Another consequence of the appeal of Roe V Wade; My Ob/Gyn profession

A gift to myself when I finished residency

By the time I had started my ob/gyn residency, Roe v Wade had been the law of the US for 15 years. I never knew a world where patients attempted to end a pregnancy by themselves or in a back alley clinic. When I graduated from residency in 1991, the world of healthcare for women was rapidly changing and improving. Over 50% of residents were now women, the first residency to see that change. Ultrasound capabilities were rapidly changing; we could diagnose an ectopic pregnancy before the tube ruptured and identify fetal anomalies at 20 weeks, when women still had a choice in whether to continue their pregnancies. Contraceptive options were become more than just the pill or condoms. Minimally invasive surgery technology was in it’s infancy but we all understood how it would dramatically change our future careers. Reproductive options were expanding for infertile couples. It was an exciting time to be part of women’s healthcare. 30 years later as I am winding down my career, I am frustrated that we are suddenly losing so much of what we have gained. Now only will healthcare for women suffer, but the training of new ob/gyn physicians will also deteriorate.

Attracting medical students to consider a career in ob/gyn has always been a bit difficult due to high malpractice costs, work hours and caring for only women. Now, more than 90% of ob/gyn residents are women and most are at a time in their life when they are starting families or have young children. Our profession is one of the few that still involves both office and call schedules, rather than shift work. It is a delicate balancing act that is often worsened with sleep deprivation. In states where abortion is now illegal, that work burden will become even heavier when caring for pregnant women with complicated pregnancies; partial miscarriage, ectopic pregnancies, lethal fetal anomalies, second trimester rupture of membranes. Many medical students will decide not to choose a career in ob/gyn due to one or more of the above risks that are unique to our profession.

And then there are the politicians and Attorney Generals. The AG of Indiana recently called out the young female physician who provided abortion care to a 10 year old pregnant child. Previously she had quit working at Planned Parenthood when there were credible kidnapping threats around her daughter. Her entire career could be destroyed by one man. Politicians have wrongly stated that ectopic pregnancies can be reimplanted in the uterus or that there is no risk to a 10-14 year old to carry a pregnancy. Combating these falsehoods while also worrying about risks to family/self and accompanying lawsuits is a scenario many women will not choose for their workplace atmosphere.

Abortion has always been legal while I have been in training or practice. I took that for granted until I started to travel to Haiti for medical mission work in 2006. It was there that I saw the consequences of illegal or self inflicted abortion – women who died of uterine infections or lost their reproductive organs due to uncontrolled bleeding. In the larger cities, entire wards were devoted to the care of these women. Emergency rooms in states that have outlawed abortion will soon start to see some of these very same cases. Unlike my Haitian colleagues, US physicians are ill adapted to know how to treat these complications and may waver in their care as they worry about the legal implications. Worse yet, some may be obliged to report a women who has obtained an illegal abortion.

Maternal mortality is already highest in the states that have chosen to make abortion illegal.

• Louisiana (58.1 per 100k)
• Georgia (48.4 per 100k)
• Indiana (43.6 per 100k)
• New Jersey (38.1 per 100k)
• Arkansas (37.5 per 100k)
• Alabama (36.4 per 100k)
• Missouri (34.6 per 100k)
• Texas (34.5 per 100k)

These are also the states where it is more difficult to obtain inexpensive birth control or access to comprehensive sex education. Ob/gyn residency programs in these states will be handicapped as potential candidates preferably seek education in states where abortion remains legal, maternal mortality is low and women have more access to birth control so that pregnancies can be planned.

The governing body of The American College of Ob/Gyn is located in Texas. In order to obtain board certification, every Ob/Gyn has to travel to Texas 2-3 years after finishing residency to take an oral board exam. That exam was made virtual during Covid and was supposed to resume in person this year. Due to an outcry from many in our profession, the exam will remain virtual for the foreseeable future. If our own governing body does not think Texas is a safe place for women, what does that say for the future of women who might wish to practice in those states.

On Reproductive Choice: The faith difference between Melinda Gates and Amy Coney Barrett and what that means for women

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I recently finished Melinda Gates book, “The Power of Lift”, and was most impressed by the intersection of her strong Catholic faith and her views on reproductive choice. The Catholic church is often seen in sharp disagreement with not only abortion but also the use of contraception. Ms Gates acknowledges this dissonance and then lays out a thoughtful argument as to why she is able to honor her Catholic faith while at the same time using her platform and funding thru the Gates Foundation to increase access to contraception that enables women to make informed decisions about whether and when to have children. It has been proven that spacing of pregnancies reduces maternal and newborn deaths as well as increases the health of children already in the family.

Foremost, Gates admits that it is not only difficult but also misogynistic for a celibate male hierarchy to be allowed to make decisions about the reproductive life of woman when these same rules can harm the mothers and the children they birth by perpetuating the cycle of poverty. It is her empathy with poor women and children, per the Franciscan teachings of the church, that has led her foundation to provide funding for innovative contraceptive options as well as increased access to these options. Thru her travels in the developing world, she came to understand that contraception prevented millions of unsafe abortions by preventing unwanted pregnancies. While 93% of Catholic women in the US have used contraception, the Catholic church was working to prevent women outside of the US from having those same choices.

Amy Coney Barrett is also Catholic but has chosen to use her faith as a way to limit reproductive options for women in this country. If she becomes the next Supreme Court Justice she may be the deciding vote in overturning access to legal abortions. Even more timely are her views on the Affordable Care Act and what that means for women and their reproductive health. Prior to the ACA, women were required to pay for contraception and could be charged more for health insurance as having babies is a costly endeavor. After the ACA was passed and the more reliable, but costly, long term contraceptive options became available for free, unintended pregnancies and teen pregnancies plummeted and the abortion rate hit its’ lowest point, dropping 14%.

Ms Barrett has a developing world example in her own home. Two of her children are adopted from Haiti. Abortion in Haiti is illegal and reliable contraception difficult to obtain. Poverty is endemic as is the role of men in controlling women’s lives. When women are unable to feed their growing families, they often place a few of their children in a religious sponsored orphanage with the intent that “when my situation improves, I will go back and get my children”. Most of these mothers are never reunited with their children because their poverty does not improve.

I have worked intermittently in Haiti as an ob/gyn physician since 2006. Some of the most horrific situations I have encountered are when desperate woman seek an illegal abortion. The maternal mortality can be exceedingly high when unskilled providers perform medical or surgical abortions. This may be the future of our country if we restrict access to contraception at the same time that we make abortion illegal.

Religious faith can be a powerful force for doing good, as evidenced by the work of Melinda Gates and her leadership in increasing access to contraception, which she believes, and has been factually proven, to lift women out of poverty. . It can also be a force that demonizes the tragic choices that women in poverty sometimes have to make in order to support their children. That is the faith of Amy Coney Barrett.

What did the mother of Jesus know about maternal mortality?

During the Christmas season, many of us are reminded of the part of the Christmas story where an angel speaks to a teenage girl and tells her not to be afraid that she has found herself unwed and pregnant. Sermons thru time have often focused on the accusations that Mary would face in her community and the punishment of stoning as reasons why Mary was fearful and put her trust in God that this would all work out. As an obstetrician I have always thought of another reason that she would be fearful; fear of death in childbirth or shortly thereafter.

We have no statistics as to the maternal mortality rate in biblical times. The first evidence in the early 1800’s was that 1 out of every 100 women died during childbirth, or a 1% chance of death with each pregnancy. With no access to birth control and marriage occurring around age 13-14, Mary would have had 5-7 children before she died of “old age” in her mid 30’s. Overall, her risk of dying due to pregnancy related complications was 5-7%.  As well as seeing an angel in her dreams, Mary may also have seen visions of her death due to post-partum hemorrhage or puerperal sepsis (childbed fever), the two most common causes of maternal death in 1800.

Just a few millennium later, newspapers headlines in the US have been announcing the rise in maternal mortality, especially for women of color,  in our country as compared to other industrialized nations. Although we are not even close to the 1% maternal mortality rate of the 1800’s, the US rate of  24 per 100,000 pregnancies far exceeds the lowest rate in Finland of 2 per 100,000 pregnancies and the overall rate of 8/100,000 deliveries in the European Union. Even more concerning is that the US rate has risen since 1990.

What is happening in the US as compared to other industrialized countries? Why is it less safe to have a baby here than in Belarus? When we compare healthcare for women in the US to those countries with lower rates, we find a few glaring discrepancies.

1. Lack of access to universal healthcare. Expansion of Medicaid after the Affordable Care Act was not equal in the US and we are now able to see what a difference that has made. In those states where Medicaid dollars cover pregnancy, the maternal mortality rate is lower compared to states that have not expanded access. This expansion not only benefited mothers but also decreased the rate of infant mortality, especially among women of color. Women who do not receive prenatal care have a 3-4 times higher risk of maternal mortality.
2. Contraception. In developed countries with access to free or low cost birth control, the average number of children per women is just under 2. The conservative agenda in this country has decreased the number of reproductive health clinics that supply many women with birth control options, increasing both the number of unplanned pregnancies and the maternal mortality as these women are less likely to seek prenatal care and be able to adopt a healthy lifestyle during pregnancy.
3. Chronic Health Conditions. The epidemic of obesity in the US as compared to other developed nations has increased the rates of chronic hypertension, heart disease and diabetes both before and during pregnancy.  Pre-existing conditions such as these are now the leading cause of maternal mortality as compared to complications of delivery, such as hemorrhage.
4. Diverse Population. The majority of the countries who have the lowest maternal mortality also have a homogeneous population: Finland, Japan, Iceland, Singapore. They do not have to deal with as many genetic and lifestyle factors when working to reduce overall mortality. African American mothers have a 4x greater risk of maternal mortality and also have higher rates of obesity and hypertension as well as lower socio-economic status. We have many more moving parts of the problem to tackle in this country as compared to the EU.

Solutions to this problem come both from a policy perspective (universal insurance coverage, access to contraception) and individual lifestyle change to reduce obesity, hypertension and diabetes. The mother of Jesus did not have many choices in her life – her job was to become a teenage bride and produce children until her reproductive years were over or until death, whichever came first. Today, we have choices. Vote for those who support equal access to reproductive health care as well as universal pregnancy coverage.

 

 

A letter for Elected Officials

Dear Senator, Representative, Governor, State Officials,

It has recently become noticeable that many of you are trying to pass laws that affect women’s bodies, without the knowledge of how women’s bodies work.  As an Ob/Gyn for 25+ years I feel that I am somewhat of an expert on this topic and would like to set the record straight on a few common misperceptions.

1. On average, women start menstruating at age 12-13 and finish around age 52-53. The lifetime cost of pads and tampons is estimated to cost a woman approximately $1800. Most women I know do not consider bleeding for 7 days each month a luxury, but many of you have legislated the addition of a luxury tax on feminine hygiene products. Women already pay more for our clothing than similar clothing choices for men, so an additional tax on a product that only women use seems to be singling women out for monetary punishment. Not only should the luxury tax be abolished, but we should provide tampons/pads in every bathroom that has toilet paper.
2. We also bear the financial burden of contraception. Short of permanent contraception with a vasectomy, the only method of contraception available for men is a condom, which is relatively inexpensive and does not involve an office co-pay to obtain. With the implementation of the Affordable Care Act, contraception is provided free of charge under the majority of insurance plans and has markedly increased the use of the more expensive, but vastly more reliable, long acting contraceptive methods such as IUD’s and Nexplanons. Abolishing the ACA will allow insurance companies to retract this coverage.
3. Contraception does not cause a pregnancy to abort. Please educate yourselves on the scientific facts behind contraception and don’t spread false information that makes it all the more difficult for those of us who care for women to do our jobs. Birth control methods such as pills, Depo-Provera, Nexplanon, rings and patches work by preventing ovulation (the release of an egg from the ovary). IUDs thicken cervical mucous and provide a hostile environment to sperm, killing them before they get far in their journey to the egg. Plan B, or the morning after pill, also disrupts ovulation and prevents fertilization.
4. A “normal” menstrual cycle is considered 25-34 days. As most women will tell you, sometimes our cycles can be shorter or longer than average. This accounts for the reason we have stashes of tampons/pads in interesting locations outside of our homes (car, purse, backpacks, office desks, suitcases etc). We have busy lives and are not always counting the days until our next menses and may not realize that we are late until a few weeks have passed. Thus, the 6 week heartbeat bill that many of you have passed does not allow us time to recognize we have missed a period, take a pregnancy test (also paid for by women at an approximate cost of $20) and then make an appointment at a clinic to confirm that double blue line that appeared on a pee stained stick at midnight when our long day was finished.  All of this usually occurs while our partner is clueless as to what his plans are for the upcoming weekend.
5. Responsibilty.  Pregnancy happens when a man AND woman have sex. The “and” is the important part. Texas has introduced a bill that would allow for the death penalty if a woman seeks an abortion, with no mention of a penalty for the other sex. Our society needs to start holding men as accountable as women for an unintended pregnancy and the decision to end that pregnancy.
6. Hormonal methods of contraception can provide long-term health benefits to women. 5 years use of birth control pills decreases the risk of ovarian cancer by 50%. Because of the obesity epidemic, the rate of endometrial cancer is soaring and Mirena IUDs can be used for both prophylaxis and early treatment in those women who are not good surgical candidates. The recent federal funding of anti-abortion clinics in California that are opposed to any form of contraception outside of natural family planning, do not provide “comprehensive women’s health care” as advertised in that they have no resources for treating women’s health problems outside of reproduction.
7. Sex Education. Just as you as an elected official should educate yourselves, we also need to provide sex education for our children so that they can best take care of themselves. Abstinence only education has been proven not to reduce teen pregnancy. Comprehensive sex education not only reduces teen pregnancy but also decreases the rate of abortion as there are fewer unintended pregnancies. Seems contradictory to be both pro-life and anti-sex ed, but that is what many of you embrace.

Women have trusted me with their health and bodies for years and I have respected that trust by staying up-to-date on the changes in health care as well as offering each patient the full spectrum of choices without judgement. I would expect that our government officials would do the same. Please feel free to contact me if you have questions.

Sincerely yours,

Leslee Jaeger, MD

 

The life of a woman in Vietnam

International Women’s Day, a day to celebrate the accomplishments of women both past and present, was celebrated earlier this month.  During my recent trip to Vietnam helping to care for women patients, I had the opportunity to hear many women’s stories, see their hard work both in the hospital and in the shops and visit the Women’s Museum in Hanoi.

Each day on my walk to the hospital I encountered women that had arisen before dawn to start food preparation at their street-side restaurant or had traveled to the wholesale market to purchase fruit for sale at their sidewalk stall during the day. Many of these women have husbands and children who live hours away in a rural location who they only have the opportunity to visit a few times each month. The income earned in the city makes it possible for their children to attend school, as public school carries fees of $25-30 each month.

Women who remain in rural locations closer to their families are responsible for all the domestic work in addition to working in the families rice plot. The rice plot is a source of not only food for the family, but also cash income as some of the rice is sold. While Communism has afforded women the opportunity to be employed outside of the home, it has not coerced men into assuming any of the household responsibilities. A Vietnamese meal is delicious, but time-consuming to prepare as it contains no processed components. Due to lack of refrigeration, prepared food is consumed immediately and there is not the availability of saving food for a future meal.  In the urban areas, many of the married men in their 30-40’s helped with some of the food prep and child care. This cooperative marriage model has not filtered out to the 65% of Vietnamese who live outside of the cities.

 

 

Similar to China, Vietnam has a 2 child policy that was implemented in the late 1980’s to control population growth. A patriarchal society that depends on a son to carry on the family name often comes into conflict with the reality of a family that consists of 2 daughters. This has led to utilizing abortion for sex selection and upsetting the gender balance of the society. Although contraception is free there is a lack of sex education and general taboo against pre-marital sex, resulting in many unplanned pregnancies outside of marriage. Young girls bear the brunt of these cultural beliefs, often visiting clinics or hospitals in secret to have an abortion.

Approximately 1/3 of the ob/gyn residents I worked with were women, most unmarried and living at home with their parents. Only a few of the attending physicians were women, a prevalence that was familiar from my early residency days. One of the attending physicians lamented the dual roles that Vietnamese culture places on professional women – achieving personal high educational performance and job status in addition to perfection in raising children and household responsibilities. Young women physicians worried that their “advanced age” of 25-27 years was making them less eligible for marriage. It seems that women in Vietnam and the US share many of the same concerns regarding careers and home.

Family is very important to Vietnamese, influenced by the Confucius culture of China. The most important job for a woman is to bear children and her worth within the community is influenced by this ability. Having sons is considered the highest praise. Adoption is only considered if a couple is unable to have children of their own. Each day as we saw many women in clinic, one of the first items discussed in their health history was whether or not they had children. It was assumed that all women wanted 2 children, without asking the woman. For this reason, there seems to be an unwritten taboo against birth control, as even health professionals falsely believe that it may influence a woman’s future ability to become pregnant. Unfortunately this mindset has resulted in Vietnam having the highest abortion rate in Asia. Abstinence only education doesn’t work in either America or Asia!

Walking the crowded hallways of the hospital on the obstetrical floor afforded me a brief glimpse into the world of women as they supported each other during the process of childbirth. Sisters, mothers and mother-in-laws often surrounded the pregnant women as she labored on a narrow cot or weaving her way down the packed hall. Food was cooked at home and brought in, urine buckets were taken away and emptied, arms were offered for support. Older women help new moms to breast feed and care for newborns. After a 7 day stay in the hospital (compared to 2 days in the US), moms are proudly escorted home by their husbands on the back of a scooter – the primary means of transportation in Vietnam. If employed, they are eligible for 6 months maternity leave.

Compare this family centered care to the medical care of women in labor or gynecology. Acquisition of technology to advance medical care has markedly improved in the past 10 years, but there has not been a similar interest in developing patient centered care. Women deliver their babies on a unpadded metal table with no family or friends nearby and nurses and doctors that are too busy to provide comfort. During gynecology clinic, patients are led into a room containing 10-15 students/residents/attending physicians that are all discussing her medical record. The nurse helps her climb up onto the exam table, again unpadded, so that she can undergo 4-5 pelvic exams while everyone continues to watch and discuss. Sometime after she leaves the room, a physician has a brief conversation with her and her family in the crowded hallway with a treatment plan. Most of these women feel privileged to be able to afford this care as it is only available to those who can pay the yearly fee for health insurance.  They have the opinion that “the doctor knows what is best for me” and don’t question recommendations. This is changing as patients in private hospitals are demanding more interaction with their physicians and lawsuits have started to climb.

As in many parts of the world, the power and influence of women is changing age-old traditions. The overall rapid progress of change in Vietnam elevates the voice of women as they advocate for change that benefits their role as well as that of policies that benefit their families. Our role in the West is to provide educational support while allowing leaders within Vietnamese health care to create systems that work for their people.

 

 

 

 

 

 

#MeToo in Women’s Healthcare

The #MeToo Movement, in regards to sexual harassment, has created a great awakening in our country as to what we have tolerated in the past and what we are willing to tolerate in the future. This powerful movement needs to extend beyond just sexual harassment and into other platforms that are unique to women but have been controlled by men. One of these areas is women’s healthcare policy, a sphere that has been traditionally dictated by men as the people in positions of power in government  that make the decisions around funding and laws.

Two conversations with patients this week made me realize how far we have come in women’s healthcare over the past 10 years …. and how far we have backtracked in the last year. A new patient in her early 20’s presented for discussion of contraceptive options. After reviewing the pluses and minuses of each contraception method, I realized that her job was with Hobby Lobby. This is one of the businesses that have used the religious objections to birth control by their founders to justify that they will not provide coverage of contraception to employees who use employer-provided healthcare. Although many forms of hormonal contraception are used for non-contraception reasons, these are also not covered. Luckily the patient was well aware of these limitations and had remained on her parents insurance plan for this reason.

The second patient was an immigrant from Liberia and delivering her first child. When the baby was born she and her husband informed the delivery room staff and their family that the baby was being named after the husband’s sister – a woman who had died in her late 20’s of an illegal abortion in Liberia, leaving behind 3 small children. That same week, CNN published an article with the statistics that only 1 abortion clinic exists in Kentucky and the governor is working hard to outlaw abortion in the state. With 47% of pregnancies in Kentucky being unplanned and the teen birth rate 68% higher than the rest of the country, it does not seem that the women of Kentucky are being served well by their male governor.

The most effective way to prevent abortions and reduce the teen pregnancy rate is providing education and free or reduced cost access to contraception. Statistics prove that contraceptive education does not increase teenage sexual encounters but does reduce the teenage pregnancy rate.  When teens in a rural area of Colorado were provided with contraception education and free access to long-term contraception (Nexplanon or IUD), both the teenage pregnancy and abortion rate declined by almost 50%, saving the state $70 million in public assistance.

The current administration is attempting to take away the gains that were made in women’s health care over the previous 8 years by limiting funding for sex education, removing contraception as a required insurance benefit and pushing the anti-abortion agenda to include the persistent attempts at de-funding Planned Parenthood. This affects not only women but also their partners. We need to use the tidal wave of the #MeToo movement to include a push back against the current culture of anti-women healthcare policies that have been put into place by male legislators. Speak out, call and write your legislators, donate money. But don’t be SILENT. We have seen the power of our words changing a culture of sexual harrassment and we know that a long history of silence didn’t effect such a change.

The cost of being a woman

 

Two headlines caught my attention this week. One focused on the luxury tax for tampons that is part of the law in 46 of the 50 states. The other headline was buried in all of the news about the Republican sponsored Health Care Act.  Tom Price, head of HHS, would like to see the co-pay for contraception reinstated. As part of the ACA, contraception is free under the majority of health care plans. Both of these costs are charged to women. On a monthly basis this may not seem too costly. But let’s look at the average sum that a woman would need to pay over her lifetime for both tampons and contraception.

Tampons: an average woman uses 30 tampons for each menstruation. A box of 36 tampons costs $7 at Target. That amounts to 360 tampons per year or $70. When multiplied x 35 years that costs a woman $2450.

Contraception: Prior to the ACA, an average co-pay per month for birth control pills was $30. If a woman were to start pills at age 20 and continue to age 45 it would cost $9000 for contraception.  The average family size is 2 children, so you could subtract $1000 for the time it takes to become pregnant and the pregnancy itself. I would argue that there are other costs during that time that offset the $1000 (maternity clothes, nursing bras etc…) but those are probably considered “luxury items” by society standards.

$10,450 is the total cost of tampons and contraception for a woman during her lifetime. But some of our lawmakers want to extend this burden even further, questioning why men should have to help pay for maternity care as part of health insurance. Despite the backing of Ivanka Trump, I doubt that the current legislature will approve any bill that provides for paid maternity leave. Women caregivers are the norm for elderly parents who need assistance and many choose to decrease their paid work commitments to provide this care.

At what point will our society honestly discuss the financial inequalities that exist between men and women?  Male partners should share the finances of contraception – much cheaper than the cost of supporting  a child to age 18.  Women should not be the only members of society that are burdened with the cost of maternity care.  Removing the luxury tax on tampons is a no-brainer as I have never heard any woman describe her period with the work luxury.  And I have heard many words used to describe periods! Paid maternity leave is present in  every  country in the world other than the US and Papua New Guinea. If we want to make this country great, maybe we should start with the women.

 

Dear Kellyanne Conway – This is what feminism looks like

Ms Conway spoke at the CPAC convention last week on the contemporary definition of feminism as anti-male and pro-abortion. I consider myself a feminist and don’t identify with either of these definitions. I heard about her commentary as I was driving between appointments and reflected on my “feminist” activities on the same day as she was speaking at the convention. Following is the run-down of what a feminist does on her day off from her usual job as a physician serving women – the ultimate feminist job.

1. Awake at 6 am to make breakfast for daughters as they head out to high school.
2. Text with 26 year old son about upcoming interview for nursing school.
3. Spend 2 hours on Haiti non-profit, Helping Haiti Work, that grants microloans to women and operates a sewing center that constructs reusable menstrual pads for sale in the community. Women that participate in this program are empowered to be leaders in their families and communities.
4. Volunteer at a local public elementary school tutoring first graders in reading and math. 90% of the students in this school are children of color. The teachers are dedicated and constantly working to involve each child in the curriculum.
5. Grocery shopping for the week. My husband and I split this task, but he often does more than 50%. Arrive home and start dinner in crockpot for husband and daughters as we will be eating at different times. I cook because I love to and not because I am the mother. Husband also does his share of meal prep.
6. Drive across town to the MN legislature. I have volunteered to speak before the Health and Human Services Committee in opposition to 2 bills that are being introduced to restrict access to abortion. I am NOT pro-abortion, but rather pro-choice and pro-contraception. Along with many of my colleagues, I feel that government should stay out of the room when a physician is counseling a patient.
7. Attend a year-end meeting of our independent medical clinic, one of the few non-hospital owned clinics left in our area. I am a board member of this clinic and up for re-election so give a 5 minute speech about the value of independence and what measures we need to take in the future to stay that way. My value as a board member is based on experience, working hard and ability to appreciate other’s opinions. Being the only female board member is a responsibility I do not take lightly.
8. Head back to St Paul to attend a visit to an Eastern Orthodox church, arranged thru Tapestry, an interfaith group of women that works to break down religious and cultural barriers thru education and service. I am proud to be one of the 3 founders of this growing organization but saddened to know that our existence is needed now more than ever. It was interesting to hear the stories behind the iconography that is so much a part of the Eastern Orthodox religion, but also to reflect on the similarities between the Jewish faith and to view the women in the pictures as wearing the traditional head coverings or hijab. During the social hour following the church tour, I lamented with my Muslim friends about the difficulties of encouraging our teens to stay involved in their respective religions. We found that we shared many of the same difficulties as well as joys.
9. Arrived home around 9:30 and discussed husband’s experience at local town hall political meeting that was attended by 1000 constituents but not our legislator. We made plans for future involvement in politics and discussed our shared values with our daughters.
10. Crawled into bed around 11 pm as I had an early morning surgery and clinic the next day. This is where the real feminist is unleashed – advocating for free birth control, vaccinations, knowledge about our bodies and how they work and access to health care as a human right and not a privilege.

Feminism is the right to be treated as an equal human being and to be able to make our own choices. That is not anti-male or pro-abortion. That is human decency and what I teach both my sons and my daughters.

 

How Roe v Wade is affecting the upcoming election – and how we can change the discussion.

Life must be interesting for Ruth Bader Ginsburg. As the oldest member of the Supreme Court, she is the most likely to retire/pass away in the next 4 years, allowing the next President to change the dynamics of the Supreme Court. Either it remains with a conservative majority or changes to a more liberal bench. The SCOTUS (Supreme Court of the United Sates) appointment is the reason many conservatives still back Mr Trump, even though they confess  they don’t believe he is Presidential material.  With a conservative majority, their hope in the future involves the defeat of Roe v Wade and the outlawing of abortion.

One of the frequent arguments against abortion involves the practice of partial birth abortion. In fact, in the third presidential debate Mr Trump described partial birth abortion as “ripping a baby out of the womb only days before birth”. As an obstetrics doctor, I routinely do this. I refer to it as a cesarean and would use the nomenclature cutting rather than ripping. Spreading false rhetoric only works to push people apart. We need to look at how we can find common ground in this debate.

These are the facts. 91% of abortions are performed before 13 weeks of pregnancy and only 1.3% occur after 21 weeks of pregnancy. The majority of these later terminations are due to fetal anomalies that are not diagnosed until the 5 month ultrasound. Heart-wrenching decisions need to be made by parents in a short time frame, as most states outlaw terminations beyond 23 weeks, only 3 weeks after a diagnosis is made. In the past few years, I have been involved in 2 of these scenarios that resulted in different decisions. One child was diagnosed with a lethal heart defect that would require multiple heart surgeries to allow the child to become old enough so that she would be a potential candidate for a heart transplant. Years of surgeries, hospitalizations, medications for at best a 20% chance of life. The other mother was diagnosed with rupture of the amniotic sac at 20 weeks of pregnancy, preventing full and complete development of the baby’s lungs. One couple chose to continue the pregnancy, the other to terminate. The important point is not which option these couples chose, but that these parents were able to make a CHOICE. A decision that made sense for their family now and in the future.

Rather than focusing on the 1.3% of abortions that are classified as late-term, why not focus on the 91% that are performed prior to 13 weeks. The number of these abortions can be dramatically reduced by reliable contraception. For example, use of long acting reversible contraception (IUDs and implants) by teens has been shown to reduce the pregnancy rate by 50%.  It is always amazing to me the number of women I see for a pregnancy confirmation that have not been using birth control because they are worried about all the “bad side effects”,  but yet didn’t want to become pregnant. Do they understand that an unwanted child is a “bad side effect”. An educational campaign focused on contraception,  healthy pregnancy and involving men in contraceptive decision-making would pay back large dividends in reducing health care dollars spent on unwanted pregnancies that are often high risk.

An unwanted pregnancy that may end in abortion was not created by just one person. But it is the woman who is blamed for the decision to terminate the pregnancy. Why don’t we hold the male partner accountable? They could have used a condom if they didn’t want their partner to become pregnant.

Overturning Roe v Wade and outlawing abortion is not the answer. I have worked in many developing world countries where abortion is illegal. This does not mean that abortion does not happen, only that it becomes expensive and dangerous. Unlicensed and unqualified practitioners put women’s lives at risk in order to make money. These are some of the same countries where birth control is difficult to obtain and rape of women, both by their spouses and others, is common. During one of my trips to Haiti, I was able to save a woman’s life (the mother of 4 children) when she suffered a perforation of the uterus and horrific bowel injury by an unqualified physician. If our surgical team had not been operating that week, she would have died and left 4 children orphans. Her response when I told her that we had to remove her uterus in order to save her life was a grateful thank you because she would not have to worry any further about pregnancy. One ward of a hospital in Port-au-Prince is devoted to women who have suffered complications of abortions. Many of these women die due to lack of antibiotics and the funds to pay for adequate care.

If you are against abortion, work to increase education and access to contraception. Educate men and boys about their responsibilities. This will work to reduce 91% of abortions; those that occur prior to 13 weeks and are often due to lack or failure of contraception. Leave late-term abortion decisions to women and their families. This is a personal decision that is different for every woman. We as physicians are able to provide factual information and support women in their decisions. This should not be decided as a one size fits all policy.

 

 

Female Body Parts 101 – a course for college freshman and Donald Trump

I started writing this post a few weeks ago and then realized I needed to publish it after the recent comments by Donald Trump following the Republican Presidential debate. It seems that he took offense at questions directed to him by the female moderator and later claimed that she had blood coming out of her eyes as well as “where ever”. Most took “where ever” to mean her vagina. If Mr Trump has a chance to read this blog to the end, I hope that he will realize that the female eyes are not connected to the reproductive parts!

Knowledge of female reproductive parts is important for young women so that they are better able to make responsible decisions regarding contraception, sex and health in the future. But inevitably, I am trying to convince women that the information I give them in the office is more accurate than the information they have gleaned from mothers, friends and the internet. Following are some of the comments that I have heard over the past few months.
1. “I feel a string in by armpit. Do you think my IUD might have moved out-of-place?”
2. “I don’t want any foreign objects in my body.” This from a patient who was sexually active without birth control and a smoker. Tobacco, a baby and a penis are all foreign objects with much more serious consequences than an IUD or birth control pills.
3. A patient was concerned that she would not be able to urinate after having a procedure done on her cervix.
4. A woman was told by her boyfriend that her labia did not look normal. She remained skeptical about by reassurance that her external genitalia were within the range of normal. Unless he is a male gynecologist, I wonder how many lady bottoms the boyfriend has seen?
5. The vagina is a closed tube. Objects (tampons, contraceptive ring or pessary) cannot become lost.
6. “I had a pap smear done in the ER and they said everything was fine.” A pap smear screens for cervical cancer only. It is never done in the ER even if a speculum is placed. It does not check the health of your ovaries or your uterus.
7. “I don’t need a mammogram because there is no family history of breast cancer.” 90% of breast cancer is not hereditary and the major risk factor is obesity.
8. “I don’t want to breast feed because it doesn’t seem natural.” What do you think is the function of the breast?
9. “Pubic hair is disgusting”. Shaving it can cause ingrown hairs and contribute to recurrent vaginal infections.
10. “I won’t have a hysterectomy because then I won’t feel like a woman anymore.” Female hormones are made by the ovaries and not the uterus. A hysterectomy refers to removing the uterus and usually leaves the ovaries intact. And who thinks hemorrhaging each month makes you a woman?!

This is a plea for women to educate themselves about those parts below the waist or “down there”. It will make your doctor’s job much easier when you can name a part of your anatomy rather than referring to “something in my girl parts” when you have a concern.