Thursday, September 14, 2006


I was watching Grey's Anatomy about a week ago and one of the story lines was about a woman pregnant with her seventh baby who was about to undergo a cesarean section and who didn't want to have any more babies. Normally, she would be a good candidate for a tubal ligation, but her husband was a staunch Catholic and refused to go against that church's teaching about using no birth control (except for the rhythm method, which isn't really birth control.) Because of that, the woman would not sign consent for tubal ligation, but she really wanted the obstetrican to do it anyway. The OB felt sorry for her and during the cesarean section "bovied" (cauterized) the Fallopian tubes - she made up some excuse like there was bleeding by the tubes - and rendered the mother sterile. The assisting resident was offended by this - remember, they had no consent to block the Fallopian tubes - and told the woman's husband, who threatened a lawsuit against the hospital, and so on. (I think I've got the story line right; I only saw part of the show.)

The episode reminded me of a conversation I had long ago with an older obstetrician who was a Catholic himself. He told me stories of obstetricians in the 1960's and 70's doing hysterectomies for birth control in Catholic women who wouldn't have their tubes tied because of the church's prohibition against it. The OB would fabricate a reason for the hysterectomy - say the woman had excessive bleeding, for example - do the hysterectomy and voila, faster than you can say"unethical behavior", the mother has birth control but doesn't have to tell anyone, including her Catholic friends or priest, the real reason for the hysterectomy.

I'm not writing this to debate the correctness or not of the Catholic church's teaching that birth control is wrong. I happen to think it's wrong, but a church has the right in our country to believe what they want. But I am bothered that obstetricians would actually do that. It's not only medically unethical, it's not even correct from a moral or Christian standpoint. In order to do the hysterectomy, the OB would have to, one, lie about the indication for surgery, and two, put the woman's life at unnecssary risk by doing an operation that was more than was needed to effect birth control. In other words, lying and causing unnecessary harm were okay; just don't go against the church's teaching re birth control.

I don't doubt that this happened. I've known Catholics and some can be very picky about doing what the church teaches. It's as if the teachings of the church trump common sense and morality. I don't think, though, that it happens much anymore, mainly because most U.S. Catholics ignore the church's teaching about birth control. I wonder, though, if it still happens once in awhile, or if it happens in other countries where perhaps some Catholics are more adherent to their church's teachings. Happening even once is too many times.


Blogger stockingup99 said...

Monty Python sang a tune:

Since when do doctors need consent anyways. They seem to have lots of reasons to take away my rights.

After many discussions on how I would prefer to tear, I saw the sOB doing an episiotomy. I asked him to stop, and he continued.

Tubal ligation carries risks, and that's why I do rythm. There is no safe birth control. Every one I have researched has side effects I am not willing to risk.

Caught between a rock and a hard place. Having a fourth baby wouldn't be a hardship. It is the fear of what the system will do to me for not going to the hospital to be 'delivered of my illness'. Around here homebirths are reffered to CPS. And doctors are bullies. No food or water for labor, and enforced separation. Draconian. No tubs, no birthing stool, and enforced lithtomy.

Take back our birthing rights. Women have been having babies outside hospitals for much longer than inside. Why risk going to a hospital? Oh, that's right, Dr. Amy has decreed homebirthers are ...

10:30 AM  
Anonymous Anonymous said...

Actually, all of the things the Catholic dr described are very much against the faith, but Catholics (and all Christians)aren't supposed to judge each other. There is a real lack of understanding of the Catholic faith & the Humanae Vitae (key encyclical written about the importance of human reproduction) if a woman is willing to go so far as a hysterectomy to avoid discussing her options. There is a lot in this post that is both very sad and also ignorant about Catholicism.

For starters, NFP is not the rhythm method at all, it is very effective, about the same as the pill if done properly. After a baby is born, ecological breastfeeding until the cycle returns and charting can begin is very effective. Of course, everybody knows an exception but in my experience you can safely delay or avoid pregnancy this way. The church has also always put the mother`s life first, so if she has a grave reason to not be pregnant, she could have a tubal or even an abortion in severe cases like early and dangerous pre-e or cancer in the mother for example.

11:48 AM  
Anonymous Anonymous said...

As a Catholic, I was really bugged by that episode. While, I'm not 100% in agreement with my church on birth control, I do see a point in fertility awareness for natural birth control. The constant refrain about the rhythm method is misleading.

Now, fertility awareness/natural family planning isn't always going to be easy*, but you'd hope this couple would have at least tried it first.

*I say this from experience, not as someone who has had oopsie pregnancies, but simply as someone who has followed her own cycles to anticipate my period, and the signs of ovulation (ie cervical mucous) were really obvious when I was a teenager, but they're pretty much invisible to me now that I'm trying to figure them out in preparation for my marriage next year. Yeah, I can take temperatures, too, but you need a consistent good night sleep to see a real trend.

3:11 PM  
Anonymous Dianne said...

you need a consistent good night sleep to see a real trend.

Hello, oopsie second pregnancy! Seriously, you're not going to get a good night's sleep with an infant, although if you breast feed very regularly you MAY be infertile from that. (Though not necessarily. I know one woman who got pregnant while exclusively breastfeeding triplets.)

Another problem with any NFP method is that it counts on regular menses to work reasonably well. If your menses are irregular (as mine are...I sometimes think I have a menstral random event, not a menstral cycle), then NFP will fail for you on a regular basis.

While we're on the subject, I have a question about Catholic theology. I hope it isn't too offensive. So, if having children is good and interfering with fertility is bad, isn't abstinence the ultimate evil? If you don't have sex it's almost certain that you won't have children. Isn't that even more not being open to bearing all the children god wants you to than using birth control?

4:03 PM  
Blogger Flea said...

How about doctors who obtain consent and tell the truth about what they're doing etc, but do operations that violate primum non nocere? For example, see the story of the docs who amputated Ronnie Lott's finger.



4:38 PM  
Anonymous Anonymous said...

Dianne, yeah, that is kind of offensive. I came here for a discussion around medical realities, not to discuss theology that isn't connected to biological facts.

6:16 PM  
Anonymous Anonymous said...

for the record, I think the assisting resident should have kept his mouth shut. that the wife and her husband had major disagreements between them was not really an issue of medical ethics. fact was the patient consented, even if it wasn't on paper. all he did was get his colleague in trouble and pissed at him, and stir up further trouble between the husband and wife.

6:22 PM  
Anonymous Anonymous said...

"In other words, lying and causing unnecessary harm were okay; just don't go against the church's teaching re birth control."

to continue my babbling, if not for the lying, are you against women electing to have tubal ligations for birth control when there are no barriers (ideoligical, privacy oriented or otherwise) to other forms of contraception, or does that fall under unnecessary harm in your view?

6:27 PM  
Blogger SmartBlkWoman said...

It's as if the teachings of the church trump common sense and morality.

Neonatal Doc, the teachings of the church are their morality.

I completely respect the Catholic viewpoint and I'm actually considering the discontinue of my artificial methods of birth control. But then I'm not having sex with anyone so this shouldn't matter too much.

Patients have the right to get whatever treatment they want done, even if other people think it is completely ridiculous and we don't understand it.

6:39 PM  
Blogger M's said...

First let me start by saying that I LOVE Grey's Anatomy. Love love love. Second... as a nurse, medically that show is bogus.
I believe that no one has any right to judge another being. That being said... although I will not judge someone for their religious beliefs, I do not agree with the catholic religion on this issue and I probably could go on and on (but I won't, don't worry). One question sums up what I believe: Is the health of children more important than the health of the mother? No, it isn't (in my opinion).

Although I love Grey's, that particular episode got to me as well. Addison did the right thing by doing what her patient wanted ...but yes, she should have gotten consent. Without consent, legally, she shouldn't have done any procedure. Next: the woman needs to suck it up and stand up to her husband. It happened, why lie? If a religion is the basis for you lying to your husband you have bigger issues than using tubal ligation as birth control. Next: Alex was a prick and shouldn't have gotten involved and breached pt. privacy.

In the litigious society that we live in with the cost of malpractice insurance as is, I believe there is no room for this type of behavior.

7:05 PM  
Anonymous Laina said...

Just a note about the rhythm method: IT IS NOT THE SAME THING AS FERTILITY AWARENESS.

Fertility awareness [not the rhythm method] is actually quite effective, if you do it right. By 'do it right' I don't mean count the days since your last period, I mean measure your basal body temperature every day and check your cervical mucus to see if you are fertile, and abstain from sex for 6-9 days [or use a barrier, which I imagine the people in question are not into] depending on your cycle. It has such a bad reputation because everyone thinks that it only consists of counting the days. It doesn't. If done correctly [meaning you are diligent about checking your cervical mucus and your basal body temperature, charting these things, abstaining from sex when necessary, and ONLY USING THE METHOD IF YOU HAVE A REGULAR PERIOD] it is up to 95% effective. There are tell-tale signs that a woman is ovulating, and they are evident when a female is aware of her bodily changes. Does your cervical mucus resemble egg-whites? Well, you're probably fertile, don't have sex. Of course, most people will not use this form of birth control properly, considering the fact that so many women can't even take a pill on time, much less check her cervical mucus, check her temperature, and record this all first thing in the morning. Nonetheless, for the people that use it properly, it works.

7:09 PM  
Anonymous Pine Baroness said...

Neonatal Doc - you always have interesting thought provoking posts.

This topic was explored on the TV show House, too. A woman was receiving fertility treatments to go along with her hubby's wishes for a child but she didn't want one so she was also taking the pill. It caused all kinds of medical problems.

If you have never seen it, it is good, about a crochety but smart doctor. (Tues 8pm Fox network)

What do you real doctors think of that show? Do you ever want to say the things to patients that House does?

7:43 PM  
Anonymous Dianne said...

anon 6:16: I came here for a discussion around medical realities,

Patients' moral and theological issues are part of medical reality. As anyone who's ever treated a Jehovah's witness with leukemia can tell you. Or a pregnant Catholic with pulmonary hypertension.

7:46 PM  
Anonymous Anonymous said...

yes, dianne, but your particular question is cheeky and of little relevance.

8:05 PM  
Anonymous Kelley said...

I always get good drama in the "comments" section of your blog :) Much fun. I remember that episode very well and have always wondered how medically accurate that show is. I have figured not so much. I don't know enough about the Catholic faith or medicine to have a real opinion on the matter. The writers of the show definitely manipulated the story line to have the viewers side with Addison and the patient. It was a good show.

8:42 PM  
Blogger Ex Utero said...

Didn't see the show. But I've seen enough reality to know that when men and women can't rationally discuss birth control in a stable marriage, then the woman has little control over her life. Religion is just a part of the problem in such situations.

10:39 PM  
Anonymous Anonymous said...

No offense, but all I can say is that I'm so glad that I'm not Catholic (and therefore have control over what is and is not allowed with regard to MY OWN BODY - reproductive organs and/or otherwise). I certainly do NOT need non-married men subjectively interpreting biblical doctrine and then making blanket statements about what they feel is the "right" thing for woman kind to do. Ridiculous.

11:04 PM  
Anonymous Anonymous said...

When I was getting married, the priest that was going to marry us was a close family friend...more like a brother than a friend.

I loved what he said to us in our 'marriage counseling session'. His priestly advice was ' Look, God gives you a brain. When it comes to birth control, do what you feel is best for your personal situation'.

He was the second oldest in a traditional Catholic family of 11 and was more than aware that having too many kids can make life financially difficult.

12:43 AM  
Anonymous me, myself said...

Dianne-- marvelous question. I don't know what the church would say, but as a half-Catholic with a good sense of humor and irony I'd say that abstinence is a form of self-denial, like fasting during Lent, and thus is spiritually cleansing. St. Paul was all for it, anyway, and actually I support it myself, at least before marriage. Onward the cheek!

1:14 PM  
Blogger Clark Bartram said...

House is as medically ridiculous as every other show. I actually watched it last night for the first time as I was told it was a cut above the rest when it came to realistic situations. I do wonder though, might there be an internal medicine doctor at an academic hospital that takes care of patients of all ages, reads transesophageal echo's, and performs brain surgery, all while hopped up on ketamine? Ketamine? What the hell is that about? And I especially loved his choice of performing three seperate bleeding time tests before deciding to send some coags and the upper and lower endoscopy(not sure if he did those)to investigate the child's bright red blood per rectum. But I digress.

4:45 PM  
Blogger ericales said...

sidetrack about House: he's supposed to represent a "modern day Sherlock Holmes", hence the drug addiction. dunno if it "works" for me as a show. medically, as with all made-for-tv stuff, it's as bogus as everything else out there.

9:54 PM  
Blogger neonataldoc said...

Thanks, everyone. So many interesting comments. Pardon me if I don't reply to each one. Stockingup99, you've got to get a new obstetrician or midwife or health system. They're not all as bad as the one you describe. Flea, I don't think doctors have to do everything the patient desires. I've only seen parts of House, but from what I've seen my opinion would be about the same as Clark's.

Anonymous 6:27, very interesting. I think that, in the long run, tubal ligation might actually be less risky than long term use of other methods, such as the pill.
And I agree that the inability fo this woman to discuss birth control with her husband was a pretty sad comment on their marriage.

3:29 PM  
Anonymous Anonymous said...

Dianne, you say:

Another problem with any NFP method is that it counts on regular menses to work reasonably well. If your menses are irregular (as mine are...I sometimes think I have a menstral random event, not a menstral cycle), then NFP will fail for you on a regular basis.


The rhythm method is what relies on regular cycles, as you simply decide whether or not to have sex based on the cycle day. With NFP, you chart your fertility signs every day. NFP can detect anovulatory cycles, cycles with delayed ovulation, cycles with earlier-than-normal ovulation, you name it. You're probably not interested, but Toni Weschler's book Taking Charge of Your Fertility gives an excellent explanation of how fertility awareness can be used no matter what kind of cycles you have, as well as how it can help a woman communicate better with her doctor if there is a pathology causing the cycle irregularity. NFP also doesn't have to be religious, and charting couples do have the option to use a barrier method during fertile or potentially fertile days, although the method is known as "fertility awareness," or FAM, when barrier methods are used.

As to your question about Catholic teaching (I'm a disgruntled ex-Catholic, for the record)'s not a teaching that having children is the be-all, end-all. Rather, the teaching is based in respect for the way our bodies and fertility work without interference. Sexual acts that "respect" the basic procreative nature of heterosexual sex are both allowed and encouraged. NFP is seen as okay because it works with the body's natural rhythms. Barrier methods are out because they allow the couple to "ignore" those rhythms; hormonal methods are out because they do away with the rhythms altogether and also because of the potential for a fertilized egg to be prevented from implanting. But NOT having sex is fine, and the church does recognize that procreation is not the only purpose of sex.

(My issues with the church obviously stem from other areas ;) )

10:00 PM  
Anonymous Anonymous said...

I considered not answering your cheeky question, Dianne, but in the end, I couldn't resist.
Every priest I have ever heard expound on the subject (and every Protestant minister, come to think of it) has advocated abstinence before marriage because he believes that if one isn't going to take a vow of celibacy, then sex was intended by God to unify two people "until death do us part" in a picture of the relationship that God, through Christ, wants with the Church. It goes hand-in-hand with not advocating divorce (while understanding that you shouldn't stay in a marriage where you are being abused). It just so happens that abstinence is also the only 100% way to prevent unwanted pregnancies and that can be a strong selling point to get smart teens to practice it. Of course, some smart teens also use birth control, but there are spiritual consequences to having sex outside marriage and it's those consequences the Church tries to help people understand.

7:42 PM  
Anonymous Anonymous said...

Tubal ligation is a farce, and should not be performed on any woman.

12:41 AM  
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