Bringing our own expertise back into health care

In my latest column for RH Reality Check I reflect on the statement released by ACOG last week supporting making birth control pills available over the counter without a prescription.

What interests me about this, beyond the issue of improving access to contraception, is how it might mark a continuing shift in the role of medical providers in health care.

As doulas, we probably already understand that there is a movement of people working to take back more control and responsibility for their own health, particularly in the reproductive health arena.

In the article I mention Pati Garcia and the Shodhini Institute, a group that is working to bring back the practice of self-help and particularly cervical self-exams as a way to allow people to be more aware and active in managing their own health.

Doulas, in many ways, are part of this movement to empower and encourage pregnant people to be more educated and more involved in their own health.

I know personally this has been a struggle for me, and I’ve mostly been motivated to be more in charge of my own health by my frustration with providers who have not been able to address my own ongoing health concerns. They’ve suggested drug treatments that haven’t worked, tests I couldn’t afford, or dismissed my concerns outright. These negative experiences mean I’ve never built a long-lasting, trusting relationship with a medical provider. The closest I’ve come was an amazing acupunturist/herbalist I saw for over a year in Brooklyn. But with Western medical providers all of my experiences have been negative.

I think this shift could be a really great development in how we all manage our health, but its going to require a serious re-education effort for many of us who have lost touch with our bodies, have come to mistrust our role as experts over our own bodies.

It’s sad, really, when you think about how much we’ve relinquished to the “experts” and how much we’ve minimized our own experiences of our bodies and our health. We rely instead on tests and book knowledge and medical studies, rather than our own daily experience of our lives and our health.

In my ideal world both things would be useful, but in equal degrees.

Armed with the knowledge of our own bodies, rhythms, cycles and changes we can much more effectively partner with medical providers when necessary. We could go to them with knowledge that will help them know how to treat our illnesses, rather than expecting them, from seeing us once or twice a year, to have all the answers. Then we won’t need these prescription-filling visits to remind us to take care of our health—we’ll be taking that responsibility on ourselves.

I’m proud that doulas are playing a role in empowering folks to make this shift–to trust their own intuition, their role as experts on what is happening in their bodies. In the coming weeks I’ll have more information from Shodhini Institute and Pati Garcia about this work.

Read the rest of the column here.


Menstruation Optional

After all the recent buzz about the new birth control pill Lybrel, which gets rid of the traditional “sugar pill” week and allows women to skip menstruating all together–the pill is finally on the shelves this month.

Karen Houppert has an Op-Ed about it at the NYTimes today, and she points out the interesting ways the menstruation as proof of inferiority has been used to certain groups advantage. She points out that when women were needed in the factories during the World Wars, they were told that having their period didn’t matter, and they should “buck up.” But when it comes to having a woman in the White House, its not uncommon to hear PMS and emotional instability thrown around like character flaws.

So we’ll see how Wyeth Pharmaceuticals, the makers of Lybrel, decide to try and market their new pill. But in my own, non-biologist opinion, I have some immediate concerns about these new technologies:

  • All those synthetic hormones? I personally am wary of all hormonal birth control, I’m not sure if I believe that there are no negative side effects to them. I’ve also been told that when you introduce synthetic hormones into your body, your body doesn’t make any of its own hormones–so you might be subsisting at a level that is too high or too low for you, which can have side effects like bone loss. Also let’s remember the Hormone Replacement Therapy fiasco.
  • What about the good effects of the sloughing of the uterine lining each month? I think of it as rejuvenatory, allowing new and healthier cells to grow in its place. Could this have an impact on risk for uterine cancers?
  • Lastly, when I think of missing periods, or amenorrhea, I think of it being an indicator of something else wrong with the body–bad nutrition, stress, (or pregnancy). How can something that indicates a bodily imbalance be a good thing?

There could be a lot of other arguments about how great menstruating is, and how it connects us with mother earth, la pacha mama or the lunar calender. I’ll spare you all of those, and leave it at my concerns above.

All of this controversy reminded me of a great piece written by Gloria Steinem, called If Men Could Menstruate. Read it. While published in 1978, I think it has particular resonance today.

I’d love to hear what other doulas and midwives think about this new pill.