Christ on a cracker. I missed this one until I saw it over at Pandagon. Check the headline:
Beyond Medicine, a Doctor’s Urge to Save a Patient From Herself
Well, gosh. That sounds serious, doesn’t it? Maybe she’s self-destructive, this patient. Maybe she drinks herself into a stupor and is beginning to show signs of cirrhosis. Maybe she’s into extreme sports despite shredding her rotator cuffs. Maybe she’s turning tricks in exchange for heroin injected with dirty works. Maybe she frequently finds herself on bridges and ledges. Maybe she refuses to comply with her antipsychotics and the voices are telling her to push people in front of the train.
My god, Doctor, what is this woman doing? What can you do to save her from herself? For the love of Pete, is it too late?
Earlier this year, a patient of mine in her early 20s who was expecting her third child asked to have her tubes tied. A mother of two, with a full-time job and part-time school classes, she saw a fourth child as an impossible burden.
Oh.
I acknowledged to my patient that the surgery was effective in preventing pregnancy. In terms of making her life better and her happier, though, the prognosis was poorer.
The best study done on surgical sterilization followed more than 10,000 women who had the procedure. Women under 30 felt regret much more often than those over 30, the researchers found. Other studies suggested that my patient, younger than 25, might be at even higher risk for regret.
Gee, Doc, you think preventing pregnancy might make her happier in the long run? Seeing as how she already has three kids and she feels her family is complete and that adding another child might be stressful and financially difficult and spread her even thinner and she’s under 25 with three kids and a job and classes already, did you mention that, yes you did, but somehow it seems to have made no dent whatsoever?
And what about that study, Dr. Friedman — of these 10,000 women, sure, the ones under 30 were more likely to feel regret — but just how many felt regret at all? If, as one of the commenters at Pandagon pointed out, the rate of regret (and I’m assuming “regret” means “thinks it’s such a mistake that reversal would be nice”) is something like 4% for those under 30, then that means that the “prognosis” for making her life better and happier is rather better than “poor,” now isn’t it?
But Dr. Woulda Coulda Shoulda knows best:
My patient could change her mind and have children after sterilization. A subsequent surgery could reconnect her tubes. She could undergo in vitro fertilization, removing the eggs directly from her ovaries, fertilizing them and placing them back in her uterus. But both options carry risks and are very expensive, and if my patient did not have the money, she would be out of luck.
Hey, Doctor, didja think that maybe not having the money for another child was kind of one of the issues in the first place?
One thing that really surprised me about this article was the idea that doctors would pull this kind of paternalistic crap with patients who’d already done their womanly duty to have several children. I mean, my mother had so much trouble getting a tubal in 1970 after surprise twins brought the total to 5 that she had another surprise in 1973. But, you know, that was 1970, and she got the tubal in 1973, after Roe. And I fully expected — and got — plenty of resistance and nosiness and questioning about my motives when single childless me asked for a tubal in 2000. But I did get it.
But I guess if you’re young and demonstrably fertile, your duty is to produce children and to always leave open the option to have more. Because an adult woman of childbearing age should never be without a child, or the ability to make one.
I wanted her to understand the implications of her decision.
“What if your children died in a fire? Would you want more children?” I asked, a horrible to question to put to a pregnant mother.
No, she said.
It’s a horrible question to put to anyone, you idiot. Her children are individuals, they’re not game pieces to be replaced with substitutes if they fall behind the couch.
“What if the relationship you’re in now ended and you met someone else? Would you change your mind?”
Still no.
Because it’s vitally important that the new man get his chance to park his sperm in her womb, after all. He shouldn’t have to put up with knowing that she accepted another man’s sperm but refuses to allow his to take up residence in her womb. That uterus belongs to her husband, dammit, and when he relinquishes it, the next man to come along has ownership rights. How dare she act like she owns her uterus!
And how dare she act like she knows her own mind:
My patient’s request wasn’t unreasonable. She was choosing a form of birth control favored by millions of other American women. For her, I just felt it was a bad choice because in 15 years, much could change: her children might go off to college, she might be remarried, she could have a higher income. She might want a fourth child by then, and with excellent reversible birth control options like the intrauterine device, there was no need for her to take a risk with a tubal ligation.
He’s making a medical decision based on what might change in her life, rather than what she wants now. And what she wants now is no more children. She has three that she loves. She’s considered the risks and the options, and she’s made the decision that’s right for her.
But Dr. Friedman saves the best for last. Really, it’s just dense and chewy with all manner of paternalism — both of the patriarchal sort and the doctors-are-GODS-dammit! sort. Savor this:
“Treating people as rational adults means letting them do things they may bitterly regret later,” wrote Piers M. Benn, a medical ethicist at Imperial College London and the lead author of a paper on sterilizing young, childless women, published last year in The British Medical Journal.
If society let a person ruin her health by drinking a bottle of whiskey a day, Dr. Benn wrote, “it might be reasonable to ask what is so special about voluntary sterilization.”
He is right in the abstract. Practically though, my hands would do the pulling, tying and cutting that changed a woman’s life in a fundamental way. Despite free will on her part, I would feel culpable if my actions made her life worse.
Wow. Just, wow. I knew this attitude existed, but am surprised to see that this doctor really has no shame in admitting he thinks he knows better than an informed patient about decisions regarding her own body.
I have to wonder how this guy is able to do anything at all. “If I brush my teeth, I might trip and fall and the toothbrush could poke through the back of my throat and cause me to choke and bleed to death. I probably shouldn’t eat those eggs this morning – who knows what kind of contamination is in them, and then what if it’s the final straw in my high cholesterol and I have a heart attack?” Etc.
Of course, he doesn’t actually think this way – he’s just rationalizing his meddling in the reproductive affairs of a woman he doesn’t know well, but still feels he has the authority to step in her life-changing decisions. Idiot.
What a condescending prick of a doctor. That question about her children being burned to death, emotinal abuse if I’ve ever seen it. If I was ever asked such a question it would take a great effort of will to resist spitting in the scumbags face and walking out. Being old and trans doews sometimes have its advantages. That Dr. Friedman boasts about this on the pages of the NYT says volumes about that state of womens status in this country
If anyone here is familiar with the old “Misanthropic Bitch” website (which hasn’t been updated for a few years now), I believe she had seen a doctor about getting her tubes tied and reported an experience very similar to what this doctor is relating. The guy she saw just kept asking her if she was sure and implying that she would regret it later on.
http://www.misanthropic-bitch.com/tubal.html
(Note: I had to read that link in google cache because my employer blocks the site. I hope it still works. Otherwise, google the words misanthropic, tubes, and tied.)
Jesus Christ on friggin’ bike.
But, but… you might want have more children maybe someday! And [though this procedure does not make a woman unable to carry a child later - it's reversible] there’s all these other BC options [that aren't 100% fool-proof]! Damnit, don’t you understand that your meaning in life is ultimately tied to uterine viability on demand!
This guy thinks that women are walking incubators, and that anything that they value beyond that function in their lives… well, then they’re just silly women not thinking of the future, of course. And he wraps his condescending cavalier crap up in a “I’m concerned about her happiness” package. Does he even know that he’s carrying on as though we don’t have brains? Is he aware of the fact that he believes that?
Is there any way in this world to make people like this doctor realize how ass-backwards they are? Is there?
To draw some parallels to other feminist issues relating to agency over our own bodies… this is VERY similar to a lot of the grilling that a whole lot of trans people go through when we want to do anything that changes our bodies. I think a lot of the resistance here comes from things that doctors feel are “unnatural” somehow.
For instance, choosing to have a kid (or two, or three!) is obviously a very serious decision too; it’s one that can’t be reversed, is permanent, and has serious consequences for others including the child. But doctors don’t go around trying to convince women not to have kids — unless of course they’re poor, or black, or otherwise considered “unsuitable”… apparently gay is now on the list too, in the post-Cheney-pregnancy world.
Similarly, for trans people, choosing to live your life without taking hormones, without changing how you present yourself, without surgery, etc. is also a major choice that is going to have serious impact on your life and those of others you touch. But nobody ever even regards that as a choice, because it’s the “natural” default state of affairs. Instead, there are a lot of forces trying to talk trans people out of doing things with / to our bodies.
You see this most prominently in discussions about trans youth, where someone invariably makes a statement like “but how can the parents consider letting their child make such a permanent irreversible decision that might not be what makes the child happy? How will we even know, even 20 years from now, whether it was a good idea for that kid?” Heck, in a recent film even Judith/Jack Halberstam said something like that. But think about it the other way: if you let a trans kid go through a puberty without any intervention, that’s just as permanent and irreversible an experience! And how would you know 20 years from now whether that was a good idea either? And that’s why a lot of parents of trans kids these days choose to put off the decision and delay puberty until the kid is older and has had more time growing and thinking about things. There’s just a huge bias on the side of “what’s normal,” and unsurprisingly medicine operates with all sorts of assumptions about what a “normal, healthy body” is. For women, that tends to mean we’re supposed to be reproductively available and ready to go. GO FIGURE, BABY FACTORY R US
Who the hell doesn’t “understand the implications” of getting a tubal ligation?
Isn’t it a doctor’s job to be absolutely sure a patient wants elective invasive surgery before he performs it? If a man in his early 20′s goes in for a vasectomy any doctor is going to have a shitload of questions for him, and will almost certainly try and talk him out of it, regardless of how many kids he has. People in their early 20′s are somewhat known for making rash decisions, and that’s equally true of either gender.
“Because it’s vitally important that the new man get his chance to park his sperm in her womb, after all.”
It’s a valid question. Strangely enough, it might be vitally important to her rather than him. I’ve heard rumors that sometimes when a woman falls in love with a man she wants to have a child with him, even though she’s already got some. Weird, I know.
Henry, the problem is with the assumption that she wouldn’t have actually thought about any of this. It’s one thing to make sure that the patient understands the risks and understands that this is not easily reversible, but in what way is it appropriate for a doctor to bring up your kids dying in a fire or some future husband’s wishes as a medical reason not to perform surgery?
To review: “This is permanent, I want you to understand that” is an appropriate medical concern.
“But what if your kids die in a fire and you can’t make more?” is not. Nor is, “But you’re young, you’ll change your mind someday,” or, “What if some hypothetical future husband, even though you’re married now — well, ya could get divorced — what if he wants kids and you somehow forgot to mention to him that you had a tubal?”
I’m almost certain I’ve heard this line/exact reasoning before, it’s incredibly familiar. Anyone else?
Why stop at four, anyway? What if she wants more? Won’t those kids need in-house playmates?
That’s a bridge that must be crossed when she comes to it. The patient in this scenario is already in a relationship and already has kids and already has decided she does not want more. How hard is it to understand that some completely speculative chain of personal circumstances that may or may not happen 15 years in the future should really have no bearing whatsoever on her present medical treatment?
Methinks Dr. Friedman is an anti-choice mole, trying to prove he’s “compassionate” by denying grown women the healthcare the desire. I’m sorry, but if I was 25 with #3 on the way, I’d op for a tubal litigation, too.
What if, Dr. Friedman, she has that tubal litigation, finishes college, and gets a job that can enable her to give a great life to herself and her kids? And, shockingly enough, she’s actually happy with the grown-up decision she made?
The horror.
Don’t you guys remember the Maryland rape decision from a few weeks ago? They ruled based on old common law that women’s reproductive organs are the property of the father or husband! (Which, as we know from other posts, is a property that’s transferred at marriage.) So really, Dr. Alex was just protecting some guy’s property from a woman that wanted to mess with it. Some people just have to be protected from themselves! Especially the people with wombs because wombs are our future! Haven’t you seen “Children of Men” yet? Those babies are going to be EXTREMELY VALUABLE with armies chasing Clive Owen trying to get them back as he protects his convoy — I mean, his small poor black pregnant woman.
That’s why we can’t let women take certain drugs because you might maybe could be possibly be pregnant, even if you haven’t had sex with a guy in ages — what if you slipped and fell on some sperm on the sidewalk? It could happen.
Seriously, this shit makes my head explode. Why can’t people just be reasonable about informed consent? It’s a bunch of simple principles that don’t involve browbeating your patient with what you feel must be “correct” socially.
When I consulted with my gyno about getting my tubes tied, he was resistant. But he had a good reason: “If you have a tubal ligation, that’s abdominal surgery. It’s one we do a lot of, it’s one we’re good at, but it’s still abdominal surgery and it still puts you at risk of some major complications and possibly death. Your husband wants a vasectomy. For him it’s NOT abdominal surgery. Let HIM get snipped. For you, how about an IUD?”
It’s good for a doctor to spend some time establishing that a patient really does understand the significance of a procedure. It’s insulting and bad medicine for a doctor to tell a mentally competent patient, “You don’t really know what you want.”
Also, let’s not forget that some men, like baboons, will eat the previous children of women they mate with, to insure that she has to replace them with his own offspring. How is she supposed to get new babies to replace the ones that became her new boyfriend’s lunch if the doctor makes her baby-maker malfunction?
I did a quick perusal of some medical literature, and found rates of regret for tubal ligation floating low (5% for a Danish study, 6-10% for a Norwegian, in the US a summary of studies from a while ago show a range of 1.3-15%). But turn these the other way around – 85 to 95% of women without regret.
Of course, it would be nice if no one regretted this decision, but life isn’t easy like that. All the articles suggested thorough counselling procedures were the way to combat this, not, you know, writing a NYT article about how you’re trying to save them from themselves.
Also, it *is* reversible. And if the doc is worried about malpractice claims, getting tubal patients to sign a well-worded consent form is all they need.
Ok, but then would the doctor write a condescending editorial piece on the young man’s private medical decision? Very likely he would not.
I almost choked on my soup when I read this. HILARIOUS!
Also, from an interesting study of a whole bunch of German women:
“It emerged that satisfaction was greatest with sterilization (92% of users), followed by OC (68% of ever users), IUD (59%), NFP (43%), and condoms (30%).”
My method of getting fixed worked pretty well for someone under 30: get an abortion, then ask for a tubal. It was pretty clear to the doctors involved that I didn’t want a kid. It didn’t stop them, however, from asking me (someone with a masters degree in biological science and who had TA’d college biology for 3 years) to write down what was happening to me, on paper, in my own words, just to make sure I understood it was permanent. And “tubal fulguration” didn’t count as “my own words”. Of course, they all forgot to mention that the med students were going to perform (unnecessary, unrelated) pelvic exams on me when i was unconscious, before the procedure. I guess the permission for that didn’t need to be written out in my own words.
This, to me, is the most incredible argument…It seems to suggest that children are interchangable. I’m not sure if the argument is more insulting to women or to children and ex-children (ie people in general). If Friedman had died in a fire when he was a child does he think that his parents would just said “oh, well” and gone off to conceive another one sort of like going to the pet store and picking up a new goldfish if yours dies?
I’m not getting a tubal ligation because I’m not sure if I’m done yet (besides, I’m just not that fertile…my chances of an oops baby are pretty low), but if I lost my child the last thing I’d want is to replace her. A sibling for her, maybe, but not a replacement.
Does he do the same when he talks to pregnant women?
This is permanent. You’re going to be responsible for another persons survival and happiness for the rest of your life. Not to mention how this will affect your health. Don’t go through with the pregnacy unless you are absoluitely certain that this is what is best not only for you but also for your future child.
Funny. I thought the purpose was to prevent a certain situation from making her life worse and her unhappier. Is this guy comparing notes with the FFL losers who were on about how abortion sucks ’cause it can’t erase rape?
So how much financial burden would he feel “culpable” for if she had an “oops” pregnancy she didn’t want? Abortion money? Child support for eighteen years?
Ha!
Really? Ugh. That’s horrible. I would have sued.
No. He says, “Congratulations! I’ll schedule you for a C-section.”
I take grave exception to all the paternalistic concern for her potential future regrets.
For Christ’s sake. If she has regrets, they are her regrets to have. It’s part of being an adult, it’s part of being alive. Sometimes you have regrets.
Holy shit, jm, that’s got to be all kinds of illegal. And if it isn’t, well, fuck.
Zuzu already got this one, but the problem isn’t with the doctor raising medical issues and risks, or even with him saying something to the effect of, “This is permanent, and before we go through with it I just want to make sure that you’re absolutely sure that you will never want any more children, under any circumstances.” I wouldn’t even have a problem if he said, “I’m just making sure because I don’t want you to regret this” — provided that he says it once, and doesn’t feel the need to tell her what he thinks she will or will not regret. And interestingly, it would appear that regret over vasectomy and tubal ligation has quite a bit to do with marital stability, at least according to this.
As others have pointed out, this is one procedure among many that may beget regret. And yet it’s one of the only ones that doctors feel the need to lecture their patients about. Men who go in for vasectomies simply don’t get lectured like this, at least not on the same scale and not to the point where doctors are writing op/eds in the NYTimes about it. Women who decide to give birth aren’t told that depression is one of the most common side effects of pregnancy; they aren’t told that raising kids is a pretty big deal, and they should be really really sure before they decide to give birth. Adult men who donate their sperm aren’t lectured up and down about how they may regret being the biological father of a child they’ll never meet. They sign the consent form, and since they’re rational adults, it’s generally assumed that they know what they’re getting in to.
johanna said: “Methinks Dr. Friedman is an anti-choice mole, trying to prove he’s “compassionate” by denying grown women the healthcare the desire.”
It’s ironic because if she really, really, really doesn’t want to become pregnant and doesn’t have access to reliable birth control, she’d probably end up getting at least one abortion.
What a fucking arrogant asshole.
And it’s shit like this that makes me really reluctant to even go to a doctor and *ask* about a tubal, despite the fact I’ve pretty much been decided on it since I understood what this whole having children thing meant.
Hello — new reader here — looks great, I’m adding you to my regular blog stops.
Belledame ( frequent reader here) just brought to my attention this other Zuzu (yourself) but I know of one OTHER Zuzu. :)
http://bastantealready.blogspot.com/2006/12/kittens.html
Let’s hope you Zuzus do each other proud :)
It’s not illegal to do pelvics on women who are out for other surgeries: I saw it on “20/20″. That’s right, the tv show. I thought, damn, those sensationalist tv shows make people afraid of all kinds of things. But a year later, when I went in to see the OB/GYN right before the tubal, I said, “So, I saw this thing on ’20/20′, and I know it’s crazy, but…” He admitted that yeah, teaching hospitals (associated with universities) do that– why, did I want to opt out? It turns out that even though my vagina was not in any way involved in the tubal, any procedure having to do with reproduction allows med students to have a go at pelvics beforehand. Since I brought it up, he talked about it with me (I got to meet the med students), but he wasn’t going to tell me about it on his own. The lessons are: Sometimes tv is right, and Watch your back (and other parts) in teaching hospitals. Oh, and They don’t need explicit permission if they think you won’t find out about it.
Great can we develop a feminist string bikini that you can wear under you hospital gown that has the words “No Trepassing” printed on the cotton crotch liner.
That’ll learn those nosy med students. gahh creepy
Ok that’s supposed to say Trespassing. Sorry Internet.
Yeah, tell me about it. I am prety well resolved to not even start having that fight with doctors until I’m 35, because I know damned well that at 28, with most doctors I will have no credibility whatsoever on this. MAYBE at 35 I might get somewhere. MIGHT.
To be fair, god knows I’ve heard of people who (a) insist on having babies with every new man, and (b) did actually replace lost children, so I think he isn’t unreasonable to ask whether or not someone would want the tubal undone if their life situation changed. It’s the part where he STILL wants to balk after she said no to both questions that annoys me.
Mmmm… lipids.
I asked this at Pandagon too, hoping someone can help:
Can you confirm that the doctor in question is male? Alex is a common female name as well. Not saying the doctor is not an asshat, just makes framing my response different.
Jennifer,
Good luck with that. I’m 35 with one child and I still can’t find a doctor to perform a tubal for many of the same reasons espoused in the referenced article. Even funnier is the man I’ve been with for 22 years got a vasectomy over 8 years ago BUT because I’ve never been married and only have one child, they still won’t do one.
When he had the vasectomy, I was REQUIRED to come into to the doctor’s office for a “consult” before his procedure. Though I clearly stated I was not his wife, they were violating his medical privacy, and it was his decision, they insisted that I understand that I could not have more kids with him after the procedure. DUH!
Oh, no. Ask. Ask early, ask often.
Seriously. This was something that the surgeon who did my tubal tried to pull on me. I’d gotten her name from another woman who was single and had been asking for a tubal for years. She tried to use the fact that I’d never asked her before as a reason why I wasn’t really serious about it.
I mean, not for nothing am I a lawyer. I managed to shoot down every last bit of that. As in, a) this is my first visit to you; and b) this is the first time the procedure’s been covered by my insurance companies. Plus, c) you’re already doing my friend’s surgery, and she’s younger than I am.
However, I *am* a lawyer, and I live in a deep-blue city (and with all that, I still had to sign special consent forms and wait 30 days). It won’t be so easy for other people not in my position, so it’s worth pestering your doctor from jump.
You can also go to Planned Parenthood where they have large clinics with surgeons.
I should also mention: being a lawyer, and letting your doctor know that, is conducive to getting good treatment. They think we’re extra litigious.
I actually had a nurse practitioner FREEZE during a pelvic exam during law school. She was chatting with me and asked my major — and when I said I was a first-year law student, she froze and then made a nervous joke.
Hmm, it’s good to know* that some things haven’t changed over the years. I know at least five women who have had their tubes tied, three of whom encountered similar attitudes from their doctors. Surprisingly, the one in her late 30′s with five kids found more resistance fifteen years ago than the one in her twenties who wanted to remain forever child-free, twenty years ago.
Fortunately, in this century the two who were already pregnant with their “oops” babies managed to have get their tubes tied shortly after they gave birth.
*(Please note the “heavy sarcasm” sign flashing over my head.)
Megami:
http://www.healthgrades.com/directory_search/physician/profiles/dr-md-reports/Dr-Alex-Friedman-MD-EB5D6937.cfm
I believe this is him, and yes, he’s a man.
And this is why I haven’t had one. Not because I want more kids (I absolutely do not), but because I don’t want to have unnecessary surgery. But the husband has promised me a vasectomy in the next year, so I’m really looking forward to that.
And as to the asshole docs who won’t perform the procedure, my younger sister had to have c-sections with both her kids and with the last one, she asked the doc to go ahead and give her a tubal while they were in there. The AirForce doc she saw flat out refused. When she asked why, the reasons they gave were mainly age (she was 25 with the last one) and that her husband may decide he wants more kids later on. Not even that she might change her mind, but that her husband might. I swear, I don’t know how she puts up with some of the bullshit she does being a military wife, I would have kicked that doc in the balls or something.
Oh hell yeah! I haven’t read her in years, but back when I was in high school, that was all I read (back when she was on shutdown.com, along with the “chicks suck” guy).
Oh man, memories.
I had a gyno named Friedman, or Freedman, I can’t remember who said exactly the same things to me when I was considering getting a tubal after having three kids from a marriage to an ass who refused to use birth control of any kind or allow me to. He delivered the third child and knew full well the horrid circumstances I was living under, in fact made the comment once about it. But of course, like so many others who had intimate contact with me and my family, couldn’t be bothered to let me know about any community services to help me get free of the asshole. I was young, overwhelmed and fighting to keep my sanity in a marriage to an irresponsible nutbag with no family of any kind within 2,000 miles to help me and no financial means to get out.
This was in the late eighties. I’d like to know, or maybe not know actually who this prick is, because if its the doc that sat with me and asked the very same questions of me and convinced me to forgo a tubal I wanted, I well…
just suffice it to say that he succeeded and I had another pregnancy a year later which I had to abort as I was homeless and was working on getting rid of my deadbeat, pathological breeder husband and had made up my mind after the third child that I wasn’t having anymore, period.
My fist would never get sore punching him if that is indeed the Dr. Friedman that talked me out of tubal in the late eighties.
Fuck you asshole.
Thanks Bridgetka.
I posted the article on a mothers’ forum I am part of, and the response was amazing. Almost all agreed with the doctor! They did not get that it was an issue of personal choice, rights, etc. it was all “well, I know people who have changed their minds/but maybe she didn’t think it though”. How insulting is it to assume that the woman in question had not thought her options through, and that as this is a legal procedure she was well within her rights to ask for one??!!
And on this same mothers’ forum, they were fine with the doctor using the ‘kids dying in a fire question’ which I found most offensive.
Thank the FSM for sites like this!
zuzu,
Thanks for the advice. I suspect there will be slight differences for me, given that I’m in Australia rather than the US (so for one the PP idea isn’t really one for me, though I’m sure it would be helpful to others), but you’re probably right about the asking early and often thing. I think it’s that I’ve only ever heard these sorts of horror stories in terms of it happening in the country, so it’s kinda of daunting.
The crazy part is, getting your tubes tied doesn’t preclude having more kids, even if you never get the procedure reversed. Has this happy asshole never heard of adoption?
Thanks for the address, Bridgetka! I’m considering writing him an angry letter. I’m good at writing scathing letters without swearing.
I might also write to the goddamn NY Times. Have you guys looked at the link to the full article? If that drawing of a woman with a whole where her torso used to be doesn’t imply that an infertile woman is ‘incomplete’ I don’t KNOW what does.
“hole where her torso used to be”. Heavens, I need to wake up.
Not sure where this story fits in, but I’ve also seen the opposite form of paternalism happen…When I was a med student one patient in the gyn clinic was a woman in her late 20s who had severe cervical dysplasia (that is, was one mutation away from cervical cancer). The resident was trying to convince her that she should have a hysterectomy or at minimum a cone resection of her cervix. She refused because she wanted more children (she described herself as having had “only” four…which sounds like a lot to me, but it was none of my business how many children she wanted,except insofar as it seemed like she was in a situation where she needed to take care of herself and the children she had rather than her theoretical future progeny.) So they started a long discussion of the risks of pregnancy, risks of delay, possibility of completing a pregnancy with the cervix half missing, etc.
While they were going back and forth, I was idly reading her chart. I noticed that her past medical history included “BTL”, which is the usual abreviation for bilateral tubal ligation–getting tubes tied. So I asked her if she’d had her tubes tied. She said “Yes, but they’ll come untied sometime.” Clearly, she had NOT been told what tubal ligation means and had not been seeking permanent sterility. It was a very bad scene.
My guess (and it’s only a guess since the resident who’d done the procedure was long gone) was that after her last child her doctor thought she had had too many and convinced her to get a tubal ligation without being clear that it was permanent. If you’re wondering why this woman got sterilized without proper consent while so many people here are having trouble convincing their doctors to allow them to have a tubal ligation, I don’t know for sure, but I have the feeling that the fact that this woman was black might have had something to do with it. The underlying problem is, of course, the same: doctors, politicians, and others who think that they have a better right to decide about a woman’s fertility than the woman herself does.
Ah, memories…
I grew up in Maryland in the 50s and 60s. There, at that time, women couldn’t have a tubal until they’d had six children. I presume there were exceptions for health, but who knows?
My mother had it doubleplusgood in that she had a Catholic doctor and some issues regarding only feeling useful when pregnant (the latter I learned when I was an adult). So she pushed the envelope to TWELVE children.
She also had to get papers signed. Somehow I ended up signing one. Not sure why. I was in my late teens then. I always thought that was weird.
(I myself knew when I was pregnant with my second child that I wanted three and knew when I was pregnant with my third child I wanted three. The baby is now 27 and I’ve never changed my mind.)
Ironically, my mother’s last child died just before her first birthday. So I find that “what if they died” question hateful, hateful, hateful. And I hope that that kind of talk has never hurt my rather fragile mother, but I suspect it has.
You know, there are some fine OBs out there…but also many of them whom seem to have gotten into the business solely because they think women are idiots and need their wisdom on how to manage their lady parts. They’re not any better if you ARE reproducing…that’s one reason why our c/section rate is through the roof…because they know how to get that baby out better than you–they’re doctors, dammit! And what are you? Just…a WOMAN. How the hell would you know how to handle your own body? The nerve!
I’ve heard this emjay and have seen it myself as well (women and girls all saying they were advised to have c-sections). I had my kids in the early to mid eighties when there was a big backlash against c-sections and a big push for ‘natural’ childbirth, which is how I delivered mine.
I never thought I’d see it come back, but then again, I have also heard said that docs and hospitals like to cut their risks and also increase their control/timing/convenience. To hell with what is best for the mother and baby.
[...] another child was kind of one of the issues in the first place? And then, commenter Holly chimes in with: Also, let’s not forget that some men, like [...]
Yep, same questions and same attitude I got when I had my tubal.
So there I am, thirty-five weeks pregnant. I am almost unable to walk from sciatica. (And that’s the most mentionable thing going on with my body at that point, too.) I am going from one doctor to another…I have two kids. I have been pregnant seven times in the last six years. I wanted two kids, spaced four to five years apart. This pregnancy will give me that. And I never EVER want to be pregnant again.
I kept getting turned down because “I might change my mind”. Finally my sister, working as a nurse at a local hospital, had a conversation with a gynecologist there. He did my surgery. I am grateful for it every day.
I did get asked all the questions about replacing children and such, by at least one of the doctors that saw me. I don’t, at this point, remember which one. I do remember my answer to the last one when he asked why my husband wasn’t getting a vasectomy.
“Because he isn’t the one who puked up everything she ate for five months.” He nodded, and scheduled me for surgery.
If a man in his early 20’s goes in for a vasectomy any doctor is going to have a shitload of questions for him, and will almost certainly try and talk him out of it, regardless of how many kids he has.
Funny, a friend of mine who went in for a vasectomy in his early 20s didn’t get asked anything other than his insurance group number.
If Dr. No had just asked the patient questions about permanence–”Would you want other children if, God forbid, something happened to your children or to your currently relationship?”–I don’t think people would be so upset. It’s all the other paternalistic wallowing that’s getting up everyone’s nose. Some people don’t think about what would happen if Mr./Ms. Wonderful left, or whether they would want more children if they were to find themselves tragically without children. It’s certainly possible to present these cautions without suggesting that your patient would be nuts not to want more Sperm Magic.
(Alexandra, I do think that was a fair question by your doctor, since he apparently wasn’t using it as a excuse to turn you down. Vasectomy is a much simpler procedure, and there are plenty of men who think that it’s A-OK to insist their spouses undergo abdominal surgery because nobody touches the family jewels.)
Bridgetka, Megami, Cecily, et al:
Before anyone writes any letters, the doctor Brigetka links to is not the author. For what it’s worth, the real author has been out of medical school less than two years.
Horrible. I’m sure no one kicks up a fuss if you want to get breast implants or liposuction, also major surgery and a big deal.
For what it’s worth I got a tubal this year, am 35, in Northern California, my doctor didn’t ask any invasive questions and she seemed to think it quite a reasonable thing to do.
I should think that Planned Parenthood would be a good resource to find doctors who are willing to do the surgery without any kind of insane-ass fuss about making boyfriends, fathers, husbands, or dogs sign permission slips, or requiring time travel from your future unregretful self.