Tagged: gynecology

Call The Midwife

Midwives on wheels

I don’t watch much TV.

Don’t get me wrong: it’s not because I don’t love sitting on the couch and passively receiving information from the screen. It’s just that I’m way too cheap to pay for cable, which means we only get PBS, Fox, and Univision. I hate Fox and I don’t speak Spanish, and I’m not a fan of Rick Steves.  So most of the TV I watch is children’s programming on PBS. Otherwise, I rely on Netflix and DVDs from the public library for my evening entertainment.

But last Sunday night, for some reason I turned on the TV, and was pleasantly rewarded with an episode of Call the Midwife.

Have you seen this?

It’s an hour-long drama about midwives in the 1950s in London. And it’s so good! In my wildest dreams I could have never imagined this program would be on television. It’s been airing in the UK for a year, but PBS just picked it up here (is this what makes Mittens want to defund the station??).

Created by writer Heidi Thomas –who wrote a screen adaptation of Middlemarch and is doing a remake of BBC classic Upstairs Downstairs– the program follows four young midwives in East London who work with the nursing nuns at Nonnatus House.  They deliver 80 to 100 babies a month.

In the first episode, we’re introduced to Jenny Lee, a new midwife. She rides a bike. She delivers a preemie. She treats a woman with syphilis. And although she is initially disgusted by the syphilis and overwhelmed the sheer number of pregnancies, by the end of the episode she characterizes the women she serves as heroes who endure tremendous hardship but always keep going.

To me, the show functions partly as a public service announcement for the health benefits of contraception and safe, legal abortion. The woman who gives birth to the preemie has 24(!!!) other children. The patient with syphyllis miscarries her 13th. These unending pregnancies ravage women’s bodies, age them before their time, and add to seemingly insurmountable poverty.

But what was a woman to do?

At the time, there was no accessible birth control, no family planning clinics, no way to really limit pregnancies in a safe and effective way.  It makes me wonder what those Republicans who want to restrict contraception have in mind for the future. Would they see this ceaseless procreation as a type of utopia? It’s hard to imagine anyone actually advocating to make contraception less accessible.

Opposition to family planning technologies cannot possibly have any public health benefit. That means that opposition to birth control can only mean one thing: opposition to gender equality. For women, having control over our fertility is the baseline for equality. Without control over your fertility, you have no hope of  social equality. Period.

That doesn’t mean that I’m jumping up and down with joy because Bayer has decided to make contraceptive implants more affordable for women in poor countries, or that I’m an unapologetic supporter of DepoProvera, or that I think that the contraceptive patch is the best thing since sliced bread. It doesn’t mean that I don’t see issues with many family planning interventions. But although I have plenty of reservations about hormonal birth control, and sometimes question the zealousness with which international development organizations approach family planning initiatives in other countries, I am 100 percent certain of one thing. Female-controlled birth control is a fundamental right.

I don’t watch much television, but for the next several weeks, I’ll be glued to my set on Sunday nights.

I’d love to hear your thoughts. Do you watch the show? Do you like it?

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Why does gynecology have to be so rape-ish?

Did you know that it’s common practice for medical students to do pelvic exams on women who are under anesthetic? Apparently, when a woman goes to the hospital to have her tonsils out, or her knee operated on, or a cancerous tumor in her breast removed, it’s entirely possible that an ambitious medical student may stick his hand inside her vagina while she’s unconscious so that he can brush up on his pelvic examination skills.

In her post on Our Bodies Our Blog, Rachel Walden quotes Shawn Barnes, author of an article published in the October issue of Obstetrics and Gynecology.

For 3 weeks, four to five times a day, I was asked to, and did, perform pelvic examinations on anesthetized women, without specific consent, solely for the purpose of my education. To my shame, I obeyed

This kind of thing is what got me interested in women’s health issues.

Many years ago, when I was a  wild and crazy studious undergraduate, I had a pap test that came back indicating irregular cells on my cervix. The doctor at student health recommended I have a colposcopy at the hospital. The only doctor who was available to do the exam was male. I was not enthusiastic about this, but I went along with it.

A colposcopy is like a pelvic exam on steroids. It was painful, and made me dizzy and nauseous, but that I could endure. What I couldn’t endure was the commentary by that the gynecologist who performed the exam.  At the time the war in Bosnia was going on and there was daily news about the rapes there. As I lay on the examining table, naked from the waist down while he did the procedure, he made small talk.

“I’ve had patients who were way worse than this,” he said. “I’ve had patients who look like a group of Serbians went through them. But don’t worry,” he assured me, “I can fix you up like the Virgin Mary.”

What? I wasn’t quite sure what he meant. That my cervix look better than the cervix of a woman who had been gang raped?  That I shouldn’t worry because things could be much worse? I was struck speechless, but the memory persisted.

After that, I started talking to women about their experiences. I found that for women, humiliation at the hands of medical providers was endemic. It was also institutionalized: at the time, abortion was legal in Canada but women had to go before a panel of three doctors who would decide if their case was worthy.

But still, when I read about medical students doing pelvic exams on women under anesthetic,  I’m outraged and shocked all over again. It shouldn’t be a surprise. As the  historian Deborah Kuhn McGregor writes in her book From Midwives to Medicine, Dr. Marion Sims, the founding father of gynecology, perfected his surgical skills on enslaved women without using anesthetic. Seen in this context, encouraging medical interns to conduct non-consensual pelvic examinations on unconscious women could be interpreted as just the natural progression of the field.

Sometimes I forget about this kind of thing. But then I remember.