Archive for medical madness

Birth and Breastfeeding in Season 1 of Lost

There will, of course, be spoilers for Season 1, which is all I’ve watched so far. This is a warning re: such, and I’d really really appreciate it if you didn’t comment with spoilers for seasons *past* Season 1. Any such spoilers will a) make me all angry and annoyed, and b) not be approved. Thanks.

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Feminism and birth, said better than I could ever say it

When changing birth culture meets fighting rape cultureSpilt Milk gets this so right and says it so clearly. This is a must read. In particular, this is the part that really got my attention:

When a woman has a hand or an instrument inserted into her vagina whilst she screams and thrashes out her non-consent, and when this action is sanctioned by society because it occurs in a medical setting (and because it is believed it must be for the ‘safety of her baby’ if carried out in this setting, regardless of whether or not it was medically indicated or evidence-based care), we have a problem.

But read the whole thing.

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Cutting the Genitals of Children, Part 1

I committed to writing a post a week for the month of May on the above topic, because I attended a session called Social Media, Social Justice at the Northern Voice 2010 conference, and we were asked to make a concrete commitment in some area of social justice that was near and dear to us. This is post #1.

Although of course these posts are going to be about the medical and religious procedure most commonly know as circumcision, but let me first speak about values.

When I use the word values, I mean the moral weight and reasoning that we use to evaluate the world. We all have values, most of which are unspoken and unacknowledged, and they aren’t universal, even though it feels very much like they are. Values also aren’t entirely logical, though we can usually rationalize them, and our values can over time change through education and experience. I think it’s important to be able to speak our values so that people know where we’re coming from, so here’s a few of mine.

Value 1: People who choose to parent children have a responsibility to protect them from harm. This seems perhaps obvious, but there’s a lot of uncertainty on what that protection means. And what harm means, for that matter*. Nonetheless, once you know or suspect that a harm is occurring or likely will occur, it seems to me that by choosing to be a parent (an undoubtedly complicated choice) you also make a choice to take on the responsibility of protecting your child from that harm.

Value 2: People are more important than concepts. Concepts, including values and religious ideas, are intangible. And of course, they can be important. But for instance, it’s very difficult to say whether a concept has been harmed by someone’s actions or how great that harm is. Concepts need people to define them, to explain them and to speak for them. Concepts do not and can not exist without people.

Value 3: Actions should be judged by their effects, not by their intent. Good intentions do not erase the actual bad effects of the things we do. Knowing that a friend meant only good when they served a meal full of allergens doesn’t make the allergic reaction any less, for example. Unintended bad effects are no less bad.

Value 4: Adults, in my world, get to do whatever they want to do with their own bodies. Any marking, piercing, modification or amputation that an adult wishes to do or have done to their own body is or should be their right. There is nothing we possess more totally than our bodies, they are entirely our own.**

Given that these are my values, I know very clearly where I stand with regards to medical or ritual male or female infant or youth genital cutting, sometimes known as circumcision or mutilation. It is, quite simply, wrong.

My values tell me that it is wrong to permanently alter the bodies of children and infants without their consent (and as children and infants they cannot consent to this). It is wrong to cause them pain for no medical benefit, perhaps the most excruciating pain of their lives, and this is true regardless of what the reasoning behind the pain causing is. It is wrong even when “pain relief” is used, as this is rarely sufficient to remove all pain and can cause further problems and damage. It is wrong to risk their lives, their health and their sexual future for aesthetic reasons.

Next post: Some musings on religion and the clash with values.

*I suspect the concept of harm in parenting is based on another set of values. For instance, if you believe that children are inherently “sinful” and/or inherently inclined to be uncooperative, then you’re going to view things like punishment and rigid parenting practices and a child’s behaviour very differently than if you believe that children are inherently community-minded and inclined to want to get along with others. For the record, my beliefs re: children and therefore my practice as a parent tend more along the latter values set.

**I want to state this because I don’t want to be misinterpreted as saying that cutting/amputation/body modifications are a wrong in and of themselves. In my view, these are neutral acts, and their morality is decided by the context in which they take place.

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Links links and more links from your lackadaisical and unloquacious blogger

Cult of Mommon over at Letters from Gehenna. In general, read the whole post, but in particular, this bit:

The “gift” of motherhood is a trap, simultaneously erasing investment and effort and commitment and choice and dedication and making it unconscionable to express displeasure, talk about issues, have postpartum depression, express a realistic picture of what it is to have a baby. It erases the experience in order to replace it with something clean and pristine that can be adored without contemplation of consequences or actual respect for the real efforts of mothers.

An Interesting Parallel and
Parallels Part 2 over at Keyboard Revolutionary. My teaser for you:

So what does it mean when another wielder of authority says, “Do what I say or your baby will die”? Are they looking out for your best interest….or are they a bully, a rapist, an abuser, deliberately playing on your unignorable instinct to protect the ones you love in order to get what they want from you?

My opinion: doctors and obstetricians who manipulate and coerce women into unneeded surgery are committing assault. They need to know that this is what they’re doing, and the ones who don’t care and won’t change need to be prosecuted.

Single Serving Pie in a Jar. I need canning jars and pastry. Stat.

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The system is broken if it doesn’t leave people whole – Part 5

Previous: Part 1: I maunder on about my experiences as a doula
Part 2: Statistics
Part 3: Illustrative Non-Fiction
Part 4: The more things don’t change

But then, I’m kind of an optimist. Or perhaps the better word would be idealist, although I think we are wrong as a society to say “idealist” with the kind of sneer. If we do not ask for and strive for the ideal then we’ll never come close. Asking for a compromised position right off the bat means that the eventual product will inevitably be even more compromised (just look at the current American health care debate for a prime example of that).

As I said before, I don’t believe that all or even most doctors and registered midwives are evil people looking for the quickest and most painful way to hurt people. That’s ridiculous. Of course most of them are caring and well-meaning people. I say that even though I’ve witnessed quite a few fairly ignorant or arrogant people in the field, one or two exceptionally abusive and manipulative individuals, and rather a lot of folks who exhibit that passive “just following orders/my protocols/our customs” well-intentioned uselessnes.

But the problem is this. The system is broken. It did not and does not have women’s best interests or the best interests of their babies at heart. It is a fraud.

A 30% c-section rate (and a 19% primary c-section rate) is not a bug, it is a feature of the broken system.

That some women would choose to give birth unassisted because they fear what they will experience otherwise at the hands of the medical system, this is also a feature. Unassisted birthers can be used by the mainstream model to make homebirth seem extreme and outlandish, something that only those crazy hippies or religious fundamentalists would do.

I say that as someone who chose to give birth unassisted, and who feels that this can be an awesome valid choice for some folks, but that it should never feel like the only choice available.

When I say that I believe people are well-intentioned, I should also say that it’s time for folks to face the fact that intentions really don’t matter. Or at best they matter only a little bit. What matters is not what you intend, it is what you do. It is the real results of your actions in real people’s lives. If you as a provider through your action or inaction facilitate 20% of of your clients right into unnecessary surgery with very real and significant impacts on their life, health, future fertility and reproduction and on their future children’s life, health and births, but you meant well, it doesn’t reverse the effects. It doesn’t change the real effects that a cesearean scar on her uterus and belly produce.

It seems to me that with a system as broken as this there are only two ethical choices. The first is the actively try to fix the system from the inside. The second is to work outside the system to provide another option for women. I suppose, now I think of it, that there’s a third ethical choice, which is get out of this business entirely. Passively continuing within the system, acting in such a way that you perpetuate the harm that it does, this is not an ethical choice.

I’ll be honest, I’m not sure if it is possible to fix the broken system from the inside, but if you are a care provider within the medical model, there’s a lot you can do to try. Here’s a few suggestions:

  • Practice research-based care.
  • Accept that women are individuals, their bodies are individual, and there is a wide range of normal.
  • If a rule is a bad rule, don’t follow it.
  • Don’t induce women at 38 weeks, at 39 weeks, at 40 weeks, at 41 weeks, at 42 weeks because you’re pretty sure she should deliver by now.
  • Actually, don’t induce them at all if you can help it. Women will, for the most part, go into labour spontaneously when they and their baby/ies are ready.
  • Don’t hold the threat of induction over their head, ever. “If you don’t go into labour by 42 weeks, we’re not allowed to do a homebirth.”
  • Don’t encourage women to induce “naturally”. We do not know exactly causes labour to start spontaneously, but we know that it seems to be a combination of factors regarding readiness for both mother and child. Knowing that, it seems foolish to think that a “natural” induction would be any less dangerous than an “unnatural” one. I would suggest that there is no such thing as a “natural” induction.
  • Actively encourage home birth for all women, low and high risk, since this is actually supported by research. Don’t force it, of course, but assume as a matter of course that this is where birth occurs. Research has shown repeatedly that hospital birth is not as safe as home birth.
  • If a woman prefers a hospital birth, do not admit her to the hospital before she is in active labour (4 cms).
  • Do very few cervical checks. Do none if you can manage it. Learn to gauge the progress of her labour using other less interventive signs.
  • Intermittently monitor the fetal heartrate with a stethoscope instead of using continuous electronic fetal monitoring.
  • Accept that it is not uncommon and not pathological for labour to proceed in a less than straight ahead fashion. Pauses and breaks in labour are actually quite common and don’t mean the process is broken and needs fixing.
  • Learn about non-narcotic comfort measures for women in labour.
  • Accept that there is a difference between pain and suffering, so that just because a woman is experiencing pain, that doesn’t mean she is suffering.
  • Accept that you don’t need to rescue women from their birthing process.
  • Learn to sit on your hands. A lot. Birth needs very little “doing”. If sitting on your hands isn’t a good option for you, learn to knit. Embroidery is probably another good option. Machine quilting might be a bit much.
  • Buy a good quality labour and birthing pool and make it available for your client’s births.
  • Don’t transfer women to the hospital or start otherwise intervening because of arbitrary timelines that have nothing to do with what is actually happening for her in her body. This includes long early labour, long active labour, long pushing stages, long periods with membranes released before the birth of the baby.
  • Use antibiotics responsively, not automatically.
  • Practice informed consent. Be able to articulate the benefits and problems inherent in the interventions you do offer or that clients request, so that nobody ever says, “if only someone had told me what this could do”.
  • If a woman has PROM (premature rupture of membranes), do no cervical checks at all. Be watchful for signs of infection and encourage good hydration and nutrition, but otherwise just be patient.
  • Talk a lot more about nutrition with your clients, since this is one of the only things actually shown by research to make a difference in the health of women and their babies.
  • Study methods to safely facilitate vaginal breech birth.
  • Keep mother and baby together in the period immediately following birth (out to a half an hour or more). They need each other.
  • Practice expectant management of the third stage of labour (delivery of the placenta).
  • Leave the cord intact until the placenta is delivered.
  • Foster friendships with likeminded individuals in your field. Have someone you can call when you think things aren’t going as they should.
  • If a cesarean is necessary, be as humane as possible. Don’t let a hospital’s rules get in the way.
  • Don’t be a martyr. Take good vacations. Get sleep at night. Spend time with your family. Birth work is unpredictable, but try to just live your life.
  • Take good naps at homebirths and eat good food. Nobody needs your attention 100% of the time, and it can be reassuring for women if her care providers remain relaxed and low key.
  • Get help to deal with stress. Foster positive relationships in your personal life.

Perhaps you already do some of these things. Perhaps these do not seem like workable suggestions to you. But if not, ask yourself why and own your answers. And feel free to add your own in the comments section.

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The system is broken if it doesn’t leave people whole – Part 4

Previously: Part 1: I maunder on about my experiences as a doula
Part 2: Statistics
Part 3: Illustrative Non-Fiction

I didn’t stop being interested. I hung around with a lot of unassisted birthers online. I didn’t stop reading or following research. The evidence for less interventions or for only appropriate usage of interventions keeps piling up, they reversed the prohibition on “allowing” women to go past 41 weeks without inducing them, a vancouver doctor did a massive study on episiotomy and proved once and for all how useless and dangerous it was and the rate actually dropped, there are positive changes.

At the same time, the rate of positive change is very very slow, and it often seems like for every one step forward there’s half a step back and one step off in a complete other non-helpful direction. I’ve been witness to two births in the last couple of months, one a homebirth and one a very interventive hospital birth. It was night and day between the two.

The homebirth was a VBAC and resulted in a home waterbirth to a beautiful baby. This was after the mother was told she couldn’t possibly have a homebirth after a previous cesarean. She then asked her care providers whether she could at least labour in a tub of water in the hospital and was told that of course she couldn’t. Irrirtated at being undermined at every turn in her very reasonable and safe wishes for her birth, she sought out a traditional birth attendant who had no problem facilitating her (safe) homebirth.

The hospital birth was of a young woman having her first baby with registered midwives as her caregivers. It was truly shocking to me. It was as though someone had brought to life my old story of the cascade of interventions. The fact that the birth ended in a c-section was all so unnecessary, every step along the way so unsupported by the available research.

It’s sometimes mind-boggling that as a birthing community, in which I include doctors, midwives, doulas, OBs, pregnant women and partners and all the rest, we can know the right things to do or not do. We can have the research in front of us, from well-executed and documented studies and trials and we can have it for years with every new study backing it up, and yet the reality of the abuses that occur in mainstream birthing all in opposition to what we know continue. Does spontaneous uninterfered with birth just not have a great marketing department? I don’ t know, and I sometimes feel very discouraged.

Next: Part 5: The system is broken. What next?

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The system is broken if it doesn’t leave people whole – Part 3

Previously: Part 1: I maunder on about my experiences as a doula
Part 2: Statistics

The last birth I went to as a doula was for an aboriginal woman and her husband who had been referred by a friend of a friend. I met them, literally, outside the hospital’s door when they were going in for an induction. She was only 38 weeks pregnant, but was diabetic and her doctor was quite concerned that her baby would be enormous. “Huge, 10 pounds at least!” was the way it was quoted to me.

She was pretty chilled out about being induced early, because with her previous child, now an active three-year-old, she had been induced at 38 weeks as well. 10 hours later she was holding her vaginally birthed baby in her arms. Hard to argue with that record of success, and although I suggested that perhaps waiting at least another week would be a good idea, big baby or no, I could see that this idea was falling on deaf ears. I didn’t say much.

She went in for her induction in the evening and they gave her prostaglandin gel applied to her cervix. Her cervix was “unfavourable”, which is to say, nowhere near ready for giving birth, but the induction happened anyway. By 1 a.m. she was having frequent sensations and was throwing up – often a good sign of progress in birthing. This continued through the night. Her husband wouldn’t lie down and sleep for an hour to remain rested, so when morning came they was pretty exhausted, but they were both convinced that things must be going swimmingly and the birth would be soon.

The OB-of-the-day arrived and checked her and her cervix was as it was before, not dilated at all, not effaced, still posterior. Still, in other words, unfavourable. But still, her sensations were still frequent, and so the doctor started her on pitocin. The sensations became more uncomfortable and during one when she was moaning through the sensation a nurse poked her head in the door and said, “You look like you’re in pain. I’ll get you some demerol.” She came back and put it in the IV, I think. This, by the way, is an excellent example of the kind of “informed consent” that is often demonstrated in hospital births. She wasn’t asked whether she wanted it. She wasn’t even asked if she was in pain or suffering. She wasn’t presented it as an option with these pros and these cons. It was just given to her.

Once the pitocin was started, of course, external fetal monitoring was put on next. The contraction monitor worked consistently, but the baby, as babies pretty consistently do, kept moving around and the monitor would no longer be correctly placed so that the nurse would come in and fuss with the monitor, get the baby heart swooshing away on the speaker again and then bustle off, only to repeat the scene five or ten minutes later. She dozed with the demerol for quite a while, not even feeling her contractions any more and her husband and I dozed too in uncomfortable upright chairs against the wall.

The OB-of-the-day kept coming in and telling the nurse, who had already been upping the pitocin on schedule, to up it some more. At one point the nurse said, “We’re already at the limit that we’re supposed to use for an induction.”

The OB replied, “This is an augmentation, not an induction. Up it some more.” The nurse bit her tongue and did as she was told.

Every time she was checked her cervix was unchanged. Or no, a little changed. Effaced (thinned) to two fingers instead of three, still not dilated at all, but perhaps less posterior. This was considered to be progress.

Finally, after 24 hours from the first prostaglandin gel and about 2 hours before the OB-of-the-day was supposed to end her shift, the OB came and inspected the situation.

The baby was healthy as a horse, moving around, repeatedly bashing and kicking at the monitor, strong heart rate throughout, so they couldn’t use fetal distress as their reason for a c-section.

For some reason (because her cervix never dilated much most likely) they had never gotten around to rupturing her membranes, so they didn’t have that artificial timeline on their side, something to point to with assurance for why they needed to do a c-section.

Since she’d had a previous large baby vaginally it would be very difficult to argue cephalopelvic disproportion (where the pelvis is too small or narrow to allow the passage of the baby’s head).

And of course, they couldn’t just let her go home, say, “Oops, our mistake, your body wasn’t ready.” Not with that enormous ten pound baby inside.

Nope, they needed an ironclad irrefutable reason to cut this woman’s belly open. So they told her her baby was breech.

How big was that baby, do you think? 7 pounds, 3 ounces. And showing signs of prematurity. And sleepy, oh so sleepy, wouldn’t get on the boob and nurse, not for days and days and days. I lost track of them when she went home to her active three-year-old with her belly cut open.

It’s not like I did them any good. And while, as I say, I kind of suspect I just really wasn’t very good at this doula thing, I’m not sure that another doula could have improved things, prevented the outcome. I realized that as a doula I didn’t have any power to change the system. I might be able to occasionally help a woman emotionally or practically, but I would be witness to so much abuse. I stopped going to births as a doula.

Next: Part 4: The more things don’t change
Part 5: The system is broken. What next?

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The system is broken if it doesn’t leave people whole – Part 2

Previously: Part 1: I maunder on about my experiences as a doula

I’m making this all sound a little grim, that’s because it is a grim business and the statistics bear that out. In British Columbia, where I live, the current c-section rate is over 30%. It’s not a stretch to suggest that for every three women who give birth in this province, one will end up with major abdominal surgery. This is not a supportable rate. The World Health Organization recommends that a reasonable c-section rate should be no more than 5-10%, and this rate has been shown repeatedly to produce the best outcomes for mothers and babies.

Now if a reasonable rate with the best outcomes is 5-10% and our current rate is over 30% then 20-25% of birthing women are having unnecessary surgery.

Let me repeat that.

The medical model of birth as practiced in British Columbia (and the rest of Canada and much of the United States) results in 20-25% of all birthing women, perhaps as many as 1 in 4, having unnecessary surgery. 2/3rds or more of the c-sections performed do not improve outcomes for mothers and babies.

And of course, it’s not as though the women who are giving birth vaginally are getting off scott free in this system. They’re birthing under the ever present threat of major abdominal surgery, for one thing. Forceps and Vacuum extractor are used 3.4% and 6.3% of the time, so that means another 10% of women at the very least are having episiotomies and having their babies pulled out with varying degrees of skill. 45% of women have epidural anesthesia, which is certainly successful, most of the time, at blocking sensation, but also makes far more likely the perceived need for “augmentation” of labour, including artificial rupture of membranes and pitocin augmentation – I couldn’t find a rate for pitocin usage, but it tends to be fairly high, often as much as twice as high as the c-section rate. 21% of women in BC also have their labour artificially “induced”.

Women are having pretty awful birth experiences. Not universally, of course. But a lot of them.

I used to explain to people how the cascade of interventions worked, how one intervention would lead to another and then another, and how one simple bad decision on the decision tree could lead to a seemingly necessary (but really unnecessary) c-section. And in my explanation, I’d pile them on a little. My hypothetical birthing women experienced as much intervention as I could believably throw at them in order to demonstrate the point.

And people were a little disbelieving. Who could blame them? It does seem a little outrageous that doctors, who are in the main probably well-meaning people, could end up performing unnecessary major abdominal surgery on one fifth to a quarter of their healthy birthing patients.

But the problem with my hypothetical is I saw it played out or heard about it played out in almost exactly the ways I’d described far too many times. It wasn’t just an illustrative fiction, it was a common reality.

Next: Part 3: Illustrative Non-Fiction
Part 4: The more things don’t change
Part 5: The system is broken. What next?

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The system is broken if it doesn’t leave people whole – Part 1

The medical model of childbirth. Don’t doubt that it is broken, perhaps from the very beginning, right to the core.

When I was just getting started with this birthing thing I was pretty enthusiastic. I did a lot of reading. I wrote optimistic essays about birthing choices for my shockingly bad website. I tried to be a doula, though I’m not sure I was ever a particularly good one. I went to conferences and training days by the dozen. I believed that I could make a difference. I believed that positive change was inevitable, that the facts were lining up and soon everyone would have to agree on the appropriate approach. All we had to do was be firm, keep tabulating research, and make it available. Wait the change out and it would happen.

But as I say, I was a perhaps not very good doula, and in the main the births I ended up attending were those of strangers, often strangers that I hadn’t met before I found them in the labour and delivery room at a local hospital (ah, the free referral service of the local doula organization), and by the time I got there things were already on their downward spiral. The induction was on and it was only a matter of time before someone became exhausted and bored and suggested a c-section. Hapless women of colour with poor english and their equally hapless husbands and partners were funnelled through to the operating room and for all my enthusiastic soothing and panting and rocking and walking and changing positions there was nothing I could do to change it.

In all the births I attended at that time, there were only two decent ones, one a homebirth, the other a hospital birth, older white mothers full of determination. They knew what they wanted. They fought for it, and they were very clear about what they wanted from me. So, it worked, you see. They had the education, experience, determination and white privilege to get what they wanted, a birth that wasn’t abusive or horrible. It certainly helped that they were women having second babies, as second babies are always more responsive to the arbitrary timelines of the medical model. It was a gift to be their doula, it really was.

In between births I did postpartum doula work, some volunteer, some for a pretty good wage. Here too I could see how damaging the medical model was. One young woman I was helping for free was in Canada alone, her husband in Malaysia waiting on his visa application. She’d given birth alone, a young non-white woman with no apparent partner and poor english. She’d had a good nurse, she felt, but the doctor, a woman, was rough and impatient with her, and had performed an episiotomy that resulted in a fourth degree tear, very painful and with a difficult and perhaps surgical recovery.

Another woman I served for a few weeks, helping out through the nights, had been pregnant with twins. Her babies were delivered via c-section, for no other reason than that they were twins. She was struggling with the continuing pain of her incision, not being able to breastfeed her son, who wouldn’t latch and would only take a bottle, and pumping around the clock to supply them both with breastmilk. She was exhausted.

Another woman was in Canada from England, but was not yet covered by MSP. The doctor she saw would not permit her to attempt a trial of labour after her previous c-section, so she was forced to undergo another surgery and pay for the entire thing out of pocket as well.

I was called to help with breastfeeding with another older couple, who gave birth at home with registered midwives. She had a tear which required stitching and while the midwives were stitching it up they kept the baby in another room away from her. For an hour and a half. The first time she tried to breastfeed after her birth her baby was already through its wide awake period and slept instead. Two days later, still not nursing.

All of this is a very long-winded way of saying that after a few months of thinking about birth! and babies! with stars in my eyes! and then attending a weekend workshop in which women imagined awesome births and inspirational stories were told by the doula instructors of how they had saved women’s births and so on, I somehow plunged headfirst into the deep end of how awful and how broken the medical model of birth really is.

Next: Part 2: Statistics
Part 3: Illustrative Non-Fiction
Part 4: The more things don’t change
Part 5: The system is broken. What next?

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Access to Plan B

Biting Beaver‘s recent post regarding her struggle to obtain Plan B reminded me of my own story, so I thought I’d share it here.

I live in Canada, and like, I think, many Canadians my age (mid-20s) I had grown a little complacent about access to contraception. Degrassi High (the show that all Canadian youth both watched and mocked) had an episode about abortion, and although the characters went through their moral and emotional struggles, actual physical access to the abortion was guaranteed. I always assumed that obtaining Plan B would far simpler even than that, given that it was supposedly available over the counter from pharmacists in British Columbia since 2000.

For years now my primary form of contraception has been the Fertility Awareness Method (FAM), which works very well for me and my male partner. For ourselves, we chose never to have penis-in-vagina intercourse during my carefully and casually tracked fertile times. This was part of an evolving continuum of choices we made about our contraception, and it changed gradually as we became more comfortable and confident with FAM. 

Other people choose other things, including using barriers during fertile periods, and these are all very individual choices. This is part of the appeal for me of FAM: I as a woman get to choose my own level of comfort and risk-taking in my sexual choices.

In December of 2003 I returned from an 8-week trip to Australia with family. My partner had not accompanied me and we had missed each other greatly. Because I had been travelling my fertility cycle was a little disrupted, and although I hadn’t had any signs that I was likely to ovulate I knew that the timing was generally right for that sort of thing to occur soon. For once, we chose to use barriers rather than to avoid intercourse altogether. Of course, in the midst of our passionate reunion, we weren’t as conscientious (i.e., freakishly paranoid) as we would ordinarily have been and discovered only after the act was completed that our barrier had slipped off and was lying uselessly on his stomach.

When I realized this I just got dressed and we drove over to the 24-hour pharmacy about five blocks from my house. Inside the pharmacist politely explained that although Plan B was technically available over the counter, it had to be dispensed by a specially trained pharmacist and the only one they had on staff wouldn’t be in until late in the morning the following day. Sorry, nothing they could do. Besides, it didn’t really matter, I just had to take it within three days for it to be effective.

Now, while it’s true that there is a three-day window for Plan B, taking it as soon as possible is important. The sooner the better, in fact, which was why I was at a 24-hour pharmacy at 1 in the morning. Of course, if I didn’t live in the middle of the second largest metropolitan area in Canada I probably wouldn’t be as close to a 24-hour pharmacy and would have had to wait until morning, so… fine. Wait until morning.

I decided that since the pharmacist wouldn’t be in until later in the morning I’d go to the drop-in clinic at my workplace to get a prescription as soon as it opened in the morning. Because I live in Canada all office visits are fully covered by Medical Services Plan, so I didn’t have to worry about whether or not I could afford to go to the doctor. When I got to the clinic only one doctor was on duty. He was a young man, possibly in his late 20s. I explained what I wanted and he then quizzed me for a while on what my usual birth control was and so on before announcing that he didn’t prescribe the “morning after pill” for ethical reasons.

“What??” I said. At the time I’d never heard of such a thing. I asked what ethical reasons those were exactly and he refused to explain. I asked if there were any other doctors on staff that I could see and he said that there weren’t any. I just sat and looked at him. He looked at me. I said, “Look, I didn’t do anything wrong. In fact, I’m trying to do everything right. I get the feeling that you’re passing some kind of judgement on me here and I don’t like it.” He shrugged uncomfortably and opened the door to indicate that it was time for me to leave. I left.

I went up to a different walk-in clinic close to the pharmacy. I didn’t really like this one because it was often crowded and busy and the doctors had always seemed quite indifferent to me, but I figured it was better than nothing. I waited my forty minutes to get in to see a doctor and when I did I ended up with a crusty older man. I explained what I wanted. He just sat there and looked at me. By this point I was starting to feel almost… defensive about what I was trying to do, so I said something along the lines of having used a condom but that it had broken (a lie, of course, it just came off without our noticing, but I felt guilty for what I perceived to be a rookie mistake that should never have happened).

“You don’t have to explain.” he said chidingly, “That’s none of my business. I’ll write you the prescription. Ask them to give you some gravol with it because it often makes you feel quite nauseous.” And he wrote me the prescription. I went back to the pharmacy and had no difficulty filling it. I got home and took my first dose along with a gravol just over 12 hours after having what turned out to be unprotected intercourse.

Now, in the end, did I get the prescription I wanted? Yes. Was it really that hard? I suppose not. And I realize now just how lucky I was in some respects. After all, of the four medical service providers (two doctors and two pharmacists) that I interacted with, only one of them really felt strongly that I should just get pregnant as a result of a mistake whether I wanted to or not. It only took me 12 hours and three unsuccessful attempts in the second largest city in Canada to get my hands on emergency contraception.

Really, we can do better than that.

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