Stirrup-Side Manners: A Plea
This is an overdue rant. It is the spillover from the inner monologue that piped up the first time I received a grossly insensitive communication from an OB/GYN. I was oddly shy about speaking up for myself, and now I find myself letting loose a longer diatribe, expanded to address a trifecta of examiners who had me belly up, legs open, and speechless. Names have been changed to protect the oblivious. I don’t want to blindside them the way they blindsided me.
Let’s start with Sybil, a nurse practitioner in New York with an Irish brogue. I was a nurse practitioner myself, albeit dealing with the literal other end of the care spectrum — psychiatry — and I was a bit enamored of Sybil. She was efficient and knowledgeable, and I am sure her accent solidified my initial impression of her as a charming and competent care provider. But during my final visit to her, before my husband and I moved to Connecticut, Sybil brought up the topic of motherhood — was I considering it? Things went sour fast.
It was clear from the dreamily hopeful expression on Sybil’s face that motherhood was one of her most adored discussion topics. But I hemmed and hawed, a manifestation of my ambivalence on the possibility. I cited our imminent move and job changes as a key reason why it was not a good time to get pregnant. I didn’t get into more personal stuff, like financial worries or the deep-seated concerns about fatherhood with which my husband was wrestling. After all, I only saw Sybil once or twice a year. But I was flummoxed by what came next.
Sybil’s voice ratcheted up to a near shriek; her rolling rrrrs coming at me like thunder: “Katherine, your eggs are rotting!! You’re running out of time!” Certainly I knew a bit about the proverbial ticking clock, declining fertility, and greater chances of medical issues as I aged. But I was not yet 30 when Sybil knocked the wind out of me with her now-evil sounding brogue. I stammered something about considering adoption if I couldn’t get pregnant, and was then struck wordless by her next pronouncement, her lilt now morphing into something malevolent-sounding: “Do you really want to adopt a little black baby when you could have your own completely healthy, white child?” I remain ashamed that I didn’t rise up and put Sybil in her place, but all I did was stutter and stumble my way to the checkout desk, stamping her practice’s name onto my check with silent and blurry-eyed fury.
Years of pleasant-enough exams and conversations with OB/GYNs intervened, the pinnacle being pregnancy and childbirth. I idolize the obstetrician who delivered my son in Connecticut — she knew just what to say and when to say it, throughout the pregnancy and as I delivered Gavin. I see her around from time to time and always have to curb an impulse to ambush her with a hug.
It wasn’t too long after Gavin’s delivery — 3 months I think — when I returned to the practice to see a different clinician for a new mother checkup, toting Gavin’s carrier into the exam room. I was 34. Although I don’t think his little eyes could yet see much, I discreetly turned Gavin away when I had my exam. Then my examiner — let’s call her Diana — began a conversation about another potential run at motherhood. Not an unreasonable topic — I had to use a different kind of birth control while nursing, and practical matters such as these have to be addressed.
I replied in ambivalent fashion once again. I had actually loved my pregnancy, and even the (blessedly brief) delivery. I loved my new baby intensely. But motherhood was so big and scary, on so many levels. I had the usual new mother anxieties. Besides that, in the early weeks since the delivery I had some disturbing thoughts I hadn’t shared with anyone. I was monitoring myself for postpartum depression and had just recently begun to level out, in terms of my thoughts and mood feeling normal again. I don’t recall Diana asking me about how my brain and emotions were faring.
Again, I found myself in a scenario in which a clinical conversation turned into the dispensation of a passionate, verbal, and perhaps hormone-fueled Op Ed. Diana was a new mother herself, of twins. She cooed at length about how even at such a young age the twins were so connected with each other, about what an amazing relationship they were developing. This spun into the strong recommendation that I have another child, and soon. Diana went on for quite a while, making it sound like choosing to have just one child was not really an option. She was tapping into my own private guilt festival about not spawning a playmate and lifelong companion for my son. She continued to expound, injecting her opinion into my future pregnancy plans (or lack of them). I left confused and angry, left with the strong impression that most OB/GYNs live for the OB and are not that excited about the GYN.
Fast forward 13 years since that new mother visit. I was parenting a teen and often visited my elderly mother, who has dementia. I had recently lost my brother to a drug overdose after harrowing years of addiction that flattened the whole family. Life had thrown some hard punches, but I finally got it together enough to schedule a well-woman checkup.
I was officially postmenopausal, in that more than a year passed with no periods, and I was thankful as I made the appointment that there would be no more baby conversations for which I had to brace. But this visit left me formulating the paragraphs of this rant before I even put the gown in the hamper. My clinician — let’s use irony and call her Hope — seemed quite annoyed by my failure to be seen for several years. I let that go; clearly she hadn’t bought into the concept of positive behavioral reinforcement.
But her sour expression stayed put, and then Hope got positively scary when I mentioned (quite off the cuff since she hadn’t asked) that I’d just had another brief period after more than a year of no periods. She looked at me ominously, and her voice descended into a deep, dramatic, register. “We take that very seriously. We must get you in for an endometrial biopsy.” I couldn’t shake the perception that her voice and facial expression had a punishing tone, as if my skipped visits had earned me an awful fate. The conversation that followed offered no balance, no nuance, no implication that some women in fact have periods when they are technically already menopausal and live long enough to tell the tale. All I remember is that Hope kept using the word “bad”, as in “We have to look for something bad.” “There may be something bad.” “We need to make sure nothing bad is going on.”
When I had the actual biopsy appointment, I made sure it wasn’t Hope who would be doing the procedure. Superstitious maybe, but I didn’t want her negative hands touching me. The doctor who did the procedure presented a much more balanced picture and I left feeling a bit less crazed with worry. As it turns out, I was healthy despite my ovaries’ surprise party, but, in case “Hope” is reading, I would have had the test even if I hadn’t been scared shitless by the way she presented the concern at hand.
I don’t believe any one of these practitioners was intentionally malicious (although Hope did seem to be in an incurable bad mood). They all seemed competent enough, in terms of the clinical and technical aspect of their business. But here’s the thing: OB/GYN practitioners enjoy a unique brand of power, and I can only conclude that some of them become oblivious to this power that they wield stirrup-side. They talk with us about the creation or loss of our children. They ask us when we last had sex, whether we are monogamous, and whether we feel safe at home. They have us, literally and figuratively, in a highly vulnerable position.
I’m genuinely grateful for the many efforts at a gentle exam, the useful information, and the excellent pregnancy and labor coaching I’ve received over the years. I’m also grateful that I have learned, at long last, to speak up about my experience, encouraging other women to do the same. But from the very bottom edge of the cold, narrow exam table, I offer up a naked plea to OB/GYN clinicians everywhere. I ask you to brush up on technique that has nothing to do with the vulva or the speculum, and to think about the effect of your words and your tone as much as you think about my Pap smear and my plans for motherhood. I ask you to check your opinions, assumptions, and bad moods at the door. You are privy to private areas that extend beyond the focus of your exam lamp. Please remember this the next time you wield your speculum: we all put our pants back on the same way — one leg at a time, grateful for every kind and sensitive word that’s given, and learning every day.