There is a new Ted talk circulating called The Lies We Tell Pregnant Women given by Dr. Sofia Jawed-Wessel. As an OB/GYN it obviously caught my attention.

Dr. Jawed-Wessel mentioned that some of her work centers around sexual behaviors of pregnant and postpartum couples, so I was intrigued especially as I am an expert on pain with sex and see many women with sexual difficulties after delivery. I have frank discussions about sex daily in my office.

I was pleased to hear the mention of uninvited touching of pregnant women and intrusive questions about birthing. Like Dr. Jawed-Wessel I hate the concept that being pregnant somehow places a woman in another category. I firmly believe pregnant women don’t deserve protection anymore than any other woman or man. Women are strong and capable whether they are pregnant or not. Pregnancy does not change a woman’s value or worth. I also hate the idea that when you are pregnant people think it is okay to ask personal medical questions.

However, about half way through I heard Dr. Jawed-Wessel say that alcohol in moderation is safe in pregnancy and that doctor’s don’t trust women with this secret.

Say what?????

And then, apparently, that OB/GYNs are telling women not to have sex in pregnancy thus denying bodily autonomy just like anti-choice bills.

I quickly read the transcript to make sure I heard what I thought I did. There are some serious factual issues with these statements and this is not okay especially if your talk is called The lies we tell pregnant women.

The screenshots below are from the transcript of the talk.

Science does not say that alcohol in moderation is safe

Alcohol is a teratogen. It has been proven to cause birth defects and no study has definitively established a safe dose. The results are conflicting as there are so many confounders such as lifestyle, poverty, maternal age, domestic violence, other substances like tobacco and marijuana, depression, and genetics. Just to name a few.

What is moderation? This is pretty important since a talk claiming alcohol in “moderation” in pregnancy is safe and TED is hoping lots of people will see this information and think of it as revolutionary. If you ask someone who has 2 glasses of wine a year, someone who has 2 glasses a month, another person who has 2 glasses a week and someone who has 2 glasses a day you will get different answers as to what moderation means. Moderate drinking is often defined as 7 glasses of alcohol a week. No one has ever said this level is safe. Does Ted talks really want pregnant women thinking a drink every single day during pregnancy is without any risk? I mean seven drinks a week in pregnancy poses a few more health concerns than a power pose. In the United Kingdom 1-2 units of alcohol a week used to be the acceptable standard in pregnancy, but that recommendation has been rescinded and now the recommendation is no alcohol. Doctors can’t tell a woman with 100% certainly what is a safe amount of alcohol might be and because alcohol is a known teratogen that really matters.

If you want to read more there is lots of information on this site from Health Canada with results from various studies.

Consider the recommendation not to eat deli meat because of the bacteria listeria. About 1/8000 women will get listeria during pregnancy. It can cause illness for the mother and be fatal to her pregnancy. The absolute risk is very low, about 120 cases in pregnancy per year in the United States. Not bad unless of course you are one of the 120. If you want to know what it is like to be the one of the 120 read this beautifully written piece by KJ Dell’Antonia. When doctors tell pregnant women not to eat deli meat or soft cheeses we do so because we know that 120 or so each year will have a devastating complication from listeria and we can’t predict who that will be so we aim for exposure reduction. What are we supposed to do, not let women know about the risk? It’s very similar to the alcohol situation.

All information, whether it is about alcohol or contraception or whatever, should be presented impartially and each woman should make the choice that she is most comfortable with. No one should be bullied or belittled or shamed. The facts are we CANNOT say that alcohol in moderation (whatever that is) is safe for a fetus. We can say the studies are conflicting and confusing, the more you drink the greater the risks, that alcohol is a known teratogen and that the spectrum of fetal alcohol syndrome affects 1% of births. That is a pretty high number, by the way, 1% of births.

Doctor’s are not colluding to keep this great alcohol secret from women

Is Dr. Jawed-Wessel really saying there is clear evidence that moderate drinking in pregnancy is safe and OB/GYNS are colluding to keep this knowledge from women? We are not holding onto some secret alcohol data because we think little ladies are going to go on a bender and smash the patriarchy with their bellies or that if women hear that 3 drinks a week is safe they will go out and have 10, we just can’t clearly tell a woman what the safe dose of alcohol is because the studies are almost all from registries and there are so many variables. For example, in one study children of women who abstained had worse outcomes compared to children of women who had 2 drinks a week during pregnancy. Yeah, that doesn’t mean go out and drink because the abstainers also smoked more and exercised less.

When you have a known teratogen correlation is not enough to make a safety recommendation. Look at it another way, if your OB/GYN didn’t tell you that alcohol was a teratogen and that it affects the brain and so you had 3 drinks a week during your pregnancy and then your child had attention deficit disorder or an I.Q. of 82 you might be a little angry if years later you found out alcohol can affect brain development. You might wonder if the two were related. There would be no way to know, but looking back I’d bet you wished someone had told you about the risks. Also, you could probably sue for not being told and you might win.

Doctor’s aren’t keeping anything from women because we think they can’t be trusted, we just don’t have clear science to make a clear recommendation about a safe dose of a known teratogen. Unfortunately, a definitive study is unlikely going to happen. If people want to read a discussion I point them to this article in the BMJ.

It would be fair to say that the message about alcohol in pregnancy presented by some doctors and government agencies has come off as paternalistic, but that is not what was said. When the CDC and ACOG say it is best not to have alcohol in pregnancy we’re not being paternalistic, we’re being honest that there isn’t enough data and we are trying to do our best. Also, we don’t want to be sued.

OB/GYNs are not lying to women about the safety of sex in pregnancy

I have never heard an OB/GYN say that sex in an uncomplicated pregnancy is unsafe. I asked 10 OB/GYNs yesterday if they had ever told anyone that information and they all looked at me with a big WTF? Did some old paternalistic dude say that in 1950 or even in 1970? Highly possible, but that’s not what I was taught and I finished residency in 1995. Might some OB/GYNs in very conservative states like Nebraska say that? Sure, I mean some say that IUDs are abortifacients and some even call the police on their patients who have miscarriages, but don’t paint everyone with the same brush unless you have data to back it up. Say that some doctors have obviously not caught up with ACOG recommendations so advocate for yourself and double check!

As for the claim that the American Congress of Obstetricians and Gynecologists (ACOG) does not have a statement and is remiss in not educating their providers? ACOG makes statements about formal policy issues or when politicians play doctor or when there is new, critical information. Every OB/GYN I know already knows that sex in pregnancy is okay.

A quick Google search reveals ACOG has commented on sex and pregnancy. Here’s a quote from their pamphlet for partners in pregnancy:

ACOG’s publication Your Pregnancy and Childbirth, Month to Month, fifth edition says this:

If you’re having a normal pregnancy, you and your partner can keep having sex right up until you go into labor.

And for those women with complications for whom sex is not recommended, ACOG says the following:

If you are having any complications with your pregnancy or you have a history of preterm labor, you may be advised to restrict sexual activity or to monitor yourself for contractions after sex. If you cannot have intercourse, there are other ways to be intimate, such as cuddling, kissing, fondling, oral sex, and mutual masturbation. In some (rare) cases, you may be advised to

avoid orgasm. It’s important that you ask your health care provider specifically what sexual activity is and is not off-limits.

How does that statement deny a woman her autonomy?

As for the unsubstantiated claim that OB/GYNs are telling women they should not have sex in pregnancy being as offensive as an anti-choice bill? Anti-choice bills are based on incorrect and unsubstantiated information, so that’s a little ironic.

The Facts

I totally agree we have to stop telling women what they can and cannot do with their bodies, we should inform and then women should make the decisions that they feel comfortable with based on that information. Some OB/GYNs probably provide information in ways that make women feel bad and that is wrong. Some doctors likely impose their own values on their patients and that is also wrong. It is also true that some messages about alcohol consumption and pregnancy have lacked nuance and have been interpreted by many women as being condescending. However, being tone-deaf does not make a statement a lie.

We don’t know what dose of alcohol and in what trimester is 100% safe in pregnancy. The more you drink the greater the risk. The studies are conflicting on what can be considered low risk. Alcohol is a known teratogen. The spectrum of what is considered fetal alcohol syndrome is expanding and now we know it affects about 1% of births in the United States.

If your pregnancy is uncomplicated then sex is fine. If you have ruptured membranes, a placenta previa, an abruption, or a prematurely dilated cervix then no, sex is not a good idea and it is definitely best to be cautious.

There are plenty of ways society and medicine imposes paternalistic values and religious beliefs on pregnant women and abuses their autonomy. There are many examples that could have been used that are factual, such as pro “life” OB/GYNs calling the police on women who are having miscarriages, doctors who lie to women about how birth control works, and doctors who tell women that pain with sex is normal (it’s not!) or doctors who brush off women who are still having vaginal pain ten weeks after their delivery. There is even the fact that courts have said a pregnant woman in labor could be considered incompetent and some doctors and courts scare and coerce pregnant women into c-sections!!!!

However, it’s not the patriarchy that is preventing doctors from telling women it is safe to have a two glasses of wine a week in pregnancy it’s the science. ACOG says sex in pregnancy is just fine unless there are complications and if your OB/GYNs doesn’t know that or says otherwise get another doctor.