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Jumping in with both…feet

I gave a lecture for the combined didactics of our graduate medical education program and the one at our affiliated hospital. It was a bit of a shock to be asked this early, and it was on a topic for which I didn’t have a prewritten lecture already tucked away. But, it was on breastfeeding, so it was fun to put together. There’s so much good information available out there from the AAFP, WHO, AAP and ACOG.

I was surprised how many of the male residents came up and told me they enjoyed the lecture! Maybe I’m being sexist? One of the male family practice / neuromuscular medicine residents came up and said he’s a midwife at heart and wanted to give me a hug!

Anyway, I’m pooped. Here’s the presentation. (Oh! And I GOT MY OWN DOPPLER!)

WordPress won’t let me embed Prezis anymore, so here’s the link: my breastfeeding presentation.

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Bliss

I’m at the end of my second week at my new obstetrics residency.

It has been an amazing two weeks. I’ve been at the ambulatory women’s health clinic at the community health center. I’m going to be on L&D soon.

I am going to get my own Doppler! Eep!

Today, I got to do an initial prenatal on my cousin Susan. She had a smile when I opened the door, even though she had already been waiting for hours. As I went through the whole checklist of her health history, I got to hear about her challenging first birth.

She had her records. She had her operative report. She told me she wanted to try for a VBAC. By all criteria, she was a good candidate. I told her that I was happy to say we were just told that the physicians’ group affiliated with the women’s center would now be accepting VBAC candidates because of our residency! The attending physicians and residents would be providing coverage to fulfill the requirements of the hospital. (One of my attendings high fived me when I told her the news!!)

I mentioned that the hospital already had the lowest cesarean rate in the county. She smiled and said she knew. At the end of the appointment, she told me she had researched her options on the ICAN website. I laughed and said that I was a fan.

This.

Plus, did I tell you I’m going to get my own Doppler?

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In which I try not to overthink blogging and share some funny stories

I had a few stories I wanted to share, and I resisted writing on here until they reached some sort of critical mass. I felt a little weird suddenly posting over and over again. I think getting into ob/gyn residency has jazzed me up in a way that cannot be ignored. I’m trying to look at it as a rejuvenation of my spirit for blogging and medicine, and not overthink what it meant about my spirit and confidence over the last two years. Anyhooooo….

Plus, I have worked ob/gyn clinic for two straight blocks recently, simply a complete coincidence, because neither of these two blocks are going to count at my new site. Ob/gyn just lends itself to a bunch of hilarious stories. I have a serious delve-into-the-evidence-because-something-is-stuck-in-my-craw kind of post a brewin’, but I won’t mix that in with the fun stuff from today.

Needless to say, no names are used, no specific descriptors are used (except for tattoos, I guess), not all stories are recent, and details are bent to obscure the innocent. None of these are my real patients, they are all stories about my cousin Susan’s adventures in health care, rewritten as my own patients to make it easier. And, needless to say, this is ob/gyn related stuff, so if discussion of private parts and fluids gets you discombobulated, you may want to go look at some lolcatz or something.

Story # 1

A patient and her husband were explaining a recent trip to the patient’s gynecologist (I was seeing her as a family practice resident). She was having an irritation down below. Her husband’s helpful explanation of the diagnosis: “My sperm, when it comes out, it’s so hot it BURNS her.” Emphasis emphatically his. I bit down a giggle and asked, “Sir, if this isn’t too personal, may I ask if your sperm has ever touched your own skin? Say, on your hand? It didn’t burn you, right? I don’t think that’s the issue here.”

Story # 2

This one is an in-the-biz special.

Electronic fetal monitor

Electronic fetal monitor

Heard on the labor floor: “I know! The pink one is for the girls, and the blue one is for the boys, right?” I kind of thought the pastel colored binary gender straps were a bit silly, but I didn’t think they’d be confusing. Maybe I should have.

(For those not in the birth biz, that is an external fetal monitor. Both of those get used on everybody, regardless of the gender of the in-utero passenger.)

Story # 3

Maybe I should have realized it could be confusing or important to patients. At a two week postpartum follow up, a mother’s biggest complaint: “Everyone keeps getting him confused with a girl.” I eyed the 13 day old wrinkled baby in a blue hat, blue clothes, blue car seat covered with a blue blanket suspiciously as he slept in a very non-gender specific way. “I don’t think he’s very worried about that right now.” What I wanted to say was, “Now I think it’s a bit early to start imposing roles on it, don’t you?” in my best Graham Chapman voice, but I restrained myself.

Story # 4

I see a lot of interesting tattoos in my line of work. I have two tattoos, and I am not judging people who have them. In fact, having a tattoo in certain age groups is actually more common that not having one. Some of the people I hung out with when I was younger had some highly questionable tattoos. A friend of mine dated someone who had a tattoo on his leg of a manatee with an erection. That was only one of the list of questions I had about her choice of this guy, but hey, poor dating choices happen to the best of us.

I was triaging a young woman in labor, and when I raised her gown to attach the eternal fetal monitors (as seen above) to her burgeoning belly, I saw two dolphins dancing on either side of her navel. I said “Oh, look! Dolphins!” Then I glanced at the cursive writing underneath her navel. It read “Wet Pussy”. And they say the kids aren’t learning cursive these days. Wait, maybe that’s a good thing for her offspring.

Not judging. Not judging.

I also saw “Respect My Mind” tattooed on a patient’s hand, which I kind of liked. It was next to a 305, which is our area code here in Miami-Dade, for the reader who is not a local, or isn’t familiar with Pitbull. (Ironically, also my birthday. OG, here. Ironic because the longest I’ve ever listened to the song was just now to copy the link.) It’s a common tattoo, on that always makes me sarcastically wonder if they’re afraid they’ll forget the area code. Maybe they just want to remember my birthday. If she did forget the area code, I’d have trouble respecting her mind. Or, I would at least try to figure out why she wasn’t oriented.

I saw “Most Hated”, which I kind of didn’t like. Well, it made me wonder about the history and self esteem of the patient. It also reminded me of the brother of a tattoo artist in a city I lived in years ago, a brother who was notorious for being a conceited, inebriated, loud, omnipresent nuisance. He had the nickname of “the Hated Joe Schmo”. Even though he was covered with tattoos, courtesy of his super cool brother, I don’t think he had “Most Hated”. It would have been appropriate.

I saw “Live Fast Die Pretty” on someone’s arm. That made me giggle.

Story #5

Not really a funny story, but something I wanted to share. I was wrapping up my ob/gyn rotation, and one of the nursing students who was also at the site told me that she would want to go to me as an obstetrician if she was ever pregnant. I am always grateful and pretty much floored when someone from inside the system tells me that. We were working with several wonderful obstetricians at the time. I don’t think it was a commentary against them. I don’t mean to get all sappy, but I think I love it so much, it really shows when I am talking to a patient. I also think it is uncommon for someone to be a mother, a patient, and frankly an adult with real world problems before becoming a physician. I am not knocking my younger peers. They say they don’t know how I do it as a mom. I don’t know how they do it as a young adult coming of age. I think my empathy comes from a different place than some physicians. Even physicians who are parents often became parents second, and were navigating the medical side of pregnancy and birth with a much greater ease and insider perspective when they went through it.

Should I throw in another story of hot jizz to wrap this up? I am fresh out, at this time. Let’s see if this newly renewed excitement carries through to me finishing the post about epidurals and informed consent, too.

Until then, live fast and die pretty.

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Blogger once thought extinct, spotted!

I had a fun experience recently. We have medical students rotate through our family medicine clinic. We’ve had some great students recently, and I got along great with one in particular. She was waiting to find out if and where she matched in ob/gyn at the time. She since found out she matched in New England, and I think she’s happy, but bracing for the cold! I’m so happy for her.

On the last day she was at our site, she and I were saying our goodbyes. I get to work with a lot of medical students, but she and I had gotten a bit closer than most. I wished her luck in the upcoming match, which was a bit bittersweet for me, considering my crappy match experience. She said, “Now that the rotation is over, I have a confession to make.” I was really curious – I couldn’t imagine what it could be. “I used to read your blog all the time, when I was planning on going to medical school.”

I laughed and blushed, and was really surprised. I have only been “spotted” twice before, and both of those times were years ago, when I was still blogging regularly, once at a Medical Students for Choice conference, and once at a Lamaze Conference. I was planning on writing about her spotting me on here a bit earlier, but I had a little excitement in my life in between. Hope you understand.

I really like to work with medical students. I hope we get to interact with medical students at the new residency. I am pretty sure we will. I hope to incorporate teaching into my practice even after I am done with my residency. It reinforces material, and I end up learning just as much if not more.

Oh, and Happy Doctor’s Day, everybody!

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Floating

backyardAlmost seven years ago, I was sitting in a dive bar* with some friends from college. We had moved to different cities after our various undergraduate experiences, and rarely got to see each other. I sat across from them and another mutual friend and coasted on bliss. I relished the comfort and joy of having beer in a bar playing punk music with people who shared so many touchstones with me – concerts, people, places, parties. People with whom I could talk in shorthand. I felt connected in a way I hadn’t in years, years that seemed brimming with pregnancy, parenthood, divorce, work, classes, exams, but not a lot of effortless connection.

But, underlying that social happiness was a buzz of elation because I had just found out that I got accepted into medical school. It was an unexpected, against the odds, fantastic dream fulfilling surprise. I applied late in the application cycle, and had to fight to even get my application considered. I was told to retake the MCAT due to the scores being just too stale to count, even though it was safely within range to be considered. I crammed for the exam in 6 weeks. I hadn’t had a physics class in 5 years. I somehow even improved my score, but was told the application window had just closed. I begged my plight to the young chipper voice at the other side of the phone line who told me just to wait until the next cycle, and I would surely be invited to interview. “Please,” I pleaded. “I’m 34.” I got the interview. I brought the application administrative staff home baked cookies. No joke. And I make awesome cookies.

So, I sat there in the bar with a stupid grin on my face, and I was hyper aware of everything. The delicious beer, the laughter, the music, the horrible overpriced art in the decor, and the strange elation in my chest of a scary dream coming true at that brief, delicious moment in time that the dream is true, but isn’t reality yet. Medical school was just a bunch of fantasy and hopes, not grueling hours of studying and gross anatomy. I was able to spend a night out with my friends on a Saturday still, without the endless string of Monday exams to come for the two years. I promised myself to hold on to that moment, and to never take for granted how wonderful it was to have a dream come true.

Today, I am sitting in my back yard. I recently moved. My house is finally mostly settled. I have a lovely little spot just outside my kitchen on my tiny patio under the awning, with my fragrant potted rosemary bush and subtle wind chimes. The breeze still has a touch of that gorgeous March coolness to it that lingers every year in Miami just a few weeks longer than my cranky cynical mind thinks it should. There are birds and butterflies and bustling neighbors in the background. I have things to do – dishes, laundry, shopping, even more unpacking, but I have time. I don’t have the kids this part of spring break. I am on a light outpatient rotation. I was able to sleep in. I took a deep swig of my coffee and closed my eyes, and felt the breeze. I felt elated. Yes, it’s wonderful to relish these last lovely mornings before Miami gets unbearably hot and muggy. But, I have an underlying elation in my chest.

I got accepted into a brand new obstetrics and gynecology residency. I found out during the shortest and most wonderful interview of my life this Friday afternoon. I am more than halfway through my second year of a family practice residency. I applied to a very geographically limited number of obstetrics programs when I was finishing medical school. I interviewed at several, but didn’t match at any. There’s only one program within 500 miles of where I live and share custody of my boys. The next year, I applied again, and got invited to more interviews. These interviews were at wonderful programs in places where I didn’t know a living soul, like Macon Georgia and West Virginia. In the meantime, I was struggling through 80 hour workweeks that included 6 night shifts in a row. I rarely saw my kids. I rarely saw my friends. I rarely saw daylight. I slowly cancelled all of my out of town interviews, one at a time, as they approached, because I couldn’t see surviving an intern year in an obstetrics and gynecology residency, which would be more grueling than the one I was in, and not have the family support I did here. I also wasn’t willing to move and leave my boys behind. Again, I interviewed at the only local obstetrics and gynecology program. Again, I didn’t match there.

I worked through my second year of family practice residency this year without thinking of reapplying to obstetrics. A new program opened up in Kissimmee, which is about 4 hours north of here, and my oldest son said he wouldn’t move with me if I applied and got in there. This is the first time he said he wouldn’t even go. The interview season came and went, merely a wistful blip on my radar. The osteopathic match drifted by, and the allopathic match started releasing results this week.

Except, I just found out a week ago that a new program got approved. I have heard rumors and rumbles of new at least six new obstetrics programs being opened for over seven years of medical school, fellowship and residency, and none of them had materialized. I never heard a whisper about this program. What’s even more bizarre, I had done a 4th year rotation with the director of obstetrics there, and she must not have known of the possibility yet, and I just finished a four week rotation in their family medicine department with one of their medical directors, who didn’t mention it. Oh, and one more thing. THIS SITE IS LESS THAN A MILE FROM MY HOUSE.

After a flurry of emails, research and phone calls on my part, I procured a phone interview with the new obstetrics residency director and graduate medical education director. It was a five minute interview with two of the nicest people I’ve ever known for five minutes. They had my CV. They had been told about me by the director of obstetrics at the site, by the clinical education director at my medical school, and others. They wanted me, I wanted them, and the match already happened, so they could recruit me directly.

I was ecstatic. My dream came true, again. In fact, my dream from that night 7 years ago included my eventually becoming an obstetrician. That was the promised land at the end of my reverie that night at the bar. It was becoming harder and hard to access that place of joy and thankfulness when I struggled as a family practice resident. Part of the dream had not materialized. I hated to say “Sob, woe is me! I’m going to be a family practice physician!” and realized how stupid and obliviously privileged and ungrateful that sounded.

But today, the dream is realized. It’s still sinking in. And I still have a day well rested and quiet to sit and relish in the fantasy of getting my dream job.

“My goal in life is to unite my avocation with my vocation,
As my two eyes make one in sight.” – Robert Frost

So, one more cup of coffee. One more pause before I get to the dishes in the sink. Because this is the feeling I will be tapping into when I’m exhausted on the labor floor, when I’m struggling with learning a new surgery, when my kids and I are fighting because I’m exhausted and they are resentful because I don’t seem to have quality or quantity time with them. The breeze, the calm, the sounds, and the elation.

*I love that when I googled the name of the bar, a box popped up with information about the hormone prolactin.

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Apology accepted…I guess?

Howdy, interwebs. I have been blogging a lot less than I used to. For those of you that haven’t been around for the long haul, I used to post a lot, and I would dive in to controversial topics often. But, I cut down on my blogging for many reasons, not the least of which is how divisive and angry people can get online, and how annoying it gets to rehash the same arguments over and over.

Well, every now and then I get pulled back in. Here is where I should warn the more sensitive of my readers that there will be some four letter words coming, because of the, um, writing style of the person involved. Today, when I woke up, one of my Facebook friends posted a link to this post about white privilege by a certain contentious blogger. It starts with “Years ago, some feminist on the internet told me I was “Privileged”. “THE FUCK!?!?” I said.”

Sigh.

Let’s hop on the wayback machine. I was that feminist. Here is the original post, if anyone wants to follow the sordid path. It wasn’t even a touchy post about white privilege, with nuance about class. It was a post about a blatantly racist display in which Obama was compared to a monkey. She still couldn’t handle it, and wanted to make the discussion about how she was poor as a child, and how mean black people were to her. She didn’t say “THE FUCK?!?!”. She accused me of reverse racism, and proceeded to call me a “cunt” who was “stalking” her (when she was posting on my blog, not to mention the cognitive dissonance of being a feminist who uses either term in that way…huh?) on twitter. She also used my real name and location on twitter, even though she was well aware that I was blogging anonymously at the time. This led me to “coming out” and subtly changing the way I discussed my patients, friends and medical school -> doctoring on here.

Here is where I was a “good feminist” as she called me in the post I saw on Facebook, and linked to many resources for her to learn about the concept of white privilege, and the BS that is so-called reverse racism.

She still hadn’t learned the lesson when we interacted here on the Unnecesarean, which all you old timers will remember was a hugely popular blog at the time in the natural birthy circles.

Now, on the one hand I am happy that she has at least woken up to the reality of white privilege, including her own. I am happy that she has spent the past few years working on her blog readership, while I have spent that time becoming a doctor and letting my blog languish, and she is getting the information out to many people. I may not agree with her, often, and honestly avoid her like the plague, as do many old timers from the natural birth blogosphere. I didn’t even find out about this post from November until today. I definitely have a problem with her lack of civility. She has gone from saying that I’m a cunt to saying “Lord help me, if I have to explain Privileged one more F*CK*NG time today. Seriously? LOOK IT UP. White? Privileged. Straight? Privileged. Man? Privileged. Got food? Privileged. American? Privileged. Health Insurance? Privileged. Please for the love of god if you think you’re a feminist, LEARN ABOUT PRIVILEGE.” I guess that’s an improvement?

So, I can’t comment on the latest post in which she has promoted me from a “stalking cunt” to a “good feminist” who introduced her to intersectionality and white privilege. I’m not a paying member, and I doubt my comment would get through her cadre of moderators. She is not well known for allowing any negative comments about her, at all, on any site she has control over. Please note I did not ban her from my site or moderate her comments. I politely asked her to, in my own nice way, to “Seriously? LOOK IT UP.” (her words now) before she came back to discuss the topic.

I still want to remind her of the concept of white women’s tears, which I explained to her back when this all started. She still spends almost the entire post about white privilege talking about her poor upbringing. Listen, I am sorry about every time she was cold and hungry. Poverty = horrible. I am a class warrior with the best of them, trust me. But, if you still spend every discussion of white privilege talking about how poor you were when you were a little white girl, you are still missing the point.

This poem is by a Native American poet named Chrystos

Those Tears

of a white woman who came to the group for Women of Color
only
her grief cut us into guilt while we clutched the straw
of this tiny square inch we have which we need
so desperately when we need so much more
We talked her into leaving
which took 10 minutes of our precious 60
Those legion white Lesbians whose feelings are hurt
because we have a Lesbians of Color Potluck
once a month for 2 hours
without them
Those tears of the straight woman
because we kicked out her boyfriend at the Lesbians only
poetry reading where no microphone was provided
& the room was much too small for all of us
shouting that we were imperialists
though I had spent 8 minutes trying to explain
to her that an oppressed people
cannot oppress their oppressor
She ignored me
charged into the room weeping & storming
taking up 9 minutes of our precious tiny square inch
Ah those tears
which could be jails, graves, rapists, thieves, thugs
those tears which are so puffed up with inappropriate grief
Those women who are used to having their tears work
rage at us
when they don’t
We are not real Feminists they say
We do not love women
I yell back with a wet face
_Where are our jobs? Our apartments?_
_Our voices in parliament or congress?_
_Where is our safety from beatings, from murder?_
_You cannot even respect us to allow us_
_60 uninterrupted minutes for ourselves_

Your tears are chains
Feminism is the right of each woman
to claim her own life her own time
her own interrupted 60 hours
60 days
60 years
No matter how sensitive you are
if you are white
you are
No matter how sensitive you are
if you are a man
you are
We who are not allowed to speak have the right
to define our terms our turf
These facts are not debatable
Give us our inch
& we’ll hand you a hanky

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Things that brighten my night

It’s been a long day. I came home feeling like a not-good-enough resident, mother, woman, housekeeper, dog owner, driver, you name it.  I have loved ones in the hospital in other states. I have friends hurting in other states that I wish I could help, or at least hug. I haven’t bought one present. I haven’t put up a tree.

I shared  this old post about things  that brighten my day with one such friend. Then, I let go for a moment. I let my teen son sleep on the couch, I left the dishes, the bills, the evaluations and logs, the laundry, and I stepped onto my back patio. I plugged in the Christmas lights my sons and I put up yesterday. I felt the cool breeze, listened to it rustle through the palms, and took in the twinkling lights and the full moon.

patio lights

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Hey, good lookin’

Howdy. I’ve been busy doing residency stuff, family stuff, house stuff. I passed my Step 3 boards (woo hoo!) so now I just need to scrape enough money together to get licensed.

Anyway, I posted about Thanksgiving on my mostly dormant food blog, Almost Healthy, if you’re so inclined.

Here’s a taste (see what I did there!)

Image

I love this time of year. I cook. A lot. Not all of it is holiday themed. My garden is going, and I try to get time off with my family. It’s been relaxed and good.

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Reply turned post, I reject your reality! style

OK for Mythbusters, not for health advocacy

I have been participating in the Facebook group VBAC Facts Community for a little while now, ever since meeting the wonderful community founder Jen Kamel at the VBAC Summit last year. It is a supportive group, and Jen runs the site well with the help of moderators and a good foundation of evidence.

This group, at times, can be a good example at how distorted internet microcosms can make uncommon opinions seem much more accepted. In this community, using midwives and having a home birth comes up in almost every thread, it seems. I have seen using a midwife treated like a hipster fashion choice recently on Jezebel and other sites. However, midwife attended births still make up less than 10% of births in the United States. Hardly a huge trend. Midwives are underutilized here compared to many other countries with better maternity and neonatal outcomes than we have. But, depending on your source, midwife attended and/or out of hospital births may seem to be common or even a glorified standard. However, in the circles I travel in my daily grind as a physician, choosing out of hospital birth is fringe, reckless behavior.

So, it’s like entering a portal in another world when I participate on a thread in the VBAC group, and the commenters have a heated argument about epidurals, and many participants did not get one. On our labor and delivery floor, it is a rare to never occurrence that someone wouldn’t get one. Because out of hospital birth, choosing not to have an epidural even if you deliver in a hospital, and VBAC are such rarely available, rarely supported choices, I am usually on the side of defending people who advocate for such choices as underdogs, not the holier than thou bullies that many paint them to be.

It’s also a really strange place for me to be in when I gently try to correct medical inaccuracies, and I sometimes get painted as a brainwashed surgico-technocrat physician. I correct fellow physicians when they say all VBAC is dangerous. For real, even my attending physicians. I also have corrected fellow physicians who state episiotomies are preferable to tearing. But, I also correct women in the VBAC group who state things that are medically inaccurate, like that worsening hypertension in pregnancy is not serious and does not warrant an induction or cesarean unless the fetus is in distress, or that leaving the hospital midlabor is a reasonable course of action if one is faced with unwanted interventions (in one particular thread in which I was painted as a typical brainwashed South Florida cesarean happy physician, the intervention that warranted attempting to leave midlabor was continuous external monitoring).

These are not the majority opinions even in this microcosm. But, they are often aggressively defended positions. One that has come up repeatedly, recently, is an insistence that tubal ligation is linked to “post tubal ligation syndrome”, which leads, according to some posters, to the majority of women needing hormonal interventions to control heavy menstrual bleeding, and / or hysterectomy to control intractable post procedure pain.

I think these communities are incredibly valuable, not just because of the sharing of strictly evidence based facts. I think a lot, even the majority of the benefit is the support and stories from other women who have experienced similar choices and situations, or share similar priorities and stories. I think in the VBAC community, and in pregnancy and mothering as a whole, there is so much value to support, empathy and stories. However, there is a big difference between asnwering an original poster who says “what was your experience with tubal ligation?” and someone answering “geez, I had pain and menstrual irregularity after” and an original poster saying “I am planning on a tubal ligation” and a slew of commenters saying “NO! This is PROVEN to cause a, b and c horrible side effects to the majority of women who get it!” and usually a touch of “Have you considered Natural Family Planning?”

Sigh.

I have reluctantly been the heavy in many of these conversations, but it is triggering a bunch of pet peeves of mine. 1. Medical inaccuracies masquerading as facts. 2. Ignoring the expressed informed choice and priorities of the woman posting and substituting the commenters’ own priorities and (often faulty or anecdotal at best) information

So, this coalesced into a recent thread, and here is the reply I posted:

“This is the best article I have found on post tubal ligation syndrome:

http://www.nejm.org/doi/full/10.1056/nejm200012073432303#t=articleResults

It is a good article because it compares women who have had tubals with women whose partners have had vasectomies. It is also a good study because it has an N number of over 9,000 subjects who had the tubal ligation. It is also authored by a group from the Centers of Disease Control (the CDC). There is no economic conflict, and the New England Journal of Medicine is about as high quality a publication as it gets. Here are the results:

“The original concern about sterilization involved the risk of heavy bleeding and intermenstrual bleeding, but we found no evidence of either problem. Furthermore, we found that women who underwent sterilization were likely to have decreases in the amount of bleeding, the number of days of bleeding, and the amount of menstrual pain and an increase in cycle irregularity. We know of no biologic explanation for these changes, most of which were beneficial, in women after tubal ligation.”

I don’t think there’s any evidence of widespread issues post tubal. In fact, this high quality study seems to indicate the opposite. I am not saying a tubal ligation is right for everybody, but I do think it is inappropriate for every thread on here in which tubal ligation is mentioned to devolve into a pronouncement that tubals are PROVEN to cause these problems, often with alarming figures like half of all women who get tubals end up with hysterectomies, etc.

As I have also said, it is inappropriate at best and borderline bullying at worst for women on here to disregard a woman’s stated informed choice and substitute their own priorities, especially if they are coming from a place of anecdote and questionable information. It is also inappropriate to ignore a woman’s expressed desire for a highly effective form of birth control (like a tubal or IUD) and to tell them to try NFP* instead, when it has a typical failure rate much higher. I hold a woman’s right to make informed decisions about her reproduction to include highly effective birth control if desired as well as safe options for trial of labor after cesarean.

I am not a surgery lovin’ medicoindustrial defending brainwashed doctor. I trained as a midwife, had both of my kids unmedicated** with midwives, and have never used hormonal birth control myself due to my own priorities and reasons. I support low intervention birth and VBAC for two main reasons which may seem contradictory, but are wonderfully not. 1. It’s a woman-centered approach and 2. It is an evidence based approach. Bullying women into avoiding their choice of safe contraception is neither.”

*I love this site for comparison of contraceptive methods: http://www.birth-control-comparison.info/
**The first labor was augmented with pitocin without my informed consent, but was otherwise unmedicated

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The past, present and future

Howdy, blogland. Long time no see. Oh, and happy Mother’s Day.

It’s been a rough string of months. I had personal changes, a 40th birthday, a malignant rotation, a psoriatic arthritis flare, the stinking IRS is holding my refund for some sort of random review, a struggle with the black dog, and now I topped it off with a nasty viral infection that doesn’t want to leave my lungs.

But, things are looking up. Or, I have to start looking at the positive. I got my schedule for next year. Most rotations, I will be doing two days a week of clinic, which I am really looking forward to. I have zero nights, zero swing shift for the year. I’ll get to do some rotations I am looking forward to, like radiology (I hope I get to focus a lot on ultrasound) and hematology. I also will get to do a full four week block of clinic and one block in a community health center, so I’ll get my share of outpatient medicine. Hooray! I also have a block of NICU and a block of obstetrics, among other hospital based blocks.

I went to a social event with a lot of members of the local natural birth community, and everyone seems to be eager to work with me in the future. I see a lot of possibilities. I have always kept myself motivated by imagining what my future would look like. I am imagining a future with a practice in a freestanding birth center, doing women’s health, prenatals, family planning, lactation medicine, pediatrics, and possibly even some births. One of the local obstetricians said she would welcome me into her solo practice to see her clinic patients. This may be a more compatible future than doing hysterectomies and cesareans.

So, the future is bright. I just have to free myself from the gloom of the recent past.

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