It’s more than the name to a catchy tune. In real life, it matters quite a bit. Unfortunately, so many people just don’t get it. That’s not an intentional pun, although it could be a play on words: many people don’t understand that despite their education and training and knowledge, they still need to treat others with respect; and many people do not get the respect they deserve.
Let me give you an example.
My sister had an abnormal Pap. A nurse at her gynecologist’s office said she had to have a certain procedure — no ifs, ands, or buts — no other options. My sister fired her gynecologist — the doctor who had attended the births of her last two children — because of this basic lack of respect. She went to her family doctor (who had had training in obstetrics and gynecology, but practices family medicine because it is less hazardous to his malpractice insurance costs), and while he came to the same conclusion, he did it in a different, more respectful way. Had the gynecologist’s office practiced this way, she would have remained with him. The family doctor explained the reasons why she had to have this procedure — what it did, why there really was no other procedure for an alternative, etc., etc. Since she felt she had full information, she had no problem with submitting to this necessary procedure. She accepted it from a doctor who was respectful of her, but refused it from someone who just expected her to be a good little girl and follow orders without question.
Inductees in basic training learn how to follow orders without question. They learn how to be subordinate; to do as told. They are dressed uniformly, as a part of the “breaking down” process in order to act uniformly. While these actions and this behavior are perfectly suited for the military (their lives, and the lives of their comrades may be lost by hesitating at a command given by a superior), is that what birthing women are supposed to act like? Allowing the doctors and nurses to think for them? Never to question the opinion of the medical establishment?
I was made to think along these lines, not simply because of my sister’s experience, but because of a recent commenter’s story. She had had a miscarriage, and the doctor told her she had retained products of conception, and the only choice she had was for an emergency D&C. She ended up with Asherman’s Syndrome, and impaired fertility. She asked about alternatives (including medications) and was told her only choice was a D&C. She tried to get a second opinion, but no gynecologists would make time for her, saying the earliest appointment was some months future. Although she didn’t want to have the surgery in which the walls of her uterus would be scraped with a knife — wanted to miscarry naturally or take a pill to complete the miscarriage — she was given no alternative, so submitted to the D&C, which took away her ability to have a child. She was not told of that possibility at the time of the operation.
Why did the doctor treat her like that? Although I haven’t read a whole lot about miscarriages, use of medications (such as misoprostol or mifepristone) to complete a miscarriage, D&Cs, etc., I read up on the subject while discussing it with this woman. Apparently, misoprostol is most effective (with the least side effects) in the first two months of pregnancy; and the further along in pregnancy a woman is, the less effective it is. It’s possible that her doctor took it upon himself to decide that in her case, the medication would not work, and she would end up needing a D&C anyway, so issued an edict that she just have it. But that wasn’t his call to make — it was hers! It was her uterus, which ended up being scarred! It was her body, not his, which cannot now bear children (unless surgery to remove the adhesions is successful in her case).
Although I may have some of the particulars wrong — I’m not a gynecologist, and as I said, only have passing knowledge in this area — this is what I envision could have happened, had her doctor been respectful: “Mrs. Smith, I regret to tell you that your baby has died. From the ultrasound, it looks as if the baby stopped growing a few weeks ago. We can wait, to see if you will miscarry naturally, but the risk of infection goes up the longer it takes for the pregnancy to pass. You can take these pills, which may induce a miscarriage, but at your stage of pregnancy, there is a slight risk of uterine rupture, and the pills may not work. I’m recommending a D&C — a procedure in which we artificially dilate the cervix and scrape the walls of the uterus with a curved knife, to remove all of the products of conception. The risks of this procedure include [fill in the blank, including telling her about Asherman’s syndrome, and the risk of infertility]. The longer the time from fetal demise until we do the D&C, the more likely you are to get Asherman’s syndrome. Since the pills may not work, and you may not miscarry naturally, I’d like to do a D&C, so that we can reduce both the risks of infection and of having to do the D&C at a later date.”
I’m not suggesting that D&C is the way to go, by any means! In fact, I rather suspect that D&Cs are much overused, just like C-sections, episiotomies, and hysterectomies. These are old, well-established procedures, and many doctors are trained to use them as the first resort, or as a sort of cure-all. Any female problem can be solved by removing the uterus, right?, so why not just take it out at the first sign of trouble? Except that a hysterectomy is not easy on a woman — the surgery takes weeks of recovery, and the sudden removal of the female organs plunges a woman overnight into full-blown menopause. (The term “hysterical” is derived from “hysterectomy”, to describe women who had undergone that procedure and had periods of apparent uncontrollable emotions.) Nor does a hysterectomy solve all female problems: by removing the uterus the source of one problem may end, only to have the lack thereof lead to other problems. There is disagreement and ignorance about the full roles that female hormones play — every year it seems that some new study is released with a flourish proving the benefits of hormone replacement therapy, only to be contradicted the next year by a study showing that HRT leads to this or that risk — the risk of one cancer may be reduced, only to have the risk of another cancer increased, for instance; or the risk of some already rare cancer is reduced but the risk of osteoporosis is greatly increased.
With all the confusion and uncertainty, it is all the more important for women to be given full knowledge of all the known risks and benefits of all courses of treatment, and not just the doctor’s favorite treatment, or what is most commonly done. What might be right for one woman may not be right for another. It’s your body; know your options; demand respect.
Filed under: birth choices, informed consent, Uncategorized Tagged: | asherman's syndrome, childbirth, D&C, episiotomy, health, hysterectomy, labor and birth, miscarriage, miso, misoprostol, pregnancy, pregnant, respect, retained products of conception, women's health