“Accepting responsibility”

When someone tries to defend being anti-choice because women need to “accept responsibility” for their actions (i.e. having sex), it always confuses me. I even heard a classmate use that as an excuse to be against birth control, also. I have always thought avoiding unwanted pregnancy, and not bringing unwanted children into the world was much more responsible than using babies as some sort of punishment for fertile women and girls.

Please read this article in the Nation about birth control sabotage as part of abuse.

Here is a chilling passage (emphasis mine):

In the largest study of this phenomenon to date, “Pregnancy Coercion, Intimate Partner Violence and Unintended Pregnancy,” published in the January issue of the journal Contraception, lead researcher Elizabeth Miller and others surveyed nearly 1,300 16- to 29-year-old women who’d sought a variety of services at five different Northern California reproductive health clinics. Among those who had experienced intercourse, i.e. who could be at risk of unintended pregnancy, not only did 53 percent of respondents say they’d experienced physical or sexual violence from a partner, but one in five said they had experienced pregnancy coercion; 15 percent said they experienced birth control sabotage, including hiding or flushing birth control pills down the toilet, intentional breaking of condoms and removing contraceptive rings or patches. These figures were consistent from clinic to clinic.

Who do we want taking responsibility for what actions? Who are we blaming for unplanned pregnancy? And, who will suffer if these reproductive clinics (like Planned Parenthood) have their funding stripped?

Sorry about the heavy. I will try to bring back some poop jokes.

Reply turned post, devil’s advocates do the devil’s work style

I am having an interesting interaction in the comments to this recent post about the ACOG convention. I am giving the commenter, Jasmine, the benefit of the doubt when she says she delivered one live birth and had one 24 week abortion with one of Dr. Jody Steinhauer’s friends as the health care practitioner. I do not have a comment policy that excludes discussion just for being, well, strange. Jasmine’s purported reason for commenting is to share her story, then justify abortion at all gestational ages based solely on the “absolute” bioethical principle of bodily autonomy. It seems suspiciously like a contrived straw man argument to me, presented as “devil’s advocacy” tempered with a little “I am the anecdote, so I am the universal truth” logical fallacy thrown in.

But even if Jasmine is someone who has had both a live birth and a subsequent elective 24 week termination, and thinks termination at all gestational ages is defensible due to bodily autonomy, and not a anti-choice troll posing as a cold, logical-fallacy calculating abortion advocate, there is room for her opinion. (Updated to add: She was an anti-choice troll. She linked to a Southern Baptist site as support, and then started leaving graphic, horrid comments about sucking out baby’s brains and killers and liars.) It doesn’t have to represent my reasons for being pro-choice. I don’t mind debate on my blog, obviously, but I really don’t think sparring over how absolute individual bioethical principles are is, well, all that important. I spent years in competitive debate. I can engage with the best of them. I have closed down more than a few comment section battles with my razor sharp management of argumentation (being a bit facetious here) and it really hasn’t saved anyone’s lives. Women are still dying from unsafe abortion and poor access to reproductive care. Children are still being orphaned.

Here is my reply:

Not everyone agrees about bodily autonomy being the only factor involved in this discussion, or that any bioethical principles are absolute. I don’t. Bodily autonomy is extremely important, but not absolute. Prostitution is illegal in this country (not that I necessarily think this is effective or ethical.) One cannot slash ones wrists in public without being restrained and committed.

Ethics is more complicated than that. I am not sure if you are trying to set up a straw man argument.

My argument for the support of abortion lies in humanistic concerns about reproductive rights and maternal death in general. It is actually the opposite of online debate on how absolute one bioethical justification is for abortion. It is acknowledging the reality of women’s lives – that they can be trusted to judiciously use birth control if it is accessible and affordable. That the 50% unplanned pregnancy rate and 22% abortion rate is not what women would choose if they had true free choice in this country. I think abortion is one reasonable health decision when faced with unplanned pregnancy or a pregnancy with medical complications, but that does not mean that I do not also want to decrease unplanned pregnancy or complicated pregnancies!

I am not going to sacrifice real women to some sort of dry sparring in a comments section. 70,000 real women die every year due to restrictive laws and real barriers to safe abortion care. Bodily autonomy? Sure, important. But not as important as them.

New here?

Howdy. I am getting a lot of traffic on my Mommy Wars Bingo from a few sites. So, if you click on the homepage / most recent post, too, I wanted to say welcome.

I am not always that funny, but I am usually that ranty. Feel free to poke around, and stay if it suits you.

Food tour of San Francisco

Sourdough creations

I put up pictures and commentary about my foodie adventures while in San Francisco at my mostly dormant food blog Almost Healthy. Please check them out if that’s your sort of thing.

Resources from ACOG

I am going through my papers from the conference. I wanted to throw up some links while I did it, since I am coming across some cool stuff.

First of all, I am excited about ordering powerpoints synced with the audio from some of the presentations I missed because they were sold out, or they conflicted with medical student activities. There was one on VBAC I definitely plan on ordering, and will see how much money I can spare on the some of the other interesting topics.

I wish I could buy lots of books, too. Such as Special Issues in Women’s Health, or Evaluation of Cesarean Delivery.

I heard about the Maternal and Child Health Library out of Georgetown. Time to sign up for another newsletter. Hmm, maybe another one. Here’s a flyer from the North American Society for Psychosocial Obstetrics and Gynecology, and I think they have a newsletter. Phew, they seem to be on a newsletter hiatus.

I grabbed a flyer on NIH Loan Repayment Programs. Interesting. I am keen on doing disparities research eventually.

The President’s Program focused on perinatal depression. I liked that he had a spectrum of speakers: one patient / activist, one psychologist, and one physician. I learned about the Perinatal Depression Information Network, which I don’t know much about, but sounds like it could be a good resource. One of the biggest issues with depression (and other mental illness) is that it can be isolating, and I am a firm believer in support networks and information for patients to counteract this sense of isolation. I noticed that one of the Presidential Program posters mentioned dyadic assessment and intervention for mothers and infants aimed at improving attachment for women with a history of trauma. This was from the University of Michigan. Sounds like some great research.

Fun times at ACOG

Hi! I missed you, blog!

My hotel left a lot to be desired, and it charged an exorbitant fee for internet access. I survived the weekend with phone internet access only! *Twitch twitch*

I am still up to my eyeballs in things to get done. So, this will be a brief update.

I met Dr. Berghella, of the USPSTF Evidence-based labor and delivery management (pdf) report on which I based my research project. He gave an amazing presentation on cervical insufficiency. When I spoke to him afterward about my project investigating why many physicians seem to not follow evidence based standards of care when it comes to labor and delivery intervention practice patterns, he said, “It makes my blood boil.” I wanted to give him a high five!

I met the author of What To Expect When You’re Expecting. I read it when I was pregnant with my first son. I wasn’t as alarmed by it as many birth activists tend to be. Then again, I wasn’t a birth activist when I read it, just a clueless first time pregnant person who was lucky her CNM only pitted her, hooked her up to the continuous EFM and made her push for hours with an anterior cervical lip while flat on my back. (Do I sound bitter?) Luckily, I didn’t get an episiotomy or anything worse, but I certainly wasn’t well informed about the interventions I received or could have received. Looking back at what I know now, I think it was certainly over-the-top about certain things (like diet, and mother blaming of food choices), and wasn’t the best resource when it came to information about actual labor and delivery, or options such as out of hospital birth. I’m glad there are a lot more books and resources available now than there were 12 years ago.

I met Dr. Fogelson from Academic Ob/Gyn. At his event, I met the physicians behind Girlology, who are great. I also met Dr. Jody Steinauer, founder of Medical Students for Choice, who is even cooler in person than on paper.

I met with some programs at the residency fair. The residency director for OHSU said she thought I would be a “good fit”. (Squeal!) I also met with a resident from University of Washington, among representatives from other programs.

The highlight among highlights was an event sponsored by Bayer celebrating the 50th anniversary of the oral birth control pill. Gloria Steinem appeared via satellite, and Dr. Sandra Carson and Dr. Joycelyn Elders spoke in person.

Here is a picture of my fellow medical students and I with Dr. Joycelyn Elders. Double squeal!!

Me, Dr. Elders, and friends

Plugging away

Howdy. I am still working on my various projects. Here’s a little update, mostly because I am excited about a few things, not that I think anyone was pining away without me.

First, I got 50 completions on my survey! In fact, the numbers are still climbing since a wonderful gynecologic oncologist I have been working with on other projects sent out an email plea to his colleagues. Thanks! I was originally hoping for around 80, but it has been incredibly difficult to even get past the office staff of most obstetricians. I am happy for 50 – 60. Analysis starts next week!

Secondly, I am happy to be working on writing two projects, including this one, the VBAC primer proposed on Birthing Beautiful Ideas. I am researching and writing the part on the “immediately available” standard. I have already written about before. I am trying not to be too overly academic about it. We’ll see how it turns out. Of course, I am still reading tons of research to write it, of course. I found this New England Journal of Medicine article (pdf) that was supposedly seminal in discouraging VBAC by looking at uterine rupture rates. It is only one cohort from the late 80s and early 90s, but it has some interesting numbers. For the fetal demise due to uterine rupture, the outcome usually brought up as the worst case scenario and the reason why VBAC should not be offered, the rate was 5.5% of all uterine ruptures. And, uterine ruptures only happened in less than 0.5% of uninduced trials of labor after prior cesarean. I do not think this is where Lyerly et al got their 0.00046 rate number for fetal death due to rupture, since they say it was from a prospective study, and I think the NEJM I link to is retrospective. If anyone has more time than me, feel free to follow that trail in various bibiliographies.

And finally, there is still stuff going on in my life outside of birthy fellowship-y stuff. In fact, I am on my way out to do that now. Wish me luck!

Happy Mother’s Day!!

I am up too early, considering. I think my husband and kids went to Panera to get me one of their evil egg souffles, hopefully with enough bagels for everyone else so I don’t end up having to make breakfast anyway.

I am really looking forward to eating brunch here, at my new most favorite restaurant ever. I made a batch of chicken broth last night, and was too eager to try it. I am afraid I burned the roof of my mouth and tongue a little bit. Argh! I have been waiting to eat here again for 2 months! It’s not that bad, but still. Bad timing.

I have been musing about motherhood ever since it was announced on Feministing that Feministing founder Jessica Valenti is pregnant. Jessica had an intensely scrutinized wedding recently. I am not a regular reader, commenter or contributor at Feministing, but I have generally been a Jessica Valenti fan from afar. When I read that she was pregnant, I wanted to write her a letter that said “You think the wedding business was rough. You ain’t seen scrutiny, judgment and lack of autonomy until you get pregnant, and then become a parent.” If she thinks having a fairly traditional wedding was surprisingly difficult as a woman and as a feminist, she will be sorely disappointed in how many people have an opinion about intensely personal aspects of her reproduction, birthing and parenting. And, how many of these opinions completely disregard her ability to make decisions for herself.

Luckily for me, The Unnecesarean has a great guest post up for Mother’s Day. So, I don’t have to write a whole post on this. Allison Phayre asks people to lay off the mom judgment as her wish for Mother’s Day:

But if I have one wish for Mother’s Day, it is that we remember that the mother sacrifices a lot of herself even before that baby is born. It’s not fair to tell a mother that her wishes for her birth experience don’t matter, as OBs often do by dismissing birth plans or refusing to be guided by them…Mom and mom alone understands on a very intimate and basic level how her safety and baby’s safety are intertwined, and the right balance of risks between those two people is going to be different for each mom and baby. Please, let’s take back the birth culture and practices in this country, so every expectant mom is not a vessel to be handled whatever way her care providers prefer, but remains an autonomous PERSON who is in control of her own body, her own pregnancy, her baby, and her birth.

I also cover some of this, including what happens after the actual birth, in my Mommy Wars Bingo Card. Let’s all cut moms (including ourselves!) some slack this Mother’s Day.

Leaving you something to read *link fixed*

I know, as soon as I said I wouldn’t be posting, I am posting. But, I forgot to share a link!

Thanks to Amy Romano from Science and Sensibility for sharing this with me. As she said, it comes with a major trigger warning for birth trauma and loss of medical autonomy.

This is the story of a patient, who was also a doctor, and her cascade of horrible care starting with being sent home from triage when she presented in labor, and ended with life changing PTSD. It is on Pulse, a site fostering the humanistic practice of medicine.

Flying under the radar right now

Sorry about the scarcity of posts recently.

I have a lot going on beneath the surface right now, some of which are some really cool collaborative projects that I will share when they are done. I also have fellowship-y research wrapping up to do, a new research project (well, three, I’ll explain when I have time) that I just got IRB approvals for, and some personal stuff.

All are exciting. But, also time consuming. I also have plans to go to ACOG’s Annual Clinical Meeting in San Francisco next weekend. I might not be posting so much.

Whenever I say that, I usually end up posting up some rant about something that triggers me off. So, no promises.

If anyone has some extra vibes, or prays, or lights candles, or sends positive energy, or any of that stuff, I would love some my way. Thanks!