On Doctors Viewing Women as Pre-Pregnant

[ubertuber]

Original NY Times Blog Post

Originally Posted by Tara Parker-Pope, on the NY Times

August 28, 2008, 1:16 pm
Do Doctors View Women as ‘Pre-Pregnant?’
A recent report raised concerns about women of childbearing age sharing prescription drugs. While the focus of the study was on drug sharing, readers of the Well blog took the discussion in an entirely different direction.

“I agree that this is a serious issue, but I take great offense at the notion that this is particularly worrisome because these women are of childbearing age,'’ wrote reader Sharon. “Not all women are “pre-pregnant.” We are more than our uteruses!”

Reader Jennifer agreed.

“Framing this as a women’s issue because we have the ability to become pregnant is just insulting. I am tired of being thought of only as a breeding machine who should be regarded as “pre-pregnant” at all times.'’

I was shocked by the reaction, although many other readers chimed in, agreeing that too often women in the health system are treated as “pre-pregnant.'’

To talk more about the issue, I called Cindy Pearson, a long-time women’s health activist and executive director of the National Women’s Health Network.

“You accidentally stumbled into an area that women have had very intense feelings about for at least 40 years,'’ Ms. Pearson said. “American history is very heavily affected by the first time we as an entire country realized that drugs could cause harm to the fetus, and that was thalidomide in the early 1960s. It changed the course of medical care.'’

While more awareness about the risks of drugs to a developing fetus is a good thing, it hasn’t always led to better health care for women, Ms. Pearson said.

“Ever since, women … feel that if they’re ovulating, they’re treated with bikini medicine,'’ Ms. Pearson said. “The attention all goes to their reproductive organs, and that is not right either.'’

To hear the rest of our conversation about the pre-pregnancy debate, listen to the Best of Well podcast, and then please post your thoughts below.

What do you think? Are doctors so obsessed with a woman’s reproductive health that they forget to treat the whole patient?

This blog article brings up an interesting point, but what is even more interesting to me are the comments responding to it on the NY Times website. It seems that there are a lot of women out there (or at least a bunch who have found and replied to this blog post) who really do feel offended that their gynecological/obstetric status and health are of primary concern to doctors in all situations. Many of them feel reduced to being looked at as breeding machines.

While I recognize that the feelings expressed are true, I can't help but feel exasperated by these attitudes. The ramifications of pregnancy during medical diagnosis and treatment are so huge that it has to come up and be documented at all times. Being upset by this is like being upset by the speeches airline attendants make prior to take-off on ANY flight. It's not likely that your plane will crash, but if it does, it's likely to be a big deal. Same with pregnancy, only now we add in the chance that the patient is unaware or lying.

Given the legal climate in which doctors work, I can understand why a woman's potential for pregnancy would be of primary concern in treatment of any kind. Honestly, I wouldn't take anyone's word for it either.

So what's the deal? Am I an insensitive male who just can't get it? Is this really an issue of women's rights?

[ngdawg]

No, more an issue of ignorance on the part of the medical profession. Example: I am established into my second century. During my recent visit to the ER, the xray technician asked me "any chance you could be pregnant?" When I stated my last period was April of 2007, she responded, "well, you never know..."
A 16 month pregnancy? nope, doubt it....
Saying that, I will say that our hormones play a huge part in our well being. Women produce estrogen, progesterone and testosterone. These help to regulate our hearts, protect us from certain disorders and affect fertility. If one is out of whack, everything else follows.
It's not a stretch to say that our reproductive organs have a lot to do with our overall health and I think those women need to get over it and just admit they're female.

[Jinn]

More importantly, the consequences to fetuses of drugs prescribed for a woman who is or will soon be pregnant is massive. While it might be a bit annoying to be asked first about whether or not you're pregnant, it's an incredibly important factor in the diagnosis of disease, and the prescription options available.

[JustJess]

I don't mind measures taken to be sure we're not pregnant before treatment of any kind - I get that. What I *don't* get are situations such as the one I found myself in last year. (Was it only last year??) I wanted an IUD. My gyno refused to give me one. Why? Ha. Okay, based on my having a couple of heavier cycles, and some random microbe that isn't pathogenic and no one ever tests for, she decided I had had PID. Now, let me assure you that there is no way in hell I would be able to treat PID with Advil. I would be vomiting, have severe abdominal pain, have all kinds of symptoms together, possibly have a history of STI, etc etc. She NEVER ONCE diagnosed me with PID. But because I *might* have had it, and I hadn't had children yet, she wouldn't give me an IUD. Because IUDs plus PID = possible infertility. And thus that would mean she'd be liable for my infertility.

The whole thing was ridiculous. Not only was the risk laughable, but I was willing to waive my rights to sue for such outcomes, as I can adopt and I would be okay with that. But that didn't make a difference.

I have a different gynecologist now. One who treats what is, and not what might be if the stars aligned on the 3rd Tuesday in June.

[Cynthetiq]

With the FDA failing us in leaps and bounds, having flipper babies again isn't something that anyone would want to have happen to their children. I can understand some of this to a degree. However, I'm still appalled at the whole answer, "But why take the chance..." for just about anything that is pregancy related.

[ratbastid]

Originally Posted by JustJess

And thus that would mean she'd be liable for my infertility.

Bingo. This isn't a "viewing women as nothing more than baby factories" problem. This is a medical malpractice and liability problem.

Frankly, this is where we end up by being as insanely litigious a culture as we are. This is the result. It's not that medicine is sexist, it's that it's been forced to cover its ass against any potential future liability--and putting oneself at risk of liability for a woman's infertility is a MASSIVE deal. And it's ridiculous in many cases, but there you have it. The cost of malpractice insurance forces doctors to do ridiculous things sometimes.

[snowy]

Originally Posted by Jinn

More importantly, the consequences to fetuses of drugs prescribed for a woman who is or will soon be pregnant is massive. While it might be a bit annoying to be asked first about whether or not you're pregnant, it's an incredibly important factor in the diagnosis of disease, and the prescription options available.

This issue stems more from doctors and other medical professionals treating women as if they could get pregnant tomorrow, simply because they have the equipment for it. Not will they get pregnant tomorrow, but COULD get pregnant tomorrow, regardless of all the other factors (like birth control, lack of a relationship, etc). This issue has come up in regards to other substances women might consume--like alcohol, tobacco, recreational drugs, caffeine, and aspirin. Basically, there are medical professionals out there who treat women as if they are only babymaking machines, without considering the fact that these women might choose to never have children, and should avoid all possible terotogens in case they might ever decide to have children. I'm sorry, but that's now how I'm going to live my life. I'm not pre-pregnant right now, and I don't want to be treated as such; doing so makes me feel, at the very least, that I am little more than a uterus.

[Sion]

Originally Posted by JustJess

And thus that would mean she'd be liable for my infertility.

and that right there is the root cause of all this: liability. in this overly litigious, sue-happy country we live in, doctors are scared shitless, and rightly so.

[Ayashe]

Originally Posted by ratbastid

Bingo. This isn't a "viewing women as nothing more than baby factories" problem. This is a medical malpractice and liability problem.

Frankly, this is where we end up by being as insanely litigious a culture as we are. This is the result. It's not that medicine is sexist, it's that it's been forced to cover its ass against any potential future liability--and putting oneself at risk of liability for a woman's infertility is a MASSIVE deal. And it's ridiculous in many cases, but there you have it. The cost of malpractice insurance forces doctors to do ridiculous things sometimes.

I agree and also consider this quote from the article.

A recent report raised concerns about women of childbearing age sharing prescription drugs. While the focus of the study was on drug sharing, readers of the Well blog took the discussion in an entirely different direction.

When a physician dispenses a medication he is responsible for giving the patient reasonable amount of data to use it safely. This is also a concern for the pharmacists as well. Now consider that Jane has received that education from her physician and her pharmacist and now receives a prescription for a headache. Jane is on birth control and is not all that concerned about the risk. Now, Jane's friend Suzie comes to visit and has a headache, Jane offers the tablet to Suzie. Jane tells Suzie that these work great for her. Did Jane give Suzie all of the necessary information to make an educated decision regarding the risks involved in taking the drug? Probably not.

[Reese]

Women who are pregnant or who can become pregnant should not handle TFP due to specific birth defects.

I won't pretend to know crap about women and medical care. All I know is forceps are cold and passing a 12cm head through a 10cm hole is probably slightly painful. It seems to me that it's better to ask than to assume though. Rendering someone infertile is quite a big deal and even though I'm fairly sure I don't want kids, having the ability taken away while trying to fix some unrelated problem would kinda piss me off.

[abaya]

I really have no problem with my health professional ascertaining my pregnancy status before treating me. I have never considered that approach to be even remotely offensive--I always saw it as a purely medical thing, and really quite important, actually. I have never felt like "just a uterus," especially since many of my doctors/nurses have been women themselves. Yes, I have a uterus, and I have reproductive organs. They are part of my body, and medicine is about treating the whole body.

Are these people offended when doctors ask them if they are on X medication, or have had Y surgery in the past? It's called a medical history. Why would a potential for pregnancy be seen any differently? My 2 cents.

[snowy]

Originally Posted by abaya

I really have no problem with my health professional ascertaining my pregnancy status before treating me. I have never considered that approach to be even remotely offensive--I always saw it as a purely medical thing, and really quite important, actually. I have never felt like "just a uterus," especially since many of my doctors/nurses have been women themselves. Yes, I have a uterus, and I have reproductive organs. They are part of my body, and medicine is about treating the whole body.

Are these people offended when doctors ask them if they are on X medication, or have had Y surgery in the past? It's called a medical history. Why would a potential for pregnancy be seen any differently? My 2 cents.

That isn't the issue. The issue is doctors refusing to give women treatment or medications (specifically medications that are teratogens) because they might become pregnant someday--whether that day is tomorrow, next week, or six years from now--regardless of the circumstances of the woman's life that affect a woman's ability to conceive.

[xepherys]

Originally Posted by onesnowyowl

This issue stems more from doctors and other medical professionals treating women as if they could get pregnant tomorrow, simply because they have the equipment for it. Not will they get pregnant tomorrow, but COULD get pregnant tomorrow, regardless of all the other factors (like birth control, lack of a relationship, etc).

So, uninvolved women on birth control NEVER get pregnant? Hmmm, that's odd because it's simply not true. The point is, as was mentioned by some wise sage above, an issue of malpractice. You tell the doc "Oh hey, I'm on the pill and not involved anyhow" so they give you medicine X. A week or a month or three months later, while still taking the prescription, you get smashed at a bar and go home with some sleazy dude. BAM! Your pill failed you now (say you were on Med X AND an antibiotic, which can mess up the pill easily). Now you are pregnant. But, you keep taking Med X. Nine months later, your mutant spawn is born. You sue the doctor. Precedent would suggest you'd win.

SO... if you want to complain about the ROOT cause of the overuse of pregnancy questioning and screening, you should bitch at the ignorant women out there that fuck it up for everyone else. Sadly, there are a lot of them (ignorant people who fuck it up for everyone else... not just women).

In fact, if you are annoyed by ANY type of over cautious action, you can inevitably blame it on stupid people, stupid lawsuits or a combination thereof.

[ngdawg]

Originally Posted by xepherys

So, uninvolved women on birth control NEVER get pregnant? Hmmm, that's odd because it's simply not true. The point is, as was mentioned by some wise sage above, an issue of malpractice. You tell the doc "Oh hey, I'm on the pill and not involved anyhow" so they give you medicine X. A week or a month or three months later, while still taking the prescription, you get smashed at a bar and go home with some sleazy dude. BAM! Your pill failed you now (say you were on Med X AND an antibiotic, which can mess up the pill easily). Now you are pregnant. But, you keep taking Med X. Nine months later, your mutant spawn is born. You sue the doctor. Precedent would suggest you'd win.

SO... if you want to complain about the ROOT cause of the overuse of pregnancy questioning and screening, you should bitch at the ignorant women out there that fuck it up for everyone else. Sadly, there are a lot of them (ignorant people who fuck it up for everyone else... not just women).

In fact, if you are annoyed by ANY type of over cautious action, you can inevitably blame it on stupid people, stupid lawsuits or a combination thereof.

QFT.

This is why we have warning labels on everything from dry cleaning bags to hairbrushes.

There is no way of knowing if the drug you're given today will mess you up later and medical malpractice is outrageous already.
When I was on fertility drugs, there came "warnings" in the news that these drugs have the potential for causing ovarian cancer later in life. Well, 15 years later and no one has verified that yet, it was a guess based on some obscure study.

If a doctor refuses to treat you because of the possibility of pregnancy later and the woman knows for sure she'll never get pregnant, she has the choice of finding another doctor. But I don't think it's unreasonable at all for a doctor to be cautious in this regard.-it's ultimately the patient's move.

[AgadorSpartacus]

As a woman and a medical professional (dental field) I take no offense in bieng treated as pre pregnant. I truely think that there are two reasons behind it. I feel the vast majority of the medical community really DOES care about harming any potential child you may be unknowingly pregant with or conceive without intention. The other, as several have stated above, is being scared shitless of getting sued. There's a story of a dentist several years ago prescribing a female patient antibiotics. The dentist didn't ask her if she was on birth control pills. (Neither did the pharmacist for that matter, and not everyone gets all of their prescriptions filled at the same pharmacy, so a pharmacist may not know all of the drugs every customer takes.) The woman got pregnant and did not want to terminate. Well, the woman sued her dentist for a full 18yrs worth of child support. I ask every patient, male or female for a list of all medications. You wouldn't believe how many women don't think that BCP's count as medication. Anyhow, my boss is a total fool IMO b/c he never asks about BCP when he prescribes antibiotics b/c he's a total prude and the thought of knowing that about a woman makes him queazy.

IMO, cut the medical community some slack. The purpose of having a uterus and ovaries is to produce offspring. It's not the job of the professinal to have prior knowledge of your intentions, or lack there of, to use them.

It's really no different than asking a man about his reproductive intentions and birth control methods if he were being given a drug that could cause bad sperm. I highly doubt most men would get there boxers in a twist over it.

[MSD]

The fact is that from a biological standpoint, we're all baby making machines. Men have evaded responsibility because half of us are part of the process for three minutes rather than nine months. Combine that with the fact that our culture is full of people who will sue over everything and bitch and moan about more than that, and the willingness of juries to award absurd lump sums for the slightest infraction, and you end up with people afraid to act.

[inBOIL]

Add me to the "this is all about lawsuits" side. It happens to men, too; Many doctors won't perform a vasectomy unless the patient either has kids or has banked some sperm, and that's when the intent is to render someone sterile.

[Ayashe]

Originally Posted by onesnowyowl

That isn't the issue. The issue is doctors refusing to give women treatment or medications (specifically medications that are teratogens) because they might become pregnant someday--whether that day is tomorrow, next week, or six years from now--regardless of the circumstances of the woman's life that affect a woman's ability to conceive.

Then you find another doctor. The issue though is about informed consent. The original discussion in the OP was about physicians who had concerns about females sharing prescription drugs. With that taken into account there is no possible way that the physician can sit down with that person and say, listen there is a good chance that if you are pregnant and take this you will give birth to a dead or malformed fetus.

You are right though, when you see a physician.. like it or not he/she is going to assess your ability to understand the warnings. He/she is going to also assess your behavior. If he/she believes that you are a risk the treatment may be denied. If a physician fails in that assessment or fails to have it properly documented, then that physician is up shit creek if things go wrong. A physician can say I don't believe in prescribing teratogenic drugs to female patients of child-bearing age that are not on birth control.

Every question you answer is being examined and considered, whether it is how many partners you have, what illicit drugs you use, how much you drink, your age, your gender, how many different physicians that you see. Call it bias if you will but it is their name, their DEA license, their Medical License, their practice, their livelihood at stake with each patient that goes out the door. Frankly, it is amazing that anyone would even want to practice medicine these days.

[Jinn]

If a doctor refuses to treat you because of the possibility of pregnancy later and the woman knows for sure she'll never get pregnant, she has the choice of finding another doctor. But I don't think it's unreasonable at all for a doctor to be cautious in this regard.-it's ultimately the patient's move.

Well said.

[abaya]

Originally Posted by onesnowyowl

That isn't the issue. The issue is doctors refusing to give women treatment or medications (specifically medications that are teratogens) because they might become pregnant someday--whether that day is tomorrow, next week, or six years from now--regardless of the circumstances of the woman's life that affect a woman's ability to conceive.

Honestly, it doesn't change anything for me. I am never in 100% control of my hormones and the contents of my uterus, and that's a biological fact rather than an ideological one. The only exception I can imagine would be if I were a nun.

[Cynthetiq]

Originally Posted by abaya

Honestly, it doesn't change anything for me. I am never in 100% control of my hormones and the contents of my uterus, and that's a biological fact rather than an ideological one. The only exception I can imagine would be if I were a nun.

ummmm helloooooooooooo....Immaculate conception?

[abaya]

Originally Posted by Cynthetiq

ummmm helloooooooooooo....Immaculate conception?

HA! Well yes, in that case, then even if I were a nun... I would be fine with this question. (But there's even chances of nuns getting pregnant.)

[Frosstbyte]

It's pretty simple. Hurt babies=large jury verdicts. It's just impossible to win that one in court, no matter what you do. The legal standard for medical malpractice is more than flexible enough to allow virtually any jury to find against a doctor whose actions (even with informed consent) ended up harming a fetus in utero. It's not so much as social issue as it is a legal, malpractice issue. If we had a system that didn't encourage people to be so litigious and didn't place so much discretion with juries, doctors might be a bit more willing to be flexible in that regard.

[genuinegirly]

The medical world realizes human limitations.

Every method of birth control has potential for failure, save physical alteration. Every woman not rendered infertile is potentially capable of becoming pregnant.
ie -
A woman who is abstinent by choice could be raped.
A woman who is on the pill could miss a day.
IUD and the depo shot are not necessarily designed for each woman's individual body chemistry.


If you're bothered about being treated as "pre-pregnant", then go ahead and find yourself a doctor who will tie your tubes or remove your ovaries and/or uterus.
If you are a woman, you might produce children. Deal with it however you must: mentally, emotionally, and physically. Don't complain.

[basmoq]

ok, to speak as a physician on this subject, I ruled out OB/GYN for this very reason. Women get upset over these sort of questions, but I would NEVER treat a woman of childbearing age without contemplating the possibility of pregnancy. The possibility that she will meet someone down the road and change her mind about children is both real and statistically common. The fact that the pt. tells me that she doesn't plan on having children is irrelevant to her ability to sue later, and there is no legal documents I am aware of that can prevent such litigation. I cannot fathom OB/GYN as an option due to the incredibly high malpractice insurance.

[telekinetic]

I don't understand the uproar about this. If there are two medications, of equal effectiveness, and if you were to get pregnant while on one of them your children would have flippers and three noses, how is it offensive to always give women the one that won't create little mutants, even if they say they don't plan on getting pregnant?

There are no signs of pregnancy until weeks after conception, and a lot of meds and procedures negative effects are strongest in early first trimester. By the time you find out you are pregnant, you already have been for a couple weeks...you can't retroactively go back and untake the flipper-causing meds you've been on.