worry about its ability to withstand labour. Either could be perfectly normal for the mother, and we could well be over-medicalising a variant of normal. Not gonna lie, we do that a lot. I am really very aware of that. Us midwives are constantly balancing the needs of the mother with those of her baby. It’s a thankless task. We get lambasted from all imaginable sides: the baby doctors who are kinda pro c-sections, the doulas who are totally anti-intervention, the hospital legal department who are anti being sued for damages, and our confused women who really want what’s best for their baby, obviously, but also no induction please because they are anti pain and also anti-epidural. I’ve made my peace with the fact that I might never get it 100% right, but I’ll never stop trying. Some would argue that, for the sake of babies, all women should possibly have planned C-sections at term. Look, don’t get mad, I obviously don’t think that, but, the fact is, the the birth process is tough for babies. And some are more vulnerable than others. We therefore do our utmost to figure out which ones need a hand. Because a 100% c-section rate would be crazy dangerous for women (and pretty bad for babies too, we know that). You get my drift? We’re not going to do that. We also know for sure that for some babies, the placenta will begin to pack up after week 41. We just don’t know which ones. Until we can figure that out for each individual baby, we are left with a dilemma as to when (or if) to induce labour for everyone after 41 weeks. Or before if you have gestational diabetes  or high blood pressure, or a larger/smaller than expected baby. That’s a lot of inductions. Which nobody wants.

Bottom line, nobody is ever forced to have an induction. But we do have to recommend them if circumstances dictate. Which, understandably, can make us seem anti-woman, anti-natural birth, pro-intervention, anti-common-sense… it doesn’t help that the stats aren’t great: a significant number of women who have an induction will have either an unplanned cesarean birth or an assisted vaginal birth. Nobody wants that. But the stats for first time mothers in general aren’t all that different, because first labours are a bit of a mission, there’s just no getting around that. Remember also that we only induce labour for those babies we are concerned about. They are, by definition, the ones we consider less resilient. The ones who’s placentas we worry about. So yes, we need them born while they have a reasonably functioning placenta and some reserves, to give them the best chance of getting through the birth process (because yes, we are trying to avoid an unnecessary cesarean), and yes, they’ll be the ones who end up needing a hand. We know that the majority of these babies we worry would probably have been just fine without our intervention. We just don’t have the foresight to know which ones won’t, and we simply can’t afford to use hindsight to figure it out.

But.

Every baby matters.

Every mother matters.

So please let us (midwives, obstetricians, anaesthetists, and all the other members of the team) take care of you. Please remember we are there for you every step of the way. We’ll keep you upright, we’ll keep you fed and hydrated, we’ll talk you through your contractions, we’ll always explain what’s happening and what all your options are, we’ll deploy all our expertise to keep you as comfortable as possible. We will keep you and your baby safe.  We know you don’t deserve to have pregnancy complications. We know you’ve done everything right. You’ve followed all the rules. You haven’t touched sushi, you’ve eaten your over-done steak, you haven’t touched a drop of booze, you’ve eaten your five-a-day, you’ve done your pregnancy yoga, taken your pregnancy supplements, you’ve attended all your appointments,  you’ve also held down your job while battling nausea and vomiting drug- free, put up with all the pregnancy aches and pains without so much as taking paracetamol,  you’ve suffered sleep deprivation, you’ve been kicked in places you never knew existed… all this to give your baby the best chance.

When we intervene with our inductions, our assisted deliveries, our cesarean sections, please don’t be offended:  we too are just trying to give you and your baby the best chance. We merely want to enhance your body’s capacity to give birth to your perfect baby. We are working with you, not against you. We know you would prefer a natural birth (and believe me when I say: we want that for you too).  Just like your ancestors, who had no choice, would have done it. And yet, I think your great grandmother (whose pesky genes you inherited) would probably tell you to count your blessings and take all the help you need.

You. Deserve. That.