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.
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.