Can we have a little chat about averages?

RethinkNormal2I see so many women worrying because they are not “average” or trying to figure out if some small variation from average holds meaning. It takes several forms, among them:

  • New mom wants to know how she can get her baby to sleep for an extra hour every day, because 3 month olds are “supposed” to sleep for 15 hours each day and her baby only sleeps 14.
  • Expectant mom wants to know if her baby is going to be too big to birth vaginally, because at her last visit her baby is measuring a week ahead.
  • Expectant mom freaking out because in the third trimester she is “supposed to” be gaining 1 pound per week and last week she gained 3, this week she had a stomach bug and lost 1. Wants to know if her baby will be permanently damaged.
  • New moms who are worried about their baby being “only” the thirtieth percentile pretty consistently and are not going up. Or who have pressure from well meaning friends and family members to supplement their breastfed baby with formula to get their baby over the fiftieth percentile.

These examples all have one thing in common: stress over being different from the exact average! Which comes from a belief that you have to be exactly at – or above – average to be “normal.” Thankfully, this is far, far from the truth. Let’s take a closer look:

What does “Average” mean?

WeightGainDataLet’s revisit math class for a bit here. (I know, I know, you thought you’d NEVER use math once you graduated. But stick with me for a little bit. It’s not the complicated math.)

Most of the time when we use the term “average” we refer to the “mean” – which is calculated by taking all of the values, adding them up, and dividing by the number of values. Let’s do a little example with weight gain in the third trimester as an example.

When we say “The average pregnant woman will gain about one pound a week in the third trimester” where does that one pound number come from? They take a whole bunch of normal, healthy pregnant women and add up the weight they gained each week. I made a super small sample of fictional moms and some sample weight gains. You can see these in the chart on the right. Just like real life, some moms will be gaining more, some less. The amount will vary from week to week. Some weeks moms might gain a lot of wait, some weeks none. There might even be a week or two where mom *loses* weight. Rarely did any of these moms gain exactly one pound in a week, though it did happen a few times. All of these variations are perfectly normal. None of these expectant parents needs to be concerned about weight gain, or do anything to change it.

Let’s look at an example graph showing each of these fictional mom’s average weekly weight gain:

WeightGain

Each one has a different weekly weight gain. Each one is healthy and normal. And when you take an average of these varying weight gains, you get….about a pound a week. And most of these moms didn’t actually gain exactly a pound a week every week in the third trimester.

But wouldn’t it be better to be at average than a variation?

Not necessarily. For each area of pregnancy, birth or parenting where there is an average, there’s also a normal range. That range can be quite wide. It’s probably better to be within the normal range, but for specifics talk to your care provider about what is the normal range and what risks there might be to being outside of that range.

There is, however, a risk to trying to be exactly average. A risk of stressing yourself out unnecessarily, a risk of wasting time and energy trying to figure out what it all means (when it doesn’t usually mean anything), and a risk that you could stress out your child trying to make them be different than they are, without medical reason. If your baby sleeps 14 hours a day when average is 15, trying to force a newborn to conform to averages is pretty much an unneeded exercise in futility.

If you’re concerned, some simple questions to ask your care provider might be:

  • What is the normal range of variation for this?
  • Is there reason for concern?
  • Should I do anything about this?
  • What are the risks if I am outside the normal range?

Some parents (and grandparents who just love to share their opinion) worry because the baby is below the fiftieth percentile. By it’s very nature, the fiftieth percentile is where half the babies will be bigger and half the babies will be smaller. It’s impossible for every baby to be above the fiftieth percentile! Unless there are dramatic changes in the pattern of growth, or the baby is outside the normal range, it’s perfectly fine for your baby to hang out under the fiftieth percentile.

As long as you and your baby are within the range of normal, take the words of Paul McCartney and just let it be.

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Wednesday Wrap Up September 7

WednesdayWrapUpBreastfeedingA great read if you’re planning a VBAC: 10 Steps to Finding a Truly Supportive Provider

A look at the ethics of consent in birth, through the lens of the ethics of consent in regards to religion: What we can learn from Jehovah’s Witnesses about Obsterical Violence and Autonomy in Pregnancy My favorite line: “If the pregnant woman doesn’t want the c-section she doesn’t get it. This is because women are sentient beings, not baby making vessels.”

I’m still looking around and exploring, but I love the new look over at Childbirth Connection!

There’s still so much to learn about breast milk and how it works. The New Yorker takes a look at Breastfeeding the Microbiome

Lots of IV fluid in labor could be inflating birth weights, making the loss of that excess fluid after birth look like insufficient breastfeeding. A new look at an approach that might be more helpful: Newborn Weight Loss and IV Fluids in Labor

A little bit of historical perspective. Twilight Sleep – the Brutal Way Some Women Gave Birth in the 1900s

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Wednesday Wrap Up August 31

WednesdayWrapUpRI enjoyed this article on hearing women’s voices in birth. I find that many, many cases of birth trauma can be traced back to a point where no one listened to the mother.

Some people don’t realize they are experiencing postpartum depression because it doesn’t manifest as *sadness* and they think that is all there is to it. The truth is, there are lots of ways it can manifest, and here are Six Surprising Symptoms of Postpartum Depression and Anxiety

It’s Black Breastfeeding Week! Here are 9 Beautiful Photos (and Opinions) of Black Moms Proudly Breastfeeding

And an eye opening discussion on the History of Breastfeeding Among Black Women – a must read for understanding of the historical and cultural influences.

My friend Beth Hardy is a board-certified music therapist and a birth and postpartum doula who writes original Womb Songs and Lullabies for expecting families. Each song uses the parents’ own words of hope and love for their baby, and is totally original and one-of-a-kind. This is an amazing gift to give at baby showers and mother blessings, and Beth is available via Skype to work with families all over the world!

September 12 there will be an online learning opportunity for childbirth educators from the Gold Learning group. Five hour-long sessions on breastfeeding, VBAC, perinatal mood and anxiety disorders, including LGBTQ families in your work, and the tipping point in childbirth education. It’s very reasonably priced and looks like a great program.

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Wednesday Wrap Up August 24

WednesdayWrapUpTI hope and pray she’s wrong, but I fear she might be right: Why the Malesta Verdict Will Not Improve Obstetrics

If you’re a doula, and feeling like your local hospitals are not doula friendly, and you’d like to open up a dialog with hospital administration, Amy Gilliland has some great steps and success stories for you.

These made me laugh: 21 Too-Real Cartoons that Capture the Highs and Lows of Breastfeeding

The idea of what you’d really say vs what you WISH you could say to people made this article on 21 Things People Feel Fine Saying to New Moms and How To Respond all too real…

Funny, but a *little* too close to what some employers expect of new moms, and the sad financial reality for many women: How to Catch a Baby at Work

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Wednesday Wrap Up August 17

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Th US is the only country where the rate of maternal deaths is increasing instead of decreasing. One way to help change that is to look more closely at the deaths that do happen and seek for ways to prevent deaths. But not all states do that. Learn more about Maternal Mortality Review Boards and how they could help.

Arbitrary time limits are not a great idea for labor, and even though this article uses the “allow” word that annoys me so much, it does have good information about limits on the length of second stage.

I don’t know that asking women at risk of preterm labor to wear a bluetooth device in their vagina that sends electrical current through the cervix and flashes light as well is a great idea. I find it really….creepy.

A bit heavy handed on formula, but an interesting look at the history of formula, illustrated with historical ads for baby formula.

I’m a little surprised – and at the same time not that surprised – that there is even a controversy about whether or not children should attend births.

I actually like seeing celebrities (who are simultaneously under the most pressure and the biggest scrutiny about their bodies) speaking out against the pressure to “bounce back” after having a baby.

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