Saturday, September 02, 2006


I wasn't going to write about this again, at least not now, but I can't help it, because it's too frustrating. Last week I saw a 24 year old mother having her fifth child and ninth pregnancy, and today I talked to a 23 year old mother who just had her third baby after her ninth pregnancy. Nine pregnancies by age 23? What is wrong with these people? Why can't they use birth control? Sure, mistakes or ignorance can occur and result in one or two pregnancies, but by then a person should be able to figure it out.

The 23 year old I talked to today who just had her third baby has had two previous children, one ectopic pregnancy, 2 miscarriages, and 3 induced abortions. This baby was born prematurely at 34 weeks gestation. The risk of delivering prematurely is increased significantly when a woman has had greater than or equal to 2 induced abortions. In other words, it is possible that if this woman had used birth control to prevent unwanted pregnancies instead of using abortions to end unwanted pregnancies, this baby might have been born at term.

I don't want to get into the whole abortion thing, at least not today, but I'm sure that some of my readers think it is okay for women to have abortions and some do not. Regardless of where we stand on the abortion issue, though, I hope we can all agree that abortion should not be used as the primary method of birth control. There are far easier and safer ways to do that.

The bleeding heart liberal side of me wants to feel sorry for these moms and try to understand why they don't use birth control properly, but the frustrated, responsible side of me just wants to chew them out. For crying out loud, take care of yourself, and act like a human being instead of an animal.

I feel better now. I probably won't address the birth control issue with mom, because I know the OB's hit it pretty hard, but if it comes up in conversation I will give it a plug. But I don't think it will make much difference.


Anonymous Anonymous said...

Correct me if I am wrong, but most of these women probably go in for C-sections at least for one of the pregnancies. The OB at that point should just go ahead and crush the fallopian tubes. No one has to know. This will render the women infertile and the problem will be solved!

12:59 PM  
Blogger Kelly said...

So are you saying that the "bleeding heart liberal" and the "responsible" are opposites?


You probably didnt mean to say that, huh?

Sorry, I know you were ranting. It just seemed too comical to pass up :)

1:20 PM  
Blogger jennifer said...

Hello Doc!

Another thought-provoking post. To your frustration, I would suggest this: some of it might be cultural. If you are like me, you were raised in an environment that reinforced the idea that actions have consequences, over and over again. I was told/taught/lived the paradigm that my world could and would be influenced by me.

In the area where I now live (on an Indian reservation), I have come to experience the culture of helplessness. Where actions are not rewarded, or are inconsistently rewarded. Where being helpless actually gets you things...aid, attention, sometimes food or money. It is a negative experience, to be sure, but negative seems better than being invisible, or ignored.

This is a new paradigm for me and I try to allow myself the possibility that there are other forces at work besides what appears to me to be laziness or stupidity. I think if it were simply a matter of these things, it would be an easy situation to fix.

Consider what your very young mothers are getting: often aid, in the form of WIC checks which are sometimes used, sometimes sold; attention, in the form of social workers, doctors, appointments, etc. which they sometimes want, sometimes avoid; a feeling of specialness, at least for some women, during the part of the pregnancy when they are showing and are given attention; an escape, in the form of a fantasy that somehow their lives will be different, happier, better with the birth of a new baby; more aid, for children ages 0-5. And if the children are taken away, it just reinforces the feelings of self-hate and despair, which can cause the whole cycle to repeat.

One definition of insanity is to repeat the same action over and over again, each time expecting a different result. It's also one of the definitions of hope. Tricky to tell them apart, no?

2:09 PM  
Anonymous Dianne said...

Three thoughts on this issue:

One, as far as I can tell, the abortion/premature delivery connection doesn't seem to be huge. The odds ratios I've seen for it have all been less than two and in some studies the confidence interval has included one. It sounds like there might be something more going on here in light of the three pregnancies that failed naturally. That having been said, though, there's almost never a situation where prevention isn't simpler and safer than treatment and prevention of unwanted pregnancy with birth control is clearly superior to treating it with abortion.

Second, I wouldn't necessarily conclude that speaking with this women about birth control is futile. Repetition can be helpful and the OB may have hit the issue so hard or so undiplomatically that she stopped listening to her or him, but she might still listen to you as an "outsider" in the conflict.

Finally, I don't think that the side of you that wants to scream at these women can accurately be called the responsible side. The angry, frustrated side, but not the responsible side.

3:52 PM  
Blogger Flea said...

I'm with Kelly on this one, ND.

Do you know any conservatives? Do you have any for colleagues? You write, sometimes, as if they are a different species of human being, or at least a defective variant!

Liberals do not corner the market on compassion.



9:19 PM  
Anonymous Anonymous said...

Exactly why I support Planned Parenthood even though personally I am against abortion but remain pro-choice, but I digress. They obviously have more than one mission. Had it not been for PP I may have been a pregnant teen myself.

I think a lot of women who get into this cycle don't feel empowered. I also firmly believe it only takes ONE person believing in them and saying the right thing at the right time to change their self image. You could be the one doc. It's worth a try! :) I feel your frustration, it's an ugly cycle.

11:13 PM  
Blogger SmartBlkWoman said...

Ok, I have to touch on the abortion thing again.....what's wrong with a woman using abortion as her primary means of birth control? I am personally against this line of action but if it's her body and her choice, don't we have to just sit back and accept whatever these young women are doing, especially since it is painfully obvious they know how to get pregnant and prevent pregnancy.

These women are not going to stop with all the "accidental" pregnancies until they are good and ready to. I hate to say it but, no amount of talking to them is going to help. I know too many women personally who engage in this kind of behavior (multiple pregnancies and multiple abortions) and nothing you say is going to get through.

I think I shock the hell out of people when I tell them I'm poor, black, and will probably be voting for some Republicans next election. I just can't understand you bleeding heart liberals anymore......;)

3:05 AM  
Blogger Felix Kasza said...

smartblkwoman --

> what's wrong with a woman using abortion as her primary means of birth control?

Aside from the idiocy of having a surgical procedure with the usual risks, instead of swallowing a pill?

Aside from that being a demonstration of an inability to learn that would put a monkey to shame?

Aside from the taxpayer financing the procedure in many of the cases that Dr. Flea must see?


4:58 AM  
Blogger SmartBlkWoman said...


I agree with you that choosing abortion as a means of primary birth control is idiocy, but the point of that matter is that these women already know very well how to use various methods of birth control and since they have already had multiple abortions, it is safe to assume they know full well the risks of abortion and what the procedure is like.

The bottom line is that these women have made the choice to use abortion as a contraceptive over and over again. It's a choice I believe borders on lunacy, but it's not my body undergoing multiple births and medical procedures.

Aside from that being a demonstration of an inability to learn that would put a monkey to shame?

Again, you and I agree. But these women who exibit a complete lack of judgement time and again are allowed to raise children.

Stupidity and gross negligence to oneself isn't illegal yet.

Neonatal Doc, I also wanted to suggest that you read Life At The Bottom by Theodore Dalrymple. I think you would really enjoy it because the author is expressing many of your current sentiments. Dalrymple is an English doctor who works in a slum hospital and jail and he writes extensively on the hows and whys of poor people consistently making bad choices.

I can't give the book high enough praise.

5:37 AM  
Anonymous Dianne said...

At risk of interrupting this happy little condemnfest, may I point out that there was (at least) one other person who could have stopped any one of these abortions from being necessary: the male partner. Men who want to avoid their partners' getting pregnant can use condoms or get vasectomies. Why aren't they even mentioned in the "bad choices" discussion? Admittedly, it's not as bad a choice for a man, who can walk away with no further consequences. But if this woman is picking the sort of man who would do that for a sexual partner then not using birth control is the least of her problems. Why do women pick men like that for their sexual partners? Probably because they've been told again and again how stupid they are: "a demonstration of an inability to learn that would put a monkey to shame" "grossly negligent", that sort of comment. After all, if complete strangers take the time to tell you how stupid you are, how can you expect better than abuse and abandonment from your partner?

10:59 AM  
Blogger neonataldoc said...

First of all, Kelly and Flea, I didn't really mean this as a comment on conservatives versus liberals. I know there are some conservatives with compassion - my brother , for instance. (When did I write like conservatives were a defective variant?) But I had to laugh at Kelly's comment.

Jennifer, you write true, but depressing, comments. And yes, Dianne, I know it's not responsible to yell at these moms, and I don't. And I agree that men also should bear responsiblilty for birth control. I'll look for a copy of Life at the Bottom.

1:34 PM  
Blogger SmartBlkWoman said...

Dianne said...
At risk of interrupting this happy little condemnfest, may I point out that there was (at least) one other person who could have stopped any one of these abortions from being necessary: the male partner.... Why aren't they even mentioned in the "bad choices" discussion?

Because at the end of the day, even if a man is trying to get a woman pregnant he won't be able to do so unless a woman agrees to have unprotected sex. The word of the woman is the final one and if she isn't willing to go for it then it won't go.

The woman is the one that is going to end up being pregnant and either have to endure the abortion or the pregnancy so she needs to be the one to take ultimate responsibility for what is and isn't going to occur.

Yes, men need to step up to the plate and take responsibility for their actions also but they have less incentive to do so because they are not the one who going to end up with an unwanted pregnancy.

Why do women pick men like that for their sexual partners?

Because these women are consistently making bad choices in every other arena of their lives. I have yet to meet anyone, whether male or female, who chooses irresponsible sexual partners regularly and then makes wise decisions in other areas of their life.

As far as telling these women they have the level of intelligence of a small monkey or that they are grossly negligent, I doubt any of these women have EVER had anyone tell them how incredibly bad their choices are. No one steps up to the plate and yells loud and clear, "this is dumb!". Instead the doctor who is delivering their umpteenth pregnancy can only talk to them in plummy tones of "other methods of birth control". Their parents are most likely raising their children for them in large part and because no one condemns these women for their actions, they never get the message that what they have been doing is wrong.

It's not that people are telling these women how stupid they are, it's the fact that no one is telling these women how stupid they are, except for us bloggers, and we aren't even allowed to do it to their faces because of course that would be considered harsh and rude.

4:14 PM  
Blogger jennifer said...

Oh Doc, I didn't mean to depress you. I think that there is a resiliancy at work here, and a force of will to survive, which in iself is quite beautiful. The trick, of course, is to find help that is actually helpful.

9:21 PM  
Blogger NeoNurseChic said...

I have to agree with Jennifer and then add that it does seem to be something that is sometimes celebrated in various cultures. Had I gotten pregnant as a young teen, my family would NOT have celebrated it. I'm not sure what the end result would have been, but it would not have resulted in pride.

But not so in some of the social situations that I see at work. I first state that this is NOT to be taken as a stereotype or generalization, but in all honesty, the only place where I have personally run into teen pregnancy being a positive thing is among the inner city community. However, keep in mind that this is where I work...probably a very similar environment to that of neonataldoc. A young 15 year old woman comes in pregnant for the 2nd time, and her mother is right there with her, all excited about the baby and carrying on about womanhood and this and that.

Far be it for me to judge, but I cannot persoanlly grasp this mentality since it's not how I grew up. Recently, we had a family bring in all the local news stations and newspapers to cover the story of their 28 week quadruplets. I'm not writing anything here that wasn't covered in the public story... The mother is 18, she is not married. I can't write anything further here than that....and I don't want to link to the news articles.

No matter if this is praised or condemned, this is an awfully hard way to grow up quickly.......

It really is rough to have to stand by and watch these situations happen again and again...and yet feel completely powerless to change it - even if we can educate about birth control, choices, self-esteem, etc etc etc.... It just keeps happening....

Take care!
Carrie :)

2:08 AM  
Anonymous Dianne said...

Neonataldoc: I didn't think you'd really yell at your patients (or even their parents), just joining in on the nitpicking of your rant.

Returning to the issue of how to approach your patient's mother about birth control, it occurs to me that maybe the question to ask is something on the order of "What is keeping you from using birth control?" Is her partner abusive and insistent that she have sex with him at any moment, without allowing for time to, for example, insert a diaphragm? Is she unable or unwilling to spend the money to purchase the necessary items? Is she unsure of how to use birth control? Is she deeply convinced that birth control is a sin and more willing to undertake the occasional sin of abortion than the daily or frequent sin of taking OCP or using barrier methods? Does she enjoy the attention of being pregnant, as Jennifer suggests? Further discussion would go in different directions depending on which problem, if any, was involved.

9:47 AM  
Blogger M's said...

Hello!! I am a NICU nurse at a reputable hospital on the east coast and I just wanted to comment that I have really been enjoying your blog. I just started my own: "Code Pink"
It isn't much yet, but it is there.
I have only read the recent stuff of yours, but I am looking forward to reading back.

Regarding this post: I feel your frustration!!! Sometimes I think that people just don't think about the consequences of their actions. What about the women who are told that they will have a complicated preganancy (due to maternal prenatal health) or that the odds of their child being a "special needs" child are high (yesssss... genetic testing). Ultimately I think it comes down to the fact that people are more focused on the "here and now" vs. the reality of the future.
I believe in a woman's right to choose, however, I do not agreed that a woman should use abortion as a primary birth control option.
So are people saying that it is okay for a person to eat and eat and eat (knowingly getting fatter and fatter) just because they can have lipo over and over again? I don't think so.

10:17 AM  
Anonymous Anonymous said...

I also don't see why some women are "repeat customers" at the clinics when taking a pill everyday would be so much easier/better. That being said, I also realize that each person's life is unique. It's very subjective. When there is a situation of the unborn baby having a genetic issue and quality of life/mental retardation are their reality, I can see why such choices are made. Since there is such a gray area with these matters, I feel it's necessary to stand firm on supporting a woman's right to choose. It seems to be an "all-or-nothing-at-all" proposition for many of our so-called law makers. If they stop elective terminations completely, what happens to the women who would choose to end a very much wanted pregnancy due to a genetic problem....or the women who were raped....or the women who have health issues of their own that would necessitate termination?

It's not anyone's place to be judge and jury. Most right-wing, staunch pro-lifers feel the need to take it upon themselves to do so while all the while going against their fundamentalist backgrounds (i.e. placing judgement on others when they supposedly believe that only a "higher power" has the right to do so).

There are so many life many variables! Each woman deserves to make the choice that she deems best. End of story.

12:08 AM  
Anonymous Anonymous said...


I'm not surprised that young pregnancy is celebrated in the poor, inner-city community. You were probably raised to look forward to college, career, and marriage, in addition to children. These women are not. If you did not think that college, career, and marriage were attainable for you, you might be excited about a young pregnancy as well. After all, the vast majority of women are raised believing that having children is joyful.

I don't know how to fix this. But I grew up in a poor neighborhood in Brooklyn and I understand how young prengnancy can seem reasonable to these women.

2:38 PM  
Anonymous Anonymous said...

I spend a lot of time working with unwed,young mothers and noticed two patterns of thought that contributed to this issue
1. Birth Control is bad. Its against my religion or it causes cancer.
2. Hope rules all decisions. This baby; this lover will change my life for the better.

I once read a journal of a 12-year-old pregnant by her 35 year old boyfriend where all her friends were congradulating her on how wonderful it was to bring a life into the world. The child's mother was a prostitute who boasted about how her daughter was so beautiful and MATURE that she had attracted such a great man.

4:42 PM  
Blogger neonataldoc said...

I, too, have seen teen pregnancies celebrated. I wonder if it's partly because when a teen pregnancy happens, you can either celebrate it or be mad at the teen - but what good does it do to be mad; you might as well celebrate it.

7:27 PM  
Anonymous Anonymous said...

I am a non medical personel who at 45 yo wants to go back to nursing school for Nursing as a second degree.
Delivering my children at the ages of 33 and 38 years old at Hutzel Hospital in Detroit was a real eye opener.
I was the oldest Mom and could be the Grandmother to to all the other babies in the NICU.(some of the Grandmothers were younger than I)
I was sitting between two 14 yo's at the discharge class and with about 18 new Moms, I was one of two Mothers who did not need to sign up for WIC.
There is no easy answer. But, I did like the crushing of the fallopian tubes and no one would know. Believe me, I am not usually that cold.

8:48 AM  
Anonymous Dianne said...

But, I did like the crushing of the fallopian tubes and no one would know

You trust a random OB/GYN to make these decisions with no oversight, without consent of the patient? What if you had delivered your first child by c-section and the OB decided that at your age you shouldn't have another and cushed your tubes? I don't think you'd be very happy. Paternalism is often tempting, but it is rarely a good solution.

11:01 AM  
Blogger Pajama said...

Personally, there is a time and place for abortion. However, it's sickening when people use it as a form of birth control and don't make their peace after the first one. I woudn't want to be in your situation, not even once with these women.

9:57 AM  
Blogger WendyLou said...

1) I already know that if I get pregnant again, it will likely be a high risk pregnancy with another preemie. Should I be told I can't procreate because someone feels this would be too big a burden? Hell no, that is DH and my decision to make. We will make an informed decision and will likely TTC when DD is over a year old. Why, because our family is not complete. Why, because DD is wonderful and perfect. Why, because we feel we are prepared and able to raise more children.

2) Who will pay for this? In my case, the health insurance that I and my employer purchase. Other than our portion for my care, DD's entire bill (over 140K) was paid by the health insurance. Oh, and we paid my portion.

3) I am grateful my OB did not (to my knowledge) crush my tubes. Pro Choice is that CHOICE. If we believe women can end a pregnancy for any reason, then we also believe she can start a pregnancy for any reason, even if we think she is nuts. I share this frustration when I remove the 5th meth baby from a women, but forced sterilization is not the answer.

4) It is fun and special to have a baby. How to counteract this with young women is to figure out how to encourge them that there is something more than being a mom in their lives. If you had nothing, there is something to be said for having a baby, then you matter to the baby.

5:27 PM  

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