I survived an entire twin pregnancy without, not once, knowing the answer to this question. Every other woman who wrote into my (largely American) multiples forum, it seemed, was routinely aware of and happy to report this magical number - sometimes with pride, often with fear - as if it held the key to how early (or not) their babies would arrive. A shortening cervix is thought to be a warning sign of premature labor. But is it always? And, if so: what do we gain, and what can we prevent, by knowing this in advance?
Spurred on by my American counterparts and the raw desire to hold this fact about myself, I decided to take the plunge and try to find out. If you’ve ever been on the NHS, you will know why I describe this effort as ‘taking the plunge’: people born and raised on this service seem pathologically unable, after so many years of quiet, British reverence, to question it or the information it is willing to provide. My husband, an extremely assertive person in almost every other arena of his life, is reduced to near docility when it comes to challenging the ‘system’, as he describes it.
Here I am at week 34, already looking full-term and carrying close to ten pounds of baby (a fact I know only because I have craned my neck to see the bottom corner of the ultrasound screen where the measurements are recorded; I have never, in the course of three pregnancies, been offered a fetal weight estimate). In other words, it is not a flight of fancy to wonder whether the delicate, neck-like structure which is responsible for keeping all that baby in is beginning to suffer under the strain.
‘So,’ I venture, ‘How is my cervix doing?’ I keep the question as neutral as possible, hoping to sound casual but at the same time confident. And this is when I get the look. It’s part suspicious (‘did someone tell you to ask me that?’), part annoyed (‘is there a problem?), and part alarmed that I even know the word cervix (‘did you say cervix?’).
As an American who is a mild medical information junkie, I am beginning to know this look well. I saw it when I asked my GP to listen to my fetus’ heartbeat (regular movement was enough for him), the hospital pediatrician to measure my babies’ length at birth (blank stare), and when I put the same request to the midwife at the ‘well baby’ clinic nine months later. This is not something she was able to do, I was told rather shortly as if I had just asked her to draw blood from two innocent sacrificial victims, without ‘indication’. Apparently ‘well’ babies only grow in one dimension.
It has become increasingly clear to me that when it comes to pregnancy and babies the NHS is not, as so many American health practitioners seem to be, in the business of providing information for the sake of reassurance. And certainly not for its own sake. But if information is control, does a lack of it necessarily mean we are relinquishing something of our power in this already emotionally charged situation? Maybe.
And yet, perhaps too much information is risky in its own way. Not only can it drive us mad with - often times unnecessary - worry but it can actually disturb the normal course of things. To take but one example, do we really need to monitor blood sugar levels in an otherwise healthy, full-term newborn? The substance naturally dips after birth, but medicalizing the issue can start a cycle of, well, medicalization, which can compromise breastfeeding not to mention a new mother’s - already fragile - peace of mind.
I hardly take the kids to the doctor anymore. This is not because they don’t get sick or because I don’t want someone with a degree in the subject to hold my hand. Rather it is that I have learned how to assess for myself what is a legitimate way to spend my GP’s time (not to mention my own) and what is not. The last time I saw him was when my twins were three weeks old and one of them was spewing milk with exorcist-like propulsion while the other was still tinged the color of sweetcorn. Even as I sat down to tell the story of their symptoms (with words like ‘reflux’ and ‘bilirubin’ carefully omitted from the narrative), I knew I shouldn’t have come.
My doctor is excellent, don’t get me wrong. He listens to me, he crinkles his forehead in exaggerated concentration at my concerns, and he never gets it wrong. But he doesn’t diagnose for the hell of it. A colicky baby is a colicky baby and there may very well be something to the philosophy that giving it a label (and prescribing medication that may, or may not, calm it) doesn’t really change the main course of treatment: the time it takes for the digestive system to mature adequately. What that label might do, on the other hand, is make mom and dad feel better.
The pitfall of this kind of medicine, of course, is that it doesn’t act prophylactically (and so misses the small percentage of problems that might otherwise be detected by routine consultation; Americans would be downright shocked at the lack of systematic check-ups we have in this country). The advantage is that it doesn’t create issues where there are none. Living here has saved me in this way from being too neurotic about my children’s health and development. For better or for worse, the NHS doesn’t pander to nervous parents and this fact alone makes it very hard to sustain worry about problems that aren’t really problems. And, in the end, isn’t this what all parents want: to not have to worry about their kids?