Risk Management

When is it OK to bend the rules?


Catherine wrote wondering if it's OK to take a medication her doctor prescribed while she's breastfeeding, even though the label says, "not safe to take when breastfeeding." Michelle wants to know if it's OK to workout on her back if she feels fine ("not dizzy or anything"), even though she's read it's "not safe to lie on her back during pregnancy." Both are wondering, when do you absolutely need to follow the rules and when can you bend them? If the label says, "Not OK" but your doctor says "OK" what advice do you follow? If the books say, "Not OK," but your body feels fine, what do you do?

This is a good chance to talk about risk management. That's what parenting is all about—balancing the risks and benefits of about ten million little details and decisions. If you get them right more often than not, in about 21 years, you'll have successfully raised a child to adulthood. If you get them wrong, you might still be successful and you might not. It's a risky business this parenting thing.

First of all, I'm not about to tell you, Catherine, whether you should or shouldn't take that medication. You really, really, need to talk to your doctor about this. You may even need to get a second opinion to feel like you're making your very best decision. What I can tell you is that while some medications have been tested and proven as safe to take during pregnancy and breastfeeding, not all are. Lots are "probably" safe but nobody's real keen on taking the risk of messing up people's babies, just in case they're wrong. Not a lot of people are willing to have their babies subjected to drug-safety studies either. That's why so many things are labeled as "not safe for breastfeeding." The companies that make these things can't afford the risk.

Michelle, I know you're working on staying in shape during pregnancy and I applaud you for that but just because you "feel OK," doesn't mean your baby does. You mentioned that you always do core/abdominal exercises while lying on your back and you're heading into your 5th month of pregnancy. I'm not going to say, "Oh go ahead and do those curl-ups." It might be safe but most of the literature advises against it. Why? Your baby and uterus are getting heavy now and lying on your back can compress the blood vessels that run down along your spine. If your heavy uterus squishes them during your workout, your circulation to the baby may be compromised. Since I don't know how big you are, I'd be taking a big risk if I gave you the go ahead. You need to talk to your doctor and possibly a certified personal trainer with experience working with pregnant women and have them evaluate your workout. Then make a decision that feels best.

This may seem like a "good for nothing" column where I'm not giving out any hard advice but the theme here is this: There are tons of risks, choices and decisions you have to make from the moment you realize you're pregnant until you're finished being a parent (whenever that is). While lots of the things experts, articles and healthcare providers try to protect you and your child from are probably fairly safe, we live in a world where taking risks is, well, risky. We certainly can't bubble-wrap our kids though and protect them from life (Oh, and bubble-wrap is probably toxic and may potentially cause suffocation). I won't be the first to say we're a rather safety-obsessed country, but we've learned a lot over the years about what risks are worth taking and what aren't. Or maybe we haven't. A local school made a decision to forbid grade-schoolers from running at recess because the risk of skinning a knee was just too great. What the heck? What about the risk of all those grade-schoolers filled with pent-up energy driving themselves and their teachers crazy because they couldn't go out and play? They probably haven't done a study on that yet. They have done quite a few studies about the risks of childhood obesity though so... Risk versus benefits. Where's the balance?

Michelle and Catherine, go have another talk with your doctors. Then make the best decision you can based on the best risk management data available. Toss in a little common sense and there you go: the recipe for parenthood. Repeat liberally and daily for 21 years or the rest of your life. Good luck. I'll try to toss in some solid fact-based advice next week.

Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.