Tuesday, February 12, 2013

Free range versus abundance of caution

I've been ignoring updating about the nuts and bolts of this pregnancy thing for a variety of reasons, most of them involving me finding it boring or slightly scary to consider. Mostly boring.

BUT. I'm getting ready to go to non-stress test #4, and it sounds like we're going to keep doing them twice a week until Little Monster arrives or fails one and then arrives very quickly. Why? Because on a day where I slept about 18 hours (and therefore didn't eat) when I was awake I noticed markedly decreased movement. Like we're talking going from 10 kicks in the first 5 minutes of an hour to just hitting 10 in 45-60 minutes (and 10 is the normal minimum that we're told to be looking for in an hour).

My doctor's argument is that it's good to be abundantly cautious. I figure that since the only cost to me at this point is my time, then I'll go along with it, because I'm a paranoid nervous pregnant person. On the cost front, I know this isn't costing me a thing because we have a high deductible for the year and we were going to hit it with this pregnancy thing anyway, so it's only costing my insurance company and the spouse's employer for me to have perhaps more tests than I really need.

I'm conflicted about it, but at least at the last NST not everything was perfect. The first part Little Monster had an elevated but only slightly heart rate, and then after that, there weren't quite enough changes in heart rate for everyone to be super happy with. I spent 2 hours with the monitor and then another half hour waiting for lab work to come back and my doctor to stop by to check in with me.

My goal in life is to be a free-range parent, to not intervene in things that are going just fine or not causing harm. It's hard for me to get used to all this monitoring and fretting when there aren't strong causes for doing it. One of the reasons I really like evidence-based medicine is that doctors are people and people get swayed by emotions. We like to know all the answers to questions we might not even have really asked. Like the liver function panel I had drawn. Were there any signs of dysfunction to indicate that test was needed? Nope. Is it nice anyway to know it's fine? Sure. Is there evidence that all this monitoring changes outcomes unless there's signs to indicate doing so? Not really...

In pharmacy school, we are often reminded that habit is a hard thing to break. There was a group of drugs back in the '80s that we were sure would lower blood pressure and reduce the number of heart attacks and strokes. It was totally true that they did lower blood pressure, but they increased the number of heart attacks in people taking them rather than reducing them. It was a big study, and then another study confirmed it, and the drug lost the indication to treat high blood pressure as a first line treatment (this class is still used but as the last string drug, when all the others are already being used). Doctors were told to get patients off of it.

Within 6 months, 70-some percent of patients taking the drugs were still doing so because the doctors were sure they were just fine. They'd used them for years without a problem! How could their personal experiences be wrong? (disclaimer: we all do this, not just doctors. It's a people thing that we do, but we need to be aware that we're doing it. I'm just acutely aware of doctors and healthcare because I'm spending so much time hanging around them these days...)

I get being cautious, I do. I'm happy with it, mostly. But I worry that doing things "that probably won't hurt but we don't know if they help" can get out of hand. I wonder if it's already out of hand here in my very own life. I'll particularly wonder it if my blood pressure stays down and I have to have another pre-ecclampsia panel on Thursday (with no other indications than that my blood pressure was almost in the danger zone once at one visit).

I keep thinking about how parents worry about increasing traffic near schools, which leads them to drive their kids to school, which means more kids who aren't good pedestrians and can't navigate heavy traffic near schools, and it's a vicious cycle of more cars and less pedestrians. Is everyone safer in cars? I'm not sure, I haven't seen the data, but I would suspect that as dying in a car crash is a leading cause of death in the US, car passengers are probably at a greater risk because they intervened in a "normal" process of kids walking to school...

1 comment:

  1. It's such a delicate balance, and a hard one to maintain in a world where So Much Information (TOO much?) is available if we just run a test, do a google search, etc. At least with pregnancy that is time limited, but I find it really hard not to carry the issue over into parenting!