Wrong person for the job?

[liv]

This worked really well when I had to lead a seminar about obesity, so let's try it again. I've somehow been volunteered to run a first year session on childbearing and reproduction. It's a bit of a grab-bag of stuff, like a lot of our first year curriculum it's pretty much just introducing the students to the issues that exist. They will revisit this stuff later in the course, don't worry, we're not trying to teach them absolutely everything they need to know about childbearing in a single afternoon.

The rest of the module is about the actual mechanics of reproduction, conception, pregnancy, labour, foetal development etc. This session is about childbearing in social context. So, does anyone have anything they'd like me to convey to some future doctors about:

• Teenage pregnancy and young parenting
• Treated or untreated infertility
• Involuntary childlessness (ie unwanted childlessness caused by not finding a partner or not being in life circumstances to have children, as opposed to physiological inability to successfully sustain a pregnancy)
• Deliberately delaying childbearing for career and other economic reasons
• Social gender roles and expectations affecting childbearing decisions
• Cultural variation in all of the above

Like I said, quite a grab-bag, and to me the glaringly obvious hole in it is that there's absolutely no GSM perspective, but that's tied up with other stuff about the way the curriculum is structured (basically we don't really introduce complicated advanced concepts about gender and sexuality until the third year). Though at least there is explicit acknowledgement that this stuff is important for men, it's not purely a women's issue.

Me, I'm happily childfree, and I haven't even experienced much of the pressure to reproduce that some childfree women report. So I can't bring the same degree of personal experience I did to talking about the medical profession and fat people. But if there are any misapprehensions you would like me to address, or hurtful stereotypes and ways of talking about these issues that I should avoid, I'd be glad to hear about them! Again, I want to be very aware that these issues affect the actual students in the discussion as well as their hypothetical future patients; some of them are mature students who might have had any kind of life experience, a minority but a few of them are right now combining parenting with medical studies, and I shouldn't make assumptions that none of this stuff is relevant to the more "traditional" ie 18-year-old students straight from school.

Comments

[azurelunatic]

Does it touch at all on people who would just like the whole apparatus out, without having had any children? Some doctors entirely refuse to discuss removal/long-term contraception with people who haven't had children.

Not all people equipped with a uterus and capable of bearing children identify as women; the ~99% of people who do identify as women may find it silly to refer to a "pregnant person" instead of "pregnant woman", but a pregnant man or genderqueer person may need that moment of affirmation that pregnancy does not erase his/their/etc. gender identity.

[liv]

I think the discussion could likely run to talking about elective sterilization, it's the sort of thing that seems generally relevant though it's not explicitly in the notes. Bringing that up could be a good way to gently prod people about the assumptions they're making about what an expected life progression is.

I would definitely like to bring up talking about "pregnant people" rather than "pregnant women", but this cohort have not had any teaching about trans* and GQ issues at all, which means that some of them at least have probably never thought about it before, and if I bring it up it risks swamping the entire discussion. I've had that problem before, in a discussion more of the biological side, I mentioned as an aside something like "the majority of people who are going to be consulting about breastfeeding are women" and ended up spending half an hour of class time calming down the hysterics over the possibility that some men may in fact engage in breastfeeding. OTOH never mentioning any non-normative gender issues because it's too complicated is itself oppressive, so I am genuinely not sure which way to go on this one.

[azurelunatic]

Oh, that is a tough one. Gender! Why so hard?

[ephemera]

Amen - with personal experience for the first one, and just general support for the second.

[highlyeccentric]

It's polite to actually believe a lady who says she doesn't want children or isn't ready for children yet? I've not run into this problem myself, since I'm single and my doctor until recently knew I was mostly sleeping with ladies. But I hear horror stories.

We have all kinds of fun genetic things in our family, but none of them have been problematic from the doctor end. I guess it might be worth noting that under certain circumstances, women (or men?) who are not themselves bearing kids may be involved in family decisions and medical stuff re: fertility and other issues. F'r instance, it was merely lucky chance which meant my cousin happened to be treated by the same specialist as me - otherwise I'd have had to be more involved in getting histories transferred, etc. I'm told there's a geneticist at a particular hospital who's 'happy to talk to me' any time, etc.

[liv]

Actually believe people who say they don't want children now or ever? Oh yes, I can actually speak with authority on that one. I am still working on trying to get a tubal ligation rather than just long-term contraception.

Good point about other family members being involved in fertility stuff. I think that's reasonably well covered in other parts of the course, we talk about genetic things affecting whole families not just the individual patient. But it may work out relevant, yes, thank you.

[highlyeccentric]

I'm getting mildly irritated by people (granted, mostly my mother...) assuming that the only reason I want to know / fret about fertility/genetic problems is For When I Want Children. What if I got *accidentally* pregnant? Also, I have a sister to fret about.

[hunningham]

I got my tubes tied at a relatively young age (mid-twenties, can't remember exactly how old I was) but I do remember that it took four years from my first visit to a doctor to talk about sterilisation.

[trojie]

(here via highlyeccentric)

I once (recently) had my doctor, whom I haven't had issue with in the past, attempt to persuade me to go off my Pill because I'm in my late twenties and married and I apparently 'should be having a baby'. Completely flustered, I tried to joke with him (my usual defence mechanism) and said, 'Come on, give me a few more years!' He then proceeded to write down in my MEDICAL NOTES that I would be 'trying for a baby' by the age of 28.

Completely poleaxed, I got him to write me the script for my contraception and left, but I still feel distinctly like my trust and privacy have been invaded by him writing that in my notes.

Please warn future doctors off doing anything like this! Just because someone is in a stable relationship and of childbearing age and in possession of a working uterus doesn't mean they 'should' be popping out sprogs!

[liv]

Argh, that's awful that your doctor would act like that. I really do hope that if this discussion conveys one thing it's that there isn't a single "right" age to have children and it's certainly not up to doctors to decide when that is for any given patient. Unfortunately your experience is a really good example of how these things shouldn't go; thanks for mentioning that.

[crystalpyramid]

I don't know if this is relevant in the UK, but in the States I once had a fourteen-year-old girl tell me she really wants a baby, and when I asked what her parents thought of that, she said her mom was really supportive of it. (I left the school at the end of the year so I don't actually know how that worked out for her.)

We in the middle class and above think that the best things we can give our children are our own resources, money, and expertise, so we save and build careers until we can build stable lives for our children, generally without much parental support. Take away the expectation of a career and money, and the best thing parents have to offer their children is time and energy — their own youthful energy, and the time and expertise of their still-energetic parents. There is an argument that teen or very young parenting really does work better if you're not expecting to be anything but tireder later on.

Elaborated on slightly more here: http://devilscarpet.livejournal.com/363747.html

[liv]

Thank you, that LJ post you linked and the ensuing discussion is really valuable, just the kind of thing I'm looking for.

The situation is less extreme in the UK than the US, but there is certainly an issue that it does in fact make rational sense for working class and / or poor people with few prospects to have kids very early. A big part of what this seminar is trying to address is the fact that very nearly all medical students are middle-class, and if they're not when they come in they become middle-class by the time they graduate. So they're very much coming from the assumption that teen or very young childbearing is a problem, that the "right" thing to do is to wait until you have established your career and have a stable relationship and so on. A lot of the discussion will be structured around trying to introduce the idea that there can be advantages to young childbearing, and there can be disadvantages to delaying, and it depends a lot on individual circumstances.

[crystalpyramid]

Yay! I found it really eye-opening — I grew up in situations where my parents, who had me at 28, were always the youngest parents in the room — so I'm glad it was interesting and useful to you, too!

[siderea]

I'd like to dissent on that article. I find it deeply problematic. I don't really have the spoons to go into it right now, alas.

I will simply say this. It seems to me there's apparently several developmental stages of thinking about teenage pregnancy.

(1) Having babies out of wedlock is wicked, you shameless hussy.

(2) Having babies out of wedlock, as a teenager, is such a ghetto thing to do; don't they know any better?

(3) Those poor girls, unable to find (decent) men to marry. No doubt they would totally adhere to middle-class norms if it weren't for all the men being behind bars, in bars, or dead.

(4) The poor will always be with us, because being poor is in their natures. Poor people have their quaint poor-people ways of going about their lives. Having babies before 20 is just part of that.

(5) Nothing, but nothing, can fuck up a young impoverished, urban, developed world woman's entire life like getting pregnant before 25 without the support of a large, positive, useful extended family in the immediate vicinity. It is in the vast majority of cases a life sentence of crushing poverty, desperation, instability, exploitation, and abuse.

As someone responsible for the mental health of many desperately poor single mothers, some young, some now the parents of teenagers having babies themselves, I am appalled at what getting pregnant young did to these women. It meant not daring to quit jobs with abusive or exploitative or sexually inappropriate bosses. It meant not getting necessary inpatient medical care for themselves due to lack of baby-sitting. It meant going for days without food to make sure the kids ate when there was more month than money. It meant being toyed with by the fathers of their children, who held child-support out as bait. It meant staying with batterers. It meant turning to prostitution to make ends meet, to shoplifting, check fraud, drug smuggling; it meant getting a criminal record and a permanent crimp in their employability. It meant moving back in with their own abusive, addict parents and desperately, desperately hoping that DSS never finds out. It meant moving in with their baby's father's mother and all her crazy; it meant accepting childcare from grandparents who refuse to believe the kid actually has diabetes, allergies, chemical sensitivities, ignore the brown bag meal sent with the child, and feed him things that could kill him, because who else will look after the child? It meant making parenting choices out of the depth of their childish ignorance which they later had excruciating cause to rue -- some of which were fatal. It meant eight years couch surfing with a kid while waiting on the Section 8 waiting list. It meant driving unreliable, dangerous cars; it meant having no car at all and no way to take the kid to the doctor except by bumming a ride or calling an ambulance. It meant going without their psych meds because they needed that $12 for their kids to have something to eat. It meant roaches, basement apartments that flood, rats, mice, and, most memorably for me, That Story About The Maggots. It meant giving up on career aspirations; it meant abandoning their educations. It meant giving up their artistic and athletic and romantic aspirations. It meant constant low-grade (if you're lucky) terror about not keeping all the plates spinning, shaving years off their lives. It meant never, ever feeling safe, feeling secure, feeling that things, at least for the next little while, were going to be okay.

If there's something past #5, I don't know what it is yet.

The author of that post seems to be at #4.

[loligo]

Nothing, but nothing, can fuck up a young impoverished, urban, developed world woman's entire life like getting pregnant before 25 without the support of a large, positive, useful extended family in the immediate vicinity.

I'm not at all disputing what you've seen and experienced; I just want to add my own experiences, which are somewhat different. I work for a social service program that provides support to low-income first-time parents who have one or more risk factors for poor parenting outcomes (factors like mental illness, substance abuse or domestic violence in the home, social isolation, young maternal age, etc.) We operate in four rural counties in the U.S. Midwest. And what we see is that a lot of the teen parents in our program *do* in fact have large, supportive, useful extended families. They have grannies and aunties who are happy to provide child care while the young mom finishes high school and gets an associate's degree for a job like dental hygienist or certified nursing assistant, and then she's on her way to a reasonably successful life. (Also, the wait list for public housing is only six months long in most towns, and the units are halfway decent and fairly safe.)

Do things turn out so rosy for every teen mom in our program? Hell no. But we also have plenty of first-time parents in their late 20's who spend the whole five years they're in our program careening from crisis to crisis, never managing to get their lives pulled together. Among our specific service population, maternal age by itself is pretty weak predictor of what someone's life will be like. There are other red flags that are much redder and flaggier.

[crystalpyramid]

If context helps, the author of the post was a college senior who was raised on food stamps and graduated top of her class in high school. My impression from reading the post was that it was the first thing she'd read in college — surrounded by all the upper-middle-class kids you are surrounded by in college, especially at an American small liberal arts college — that actually validated her own experiences and those of her family. She may be painting a rosier picture than the grim realities you're dealing with, but I also think she is othering "the poor" a lot less than you are assuming she is.

The biggest takeaway I got from this article was the idea that having a child early could seem like a logical choice, to someone making that choice, especially if it doesn't look like they have a lot of options anyway. Maybe not a wise choice in the long run, but not quite as astoundingly stupid as it seems to the average upper-middle-class kid from a good school who ends up going to medical school, either.

[crystalpyramid]

And if people are at 1 and 2, and the goal is to get them to 5 and enlightenment, 3 and 4 are probably steps towards having some kind of picture of what a mess things are. I suspect that the average student who hasn't thought about it is at 1 or 2.

[kerrypolka]

Thank you so much for that link - I had never thought about the issue in that way before, and I'm really, really glad I have now.

[monanotlisa]

Whoa. Thanks for pointing this out. I'll bookmark your post for later too.

[crystalpyramid]

I can't take credit for the post itself — it's someone I met because she was considering going to my college. But I've been passing it on every time I get the chance!

[lilacsigil]

I'm happily childfree in a lesbian relationship of many years, but I was diagnosed with two conditions in my mid-20s that are likely to strongly affect fertility: PCOS and cancer. Each time it was really distressing to have the doctors focus entirely on my potential fertility (and constantly ask, in the diagnosis stage, if I was having a miscarriage) and keep asking me about male sexual partners in front of my female partner. I had to (not entirely voluntarily) come out to several doctors and even then they kept talking about "male partners", and concentrating on fertility issues rather than the things I actually asked about such as risk of death in surgery. The assumption that a young woman would only be interested in BABIES was distressing and harmful to my medical treatment.

Later I had to have a course of radiation and the staff in charge of that had to make sure I wasn't pregnant. I explained why I didn't think it was necessary in my case and they explained that they needed to check any person even remotely capable of becoming pregnant for medical liability reasons. They were calm, polite, explained clearly why they needed to do the test, and didn't ask other questions about my sexual history. It was a great contrast.

[liv]

Wow, I wish you didn't have so many terrible experiences so illustrative of what my doctorlings should not do! I could definitely mention the need to be sensitive about assuming people will always be interested in fertility consequences of medical issues in the way you expect, thank you.

I have definitely heard stories of people being really distressed by being forced to have an obviously irrelevant pregnancy test. It's at least somewhat comforting that in your case that bit at least was handled appropriately.

[lilacsigil]

I had a rare cancer at a young age while daring to be fat, which is a triple whammy for learning about the nastier side of the medical system!

[liv]

:-( I can only imagine.

[monanotlisa]

Unfortunately, I second that -- here in the United States, I have had to take a pregnancy test. This is an open post, so I am not going into detail about all the reasons this was ridiculous, but I could not get the doctor to back off, his main argument being, "Down the road, the other hospital wards and speciality clinics will want one for sure."

Probably true, but ridiculous for the same reason as originally...

[lunabee34]

This is very true of health care given in a college context. If you have a cold and you go to the doctor on campus, you will be accused of being pregnant and have to either convincingly defend that or take a pregnancy test anyway. I remember being so frustrated as a graduate student that every time anything was wrong with me, the default assumption was that I had become pregnant.

[rmc28]

Social assumptions:
"Leave the rest of your stuff in the car and dad can get it when you are back on the ward"

A discharge process from the maternity ward that assumed my lift home would be entirely happy with waiting around for over 6 hours, being told "just another hour or so" at intervals. Because of course it would be dad, with a car. (haha no).


Involuntary childlessness / mental health:
When I got married, I wanted lots of children. My first pregnancy was difficult enough that it took me over four years to even consider going through it again. My second pregnancy was so much worse that I will never voluntarily be pregnant again. I am both fierce about needing good contraception until I hit menopause, and significantly upset that I "can't" have more children.

A lot of well-meaning friends & family minimise my decision "oh, you say that now!" or "it might be better next time", or the extra-special "well, if you feel like that, why didn't you get sterilised while they were doing the c-section?"

My mother at least, who was very cheerleady "it could be better next time!" after the first pregnancy, has taken me seriously after seeing the state I was in at intervals during the second.

Not all the family is: I've had several variations on "but your babies are so lovely, what a pity you won't give us any more" or even the creepy-eugenics "but if brainy people like you and T don't have more babies, we'll get outbred by stupid people who can't use contraception".


Being fat while pregnant:
It would be nice if midwives / obstetricians didn't express such complete surprise that my blood pressure remained normal, or that I reported doing regular exercise. The booking-in midwife for my second pregnancy asked me FOUR times if I was SURE I hadn't had gestational diabetes with my first. Because I was so Terribly Overweight, see.

[liv]

Thank you, these are really useful, though I wish you hadn't had so much awful personal experience in the first place to be able to share it. I'll do my best to form non-awful future doctors for anyone else who has similar experiences!

Definitely good illustration about the medical system assuming that all mothers have supportive, available husbands. I may well use that as an example.

And that's a very good, if devastating, reminder, that infertility / childlessness isn't just about people who have never had children. But creepy-eugenics and families wanting more babies could certainly be relevant for any sort of infertility too.

[crystalpyramid]

The only person I know who had preeclampsia was a skinny vegetarian who runs.

[403]

I don't have much to contribute personally, but I recently happened on an article that seems relevant: Before I Forget: What nobody remembers about new motherhood.

[liv]

Thank you, that's a great personal description, what a brilliant idea for her to have written down just how bad things got at the time so she wouldn't forget.

[mecurtin]

Ta-Nehisi Coates has written a couple times about how his partner's pre-eclampsia was overlooked because the doctors kept focusing on her (and his) weight as the cause of her HBP. She nearly died.

Weight issues have become a huge conflict zone for patients and doctors recently, as I'm sure you know. Obsessing over too much/too little weight gain in pregnancy turns all the stress up to eleven. You can probably find a magazine in the checkout line comparing Kate Middleton (too thin!) to Kim Kardashian (too fat!) to use as an example of what *every* pregnant woman goes through.

One thing not often discussed is that pregnant women's bodies often get treated as public property. In the last trimester all kinds of people feel they have the right to "just put my hand there for a moment to feel the baby". And to comment about how you're progressing, and to ask if you're having twins. Not to mention the yelling if you're drinking alcohol or smoking or carrying a package in public.

This kind of public disrespect is often especially trying because the most persistent offenders are older women, who you're trained not to be rude to. And I must confess that now that I'm an older woman, edging into the Grandma age-group, it's a hard impulse to quash, because you feel that in this are at least you are a World's Leading Expert.

I posted an account of my childbirth experiences and posted it here on DW; it's flocked, but I've given you access. If you think your students would benefit from reading it, I'll arrange to post it publicly.

My children are now 17 and 24; don't hesitate to ask if any more questions occur to you!

[sea_bright]

One thing that might be worth flagging up, at least in passing, is varying religious attitudes towards things like fertility treatment (especially those that involve the creation of additional embryos, or the involvement of a third party as a donor). This is complicated by the fact that people may not have given much thought to the issue until it arises, and hence may not have had a chance to work out what their own views are, or what the official position (if there is one) of their tradition is. It's worth doctors keeping in mind that there may be additional non-medical considerations when deciding what course of action to adopt, and that people may be confused (and possibly conflicted) about these.

[loligo]

Hi, here via Monanotlisa -- I work for a program that provides parent support and education to parents who are in various challenging life circumstances. My advice, boiled down to its most succinct form, is: don't make assumptions about people. Don't make assumptions about their life circumstances, don't make assumptions about how happy or unhappy they are about being pregnant, don't make assumptions about how supportive their family members (if they have them) may be... if you need to know any of that socio-emotional stuff for medical reasons, just ask in as neutral a way as possible.

Two bonus pieces of advice that are more medical in nature: (1) even though post-partum depression gets all the press, hormonally-induced depression *during* pregnancy is also a real problem for some people. And (2) of all the risk factors that we deal with in our program, probably the most damaging is substance abuse. So I want doctors to understand that when you help a parent find effective treatment for their alcoholism or drug abuse, you are making an enormous difference in the lives of their children, as well.

[em_h]

Seconding the point about depression during pregnancy. It's a serious and very often overlooked problem.

Among the other things not to assume, when dealing with a heterosexual couple, is that the mother will necessarily be the primary caregiver. Pretty much as soon as the baby is out of her body, that is not a safe assumption; while it's rare for the father in an intact couple to be the primary caregiver from infancy, it is possible. And there are couples where caregiving is genuinely pretty evenly shared, even from very early days.

[(Anonymous)]

Oh. Psych meds and pregnancy. I think it's a safe generalization that any psych med that is sufficiently assertive that it might have adverse effects on a pregnancy is likely to be needed enough that being off it is one hell of a ride.

[azurelunatic]

(That was me.)

So you've got:

Someone goes on a medication that it's not safe to become pregnant on; they should know this when going on it, and know what to do if they suspect they have become pregnant. This should likely be reviewed periodically; "you're a woman of a certain age so I won't give you that" should not be a reason to deny someone a medication they need. Reviewing their contraception plan (which could be anything from not having sex at all, with a plan to use X method if that changes, to being in an exclusive non-reproductive-capable relationship, to using a traditionally recognized contraceptive) is probably in order at this point.

The patient is on medication that they don't know whether is safe to be pregnant while on. This is where the doctor knowing the meds and doing/delegating the appropriate research is a valid life choice. If it's ambiguous, the patient should be given enough information to make an informed choice.

The patient is on medication and it's safe to be pregnant on it -- godspeed if they wish to become pregnant.

The patient is on medication and it is not safe to be pregnant on it -- the patient should be given enough information to make an informed choice between medication and pregnancy, with their quality of life given serious consideration, and any side effects of discontinuing the medication discussed, as well as a safe discontinuation schedule. Also extra/alternative support for the condition that requires the medication while temporarily off it.

The patient is on medication and it is not safe to be pregnant on it -- and the patient is already pregnant -- the above, plus sometimes abortion is in fact an option especially if there are significant problems.

Medication vs. breastfeeding.

[azurelunatic]

I guess what my wall-o'-text boils down to is: going off meds that have brain/mood-related effects (whether or not the patient is using them for psych reasons) are going to affect the patient's emotional ability to cope and quality of life, and those aspects of the patient's health should be treated seriously and with respect.

If a patient is otherwise physically in the peak of health and all cleared for childbearing as far as the rest of their body goes, but is at risk of suicide or other similarly serious problems while without their incompatible-with-pregnancy meds, the doctor responsible needs to take those risks as seriously as they would high blood pressure or whatever.

[tielan]

I'm childless, and I haven't had to face the childbearing question (through a fortunate circumstance of unpressuring parents and an accepting community), but I have a friend who hails from rural US (Oregon, I believe) with thoughts on this stuff. She's in Australia now, so that might colour her perceptions, but I think she might be interested in contributing to this?

She's in her mid-twenties, the mother of one, about to become the mother of two. Married, pro-homebirth (but not obsessively so: they had a medical berth booked in at the hospital and if anything had gone wrong they'd have used it), pro-sex-ed, with close family who's been through teenage pregnancy, etc.

She's not on LJ, so I'd give you her email if you're interested and she's willing.

[lunabee34]

Here via monanotlisa.

I am pregnant right now with my second child and having a very positive experience. Eleven years ago, when I was pregnant with my older daughter, we were very poor, living away from family as grad students, the only married couple in our circle, the only couple with children, and I was super super sick with nausea the entire pregnancy (I steadily lost weight and didn't regain to my pre-pregnancy weight until I was sixth months pregnant) and then with preeclampsia at the end. We had no support network at all, and people weren't really using the internet the way they are now to look for info and etc. I was completely at the mercy of my doctors, and I didn't know anything about anything. LOL

I was not successful at breastfeeding, and I know now that this is because I received very little useful info or help post-partum. My daughter was a premie, and I didn't even realize until doing research for this pregnancy in an attempt to be more successful breastfeeding that that probably prevented her from latching on properly. I feel like I didn't get adequate support the first time around for breastfeeding and no one really discussed with me potential complications of my daughter being premature, probably because she could breathe fine and didn't have to go to the NICU and we got to go home after a week in the hospital.

I don't know if this is even within the purview of what you're discussing in this course, but it's what came to mind for me. :)

[resonant]

My suggestion isn't as sociologically interesting as others', but, doctors, please, if you're going to say, "Gallstones are a common side effect of pregnancy," it might be nice to say that at the beginning, before your patient is writhing on the floor with unexplained pain.

I had two obstetricians, one male and one female. I described my pain to the male one and he gave me a blank look; the female one said, "Where does it hurt?" and I said, "Where the bra fastens," and she said, "Yeah. Gallstones."

[belleweather]

(Here via network)

So, I have endometriosis and have had it since I started my period. I was unbelievably ill 3-5 days a month, every month, from the age of twelve onward. I went to doctor after doctor after doctor, each of whom would pat me on the head and tell me to hang on and eventually -- when I was older, when I was skinnier, when I had a baby, when I got in touch with my sexuality -- the pain would stop. The pain never stopped. I lost jobs, relationships, scholarships, and my dignity before I finally stumbled my way into enough middle-class pseudo-respectability that someone took my pain seriously, gave me good drugs and good surgery. I'm now able to support my family and have a pretty high-flying serious job and career and some self respect and stability; things I could only build because I'm not missing 3-5 days of work every month.

My point is: Please tell your doctorlings to take their patients seriously. Even if they're poor. Even if they're teenagers. Don't discount what they're telling you. Don't ever, ever discount a woman's pain because it's gynecological. If you don't know, don't blow your patients off -- lean in, not out, and try to collaborate with them. I still remember the first doctor I saw when I was 16, who was a family GP and knew nothing about gynecology but when I told him my symptoms was willing to at least strategize with me and talk through the options. He turned out to be on a total wrong track, but the effort made an enormous impression and I remember him 20 years later.

[siderea]

(1)

"A brief history of food: when the rich eat white bread and buy
formula, the poor eat brown bread and breast-feed; then they trade
places." -- Jill Lepore, in "Baby Food" http://www.newyorker.com/reporting/2009/01/19/090119fa_fact_lepore?currentPage=3

Maybe some comment about how bound to culture and class childrearing practices can be, with special focus on the differing cultural attitudes about breastfeeding over the course of the last 50 years?

(2)

I would like all doctors everywhere, but most especially all obstetricians and surgeons, to read Atul Gawande's article The Score. I was introduced to it in my Human Development class, where it rocked my socks in so many ways. Huge numbers of awesome things come out of that article, but to pick just one, he makes the point that we now have a system which rewards doctors for delivering healthy babies, and has no incentives but sentiment for maximizing the recovery and health of new mothers; consequently obstetrical choices can tend to put the best interests of mothers lower than the best interests of babies -- sometimes much lower.

(Also, I consider this article one of the best things I've ever read in the English language. It's on my short list for how non-fiction should be done. I commend it to anybody who wants a mind blowing, thought provoking, riveting ride.)

(3) Did you see "The C-Section and the Internet"? Recommended. ETA: aaaaand that's now behind a paywall, dammit. I don't have a copy, alas.

[busaikko]

Here via Monanotlisa.

I gave birth twice here in Japan, both times while (normally-for-me) overweight. A few things that might not be relevant overseas:

* Pre-birth classes were advertised as for "both parents" or "mother and father-to-be" - but attendants could be friends, siblings, parents, etc. as well (not advertised)
* For my first exam I was given all the routine tests, including for STDs and HIV, automatically and without word beforehand. I would have liked to know beforehand (and hope that counseling was available for those who tested positive)
* Because I was overweight by Japanese standards (US size 16), I was kept on strict diets both times so as not to gain any weight myself.
* Japan at the time had the attitude "pregnancy is not an illness", which was fine except that this meant insurance did not cover fees for monthly (and in the last month, weekly) doctor's visits, and had a reimbursement-only policy for the birth and hospitalization (in Japan, 1 week for first child, about 4-5 days for second) -- which meant that people short on money skipped on check-ups. (This has since changed, I hear.)
* The long hospitalization includes lessons from nurses on breastfeeding, bathing the baby, dressing the baby, child development, and so on. I found it a very good way to start off, rather than heading home immediately.
* A friend of mine miscarried a tried-for and wanted pregnancy, and unfortunately was treated at a hospital which did not have any kinds of counselors on staff, and was devastated by impersonal care and a callous nurse afterwards - she didn't need to hear that she could just 'try again' (at 40) and that she already had a lovely child. If counselors are not available, having staff be aware of the impact of their words and what kinds of advice/support *not* to offer would be good.

[azurelunatic]

Thank you for including that last point; it reminded me of a horror story from a friend.

[azurelunatic]

FOR THE LOVE OF ALL THAT IS HOLY, YOU DO NOT BAPTIZE THE DEAD BABY OF THE NON-CHRISTIAN AND RELIGIOUS GIRL WHO NEARLY BLED TO DEATH WITH A NON-VIABLE PREGNANCY. NO. DO NOT DO THIS THING. IT IS WRONG AND BRINGS SHAME UPON YOUR HOUSE.

(this was, thank all relevant gods, not me. I don't remember whether they actually baptized the dead baby or just threatened to.)

The Other Side of the Coin...

[(Anonymous)]

is one of Ga-Ga's experiences. A nurse on duty at the Liverpool Maternity Hospital, of all places, collapsed on the ward with acute abdominal pain. Although she was married, until the staff realised that she was in labour nobody, including the expectant mother, had considered the possibility of pregnancy.

(There is a context explaining this lack of recognition of pregnancy but I should prefer to discuss this with you privately.)

Southernwood

[(Anonymous)]

Wow. An awesome anthology of contributions (present company excluded).

Southernwood