Monthly Archives: March 2009

Hoo-ha doctor

female-parts Ha ha ha ha! I used to use the term hoo-ha for vagina all the time. I always said I would have to stop saying hoo-ha by the time I was in practice, or no one would take me seriously.

Hmm, maybe I should update my avatar with this image.

Courtesy of “Hoo-ha doctor wins the Nobel Prize”, from the Onion.

(H/t to Rachel. By the way, Rachel, we are Soup fans here, too.)


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Boy’s birthday reproductive rights round-up


On my older son’s birthday, I feel like it is only appropriate to post a link round-up with items of reproductive rights interest. Why? Well, when I think of reproductive rights, I think of what a fierce dedication and sense of wonder I have toward being a parent. I don’t want anyone to parent a sacred, important human being unless they really, really are up to the challenge. I don’t even want anyone to babysit if they are forced or pressured to.

So, in honor of parenting by choice, here are some links and stuff for your reading and viewing pleasure:
According to this poll, the vast majority of people in our country and most others do not think abortion should become illegal, or even legally restricted. So, why is this considered to be such a third rail, controversial topic? Only 8% of Americans think abortion should be discouraged by punitive methods. Let’s move the dialogue on past these extremists, finally, please!

From Sociological Images: Seeing is Believing.

Here is a great spot about why the fertilized egg = human argument hurts all pregnant women, not just women who want an abortion. Reproductive rights are intertwined, indeed.

And finally, the New England Journal of Medicine has a wonderful opinion piece up about the recent conscience clause rule and its proposed rescission. It ties in well with my discussions with Jill on the patient as customer and refusal of care.

(H/t to Our Bodies, Our Blog)


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The big one – oh!

after haircut

My older son is ten years old today.

I have been a mother for a decade. Wow. It seems like it’s been forever, even though I don’t feel like he should be that old.

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Reply turned post, three way mirror style

This was a reply to Jill from the Unnecesarean’s thoughtful comment on my already-a-reply-turned-post about requests for cesareans for moms who were tired of pushing. (See why I called it “three way mirror style”? It is a post of replies reflecting upon replies…)

That is a really good point. I have discussed this with my faculty adviser at school. He thinks elective cesarean section is a valid choice in the patient choice spectrum, and is an integral part of reproductive rights and patient autonomy. I sometimes wonder if I am rigid in my ignorance of what the “real world” is like in practice, and if I would consider doing some elective cesareans in the future.

Even when I was writing this post, I paused at the last paragraph and thought a lot about my language. I will tell people that I don’t think cesareans are medically justified in many situations, and that I would advise against them in situations that are medically normal (like a not-even-prolonged 2nd stage) when the risks outweigh the benefits.

The only person I know well who opted for a true maternal request elective cesarean had a family history of complications in labor and delivery. From what I have heard, none of these would indicate that she would have similar issues (I think one was a severe shoulder dystocia with a poor outcome), but I can clearly see her fear of vaginal delivery. I have strong faith in genetic issues with labor and delivery. Women deliver like their mothers and sisters, and I take do not take these concerns lightly.

I think this is a fine line that needs a lot of cooperation between patient and doctor, and an acknowledgment that this is a gray area. (OK, I have a feeling this is turning into a reply-turned-post). I know many people want a strong balance of maternal rights with practitioner or government legislation. Limiting women’s choices for elective cesarean might also limit her access to homebirth. Or VBAC. Or selective reduction. Or abortion.

I think this is a topic that needs to be discussed with a lot of nuance (der) and there is room for a balance between evidence based medicine, patient autonomy, informed consent, and yes, sigh, provider conscience. I am strongly in favor of all of these thing with a passion that sometimes makes ethical hypotheticals (as of now, who knows what I will be facing in the next few years?) very challenging.

I strongly support the right of refusal of care. I am not as fervent about the right to interventions that are not evidence based. That is one of the ways I base my ethical decision making. I am much more willing to listen to an argument against intervening rather than for intervening, for the most part. This consideration seems more likely to prevent an overzealous practitioner from pressuring someone into an unwarranted procedure or medication. Or, an uneducated or emotional patient or guardian insisting on an invasive procedure that is either elective or not indicated, that has inherent risks over any potential health benefits. Or, less likely to favor patients who insist on the latest advertised medication for PMDD or the latest compounded hormone recommended on Oprah. Most favorable health outcomes based on available literature is also a large factor for me. Luckily, for obstetrics, these two things tend to go hand in hand.

As of right now, this is how I think I will handle maternal request for elective cesarean. I will inform them of the risks versus the benefits of all of their options. If they seem to understand that cesarean section on a healthy mother and fetus with no medical indications for surgery has more risk than benefit to the mother and fetus (according to current literature), and still want a cesarean, I think I will politely refer them to one of my peers who I think is an excellent surgeon and wish them the best.


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Reply turned post, tired-of-pushing style

Pinky has a great post up about women who can’t push adequately because of their epidural who then ask for cesareans. (And, may I add, they may have an unrealistic idea of what the normal pushing a.k.a. 2nd stage of labor should take, which is, on average, 48 minutes or so for a first time mom. Up to 2 hours is definitely normal and safe if the fetus does not appear to be in distress. If they’re asking for cesareans after 30 minutes, there is a misconception there that needs to be corrected.)

Here is my reply-turned post:

I do not believe in the patient-as-customer paradigm in which a patient can request a non medically justified intervention, like a cesarean section in a slow but within-normal-range 2nd stage (or as an elective section without labor, for that matter.)

I am going to try to refuse to attend these kinds of deliveries when I get to make the calls. I have a feeling as a student on rotations and as an intern I will probably have to participate in many procedures like unwarranted inductions with poor Bishop’s scores and good biophysicals.

But, when I call the shots, I will tell the patient the pros and cons of all of their options. I will make it clear from early on in their pregnancy that I do not choose to perform cesarean sections (or any other medical interventions, for that matter) that do not have good evidence of improved health outcomes.


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Prostelytizing at the health fair

I was volunteering today at a health fair, distributing condoms and passing out literature on teen pregnancy, HIV, STDs, fertility awareness and birth control options.

A woman told me “Only two things work: abstinence and then marriage.” I said “That may work for 2%, but the 98% of us want information about birth control.”

She came back and brought me a card that said “Jesus Christ Loves You”.

I’m sure he does.

Seriously, even people who marry as virgins may want to limit their childbearing. I knew a couple who say they were abstinent until marriage. They have two lovely daughters, and the mom takes the birth control pill continuously now and works quite happily. And, the vast majority of us do want to have non procreative sex. I have heard 98% of women practice some form of birth control at some point in their reproductive years.

I was really happy about how many parents of teenagers took information and condoms.


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She’s in labor!

Some of my closest friends are having a baby. Her water broke at 5:30 this morning. I will be headed to the hospital soon.

Good vibes, please!


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Good news

I guess this is what my research methods professor meant when he was talking about regression toward the mean. There is so much back-asswardness left over, health and science wise, from the last administration that it seems like Obama is really churning out a lot of liberal policies when, in actuality, his policies are just righting some wrongs and supporting evidence and better outcomes.

Here is a good example: A federal court ruled the FDA was wrong when it dragged its feet over approving OTC (over the counter) availability of Emergency Contraception (EC). It will now be available to 17 year olds (good!). This was something that was recommended by the FDA’s own panel of doctors advised that it be available OTC for all ages way back in 2003. We are getting there. Slowly.


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Another reply-turned-post, breastfeeding style

I have added yet another blog to my reader. I liked this post at Hugo Schwyzer’s blog. He discussed the Rosin breastfeeding article and mommy wars in general. The comments had some mommy wars type arguments in them, so I figured I would reply:


Great post.

I write about the subjects of mommy wars and breastfeeding a lot. In fact, I have a Mommy Wars Bingo Card since so many of the same kinds of comments come up over and over again.

I wrote about Rosin’s article, too. The problem with her (and some of the comments on here, and many of the discussions about breastfeeding vs. formula) treatment of the discussion of breastfeeding is the assumption that breastfeeding is the intervention and formula feeding is the norm, and the greater problem of not treating this as a health decision (with obvious social and feminist and classist issues, but primarily a health decision).

Breastfeeding is and should be the normal and recommended feeding of all newborns. If an intervention is sought (formula feeding), there should be ample health indications for doing so. Just like any other health treatment, other issues do come into play (such as compliance – if the mother can’t comply due to work obligations or unwillingness) then that is of course an issue. If the infant is losing weight despite lactation consulting, that is a health issue. However, those must be weighed against the absolutely undeniable health benefits of breastfeeding.

Interventions due to complications (such as formula feeding, induction of labor, cesarean section) should not become the “normal” treatment options for women and newborns who do not warrant interventions. The evidence does not support improved health outcomes with such interventions, it actually shows more harm than benefit.

I am all for discussing the social, economic, and other considerations that come into play with delivery, access and compliance when it comes to these and other health decisions, but let’s keep the ideal treatment options in perspective when we have these discussions.

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Read this post

Shakesville has a wonderful, tragic post up by a birth mother (aka first mother or biomom) who gave up her child for adoption. I have long argued that adoption is not an easy answer to abortion (or infertility, for that matter.) It infuriates me when people talk about the so-called post abortion syndrome, yet don’t acknowledge that people who relinquish their born children experience a great sense of loss. I am surprised so many people say they have never even heard this perspective, but, on the other hand, birth mothers are so silenced by the “adoption is a wonderful gift” lobby I guess I shouldn’t be surprised. Don’t get me wrong, there are some adoptive parents who have wonderful relationships with their adopted children. However, the pain of relinquishing a child should not be overlooked.

I am going to reproduce the whole post here, since it is so fantastic.


Hey, Shakers, Liss has graciously allowed me to yell in her forum. Many thanks, Liss. I have no other outlet for what I’m about to say. I want to tell you first: at least one of you knows me in person. What I’m about to say is something you do not know about me. If it’s not you, then one of your friends might be like me.

I’m the birth mother of an adopted child, vehemently pro-choice, non-Christian, very unsuited to motherhood, and after over a decade, have got some things to tell the world about adoption. It’s been stewing since I heard about the recent rash of pre-abortion ultrasound legislation. While I am touched that so many men in such various states are so deeply worried about women possibly being all sad from having an abortion, I wish to point out to these compassionately bleeding hearts that the alternatives are not exactly without their own emotional consequences.

Keep in mind, this is from over a decade ago, and maybe things have changed – but I did four quick searches and found one site that says it’s for birthmothers, and it turns out, it’s to show them how easy it is to find a good family for your baby. It’s a placement site; they don’t care about anything but babies. I didn’t find a single one for birthmothers who have already given up their kids. I’m sure they’re out there. Somewhere. No need to go google for a half hour just to find me one site, okay. If you do, you’ve proved my point.

I have given a baby up for adoption, and I have had an abortion, and while anecdotes are not evidence, I can assert that abortions may or may not cause depression – it certainly did not in me, apart from briefly mourning the path not taken – but adoption? That is an entirely different matter. I don’t doubt that there are women who were fine after adoption, and there is emphatically nothing wrong with that or with them; but I want to point out that if we’re going to have a seemingly neverending discussion about the sorrow and remorse caused by abortion, then it is about goddamn time that we hear from birth mothers too.

Believe me when I say that of the two choices, it was adoption that nearly destroyed me – and it never ends. The only comparison I have is the death of a loved one. The pain retreats, maybe fades, but it comes right back if I poke at it. Writing this has taken me nearly two weeks. Normally, I can write this amount in about thirty minutes, with bathroom breaks. I started to type, and stopped only to reread, then go wail into my pillow. There is no such thing as “over” with this.

Birth mothers are a demographic seldom heard from, and then generally only in the context of how soon they want to “replace” their lost child. This is a huge WTF to me. I went into a self-destructive tailspin for over a decade, and never once thought that maybe a new doll would do the trick. Yet every support group, every online forum, every possible resource I found, all zeroed in on this one-size-fits-all panacea. I didn’t want a new baby. I never wanted any babies in the first place. I also didn’t want an abortion, and I don’t see how any of my reasons for any of this are anyone’s business, either. It was my choice to make, and that is that.

What I didn’t realize at the time – because not one person in my whole life had ever seen fit to mention the possibility, including the pre-adoption counselors – was that I’d spend so long hovering on the edge of suicide, desperately trying to find some way to deal with an all-consuming pain I had no idea even existed. I had never needed help so badly, and I doubt I ever will again. I’ve known a lot of birth mothers, and I consider myself lucky; I’m less broken than many of them, somehow. Maybe it’s because I never did get any kind of therapy. I couldn’t find any that didn’t make me feel inhuman.

I don’t know what the post-adoption counseling is like now, but in my day, it was through the adoption agencies or religion. In my case, the adoption agency was Catholic, lots and lots of Catholicism, so no help there; I was also extremely upset that they provided psychiatric, drug-assisted help, but not mention that it was possible you’d have need for it until after it was too late. This is the kind of thing you really need to know before you make the decision, if only to brace yourself. No, until the baby was gone, it was all paperwork and offering to put me into a nice Catholic household where I could go to church with the family, watch wholesome programs on TV. I’m not Catholic. I’m not even Christian. The idea of church revolted me, as much as it would revolt others to have to follow a religious or non-religious lifestyle that they don’t share. Also it was mentioned that I’d have to go along with all the Catholicism, because if I didn’t, my host family could have me removed. To where? That question was never answered. Also, I don’t watch TV, not that anyone asked.

So I handled it myself, which wasn’t easy, but at least, I could pee in the middle of the night without someone I barely knew hovering outside the door. I’m not sure what mattered more, privacy or freedom, but they were both necessary.

Then the baby came, and soon I realized that it had fucked me up considerably to give it away. When I did, I went looking for help. The adoption agency I went through was so Catholic that my fillings hurt. So, I looked around. I kept looking for ten years. I never found counseling or therapy or any kind of help whatsoever that wasn’t about self-hatred.

Post-adoption counseling turned out to be focused on getting yourself together enough to make yourself a new Christian baby so you could be a good Christian wife and mother. I kept getting the same thing. What if you don’t want to have a New Baby ™, or can’t? Or you’re not religious? And why the fuck are actual babies so disposable that you’re expected to get over it after a suitable period of mourning (i.e., till you get a good Christian husband) in the case of adoption? It’s odd how this does not apply in the case of aborting a blastocyst, when you’re expected to wall yourself into a tomb away from decent society and gnaw on the bitter bones of your own despicable evil. Bad woman. BAD.

Where did this all-too-common idea that the only normal reaction is “longing for replacement motherhood” come from? I think that it at least partially comes from the roles women are assigned in society. Sometimes it seems like the only acceptable choice we have is when to become a mother, not if. I had my tubes tied without having any more babies, and all of a sudden everyone viewed me as an alien life form. Maybe, just maybe, if we had less “make BABIES!1!” pressure in this world, we’d have fewer stories such as Susan Smith and Andrea Yates. There’s nothing wrong with wanting to have kids. There’s a hell of a lot wrong with making people feel like monsters if they don’t.

I’d also like to point out that every time I mention the adoption in public (including the Net), one of these things invariably happens:

1: metaphorical pat on the head: “you did the right thing”, which helped at first, but rapidly came to sound amazingly condescending. Nobody asked me if I was doing okay or anything like that, ever, even though I quite spectacularly wasn’t.

2: “what kind of a woman gives up her BABIES?!” – this is always said by exactly the kind of people I don’t want to be having a conversation with in the first place.

3: “don’t worry, you can have another one” – would people say this to a parent whose child had just died? That’s what giving one up feels like.

4: a lecture on the evils of abortion, which seems grotesquely out of place in this context, and inevitably makes me turn extremely vicious in real life. I can pretty much guarantee that talking about the downside of being a birth mother on the Net will bring out at least one, regardless of where on the Net it’s posted. I can also safely assume that any such commenter will not have read this far, but just in case, I want that commenter to know one thing: your deep concern for pregnancy (in a thread about adoption) sounds more like the self-righteous squawking of someone so deeply disturbed over their own lack of bone-deep ethics that they’re compelled to spend their days lecturing the rest of us. Address your own issues. I suggest volunteer work, but I don’t recommend any kind of personal contact; you lack empathy. Many cities, even small ones, have beautification programs involving cleanup and planting trees, which might do for a start. You will be enriching the lives of others, improving your own health, you can proudly point out “your” trees, and you’ll feel self-righteous with damn good reason for a change.

Back to my topic, which was:

Adoption fucked up my head far worse than abortion. I’ve googled over the years about the psychological aftereffects of giving up a baby, and what little I found is astonishing. Depression and suicide rates ridiculously high, comparable to PTSD – and beyond a shadow of a doubt, there is no way you can cook any post-abortion trauma study to come anywhere near post-adoption trauma levels. Strange how peer-reviewed studies on this are damn near non-existent; strange how nobody mentions any of this when it’s not just your mind on the line, but also that of your kid or kids (more on that later). Strange how this is never on the radar when these stupid obstructionist anti-abortion rules are proposed by retrofuckwits.

They’re always blatting on about how concerned they are for us, apparently because women aren’t capable of making decisions without the gently guiding hand of all-knowing patriarchy, lest we irreparably damage our emotions and drown in a whirlpool of remorseful tears. They care ever so deeply about the long-term psychological effects of not having at least 10 months to consider whether or not to terminate a pregnancy, but no mention is ever made about women who actually do give up the baby. Seems to me that anyone who actually does so is lauded far and wide for Doing the Right Thing, but is simultaneously despised for being an unnatural uterus-bearing mechanism which has horribly malfunctioned. Where the fuck did that narrative come from, and why does everyone buy into it at some level?

Nobody ever seems to address this stuff.

Nor do the pro-lifers (or the media, or anyone outside of pro-choice circles) ever address the stats on adopted kids having lifelong issues with having been given away. I freely admit that I don’t know what adoptees go through, so I’m going to let others do the talking on that topic (I really hope you do; I only know my side, and I fret and worry and freak out about my child). Again, though, you never see pro-lifers worrying about anything besides forcing a birth. I never see pro-lifers doing anything constructive about adoptees of any age.

Emotional fallout only matters to them as a political talking point, in a conversation that includes space only for what is convenient to their preexisting narratives. There’s no space to talk about, for example, how, to give a baby up for adoption, you’ve got to get the father’s signature on the papers, or else face legal hell (now, or later). I was raped, by a so-called friend; I had to go through legal hell to get a signature anyway. It was pretty damn adversarial.

Men are generally left out of the conversation altogether, and when men talk about losing a child, it is most frequently on various men’s rights forums getting worked up about having their kids taken away in divorce, as if that’s comparable. I am looking forward to a man wisely explaining to me how this is not at all the same thing as what he’s been through, because his is worse, because it’s his money, for 18 years, and he didn’t want the kid in the first place, and she was a bitch anyway, and men have no rights and it is so unfair. And when MRAs aren’t busily whining about losing their children in a custody battle, they’re whining about how they should have some say in whether a woman is allowed to get an abortion, even when they don’t want the child and want it put up for adoption. I can’t even imagine the psychological ramifications of being forced into adoption, when it’s indescribably hard after a decision made of one’s free will.

To wind this down: one size fits all doesn’t apply to adoption, any more than it does to abortion. If there’s going to be discussion about mental issues arising from abortion, then there had damn well better start being just as much – if not more – discussion about mental issues arising from adoption. I cannot say that I’d be surprised to find out that any concern on the part of pro-lifers about birth mothers ended the second she signed the papers; I will scream “Hypocrisy!” as loud as I can if they try to pass off their latest brainfarts as such. You’ve seen this already: they also argue about the sanctity of a fetus’ life, but I see no legislation addressing the quality of life of adoptees.

None of which matters to the kind of people who picket clinics. Not me, not the kid, nothing. All they care about is whether or not they win.


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