Tag: doctors

Hey, doctors: Big families are not on trial

The thing that finally relieved my anxiety about giving birth

Stop me if you’ve heard this one:

A youngish mom with a bunch of kids goes to her doctor with a medical problem. Doesn’t even matter what the problem is: problems with excessive bleeding, problems with postpartum depression, problems with heartburn, problems with sleep. Problems with her knee, her skin, or the way her hair just won’t curl the way it used to.

Any problem, doesn’t matter. If she has more than a few kids, she already knows what comes next: A glance at the chart, the eyebrows go shooting up, and here it comes: “Ohh, I see you have [any number greater than two] kids.”

And that’s all they want to talk about from then on.

They certainly don’t want to listen to you when you tell them, “This isn’t about family size.” They tuck your multipara status into your buttonhole like a red poppy so you can never forget, never forget that you brought this on yourself in some way with allllll those kids, so let’s talk about that, then, eh?

You’ll think I’m exaggerating if it hasn’t happened to you; but ask around among women who have five, six, or seven, or even three or four kids, and you’ll see nods and eyerolls, or even tears. Because it hurts. Women with lots of kids have to prepare themselves mentally every time they step into a doctor’s office. Not only do they have to deal with whatever problem they’re actually there for, they have to defend themselves against insinuations, disapproval, patronizing jokes, and sometimes open scorn.

Now, sometimes, a woman’s maternal history is relevant. If a woman is trying desperately to stop having children, then it makes sense for her doctor to talk about how she can accomplish that (while being respectful of her religious concerns). If pregnancy and childbearing are damaging her health, it makes sense for her doctor to talk about her plans for the future. That is the doctor’s job, and a good doctor thinks more wholistically, beyond the immediate problem at hand.

But that’s not what I’m talking about.I’m talking about women with many children being treated as if their wombs are a pandora’s box from which all ills and troubles flow. I’m talking about doctors behaving as if we’re nothing but a walking, whimpering uterus, and there is no sense in even discussing any other medical issue until we figure out how to put a cork in it.

Here’s what happened to me in the last week of my last pregnancy:

I had already given birth nine times. I knew what it was going to be like. There was no maternal amnesia strong enough, and there was no new technique I was going to learn for pain control or emotional calm.  I knew what was coming, and that it was going to be rough, because that’s what childbirth is like. I was weeks or days away from giving birth, and I couldn’t sleep, night after night, because I was nervous about the delivery. Naturally, my exhaustion only fed into the anxiety.

So I went to the doctor and asked if she could prescribe something safe to soothe my anxiety and help me sleep, just to tide me over.

She refused. Their policy said I had to visit their staff psychiatrist first. Okay, could I make an appointment? Oh, sure — there was an opening in three days.

Three days may not sound like a lot to you, but I was within five days of my due date. I hadn’t slept in maybe four days. Everything hurt, all the time. And I knew with all my heart that I wasn’t going to magically enjoy peace of mind just because, thanks to my doctors, I could look forward to talking to a complete stranger about my emotional state at 39 weeks. Could I maybe get a three-day prescription to get me through until then, just to take the edge off? No, that wasn’t their policy.

I WAS SO ANGRY. There was no reason for this. No reason at all. But they wouldn’t budge.

So I cooled my heels at home (actually, my heels, like the rest of me, were puffy, inflamed, and in constant pain) and turned up for the stupid appointment. The first thing she wanted to know, after introducing herself, was how I felt about having so many children.

Yeah.

Imagine there’s a building on fire, so you called the fire department — only to discover that, before they would even unroll a hose, they wanted to file a request for documents proving that the contractors who built it had been unionized.

Would that be reasonable? Maybe they were unionized and maybe they weren’t, and maybe the answer to that question would shed light on the current situation and maybe it wouldn’t. But right now, maybe let’s PUT OUT THE FIRE.

So I knew already knew I was being treated badly. But I also knew that, the more I protested, the more likely I was to be flagged as a drug-seeking patient, so I tried to speak calmly. I had already plotted out what I was going to say.

I told the doctor, “I am happy with my family size, and I do not need advice about family planning. That is not why I am here. My anxiety is not related to anything but childbirth. It is purely situational anxiety. When I give birth, I will no longer feel anxiety about giving birth. What I need is something to help me through the next few days, because I can’t sleep. That is the problem I need help with.”

And you know what she did? She kept me in that room for another fifteen minutes, probing and questioning me about my history, my long-term psychological state, my experience in past deliveries, and anything else she could think of, based on nothing but the number of times I had given birth. There were no other red flags in my history, nothing that would signal to any medical professional that I was being abused, that I was unhappy beyond normal pregnancy ills, or even that I was overwhelmed with my life in general. But she kept asking. And I just kept repeating:  “That is not relevant. This is situational anxiety. I just need to get some sleep.”

Finally, with deep and obvious disapproval, she wrote out a prescription for a mild antihistamine, which didn’t work at all. I burned through the next week in a sleepless rage, angrily gave birth, and spent the next week remembering how to sleep, and calming the hell down.

Now, you tell me.

If I were, say, a topless dancer, and I told my doctor I was nervous about upcoming foot surgery, and I wanted a prescription to help me sleep for a few days until the big day, would I have gotten a slew of lifestyle questions, probing and digging for signs that I harbored some secret regret about how I spend my days?

If I were a trans man with AIDS, and was feeling tons of anxiety about an imminent job interview, would my doctor have given me a referral for next week with a psychiatrist who wanted to sit me down and have a chat about my past and future choices about my body, my family, my life goals?

If I were anyone at all, and I turned up in a doctor’s office with an obvious and solvable problem, wouldn’t the doctor just . . . help me solve that problem?

But I had lots of kids. Lots of kids, and I was in a long-term, stable marriage, and I was fully employed, a long-term patient with no criminal record, no history of drug or alcohol abuse, no smoking, no psych issues, no weird bruises, no nothing. I got regular exercise and took my vitamins. I had turned up at every appointment well-nourished and well-informed, with no panic, no hysteria, no delusions, no complaints about anything other than, “I am pregnant and my feet really hurt.” It was very easy to explain why I was feeling anxiety and dealing with insomnia. It was very easy to predict when I could conquer those issues.

But she didn’t want to hear that. She didn’t want to believe me, because I had a lot of kids.

Guess what? That experience of not being listened to was so frustrating and painful and infuriating, it made it ten times harder for me to make another appointment later, when I really did need help with larger psychological issues (also unrelated to childbearing!). I thought, “They’re just going to say, ‘Well, this is what you get when you have so many kids; sorry, we can’t help.'” Because that is what they have always said.

So I didn’t go, and I didn’t go, and I didn’t go.

That’s what happens when you treat women like they can’t be trusted: You lose their trust.  And that means you’re not doing your job.

Doctors, this has to stop. When you see a patient with lots of children, she should be treated like any other patient. Keep eyes and ears open for signs of abuse and signs of distress, just as you would with any other patient, but do not behave as if the large family itself is a red flag. It’s offensive and disrespectful beyond belief, and it puts women constantly on guard. It’s okay to ask if she’s happy with her current family planning; but if she says yes, then you simply must let it go. Even if you don’t get it. Even if you don’t approve.

Believe her when she tells you what the problem is. Believe her, even if she has a lot of kids.

Progesterone cream (prescription and OTC) improved my Creighton NFP charting of cycles and now NFP is tolerable instead of intolerable

This is my story of how progesterone cream made NFP tolerable, instead of intolerable.

The following post is purely in the interest of public service, and is not especially entertaining, amusing, or edifying (hence the Google-friendly title).  I am not offering medical advice! I am just telling my story, in hopes that it will encourage other women to talk to their doctors, too.  I wish I had done it a lot sooner, because now my cycles became intelligible, and NFP became endurable.

This post is all medical, and not for the squeamish.  I will be using the words “cervix,” “mucus,” and “period.”

Background

PIC Lasciate ongi speranze voi ch’entrate

We use the Creighton Model of NFP.  I do not seem to be able to take my (bizarrely low) temperature consistently, and I am too technophobic and mistrustful to try a monitor.   Creighton was a good choice for us because you can use it while breastfeeding.  But still, it was pretty awful for many years.  If Creighton is “an authentic language of a women’s health and fertility,” then my charts were clearly saying, “Wha?  Hasenpfeffer.  I think!  Potrzebie!  Huh?” and occasionally, “Ow.”  In other words, I never really knew what was going on, except that we did not have a lot of days available for sex.  Some months, we had a grand total of one day (and I would be deep in the throes of PMS, so, super sexy with all the crying and screaming and paranoia).  This was no good.

My Fertility Care Practitioner knew I was frustrated and kept on encouraging me to call this NFP-only doctor she knows, but I was sure it would just be a waste of time and money, because nothing will help, I’m doomed to suffer, etc.

The problem before progesterone cream

My main problem was continuous mucus.

  • I never had dry days, even when my cycles were fully established and regular after night-weaning.
  • There was just never a very strong distinction between peak-type (more fertile) and non-peak-type (less fertile) mucus, and that made charting almost useless, and a source of constant anxiety.
  • To accommodate these ambiguities, I got yellow stamps, but the “is this essentially the same?” question hit me right in one of my weakest spots:  I’m a compulsive second-guesser, especially when I’m tired, and the strain was enormous.  We had so, so, so few available days, and I was never sure that they were actually okay to use.  And saying “end of the day on alternate days when you’re — well, do you think you’re fertile?  Trust yourself!” — well, that ain’t sexy talk.

Also, I could never do the seminal fluid elimination properly, no matter what ridiculous contortions I tried or how much water we both drank; so even once we were post-peak, there was always some uncertainty about what I was seeing.

So finally I went for a check-up.  The doctor expected that I would have a cervical eversion from eight vaginal deliveries in 11 years, which can cause  chronic irritation of the cervix, causing superfluous and confusing mucus.  They can do simple treatment right in the office.  But no, it turns out my cervix is (inexplicably) fine.  So he gave me a prescription for progesterone cream, but I didn’t fill it for several months, because nothing will help, I’m doomed to suffer, etc.

 

Benefits

So I finally filled the Rx, and within a month of starting to use a dab of cream for a week or so per month, I started having cycles like in the manual.

  • The longer I used the cream, the more dry days I saw.
  • The peak-type (more fertile) mucus is more abundant, and very distinct from non-peak-type.
  • And most importantly, we now we have what seems like a luxuriously long post-peak phase.  We can even have a fight post-peak, and still have time to make up and have sex again!  It’s pretty sweet.

There are more available days pre-peak, too, but since most unexpected pregnancies seem to come from pre-peak conception, we are pretty conservative.

Seminal fluid is easy to eliminate, and even if I don’t do it, it’s very distinct from any cervical mucus.

I’ll say it again: my cycles now look like the ones in the manual.

Drawbacks

  • When I’m using the cream, my cycles shortened from a typical 29-30 days, to 26-27 days.  My practitioner says that that is unrelated to the progesterone cream, but it sure is an amazing coincidence, because I never in my life had a cycle shorter than 28 days until I started using the cream; and now I rarely have a cycle longer than 26 days.
  • My period is more “efficient,” which means it takes 5-6 days, but most of it happens over two extremely heavy flow days.  They are no more painful than usual, but much more messy; but it is kind of nice to get it over with all at once, instead of having a gradual build-up and gradual wind-down that goes on and on.
  • You can only use the progesterone cream if you are certain that you have already ovulated; otherwise, it may prevent ovulation.  So if you suspect a double or split peak, you can end up waiting and waiting for the actual peak day to come, and then it turns out you just get your period anyway (and then your next cycle might not be as spiffy, because you haven’t had the benefit of the progesterone cream from the previous cycle).  Obviously, that’s not a drawback of the progesterone cream itself, but could happen any time – – it’s just something that adds a slight layer of uncertainty, because you’re not just waiting to see what happens in the cycle, but also waiting to see if you should use the cream.

Details

I rubbed the prescription cream into my inner wrist, inner elbow (is there a name for that part?) or abdomen once a day, starting on day P+3 and continuing until the end of the cycle.  It hasn’t caused any type of rash or irritation, or dizziness or nausea.

In order to know exactly how much progesterone you’re getting, you need a prescription, and you need to get it at a compounding pharmacy.  The only local one here does not accept insurance, and the cream costs $40 for two pre-filled syringes, which last me nearly three months.

However, after several months, I decided to try an over-the-counter version of progesterone cream called Emerita Pro-Gest, and it works exactly the same for me.  It’s much cheaper and I just order it from Amazon.  I use it in the same way at the same part of the cycle, but twice a day (morning and night).

However, I am probably going to go back to the prescription kind, because I want to make sure I’m getting the right dose if/when we go for another baby.
For goodness sake . . . 

Please, please, please, do not try progesterone cream without talking to a doctor first!  Strange cycles can be caused by any number of things, some of them quite serious. Progesterone cream is a hormone, and just because it’s sold OTC doesn’t mean it’s safe or appropriate for everyone!

Many people use progesterone cream to alleviate PMS symptoms. It hasn’t helped me with that at all.  However, at least my cycles are intelligible enough that we can say, “Yep, it’s PMS” and we know I’ll be back in my right mind in 48 hours.
But you may not be doomed to suffer

If your cycle looks anything like mine did, maybe you should ask your doctor about progesterone cream.  It couldn’t hoit!  It does make some people feel terrible, and it doesn’t work for some people.  Some people are allergic to it, and some people, as I said, have serious conditions that won’t be helped by progesterone, so talk to your doctor talk to your doctor talk to your doctor.  You are much more likely to be taken seriously if you talk to a doctor who understands NFP.  One More Soul has a directory of NFP-only practices.

I wish I had emphasized this more in my book:  there are lots of kinds of NFP, and there are often things you can do to make your cycles more manageable.  So don’t be a fatalist like I was! Look into your options, and make the investment of time, effort, and money to improve things, if you possibly can.  Marriages are not meant to be sexless.  NFP is hard, but sometimes it’s harder than it needs to be.

But for goodness sake, please, seriously, talk to your doctor. 

 

The blessings keep rolling in.

So I was sitting there, refusing to get up.  My six-year-old wanted a glass instead of a cup, the eight-year-old kept doing his evil laugh even though it makes him throw up, and the four-year-old wanted to tell me a story about how first, see, she forgot to flush, but then she suddenly remembered to flush, but then. . .

And remember, I have five other kids, too.

My husband is back at work after eight months of unemployment (and may I say:  heckova job, Barry), and I miss him.  It’s not just that suddenly, everything that needs to be done, said, investigated, cleaned up, controlled, and decided by an adult has to be done by me, me, all me.  I just miss having him around.  And I’m back to being surrounded by kids in a way that I wasn’t surrounded when there were two parents around.  The days are so long!

So despite my relief that he’s working again, I was feeling pretty mopey and despondent.  The kids were eating their stupid supper (in the fridge, waiting for husband, was ziti with chicken sautéed in olive oil with fresh garlic and basil.   The kids were eating naked noodles and poached chicken chunks.  That is a stupid supper) and I just wanted to sit down and feel sorry for myself, because I cut my toe on one of the plates the baby smashed while I was sautéing.

While I was fending off the needy ones, I read this little article from The Daily Beast(via Slate’s XX Factor blog):  I Refuse to Freeze My Eggs! (UPDATE:  Ooh, looks likeZoe beat me to it, and she chose the same quotes, too!)

The author is single and childless at 35–the age when, as she says, “all the petals fall off [your] vagina and dozens of cats suddenly park themselves in a circle around [your] cobwebby old hope chest.”  She’s enduring a gynecological exam, and her doctor starts harassing her to start freezing her eggs, just in case.

It’s super easy, she said. All you have to do is inject yourself with hormones a couple of times a day for about fourteen days, then you go to the doctor, and they scrape your eggs out of your body! Hopefully a few will be ripe enough to make a baby. They put those in the freezer. The rest are thrown into the river. I think that’s what she said. Something like that.

My doctor, who I adore, asked if I wanted to take home some “literature” about the procedure. (I never understand why these medical pamphlets are called literature, as if Faulkner was up all night feverishly writing about NuvaRing.) And in that moment, I made a decision. A decision about how I’m going to handle the fact that I’m thirty five (today!) and I don’t have kids and a kid-making partner isn’t currently on the scene. I decided I didn’t want the literature. And I don’t ever want the literature about anything related to the world of Fertility. It’s my big thirty-fifth birthday present to myself.

I’m sharing this story with you for two reasons:  first, because it’s refreshing to hear a (presumably) secular woman say what she says:

[W]hen I think about my uterus (which is rare) I don’t have any desire to bully it into doing something it may not naturally feel like doing. In vitro fertilization, artificial insemination, egg transplants, surrogacy, fallopian Xeroxing—I have no interest.

Hear, hear!

The second reason is to share with you my delight at an unexpected benefit of having all these little kids around.  I mean, I’m used to all the regular blessings:  always surrounded by love, the peace and serenity of being open to God’s precious gift of life, the constant howling, and so on.

But it never occurred to me that there’s something else:  even though I, too am 35 years old, no doctor ever, ever tries to push me into freezing my eggs.  I think I have my twenty-seven  children to thank for that.

Also, around about the time you have your fifth baby, the doctor stops trying to sneak a plain cardboard box of condoms into your hospital bag.  They’ve given up.  They think you’re an idiot; you know you’re an idiot.  Everyone’s happy, and no one tries to talk you into anything when you already have your feet up in stirrups and can’t fight back.

See what I mean?  Children are a blessing, and the blessings keep rolling in.