What's Up, Doc?

We're living at a pinnacle point in women's history.  The gender pay gap is narrowing; women in historically male-dominated countries are gaining rights they have never had before; the Silence Breakers were TIME Magazine’s "Person of the Year", celebrating those who have been brave enough to speak up about sexual abuse and harassment.  What a time to be alive!

One issue that is very near and dear to my heart is women’s health care, and it’s been swept under the rug far too long.  What do I mean by this?  I’m talking about how women approach the value of their own health.  By many measures, women’s health in the United States is a disgrace.  Ladies, if we’re going to continue moving mountains, we need to be healthy.  Mama Rama Co. intends to focus on mothers and this piece is meant to empower mothers to take their health care into their own hands.  But I do hope this piece speaks to everyone, male, female, parent or not.  Ask yourself this: how much do you value your health?

First, I want to point out that this piece is in no way meant to bash medical doctors.  I love doctors.  My oldest friend in the world is a recent graduate of medical school, is currently devoting her life to residency, and I am confident she’s going to be a world-changing doctor.  She’s one of the good ones.  The OB-GYN who was our backup plan for our birthing center treated me like a concerned father with his incredible bedside manner.  He’s one of the good ones.  Our pediatrician talks to us—not down to us—and respects the decisions we make.  She’s a mom who is genuinely interested in seeing every one of her patients grow up to be healthy and happy, whatever the unique path may be for each unique child.  She’s one of the good ones.  If you can’t say you feel respected by your doctor, find another health care provider.

I've got some not-so-great news.  Unfortunately, the current American conventional medical approach to women’s health is far from ideal.  This piece was inspired by an extremely insightful article which dives deep into the issue.  In What’s Killing America’s New Mothers?, Annalisa Merelli describes a tragic state of circumstances:  “Between 700 and 1,200 women die from complications related to pregnancy or childbirth every year in the US. Fifty times that number—about 50,000 in all—narrowly escape death, while another 100,000 women a year fall gravely ill during or following a pregnancy."  According to historical data from the Centers for Disease Control, global maternal mortality had decreased by 45% between 1990 and 2015, while American maternal mortality had increased by 60% during that same time period.  Conversely, US infant mortality rates immediately after birth are at the lowest recorded point in history.  So much focus is being put on babies, yet mom’s health is put on the back burner and becomes an afterthought.  I’m sure I can speak for most mothers when I say I’d give my life for my child without batting an eye.  But certainly a baby’s care is going to be far better with a healthy mama.  We can do better, America.  Women are not simply vessels used to deliver babies and then be kicked to the curb.  Our health is paramount to child development during pregnancy and after birth.  Take care of yourselves, mamas.  Physical and emotional self care is a vital part of health care that we women tend to dangerously ignore.

Up until 2017, not all US states required that a death certificate note whether a woman was currently or recently pregnant.  Death certificates didn’t specify pregnancy at all until the early 1990s!  So that makes me wonder: how accurate are the statistics showing the increase of maternal mortality?  Couldn’t one stand to reason that many more pregnant women potentially died and we just don’t have the data?  The fact that only last year did all states require notation that a woman was expecting gives us something to think about.  Yet, the more important question is: why are American women dying at an increasing rate during and shortly after pregnancy?

For one thing, are doctors taking their female patients seriously?   It's been asserted that doctors often write off a woman's ailment as a psychological issue more than they would with a man, especially when the condition is not immediately apparent.[1]  If a female is having serious issues, is it surmised that she is just “hysterical”?  If a woman asks for clarification or questions a risky procedure, is she being taken seriously by her doctor as much as a man would be?  Or maybe she doesn’t even ask the questions because she’s been shut down before and doesn’t want to be a nuisance.  According to a study done by a leading health science professor at Boston University, 30% of women reported holding back from asking questions of their providers because they felt rushed, 22% wanted a different kind of care than what their doctor had recommended, and 23% of women held back from asking questions because they feared being considered “difficult”. 

If I had been surveyed in this study, I would fall under all three of those categories at some point or another.  Before I found the midwives (or as I like to call them, angels) at our free-standing birthing center, I pretty much closed my eyes and pointed to a name on a list of nearby OB-GYNs.  The doctor I chose will remain nameless, but I sure had a lousy experience.  I’m sure many of you readers can relate to this.  We wait for what feels like an eternity, and then when the doctor can finally grace us with their presence, it’s a quick grope followed by recommendations—a.k.a. orders on what you “should” do.  When I did ask a question—such as why a healthy person like me with no family history of disease would need my amniotic fluid tested—I  got a blank stare and a condescending answer which made me feel all the more naïve.  Needless to say, I was quick to find another doctor.

Let’s talk about why you might want to question your doctor.  While there may be a plethora of reasons, two prevalent problems in birth care are the over-use of unnecessary Cesarean section delivery and labor induction.  Although your doctor may brush off any risks, there are risks, they should be taken seriously, and patients should be fully aware of what these risks are.  According to the World Health Organization, the ideal rate for Cesarean section is 10-15% of births.  In 2015, the rate of Cesarean section in the United States was 32.0%, that's more than double what the WHO recommends.  “Cesarean sections can cause significant and sometimes permanent complications, disability or death... Cesarean sections should ideally only be undertaken when medically necessary”[2].  Induction carries risks too, including failure of induction (which would lead to a C-section), low fetal heart rate, infection, uterine rupture, and serious bleeding after delivery.  None of this is to say that Cesarean births and appropriate inductions are all bad.  There are certainly circumstances in which these practices are necessary to save baby and mama.  Still, our bodies were designed to birth human beings and we can generally trust our bodies to square it all away with the right non-invasive support.  A lot of critics blame these types of overuse on many hospitals’ approach to birth; birth needs to be quick and on schedule.  Think about it, how many people do you know whose labor was induced because their baby hadn’t come out by their “due date”?  Believe it or not, sometimes baby hasn’t quite synced up with your doctor’s golf schedule.  I can’t tell you how many people I’ve horrified when they learn my ten-pounder came eight days past his due date, all on his own.  I’ll admit even I started to get nervous every time someone asked me when I was due, and I heard the response of “oh my GOD, 5 DAYS AGO?? When are they inducing you?!”  Luckily, it simply turned out that my (not so) little guy was cozy in there and after eleven hours of labor, he popped out just fine.

Good doctors deserve the utmost respect.  Eight years of schooling plus residency is no easy feat.  Doctors deal with so many difficult issues and have to soldier on through emotionally draining situations.  Still, just because you did not go through medical school doesn't mean you’re not a critically thinking, intelligent individual.  People often tend to worship their doctors.  They have been taught that doctors hold more authority over their body than they hold themselves.  That is so the opposite of the progress women are making these days!  You are in charge of your health and your body.  You know your body better than anyone else.  Don't be complacent with your health.  Do your research.  I’m not advising anyone self-diagnose, but do ask questions.  Be difficult if you must.  If you didn’t know, doctors get paid just fine… make them earn it.  Test them on what they learned in all those years of medical school.  Check out what alternatives exist and decide what route you are truly comfortable with.  Once you have come to a place where you understand the issue, all of the options and all of the risks, and you feel confident with your doctor's recommendation, go for it!  That means your doctor has done his or her job properly.  A genuinely good doctor will be happy you’re taking your health seriously and asking questions.

The main idea here is that medical patients need to be giving informed consent.  "The most important goal of informed consent is that the patient has an opportunity to be an informed participant in her health care decisions. It is generally accepted that informed consent includes a discussion of the following elements:

  • The nature of the decision/procedure
  • Reasonable alternatives to the proposed intervention
  • The relevant risks, benefits, and uncertainties related to each alternative
  • Assessment of patient understanding
  • The acceptance of the intervention by the patient" [3]

Is your doctor informing you of the risks associated with the drug you’re being prescribed?  The vaccine you're about to have injected into your body?  The procedure you’re about to undergo?  Your doctor may not automatically tell you the risks.  And that is when you need to step in and ask.  Don’t be afraid to ask—if you don’t, who will?  It is my belief that your physical, mental, and spiritual health should be the highest priority.  Take it seriously. At the end of the day, you are the only one who will advocate for your health.  So pay attention to your body and be accountable. Be the person who is looking out for you!