The quest to stay childfree
Aug. 29th, 2009 03:53 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
livSo I saw a sexual health nurse this week. She was ever so friendly and communicative, and didn't patronize me, and took my opinions seriously. But on the down side, she wasn't very competent at performing the actual exam, she poked me about until I bled before she managed to take any samples. I think good bedside manner is more important to me, though.
After some discussion she reckoned my best long-term contraceptive option is the plain copper coil, without hormones. Apparently that will give me ten years of protection with a failure rate that's too small to measure accurately. She echoed what I've been told before, that the NHS regard the coil as a better option than sterilization, cos it's more effective but still reversible, and doesn't require surgery.
Well, more effective is a big plus, and I can totally see the point of avoiding unnecessary operations. But reversibility seems like a big downside to me. I have this strange paranoia about finding myself in a society which is either regressively sexist, or has low standards of medical care, such that I can't get a replacement coil when this one reaches the end of its lifetime. This is probably quite unlikely, but I may have 15 or even 20 years of fertility ahead of me and I can't bank on my situation being the same as it is now for that whole period. The other reason why I want to do something irreversible is that I've had a lot of relationships with people who thought that if I loved them enough I'd change my mind about not wanting kids. I want to be able to say to potential partners up front, not just that I'm childfree, which sounds like an opinion, but that I can't have children, which would be a physiological fact.
jack expressed some of my mindset in terms of, I am afraid I might betray myself one day. I might get an attack of hormones or biological clock or something, and go through a brief period of unreason and thinking I want children after all. At least removing a coil requires making a medical appointment, so it would give me a few days to think over a hasty decision. But I'm more afraid of pressure from a partner. It's easy to tell myself that if someone tried to nag me (or worse) into having kids, I would totally dump them rather than give in, but realistically I know how hard it can be to end a relationship. Obviously I hope I wouldn't get involved with anyone abusive, but I'm no more immune to being bullied into following unreasonable demands than anyone else.
On the medical side, my feeling is that the risk of surgery, while higher, is a one-off. If I don't get a bad reaction to the anaesthetic or pick up a iatrogenic infection, well, I can stop worrying about it forever after. Whereas the very unlikely risks associated with using a coil are ever-present. Now I know that hormone-free is an option, I'm less worried by that possibility, but still.
So the question is, should I insist on sterilization even though I know it will mean a fight (and possibly paying for it to be done privately)? And even though I do take seriously the relative medical disadvantages of that option? It's the greater effectiveness of the coil that makes me lean towards accepting that option even though I would rather have something more permanent. I suppose a compromise is to agree to have a coil fitted, and if it goes wrong in some way, then ask for sterilization as a back-up plan. Or, well, revisit the issue in a few years' time and see if the medical consensus has changed, as well as me being older so less likely to be regarded as flighty and expected to change my mind about having kids any time.
After some discussion she reckoned my best long-term contraceptive option is the plain copper coil, without hormones. Apparently that will give me ten years of protection with a failure rate that's too small to measure accurately. She echoed what I've been told before, that the NHS regard the coil as a better option than sterilization, cos it's more effective but still reversible, and doesn't require surgery.
Well, more effective is a big plus, and I can totally see the point of avoiding unnecessary operations. But reversibility seems like a big downside to me. I have this strange paranoia about finding myself in a society which is either regressively sexist, or has low standards of medical care, such that I can't get a replacement coil when this one reaches the end of its lifetime. This is probably quite unlikely, but I may have 15 or even 20 years of fertility ahead of me and I can't bank on my situation being the same as it is now for that whole period. The other reason why I want to do something irreversible is that I've had a lot of relationships with people who thought that if I loved them enough I'd change my mind about not wanting kids. I want to be able to say to potential partners up front, not just that I'm childfree, which sounds like an opinion, but that I can't have children, which would be a physiological fact.
jack expressed some of my mindset in terms of, I am afraid I might betray myself one day. I might get an attack of hormones or biological clock or something, and go through a brief period of unreason and thinking I want children after all. At least removing a coil requires making a medical appointment, so it would give me a few days to think over a hasty decision. But I'm more afraid of pressure from a partner. It's easy to tell myself that if someone tried to nag me (or worse) into having kids, I would totally dump them rather than give in, but realistically I know how hard it can be to end a relationship. Obviously I hope I wouldn't get involved with anyone abusive, but I'm no more immune to being bullied into following unreasonable demands than anyone else. On the medical side, my feeling is that the risk of surgery, while higher, is a one-off. If I don't get a bad reaction to the anaesthetic or pick up a iatrogenic infection, well, I can stop worrying about it forever after. Whereas the very unlikely risks associated with using a coil are ever-present. Now I know that hormone-free is an option, I'm less worried by that possibility, but still.
So the question is, should I insist on sterilization even though I know it will mean a fight (and possibly paying for it to be done privately)? And even though I do take seriously the relative medical disadvantages of that option? It's the greater effectiveness of the coil that makes me lean towards accepting that option even though I would rather have something more permanent. I suppose a compromise is to agree to have a coil fitted, and if it goes wrong in some way, then ask for sterilization as a back-up plan. Or, well, revisit the issue in a few years' time and see if the medical consensus has changed, as well as me being older so less likely to be regarded as flighty and expected to change my mind about having kids any time.
(no subject)
Date: 2009-08-29 10:28 pm (UTC)I do think that your voiced concern about changes in healthcare/contraception is worth taking seriously inasmuch as it sounds like one o'dem psychological things saying "hai maybe we don't want permanent contraception akshuly." It might, for instance, be the ALL WOMEN MUST WANT BABIES part of your social education feebly fighting the decisions the rest of you has made, if you see what I mean. It might be interesting to try exploring that in your mind a bit, but as a practical concern I think you're right to label it as a weird paranoia - realistically it's not going to happen the world over in ten years, I don't think.
Regardless, I'd say push the NHS on properly permanent options. It happens that we're saturated in a culture that seems to think popping sprogs out of the snatch is a basic human desire, need, and right, so the NHS and its minions naturally want to prioritise that idea in everything they do. But you've been absolutely adamant that you don't want to have babies for pretty much your entire life, and anyway you're smarter than most of the NHS.
Because really, why the buggering fuck should you be denied what is clearly the most sensible birth-control method just because you've decided you don't want children and the NHS has decided you do, you're not a fucking brood mare. You're entitled to contraception under the NHS, this is the method you want, they can bloody well give it to you.
Er, shavua tov.
You are wonderful when you get angry on my behalf!
Date: 2009-08-30 01:04 pm (UTC)It may be that worrying about future blocks to contraception or generally having less control over my life and sexuality is a symptom that I'm not really sure about the permanent thing. But I think it's the other way round: I really really want to do something permanent, so my brain is coming up with all kinds of rationalizations about why I must have the permanent option even though it's objectively less good.
And it is less good. It's not just sexism which is leading people to advise me against sterilization. Having surgery when you don't need it for immediate medical reasons has obvious downsides. And the rate of spontaneous reversals of tubal ligations is genuinely, objectively higher than the rate of either unwanted pregnancy or complications for women using the coil. So it's not at all obvious that sterilization is .
At the same time, I do see the point of kicking up a fuss, because I do have a good chance of being listened to and that might make things easier for women in the future. I am rather aware that if I were poor or black or both, I would probably find the medical establishment much more enthusiastic about sterilizing me. (Though in that situation I doubt I would have doctors and nurses who had plenty of time for me and took my views seriously, and could easily be identified as People Like Us.) The problem is that I'm not sure I should put effort into fighting the system over an irrational whim. I know it's a purely emotional preference, not an actual rational medical decision. I might be smarter than many people, but I'm not being very intelligent about this, I'm acting on bizarre and unrealistic terrors!
Re: You are wonderful when you get angry on my behalf!
Date: 2009-08-30 06:36 pm (UTC)I was picturing a bit of brain, hidden like the racist bit everyone has and mostly picked up from culture, that says something like "But All Women Must Want Babies, so I must want babies. But I have also decided that I don't want babies. This is a problem. So I need to be envisaging a future where contraception isn't available, and where ipso facto I will have to get pregnant and have Babies, and everything will be okay, I will have Babies and not betray my other decisions. So let's invent a future in which we can't have contraception and must have babies because then we can be Proper Women even though we do have Principles." Anyway, not important.
Surgery is a tad more risky than the other options, etc, but hell, people have cosmetic surgery all the time, and people go through the most extraordinary procedures to try and get pregnant, I don't suppose those are entirely safe either. Not the point, I know.
...spontaneous reversals of tubal ligations...
Oh OK I was sort of assuming something a bit more drastic, like they do for puppies. They don't do tubal ligations on puppies.
I spose mostly it's just I get tired of seeing people prioritise Being Nice and Not Making A Fuss over their own wants, because no-one ever says thank you for being so nice and not making a fuss, so it's a big con. I can't tell if you're doing that or not here, but I tend to assume a lot of that in everyone, cos there's a lot of it about, and react accordingly. Which, you're right, is a bit unfair.