Content note: for this post to get across the point I want to make, it’s going to include a bit of TMI on personal stuff like sex and menstrual cycles. If you really don’t want to know, stop here. I’ll understand.
I’ve been feeling frustrated and stressed out lately, and I think my ob/gyn is the reason why.
I had a bad experience with her back at the very start of April, when I took a few days of vacation to get some medical appointments out of the way without having to use up sick leave. Among other things, one of the goals of these appointments was to get an IUD, which I was told at the time of my referral I’d be able to do in one visit.
Instead, my ob/gyn – let’s call her Dr. Cee – was so unhelpful, I think the word ‘obstructionist’ is appropriate.
She sat me down for birth control counselling, which is a good thing, but I expected it to be, at most, a formality; I had done my homework, and I knew I wanted and needed the copper-T IUD. I didn’t like the effects hormonal birth control had on my moods and my libido, and I was aiming for something I didn’t have to think about for a couple of years. Plus, I’d just got health coverage through my employer; this is something I had been planning for since December. I figured she’d write me a ‘scrip, send me down to the pharmacy, and then do the insertion.
Instead, she sat me down and informed me that I shouldn’t use the IUD; I should stick to condoms. She said that the IUD is for women who’ve already given birth. (This is not factually true.)
I explained that condoms were fine in the short term, but my partner and I were looking for a long-term contraception method, and condoms were not a solution that we liked for several reasons. (These aren’t really her business – it’s my choice, I shouldn’t have to justify it – but they include personal preference, tearing, waste reduction, and expense. We can generally afford to pay for condoms, but the IUD is covered by my benefits plan.)
She continued to tell me all the reasons why I wouldn’t like the IUD – it will hurt to put in, my periods will be worse, my partner might not like it, blah blah blah. I’m all for informed consent, but this wasn’t balanced. It felt like she was trying to dissuade me.
At this point in the conversation I noticed a metallic plaque on the wall with a quote about “the Lord” on it, and it hit me: maybe she’s trying to dissuade me for pro-life reasons.
She ended up writing me a prescription, but it came with a twist: she wouldn’t do the insertion that day (even though that’s what my GP had scheduled the appointment for). I would have to schedule a follow-up appointment once my period arrived, to come back and have it inserted.
I said that my research had led me to believe that an IUD can be inserted at any point in the cycle. On this point, Dr. Cee disagreed with WebMD, Options for Sexual Health, Medscape, Planned Parenthood, the Association of American Family Physicians, and New York’s IUD Task Force (PDF), and told me I absolutely had to be on my period. I explained that I don’t menstruate regularly, and wasn’t keen to wait up to six more months for long-term birth control. She shrugged it off. I explained that I would have a hard time getting more days off work, particularly on such short notice. She said acidly, “Everyone has sick days.”
What our conversation basically came down to was that she didn’t trust me to not be pregnant. She required me to menstruate on demand in order to prove that I wasn’t carrying a precious fetus. I guess even if it’s so early in development that a pregnancy test won’t detect it, it still has more of a right to medical care than I do.
I asked her what would happen if I were pregnant and I got an IUD; would I be at risk? She said it could cause a miscarriage. I pointed out – probably to my detriment – that if I were hypothetically pregnant at this point (and I’m not) I’d need an abortion anyway. She couldn’t name any potential consequences to me, her actual patient, beyond what typically goes with abortion or miscarriage anyway. But she still insisted that “it would not be ethical”.
Dr. Cee has a very pregnancy-heavy client list, from what I could gather. I suspect she views the fetus as her patient, rather than the woman. For pregnant women who are heavily invested in their pregnancies, that may not be as much of a problem. For women who are seeking to prevent or end pregnancies, that could be a really major barrier.
I am your patient, Dr. Cee; my imaginary hypothetical embryo is not.
Fast forward nearly two months. On the cycle that began to appear when I first came off the Pill, I’d have had two periods already. I haven’t had one yet. I’ve had a little bit of spotting on two occasions, but it went away before I could really call it a period without some major stretching of the truth on my part. I’m tempted to just make the call anyway, but I’m living in fear that I’ll take another precious day off work, travel to Dr. Cee’s office, and get fed another excuse for why this doesn’t count and I’m not yet allowed to get my birth control. I’m scared to make the plans if I’m anything less than perfectly confident that I fit her outdated, judgmental, “why-aren’t-you-having-babies-at-your-age?” criteria.
This is causing me real stress and anxiety.
It’s stressful to wait through a week of very light spotting, anticipating Schrodinger’s period, trying to make sure I’ll be ready to put in the call and schedule the appointment if my body decides to just go ahead and expel that uterine lining.
It’s stressful to know that spotting without menstruation can occur when a pregnancy attaches to the uterine wall, which will make it even more difficult and complicated to access the damn IUD. (I keep almost buying pregnancy tests even though the chances of a pregnancy are really, really low, because what if?)
It’s stressful to worry about how long this can go on: that I could be well into summer before I actually get my IUD. It’s stressful to have this constant awareness of how out-of-my-own-control my next sick day is, and to feel pressure to hoard my sick days accordingly.
The consequences are real. My interest in sex is dwindling because fear and anxiety are libido-killers. I am back to having some of the anxiety symptoms I had towards the beginning of the year, in spite of treatment, because I’m so worried about whether I can pull this off. I’m feeling especially stressed out today because it’s a Saturday, and if my spotting turns into a period today I can’t reach Dr. Cee’s office until Monday, and then I’ve already lost 30% of my possible appointment days. Anxiety is making it hard to be productive and do the things I need to get done for work and in my personal life.
This can’t go on.
Often we think, as Canadians, that we’re safe from all the abortion-related fear-mongering and fetus worship we see in the States. Our pro-life movement is less vocal, less politically tolerated. But make no mistake, it exists. I’ve seen it. I’ve been part of it.
When medical professionals are part of the movement, though, having extremely liberal abortion legislation doesn’t help Canadian women so much. A doctor can find a way to deny you the abortion or contraception you need. It’s called gatekeeping. This isn’t always a bad thing – it’s good for doctors to be able to triage patients and make rational decisions about what referrals are needed and what’s reasonable treatment – but in the hands of a doctor with an agenda other than the patient’s well-being, it can be a major problem.
That’s what Dr. Cee is doing to me.
At absolute best, she has taken the whole person out of the equation, and is looking at me solely in the abstract: just a cluster of diagnoses and medical responses rather than a real-life person with needs that go beyond the purely medical, pesky things like responsibilities, goals, plans, jobs, and relationships. She’s pretending issues like my sex life with my partner or whether I can get time off work for subsequent appointments have nothing to do with the care she’s giving me, when actually it’s all related.
At worst, her religious beliefs are interfering with my reproductive choices.
Update, 2015-05-24: According to a pregnancy test, my imaginary hypothetical embryo is indeed imaginary. Which is to say I am not pregnant at this point, and likely wasn’t at the time of my appointment two months ago. Said pregnancy, if hypothetically it existed, was clearly not viable, because here I am, not pregnant. As I suspected, my lack of a period is related to other medical stuff, which Dr. Cee was told about and has ignored. That’s good news – yay not needing an abortion, that would’ve been a pain in the ass – but bad news as well, because an abortion would at least fix the problem and I’d be able to get my birth control.
That doesn’t solve the problem that it’s fucked up to require me to menstruate on demand in order to gain access to an IUD, but it would handle the immediate problem. Now I’m just not sure what to do.
