Expecting Doctors' Respect as an NFP User
I thought about writing something for NFP Awareness Week (July 21-27). Instead, I buried my head in my pillow and screamed and watched Downton Abbey, because talking about NFP (or FABMs; it’s all semantics, fight me), or anything to do with reproductive health, makes me see red. But I was born two weeks late and I will always be two weeks late, and so now I want to say something, and that something is this:
If you are a doctor, for the love of all that is good, respect your patient's choice to avoid artificial birth control. If you are an NFP-using patient with any choice in the matter, do not settle for a doctor who doesn't respect you.
I'm going to tell you two stories.
Last summer, after my Fallopian tube ruptured and I was rushed to emergency surgery and had the tube and my child's remains removed from my body and lost half a liter of blood because this was discovered so late that it was an emergency situation, despite my expressing my concern several times in the preceding weeks that my pregnancy might be ectopic, the OB who did my surgery came into my room to talk to me about how it had gone. After she had said her bit, she asked me if I had any questions.
"Yes," I said, pushing through the anesthetic fog. "I don't use birth control, but I chart my cycle and avoid pregnancy by knowing when I'm fertile. Do you know how different I should expect my cycles to be, and how long it will be before they're back to normal?"
"Wait, you don't use any birth control?" she said. "Not even condoms?"
"Um, no. We're Catholic," I said, taking a few extra breaths because, you know, my lungs had not yet finished re-expanding after surgery, "and it's really against Church teaching. I know lots of Catholics do it anyway, but we just don't. It probably sounds crazy, but it’s really important to us. I could try to explain it, but, like, it’s a whole thing..."
She stared at me over her clipboard. "And you won't make any exceptions? Not even the pull-out method? Not that that’s reliable..."
"Nope, we really can't."
"Okay....." she said, skeptically. "Well, I guess you're just going to have to abstain for a few months, then." (False, by the way.)
I rolled my eyes, gave up, and the conversation moved on.
Fast forward to the following April. I was in the hospital again, recovering from Rosie’s death and subsequent birth. I had spent two days in bed: choked, silent, barely breathing. I stared at my toothpaste colored sheets, vainly attempted to distract myself with children’s books or TV. My eyes drifted continuously to the list of life-threatening postpartum symptoms that was taped to the wall by my bed, and my mind kept replaying the moment I saw my water break, black instead of clear. One of the doctors who had been with me during labor came in to talk to me before I was discharged.
“Do you have any questions for me?”
I shook my head, chest frozen.
“Okay, well, you’ve been through a lot, and I know this might be the last thing on your mind at this moment, but I’m an OB. I would be being a bad doctor if I didn’t ask this. Are you interested in receiving any kind of birth control prescription going forward?”
I took a deep breath. “No,” I said. “So, my husband and I don’t use birth control, we just chart. It’s a real thing, I promise. It’s backed up by a lot of research and it has real rules and it works and it’s not the rhythm-”
“Okay, that’s fine!” she said. “I understand. I just wanted to make sure that you have everything you need.”
It took me a good minute to pick my jaw up off the floor.
She believed me.
Or at the very least, she didn't make me feel like a weirdo.
One doctor, trained to use specific fertility charting methods to diagnose and treat fertility issues, had believed me before. A mainstream Ob-Gyn? Never. And then, get this: I went to my first follow-up visit, and when I told her how long my luteal phase was, she believed that too! I called my mom in the car on the way home to tell her.
And then it occurred to me that this whole situation was pretty pathetic.
My own experiences and the stories of so many other NFP-using women had taught me to expect the kind of treatment I had received from the doctor in the first story. I expected to have to fight. I expected to be profoundly disrespected, to have my reproductive choices scoffed at and dismissed. I expected to be told what to do with my body, to have birth control pushed on me, without the risks and benefits being explained, without regard for my opinions. I expected to be seen as irresponsible because I declined “protection.” I expected to be told that my concerns were not valid, and that I was being paranoid. I expected to have my questions about my cycle brushed aside and ignored. I expected to leave feeling embarrassed and afraid. I expected to be treated like a child.
I wish I could tell you that this was unrealistic; that you can find a doctor near you who knows about NFP, believes in it, and even uses it as a treatment tool. I wish I could tell you that there is a doctor in a nearby city who will take you seriously when you tell them that you are concerned that your mucus pattern might indicate PCOS, or that the spotting before your period makes you suspect low progesterone. The truth is that, although these doctors exist, there are many reasons why this type of care may not be easily available to you.
I would even love to be able to tell you how to find a doctor who will listen to you or how to get your doctor to listen to you. I would like to tell you how I found the right person and the right treatment and all my problems were solved, and I have eight kids and live happily ever after. But I don't have a success story, and even fantastic medical care doesn't guarantee results. The best I can do is to tell you that this really sucks. Patients deserve doctors who listen and have two-sided conversations; who treat them as whole, intelligent adults, even if they disagree with their choices or can't solve their problems.
Respect for your choice and your intelligence is the absolute bare minimum you should be able to expect from your Ob-Gyn. If you choose to use NFP/an FABM to avoid and achieve pregnancy, you should never have to expect your doctors to make you feel defensive about it. Not at your regular appointments, not at your prenatal visits, not after labor. Certainly not hours or days after losing a child, or nearly losing your life. Not ever.
So, if you feel up to it, know that you can (charitably) call out a disrespectful or dismissive doctor. If you don't, and also maybe if you do, switch the heck out of that office. If your insurance, location, and financial situation offer you any choice between healthcare providers, do not put up with a doctor who treats you like you're stupid.
That's all, folks.