The Silent Mother

Esoteric & Historical Gravidity & Parturition

Dear Planned Parenthood, I love you, but we need to talk.

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I had a phone call with the local Planned Parenthood office this week. I called to schedule my annual gyne exam. I also requested that at that visit they remove the Paraguard IUD I’ve had for the last eight years.

Here’s where it gets interesting… you, dear reader, know what I do for a living. Therefore, I have massive amount of information stored in my brain about all things pregnancy related. I will never begrudge a care provider telling me things I already know, because it means they are doing their job with regards to ensuring informed consent.

That’s a good thing. That level of explanation should happen every visit, every time.

What I do bite back on is what the staff member said to me on the phone. It started off reasonably well and went downhill from there.

The staff member said that if I take the IUD out, I should use other birth control, and so on. Which, for most people makes sense. I also understand that she was doing her job and trying to provide me with informed consent before scheduling the procedure. I respect that.

I let her know my intention was to try to get pregnant and therefore other methods of birth control were irrelevant and implied that she didn’t need to continue in that vein.

She didn’t listen. So, I repeated myself, “I want to have a baby and therefore I need my IUD to be removed.”

Again, she repeated her script on needing additional birth control.

I was beginning to get annoyed.

Active listening, as a care provider, is paramount to being able to treat a patient appropriately. If you don’t listen, you can’t hear what the problem is and you will possibly make assumptions that could cause harm.

Then, she said something that raised my ire. She said the provider would need to have a discussion with me about whether the removal of my IUD was appropriate.

She went on to say that the provider could refuse to take my IUD out based on medical reasons, social reasons or financial reasons.

That stopped me in my tracks.

What she’s really saying is that I don’t have autonomy over my own body to make these decisions and that I need to cede my power to a provider.

I was appalled and angry. Bodily autonomy is a human right according the United Nations, The World Health Organization and Amnesty International.

“Reproductive health…implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. …Bearing in mind the above definition, reproductive rights embrace certain human rights that are already recognized in national laws, international human rights documents and other consensus documents. These rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly on the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes their right to make decisions concerning reproduction free of discrimination, coercion and violence.”

~ The World Health Organization

In examining the reasons the staff member gave me as to why the provider might refuse to remove my IUD, I find no supporting cause.

Medical reasons – In my research, the only reason I can find to refuse to remove the IUD is if at that visit it is, or embedded, in the uterus and a surgical removal is needed. So, that’s not a refusal, that’s an “it’s more complicated, let’s schedule the procedure later.” There may be an active vaginal infection that needs to be treated first. Again, that’s a delay not a refusal.  If any readers know of any other medical reasons to refuse removal, do let me know, I’ll add them here.

Social reasons – Ummm….. no. This is my choice to try to have a baby, regardless of what you think of my personal life. No one else gets to decide that for me. This is a conversation between me and my partner only. While I appreciate the concern of my provider to ensure I’ve explored all avenues and rationales, ultimately the decision is mine whether or not to remove the IUD and when.

Financial reasons – There’s two possible perspectives we can explore.

The first is based on personal finances, or “Can you afford the procedure to remove it?”. That one doesn’t hold water for me. If you have health insurance, the removal would be covered in part or full. Planned Parenthood offers sliding scale fees for those without insurance or for those whose insurance is insufficient. So, it’s unlikely that’s to what she referred.

My assumption is that she meant, “can you afford to have a baby?” This goes back to social reasons. How can someone other than me and my partner determine if a baby is financially a good choice (they never are really, kids are expensive!). How can they make an accurate assessment about my income, my partner’s income and our lifestyles in a brief office visit? The bigger question is, why does it matter?

It is my body and my life. My autonomy.

The bizarre irony is that this is Planned Parenthood. “My body, my choice!”

Choice to have a baby or not. The statement made by the staff member belies Planned Parenthood’s mission.

“Planned Parenthood believes in the fundamental right of each individual, throughout the world, to manage his or her fertility, regardless of the individual’s income, marital status, race, ethnicity, sexual orientation, age, national origin, or residence.”

*Deep breath*

As a childbirth educator and doula, this topic, bodily autonomy, I choose to discuss with every client. With the autonomy conversation, comes the right of informed consent and informed refusal.

Bodily autonomy sits firmly in the seat of power and control.

Who controls my body? When a care provider dictates a patient must have a medical test, procedure or medication and does not give her full information, which includes her right to say, “no thank you”, that provider strips the patient of her autonomy and her power.

This also applies if the provider refuses a medical test, procedure or medication that is appropriate for that woman and her current medical condition.

Granted, the relationship between provider and patient must be one of mutual trust and openness. If a woman doesn’t trust her provider, she should find a new one. If the provider’s methodology and course of treatment isn’t suitable for this patient, the provider has the right of refusal of service. This should be after a long, informed and compassionate conversation with the patient.

However, in my opinion, this provider right of refusal must be tempered by circumstance. If this provider is the only provider in a particular geographic area, their right of refusal should be reduced. If their refusal is based solely on their personal or religious beliefs and those beliefs interfere with their ability to serve their patients appropriately, their right of refusal should be eliminated. This is the case with those who refuse birth control, etc. If their refusal will cause harm to the patient, thus violating the Hippocratic oath, their refusal should be restricted.

Key points:

  1. Patients have the right of informed consent and informed refusal.

  2. Patients have the right to change providers (assuming another provider is available in their area).

  3. Providers have the right of refusal of service for really any reason.

  4. Good, respectful communication between provider and patient is imperative.

This refusal to treat a patient is a huge issue. Look back to the Hobby Lobby case or pharmacists who refuse birth control or the morning after pill.  Providers can refuse to treat LBGTQ, transgender, women who’ve had past abortions, etc. This has a massive impact and snowballs quickly.

What we see is a clash of personal values, rather than respect for the patient’s autonomy. This is highly concerning to me.

My hope, with regards to the woman on the phone at Planned Parenthood, is that she is the outlier and that the provider with whom I have my appointment will be as respectful of my autonomy as I am of theirs. I hope we will have open communication and a mutual understanding.

I’m also curious to see what they say when I tell them I want to take my IUD home for my collection. Heck, I did pay $750 out of pocket for the thing, pre-Affordable Care Act. It is mine after all.

How far does my autonomy really go?

Have you had an issue with your provider regarding patient rights or your own autonomy? Let me know about it in the comments below.

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Arise: Sleeping Beauties No More

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Like Briar Rose, we have been asleep, protected by the thorns and brambles of our self-selected insular communities in which our beliefs and feelings are constantly validated. We ‘unfriend’ or ‘unfollow’ those with whom we disagree – growing our brambles denser over time. We choose the veil of emotional safety rather than take the risk of engaging in conversation with those who believe differently. We protect our fragile egos and assume everything will be all right because we can only see what is within the confines of our homegrown thorns and brambles. Our hubris blinded us, such that we did not see the aura which envelops our American landscape.

Sleeping Beauty, Briar Rose

In the cold, dark pre-dawn hours of Wednesday morning our edifice of thorns and brambles was ripped open with the news of Trump’s victory. We were awakened by an unwanted, unasked for kiss of a harsh new reality.

In our slumber, we dismissively believed that our constructed walls and our thorny attitudes were enough. We rested on our laurels granted to us by our mothers and grandmothers.

Somehow, in the intervening years, we forgot. We forgot what our mothers marched for and what our grandmothers fought for. We forgot that it took a struggle to even be able to wear pants, let alone a pantsuit. We are spoiled, my Gen X compatriots and my Millennial sisters. Our great conceit is that we take for granted the advances made by previous generations of American women.

My own mother was a member of NOW, NCJW, and the ACLU among other groups. She marched as an activist and advocate for women’s rights and equal rights for all. She successfully sued an employer in the 1970’s because her male colleagues were paid more than she was. She not only contributed financially to the groups and movements she supported, but she actively recruited new members and did grassroots work.

Her mother, my grandmother, met my grandfather at a socialist political rally in the late 1940’s. The two of them were politically active liberals for the entirety of their lives. My grandmother wore her pantsuits in the 1930’s and took to local elected offices in the 1960’s. She was brash and loud about her beliefs and worked to move things forward for all of us.

My paternal grandmother worked in Washington in the 1940’s until a pregnancy outside of marriage caused her to lose her job. She was an active member of the Democratic party until her descent into Alzheimer’s. She hosted dinners and rallies at her home and campaigned door to door for the candidates who supported progressive agendas.

Those women of my past worked diligently for the rights we now fear to lose. However, we quietly acquiesced to small injustices made against women including both our reproductive rights and, principally, our equal human rights.

We sat and did nothing as state by state, piecemeal, our rights have been chipped away.

Someone else will fix it. It’s not my job. Let NARAL and Planned Parenthood handle this.

A minor change of wording to a law here and there do little harm, so why fight it?

It’s still OK.  

The small downshift in the number of weeks of pregnancy that abortion is acceptable.

It seems to makes sense, right? We can still have abortions, except for when we can’t.

Hobby Lobby winning their case to not cover birth control for their employees due to their CEO’s religious beliefs.

Well, it sucks, but what are you going to do?

These seemingly small shifts affect someone else, you see, not me. Till it does.

Martin Niemoller first they came.

This death of our rights and our humanity is a death by a thousand cuts.

This is the insidious crawl of misogyny, writhing underneath the sheet of illusory safety draped upon us by men who truly believe they know what is best for women’s bodies.

It is the misogyny enforced with smug arrogance by the women who believe their religion or their tradition grant them the power to impose their way of life upon others.

I put my boots on the ground during March for Women's Lives in DC in April 2003
I put my boots on the ground during March for Women’s Lives in DC in April 2003

Our fore-mothers put their big girl pants on to actively work for change. I call on you, my sisters and compatriots, to cut away your own protective brambles, to move from the perceived safety of your self-constructed segments of reality.

I call on you now – put your money where your mouth is, lace up your boots and work to further progress. Take the risk. Open yourself up to the possibility of making this country a better place for all people.

My boots are already on my feet. I am ready.

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Moving from Passivity to Badassery

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Silent Mother, Moving from Passivity to BadasseryHow is it that we are so passive, especially as women, that our response to an authority figure is, “Well, if that’s how it is, then I guess I’m OK with it.”? Even when it’s not OK. We fall into apathy and then have regrets. Worse, yet, we are actively upset emotionally and/or physically harmed by the treatment we receive and yet we still say, “Ok, if that’s how it’s got to be…”

Going further, it’s not just an authority figure, but it’s a peer, a coworker, a spouse or significant other, a friend, an acquaintance, we acquiesce.

acquiesce – verb (used without object), acquiesced, acquiescing.

  1. to assent tacitly; submit or comply silently or without protest; agree; consent

This passivity is so ingrained in us, as women, that our lips remain locked, our throats closed and our eyes bright with tears of lamentation even as we comply.

I see it with my childbirth students and my doula clients.

“Will my doctors allow me to…?”

“I heard the hospital policy is to do… so, I won’t be able to do what I feel is best for myself and my baby.”

To this I say:

“If you cannot advocate for yourself, how will you advocate for your child?”

“Oh, I don’t think I could ask my doctor about that!”

“I don’t want to be argumentative.”

“I don’t want to be a problem patient.”

“What if my questions are off-putting or insulting to my doctor? Won’t they then treat me badly?”

“I don’t want to be disrespectful.”

My response:

“If you don’t ask; you don’t get.”

Asking for something doesn’t question your doctor’s authority, it is directly expressing your needs and your preferences.

The worst thing that will happen is that the doctor says, “no” to a patient’s request. That’s the sum total of it. The word “no”. It’s fear that keeps us from stepping forward and asking for what we want. Fear of rejection and fear of perception. We wish to maintain our image of the good girl, so we say bite our tongues and swallow our words.

Being direct doesn’t fit the standard paradigm of how we’ve been taught to behave as women. We are taught to be kind, helpful and obedient. We are told that the pleasure and comfort of others comes before our own. The stereotype of the woman who does everything for her partner and her children, while doing little for herself, is a prime example of our cultural upbringing.

We are taught, from the time we are little, that we need to respect our elders, our parents and teachers. Yet, we are not often taught to respect ourselves. Our needs and desires are held to be of a secondary status to those considered to be of higher import. We are told to mind our business, be quiet and be good girls.

Damn it, I don’t want to be a good girl! (My tattoos and sports-car-red hair might have given that away…) I want to acknowledge my reservations and my fears. Then I want to put those reservations and fears in their place and ask for what I need. Or, even better still, do what I need to do to while maintaining compassion and empathy for others. The key lies in Ahimsa, kindness to self and others. It’s a balance, not unlike all else in our lives. Badass Witchy Woman Self Advocacy Silent Mother

We don’t need permission from anyone but ourselves to lead our lives. We don’t need the permission of our doctors to labor out of bed, to eat, or to birth on hands and knees instead of on our backs. We don’t need the permission of our husbands/partners to make financial decisions or to go out with friends.

This goes beyond asking to have our needs met and it goes beyond “no means no”. This is a positive affirmation of our inner needs and desires. It is our self-expression to the fullest degree. It means we are fully actualized, badass women who know what we want and can make it happen without fear or reservation. Take that breath and allow your words to come forth so you may begin to be fulfilled. Move out of your boundaries and into badassery.

Dear reader, I want to know what holds you back? What holds your tongue when you know you should speak? What prevents you from expressing your needs and desire in favor of those of others? Tell me in the comments below.

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