Medical Students for Life

[smq123]

Planned Parenthood is not sacred. I'm just not particularly swayed by the some of the criticisms that you've raised.

Who says you need to be swayed?

My initial posts about Planned Parenthood were deliberately vague. My experience with them were all extremely painful, and that made me extremely uncomfortable about sharing them. As I got angrier, I shared more.

But - I'm not looking to get people to sign some petition to get Planned Parenthood to shut down, or trying to recruit people to boycott Planned Parenthood. Do I think that it's an organization that (to me) has contradictory methods of fulfilling its "mission statement"? Yes. Do I want everyone to think EXACTLY like me? No. Do I think that all women should automatically be apologists for the organization? No - I don't think that people should be automatic apologists for ANYONE. I criticize every organization that doesn't look like its fulfilling its "mission statement."

Yes, patients lie. In the case that I provided, she was coming to us asking for birth control - she finally woke up and realized that it might be a good idea. (Hey, when you were 21, how logical and intelligent were YOUR thought processes? Yep, she'd had nine abortions by the time she was old enough to drink.) When we asked her why she hadn't started on it right after her last abortion, she said that it'd never been suggested to her. Whenever you prescribe birth control for anyone, you need to do a urine pregnancy test, and hers was positive.

Underlined part...All women? This may be policy at your hospital but it is by no means universal. Speaking from my own personal experience on this point.

No, this is standard of care at all US hospitals. All patients need to be asked about what their planned birth control regimens will be. If they have an idea, they go home with either a prescription or something in hand. (Some women get a Provera shot right before they're discharged.) If they don't, then we hound them until they DO have an idea of what they want.

You need to go on birth control right after delivering, just so that you don't get pregnant again right away. Babies that are conceived right after a delivery tend not to do as well.

---

Members don't see this ad.

 

[All4MyDaughter]

Who says you need to be swayed?

You wondered if criticizing Planned Parenthood was "verboten" because people are defending PP from your arguments/criticism. I suggested that perhaps the reason people are defending PP/attacking your criticisms was because they aren't particularly compelling. You don't like PP because you had a bad experience there. You feel PP is "controversial" and has bad "priorities." You haven't shown any evidence other than your personal experiences, conjective and hyperbole that would support your position. That was my point.

No, this is standard of care at all US hospitals. All patients need to be asked about what their planned birth control regimens will be. If they have an idea, they go home with either a prescription or something in hand. (Some women get a Provera shot right before they're discharged.) If they don't, then we hound them until they DO have an idea of what they want.

You need to go on birth control right after delivering, just so that you don't get pregnant again right away. Babies that are conceived right after a delivery tend not to do as well.

Hounding women who've just delivered a baby? Fantastic. Stay out of *my* hospital room. I think you can ask what method of birth control they intend to use, but it's factually untrue to say that ALL post-partum women leave the hospital with contraception. Standard of care or not, women are still free to decline medical interventions like contraception and many (including an entire subset of the religious right) do decline.

 

[All4MyDaughter]

Stupid suffrage.

 

[smq123]

Hounding women who've just delivered a baby? Fantastic. Stay out of *my* hospital room. I think you can ask what method of birth control they intend to use, but it's factually untrue to say that ALL post-partum women leave the hospital with contraception. Standard of care or not, women are still free to decline medical interventions like contraception and many (including an entire subset of the religious right) do decline.

<sigh> It was a joke. Which had more to do with the fact that I feel ambivalent about post-partum rounding at 5 AM. Asking half-asleep women at 5 AM if they've "passed gas," are planning to breast or bottle feed, and if they've thought about birth control is mildly awkward, to say the least.

Rounding on patients at 5 AM (especially when they've been up for so many hours in labor) tends to involve a significant amount of "hounding." A lot of times, it tends to go along the lines of: I wake patient up, patient mumbles an answer and attempts to go back to sleep. I refuse to let patient go back to sleep, and keep pumping them for more information until either they or I cave. There was a spoof video by one of the local medical schools a few years back that showed this type of exchange - it was hilarious because it was so true.

If you don't really round on post-partum women at that hour of the day, then the joke didn't make sense to you. Sorry for the misunderstanding.

And yes, all women DO need to leave with some "contraception" plan in place. I'm not sure what your example of the religious right and their right to decline had to do with anything, since abstinence IS contraception.

All the women leave with contraception - either a prescription, an injection, or a solemn promise to use condoms or just not have sex. They also leave with a prescription for a LOT of condoms, and (in one place I rotated through) spermicidal foam, of all things.

 

[All4MyDaughter]

Well, the latest iteration of your story makes a bit more sense than "ALL women leave the hospital" with either a prescription or product in hand. Unless you write scripts for abstinence, in which case:

Your earlier posts were talking about contraceptive products, which is different from a contraception plan, which could include natural family planning methods or abstinence or something else I'm not thinking of. That does clear it up a bit, indeed. Thanks for adding more information.

I do stand by my assertion that women are free to decline and yes, there are some religious groups that eschew all forms of contraception. Their belief is that "God will only give them the children they are meant to have according to His plan." Not my cup of tea, but it happens. You've heard the term "Irish Twins" before, I'm sure. Although this phenonmena is probably more common with Protestant Fundamentalists in this day and age.

 

[smq123]

Well, the latest iteration of your story makes a bit more sense than "ALL women leave the hospital" with either a prescription or product in hand. Unless you write scripts for abstinence, in which case:

To be honest, I've never had a patient just decide to use abstinence. Maybe it's just where I live vs. where you live, but...not a lot of patients in my area that refuse contraception. A lot of women that half-jokingly say "Birth control is NOT an issue, because he's not touching me ever again!," but they ultimately go home with a prescription or a product anyway. (At least, I THINK that they're joking....)

Actually, at many hospitals, ALL women DO leave the hospital with a prescription in hand. At that one hospital where I rotated, we never even asked women - we'd just put a prescription for condoms and spermicidal foam into their discharge papers. Whether they used them or not wasn't really our concern, but they got a prescription whether they wanted to or not. And this was in a part of the country that is somewhat more religiously conservative than the place where I live.

And even women who don't normally like birth control will (somewhat grudgingly) agree to use it for a short period of time after delivery.

EDIT: Actually, I had a patient who was an open lesbian, and she tried to refuse birth control AND condoms since she didn't feel like she needed either. The chief's response was along the lines of "Tough crap, you're getting the prescription anyway." So, at many hospitals, all patients really DO leave with at least a prescription in hand.

 

[All4MyDaughter]

I agree it could be regional differences. It could also be attributed to the difference between teaching/university hospitals and community hospitals without residents, med students, etc. I *do* live in a part of the country with lots of RC's and equal numbers of religious fundies. I know lots of families with Irish twins, and/or a zillion kids.

 

[MSU2012]

To be totally frank, I HATE Planned Parenthood. They spend so much damn money on being able to provide abortions that I feel like they tend to neglect the other ways of actually preventing abortions. They can spout all the crap that they want about how they just "provide abortions," but don't believe that abortions are a good method for birth control....but that's going to be difficult to believe until they put more effort into improving both their birth control counselers (some of whom barely speak understandable English) and their birth control provision services.

</soapbox>

.....

Like I said, if Planned Parenthood were that committed to actually improving the health of young women, they'd put more time and money into community outreach and providing education that actually got people thinking about birth control.

Not to jump back a bit, but I have to. I don't know about your experiences, but in my state 97% of planned parenthood's budget goes to preventative health care such as free and reduced price physicals and birth control. Let's say that again: 97%! Which leaves only 3% dedicated to abortion services or pro-choice political activity. I'm sick of Planned Parenthood being portrayed as awful baby-killers when the vast majority of their resources go toward helping low income women have access to healthcare. Most "pro life" groups spending virtually 100% of their budgets on lobbying and advertising. I don't see them hiring any doctors or providing health care to women who need it.

Most of my college-age friends get birth control through planned parenthood because it is the only place that cuts them a break because of their lack of income. I don't see any pro life group sponsoring similar initiatives. In fact, most of them in my state lobby against any efforts that would improve access to birth control.

 

[zmeister22]

How about this: Anyone woman who needs birth control and can't afford it gets it for free (government subsidized). I'm not a giant government lover but think about it: Pro-Lifers (usually the conservatives) are happy that more abortions will be prevented and will tolerate the cost because 100 women on birth control is cheaper than 1 child on welfare, and pro-choicers (usually the liberals) are happy that there is another social program in place for women and children and don't care about the cost. Result: fewer abortions, fewer welfare dependent kids. Now we just get to debate the merits of abstinence only education and wether or not we can tell women that this is available... Just my two pesos on the subject.

 

[smq123]

How about this: Anyone woman who needs birth control and can't afford it gets it for free (government subsidized). I'm not a giant government lover but think about it: Pro-Lifers (usually the conservatives) are happy that more abortions will be prevented and will tolerate the cost because 100 women on birth control is cheaper than 1 child on welfare, and pro-choicers (usually the liberals) are happy that there is another social program in place for women and children and don't care about the cost.

The problem is is that most hard-core pro-lifers are also against birth control as well. "Life starts at conception" and all that.

 

[KeyzerSoze]

The problem is is that most hard-core pro-lifers are also against birth control as well. "Life starts at conception" and all that.

Um, birth control prevents conception.

 

[Combatbarbie]

If you don't like abortions don't do them.

 

[Perrotfish]

The problem is is that most hard-core pro-lifers are also against birth control as well. "Life starts at conception" and all that.

Um, birth control prevents conception.

Some hard core pro-lifers are against a few types of birth control that prevent implantation of a fetus (i.e. after sperm meets egg). This allows for condoms, mechanical IUDs,some types of oral contraceptives, tubal litigation and vasectomies, etc, but excludes some options in terms of oral contraceptives (particularly the 'morning after pill').

There are also several religions that believe that, within marriage, you shouldn't use contraception at all, for reasons unrelated to the pro-life debate. Catholics are one of these. Most of these groups recognize that this is a religious beliefs issue, as opposed to the pro-life movement which they see as a social justice issue. They generally don't work to prevent contraception from being sold in stores and, at least for the Catholic Church, they make it very clear that if you're planning on having sex outside of marriage they 100% want you to be using a condom.

 

[lilnoelle]

The problem is is that most hard-core pro-lifers are also against birth control as well. "Life starts at conception" and all that.

I don't think this is accurate. There are SOME groups that are against birth control. (Catholic church?) But I don't think its the majority.
I would say the majority of pro-lifers are VERY pro birth control as well.

The religious pro-lifers are definitely pro-abstinence which is apparently considered to be not a valid option by the majority of individuals today.

 

[Lopyswine]

Do I think that someone should have sat her down and said, "You know....once you're unable to count the number of abortions that you've had on one hand....there's something really wrong here...."? YES.

can you explain why you feel this way? why is your view that something is "wrong here"?

Its an elective procedure that the patient chose to have. Why does it involve you in ANY WAY?

 

[alwaysaangel]

Um, birth control prevents conception.

Actually, I found out when we covered sexual physiology last year that the birth control pill actually allows ovulation 25% of the time, which means conception could occur, but the endometrial lining is so thin it cannot implant. Surprised me too. But as others have said most religious groups have a theological problem with birth control, not the conception thing.

 

[All4MyDaughter]

Actually, I found out when we covered sexual physiology last year that the birth control pill actually allows ovulation 25% of the time, which means conception could occur, but the endometrial lining is so thin it cannot implant. Surprised me too. But as others have said most religious groups have a theological problem with birth control, not the conception thing.

Yes, most oral contraceptives inhibit ovulation, but most also have other actions as well including: changing cervical mucus, altering the endometrium and interfering with transport of the ova through the fallopian tubes.

I think the religious belief that "life begins at conception" is more important than other posters have alluded. Particularly as it pertains to the debate about Plan B. This has been discussed frequently on SDN. If people believe that "life" begins when sperm hits egg, then Plan B and other OCP could be considered to interfere with life. I think this is a poor definition of life. Many fertilized eggs never even implant. A fertilized egg is more "potential life" than anything else.

There are also those who (falsely) believe that Plan B is an abortifacient. But, pregnancy begins at implantation, and Plan B has no effect once implantation has occured. I've had colleagues (who should know better) tell me, "I'm just worried that it could cause an abortion and I don't want that on my soul." I live in a very religious part of the country.

There is so much misinformation and so many emotions clouding the issue of female reproductive health.

 

[smq123]

can you explain why you feel this way? why is your view that something is "wrong here"?

Its an elective procedure that the patient chose to have. Why does it involve you in ANY WAY?

If someone has one abortion, then fine. She made a mistake.

Two...okay, so she made another mistake.

SIX....okay, you're not making mistakes, you're either being lazy or someone has gravely misinformed you about contraception.

An abortion is STILL a procedure that has its risks. Why subject yourself to multiple abortions, needlessly, when you could take birth control instead? Or have an IUD inserted? Why keep putting yourself under anesthesia, having your cervix dilated, having something inserted into your uterus, repeatedly? The risks of infection, uterine perforation, and Asherman's syndrome are REAL....why keep doing that when you could avoid it with a small daily pill?

If someone keeps having gum infections, do you just keep giving them antibiotic after antibiotic? Or do you remove the source of the infection in one fell swoop, and keep the patient from having to take so many antibiotics (which aren't benign either)?

I mean, I would think that it'd be obvious as to why that many abortions is a really bad idea, elective procedure or not.

 

[Lopyswine]

If someone has one abortion, then fine. She made a mistake.

Two...okay, so she made another mistake.

SIX....okay, you're not making mistakes, you're either being lazy or someone has gravely misinformed you about contraception.

An abortion is STILL a procedure that has its risks. Why subject yourself to multiple abortions, needlessly, when you could take birth control instead? Or have an IUD inserted? Why keep putting yourself under anesthesia, having your cervix dilated, having something inserted into your uterus, repeatedly? The risks of infection, uterine perforation, and Asherman's syndrome are REAL....why keep doing that when you could avoid it with a small daily pill?

If someone keeps having gum infections, do you just keep giving them antibiotic after antibiotic? Or do you remove the source of the infection in one fell swoop, and keep the patient from having to take so many antibiotics (which aren't benign either)?

I mean, I would think that it'd be obvious as to why that many abortions is a really bad idea, elective procedure or not.

of course as a dentist I would try to remove the source of the INFECTION. If the infections returns due to the patient not being careful, guess what, I'LL TREAT THEM AGAIN. and again and again. WHY? because that's my job. Its not my place to judge my patient for not brushing. Its not my place to judge someone for not flossing. It IS my place to treat them when they come in. Regardless of what puts them in the chair, I will treat them.

To Tired,
Thank you. That is exactly my point. If you take the moral question out of the equation, then abortion is just another elective procedure with risks. Those risks are described to the patient and she makes a decision whether or not to go forward. Its not right for us to get between a woman and her physician.


EDIT: For some reason, I feel the need to say that even though I am pro-choice, my fiance and I would not have an abortion. She has a twisted uterus and other "woman" issues. We are not sure if a baby is even possible, so if one happens by accident, we're having it. That being said, in no way should the physician be a part of our decision other than to explain the risks of the procedure.

 

[smq123]

If you believe, and he/she obviously does, that abortion is a simple medical procedure with no morality/immorality attached to it, this is a perfectly legitimate argument. No different than having multiple EGDs, cosmetic surgery, etc. It's between the woman and their doctor.

I can see your point, but I still think that, regardless of your stance on the morality of abortion, it's still your responsibility to talk to your patients whenever they make potentially dangerous medical decisions.

EGDs may be morally neutral procedures, but I would do my best to avoid doing any of those unnecessarily. If possible, it's better to talk to your patients about behavior modification that would avoid putting them in the position to require multiple EGDs.

In the case of abortions, the prevention measures needed to avoid multiple abortions is MUCH easier than talking to your patients about avoiding alcohol or foods that cause heartburn. An IUD would be enough, and requires almost no maintenance on the patient's part.

All I'm saying is that Planned Parenthood as a "healthcare" provider should talk to its patients about their decisions. I find it hard to imagine that many patients who have had that many abortions would honestly think that an abortion is a better and less painful option than, say, an IUD insertion.

And, to be honest, I do agree with you that I find it a little contradictory that many pro-choicers are fervently in favor of "choice," but (in the same breath) say that abortion is not birth control.

of course as a dentist I would try to remove the source of the INFECTION. If the infections returns due to the patient not being careful, guess what, I'LL TREAT THEM AGAIN. and again and again. WHY? because that's my job. Its not my place to judge my patient for not brushing. Its not my place to judge someone for not flossing. It IS my place to treat them when they come in. Regardless of what puts them in the chair, I will treat them.

So....you wouldn't sit down with your patient and recommend a root canal, to remove a nidus of infection? You wouldn't even sit down and talk seriously with them about the importance of brushing and flossing?

My argument was that, after your sixth abortion, you have to wonder a little why the provider wouldn't sit down and talk seriously with that patient about finding a more permanent solution. At the very least, give that patient a Provera shot or something. It gives the patient 3 months of protection.

 

[Lopyswine]

So....you wouldn't sit down with your patient and recommend a root canal, to remove a nidus of infection? You wouldn't even sit down and talk seriously with them about the importance of brushing and flossing?

My argument was that, after your sixth abortion, you have to wonder a little why the provider wouldn't sit down and talk seriously with that patient about finding a more permanent solution. At the very least, give that patient a Provera shot or something. It gives the patient 3 months of protection.

when did I say I wouldn't recommend a root canal?

I think you aren't understanding my point. Of course patient education is an important part of health care. As a dentist it is my job to TELL the patient how to brush and floss. As a physician your job is to TELL the patients the risks/benefits of a procedure. However, in the end what the patient does with the information is up to them.

You say in an example that the provider hasn't mentioned a permanent solution. Where is the proof that those women who've had multiple abortions, have not had a provider explain an IUD or depo to them?

If the patient is completely in the dark about options then the physician hasn't done his or her job. However, if the physician has informed the patient and she still decides that abortion is her preferred method of birth control, then what else can you do?

 

[Trail Boss]

I think that physicians have one of the rare jobs where you actually need to think about what is right and wrong, not just what is legal and illegal. I don't think that it is any more wrong for someone who doesn't believe in abortions to deter or refuse than would some of you on this forum feel that it would be wrong to perform an abortion if it were illegal in this country. Legality just happens to play into your favor right now. I don't think you can legislate right and wrong. Some bad stuff has been done in this country and others recently and in the past just because it was "legal" at the time or in the situation.

 

[smq123]

You say in an example that the provider hasn't mentioned a permanent solution. Where is the proof that those women who've had multiple abortions, have not had a provider explain an IUD or depo to them?

If the patient is completely in the dark about options then the physician hasn't done his or her job. However, if the physician has informed the patient and she still decides that abortion is her preferred method of birth control, then what else can you do?

I think that's part of my point, though.

In other aspects of medicine, prevention and patient education is VERY hard. You can talk to patients about flossing, or eating healthily, until you're blue in the face - it probably won't do much good. The only way you can get some people to change their lifestyles is to physically wrestle the cheeseburger out of their hands....and that's obviously going too far.

But offering birth control after a procedure is SO easy. Is it really that difficult to offer an IUD after a procedure? Some OB/gyns are now offering IUDs right after delivery (although, granted, there are some concerns of expulsion right after parturition. I'm not sure if that happens that frequently after an abortion, though). Offering a Provera shot is even easier, and there's no fear of expulsion there.

My point is, if you explain an IUD or Provera to a woman, you can offer it to her right away. There's no reason not to, and many women would take them up on that offer. (Abortions are pretty painful, and I think it's reasonable to say that most women would rather not have one.) It's rare to hear of a woman who has no moral issue with abortion to have a moral issue with birth control.

Based on my experiences with patients who have come in post-abortion, and ARE in the dark about birth control, and the fact that they weren't offered anything right after abortion....it makes me doubt that the abortion providers at Planned Parenthood are really having these discussions with their patients.