Tag Archives: Feminism

How about a pink stethoscope?

From Saturday Morning Breakfast Cereal:


And if you like that but want some more words, check out this great post by Isis the Scientist. (It’s from June. Sorry, I am way behind on my blog reader)

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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.

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Reply turned post, did someone say breastfeeding?

I wasn’t the only one talking about the recent Pediatrics article on breastfeeding. Well, Annie at PhD in Parenting had a post up about the constant refrain that talking about breastfeeding’s benefits is somehow judgmental. People in the comment section kept saying it was a “personal decision”, as it that made it somehow a non-discussable topic. I had to reply:

Sorry I’m late to the conversation, but I am just caching up on my blog reader!

First of all, a lot of these comments are hitting on a key issue I have with these conversations. Every decision one makes, important or unimportant, affecting others or not, is a “personal” decision, so that’s a moot point.

However, here is my favorite explanation of breastfeeding, and it isn’t an analogy. Breastfeeding (or switching to the intervention of formula feeding) is a HEALTH DECISION. It’s not a lifestyle decision, it’s not merely a personal decision (whatever that is supposed to mean – done by a person?), it is a health decision.

Health decisions involve social and cultural aspects, and feelings of guilt, and controversy. But, they also invoke a certain level of scientific conversation and (hopefully!) proper weighing of health benefits and risks along with the discussions of lifestyle, emotions, barriers, etc. Some people may choose to weigh their religion, or some cultural factor when making a health decision, more than the health risks and benefits. That’s OK, and it happens. Also, all people are not able to do operate physiologically equally or able to avail themselves of all interventions equally. This doesn’t just apply to breastfeeding.

Breastfeeding is a physiological state, like a vaginal delivery, and formula feeding is an intervention, like a cesarean section. (Or breathing without asthma medication, or supplemental oxygen). Sometimes the intervention is necessary. Sometimes the intervention is coerced by caregivers. Sometimes the intervention is chosen for lifestyle or cultural reasons, not health reasons. That doesn’t mean the very real health effects are not the key issue. Sometimes people will say hurtful or insensitive things about people who have the intervention, whether they really needed it or not. Sometimes people will look back at when the decision was made, and think the decision was wrong or could have been avoided, and feel regret, or guilt, or judged. Sometimes people who have had the intervention think that no one can talk about the intervention but people who have had it, and when people say it is just that, an intervention with risks and indications, and will say “No, stop talking about those facts, and just listen to what women want to choose, you big meanie!”

It can be a cesarean section, a vaccine, a gastric bypass, circumcision, medication for mental illness (especially during pregnancy or breastfeeding, or behavioral modifying meds for children) etc. Health decisions. Also with major societal and cultural influences. Major gender, misogyny, and other privilege issues tied in there, too. Overblowing of risks to the fetus or baby, but also over exaggerating the strength of the evidence that the intervention is effective and risk free happens, a lot.

So, let it be complicated and nuanced. But don’t silence the fact that first, and foremost, it is a health decision, and needs to be discussed with the true risks and benefits to morbidity (health) and mortality (life).

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Michel Martin rocks the mic

I have been a Michel Martin fan ever since I got satellite radio, and I was able to listen to her NPR show Tell Me More. She is a great interviewer, and I love the Barbershop segment.

But, it’s her “Can I Just Tell You?” commentaries that really impress me. She is thoughtful, analytical, intelligent, and not afraid to draw conclusions and make judgment calls. So much of journalism is pure regurgitation of talking points, it is refreshing to hear someone, especially a woman of color, not just break news, but put it back together, to paraphrase an NPR advert.

Well, her most recent “Can I Just Tell You” segment, No, We’re Not Going to Sit Down and Shut Up made it on my Newsfeed on Facebook, since I am a fan of NPR. Good for them for trying to increase exposure to this commentary.

She not only crosses ideological lines to defend Sarah Palin from some pretty atrocious sexism, but takes the unfortunately predictable blame-throwing response and uses it to paint a really insightful big picture. I recommend you read or listen to the whole segment at the link above, but here is a particularly great part:

“I cannot help but think that what the fury is really about is the loss of entitlement. It used to be that men with a shred of power could say whatever they wanted about women and women had to put up with it, or get a man to duel for them or something. Well now women get to rock the mike too.

It used to be, and often still is, that one set of values or perspectives dominates the way we look at issues and talk about them. You can see where the people who share that particular perspective begin to feel they are entitled to shape the conversation for all time. But things change — new voices rise, different people win elections, or dare we say it, get on the radio. Maybe some people have a problem with that. Tough. Because we’re not going anywhere.”

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Reply turned post, Dr. Amy’s “egregious” post on KevinMD style

KevinMD invited Dr. Amy to write a post about offering VBAC, simply entitled “VBAC should not be a woman’s right”. Keep in mind on both my blog and on Academic Ob/Gyn, she has agreed the evidence supports offering VBAC. But, on this post, she mocks people who support offering VBAC, using no evidence or data, but links to blog posts and, of all things, an ad on the site of a medical malpractice firm.

The reply:

Why don’t you link to scientific evidence instead of blogs and websites of malpractice lawyers? Using inflammatory words like “bizarre” and pretending women don’t have the right to be active decision makers in their medical care is doing nothing to improve communication between physicians and their patients.

Here is the evidence report of the NIH conference on VBACs. VBAC activists are not a small group of blog writers. This is a mainstream medical cause.

Also, the pattern of obstetricians not offering VBAC has a lot more to do with the wording of a specific ACOG position statement and less to do with real medicolegal pressures. I am in Miami, which has one of if not the highest cesarean rates in the country, one of the lowest if not the lowest VBAC rates in the country, some of the worst malpractice rates and payouts in obstetrics, some of the highest malpractice insurance premiums, and really revolutionary tort reform, in that obstetricians can and mostly do “go bare”, which means that they don’t carry malpractice insurance, and effectively limit awards $250,000.

So, the only thing these docs have in common with obs throughout the country is the rocketing trend to refuse VBAC since the ACOG position statement change in 1999. They have their tort reform. They have their low VBAC rates. Their malpractice premiums haven’t gone down. Their malpractice awards and frequency of being sued hasn’t gone down. Our maternal mortality is horrendous. I can provide citations for any of that, by the way. ACOG does a yearly survey on malpractice, and they print numbers for Florida every year.

Here are two scholarly articles one and two that indicate that refusing VBAC isn’t the key to malpractice. It’s proper documentation (including during VBAC, yes I have read the first article, so don’t try to misrepresent what it says about VBAC) and evidence based standards of care. And, the AHRQ statement out of the NIH conference is the most recent, comprehensive evidence review on VBAC.

There is already good literature on risk and decision making during pregnancy if you want to talk about the rights of the pregnant patient. It reads: “These tendencies in the perception, communication, and management of risk can lead to care that is neither evidence-based nor patient-centered, often to the detriment of both women and infants.” The section on VBAC is enlightening, and calls your type of scare tactics unethical. Do you have a similarly well documented discussion published in an equally reputable journal written by practicing obstetricians that takes your point of view, that women don’t have the right to refuse elective repeat cesarean, when the most recent evidence review calls it perfectly reasonable?

I think we all know you don’t, because I have been linking to the Lyerly et al article for about a year now, and you have yet to come up with anything other than your own writing to support your point of view. Why don’t you use well established bioethical principles, and quote ACOG committee opinions on balancing the rights of women to refuse surgeries? Because they support the fundamental bioethical principles of non-malfeasance, beneficence, and autonomy of the patient. I don’t remember seeing CYA listed as a bioethical principle on weighing the rights of patients.

Calling people who are consistent with ACOG bioethics teams and the NIH “irrelevant”, “bizarre”, “Inane”, “egregious” and and “committed to resentment” is, well, bizarre, egregious, inane and committed to resentment. And, it completely ignores the basic fact that a repeat cesarean IS a procedure, and a trial of labor is the REFUSAL of a procedure. That basic inarguable “semantic” fact is the center of why women DO have the right to refuse an elective repeat cesarean. Using inflammatory insulting words doesn’t make your reasoning right NOR ethical, and when discussing rights, that is what is key.

The NIH report concludes “This report adds stronger evidence that VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans.”

Why don’t you work with activists AND the medical establishment to get the ACOG position statement on this, and the presentation of risks, both TO obstetricians about malpractice and TO patients about all risks in pregnancy and delivery in line with evidence and bioethics?

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Commenting policy: I am committed to keeping my comment sections civil. If I criticize Dr. Amy for using verbally abusive, inflammatory tactics, I cannot ethically abide by people using the same in my comments. I am also not interested in people insulting people living with mental health diagnoses by using “crazy” or “forgot to take her meds” as insults for anyone, including me and Dr. Amy.

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Exciting things a-brewin’

I am going to be in a production of Eve Ensler’s The Vagina Monologues tomorrow night. This is my third year being involved with our medical school V Day production. I was the narrator for the past two years. This year I am performing the poem at the end, a poem about birth called “I Was There in the Room”. It ends with:

The heart is capable of sacrifice
So is the vagina
The heart can forgive and repair
It can change its shape to let us in
It can expand to let us out
So can the vagina
It can ache for us and stretch for us, die for us
And bleed and bleed us into this difficult, wondrous world
I was there in the room
I remember

I also was selected to be a delegation coordinator for Amnesty International’s lobbying effort to bring attention to maternal mortality, including lack of prenatal care and racial disparities.

So, I know I am supposed to write up my cousin Susan’s birth story (which will probably be my first non guest post at Mothers in Medicine), and talk about the whole NIH VBAC conference thing, and recruit more doctors for my survey, but I’m a little busy right now. I’ll get to them soon, I swear.

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Reply turned post, that’s a nice welcome style

A reply to Own Worst Enemy, on Mothers in Medicine.

Here is my reply:

I think feminism has made us more supportive of women’s various choices and roles in life. I think women who work outside the home, go to medical school, get divorced, use birth control, have babies when unmarried, wear pants, etc. are judged a lot less now than they were a few decades ago, due to feminism.

I have been hurt by men and women alike. I think sexism and hurt in general isn’t doled out by a single gender.

Yes, women (and men) are very judgmental of women’s choices. Women definitely play along with the patriarchy and tear other women apart. “Female Chauvinist Pigs” by Ariel Levy is a really good book on the subject.

That’s why feminism has a lot more to do.

I am sorry I flounced away from your blog with a seething comment. I am just not a fan of Glenn Beck’s. You linked to a long letter of his I had serious problems with.

I think Glenn Beck is a destructive force in our country, one of those same fringe elements you seem to criticize in this post – like overly judgmental breastfeeders (most of us weren’t or aren’t) or stay at home moms who judge moms who work (most I know don’t). And he isn’t even a woman.

I hope it is less baffling to you now.

What do *I* think we should do?

I think we should be introspective and supportive. I think we shouldn’t give support to hostile fringe elements – whether it be med school friends who talk about someone’s eyebrows needing to be waxed or political pundits who stoke hatred.

I think we should support each other as best we can.

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