Stay out of my uterus” is a rallying cry for women defending reproductive rights. But it’s more than just that. Patient 1: Female went to urgent care for back pain, had a negative pregnancy test, and saw a physician who prescribed a muscle relaxer. In the end, he asked her when she would have a third child. The patient, a physician, was taken aback but answered, “I’m not.” The doctor then told her she needed a third, that she’d change her mind and that she’d regret this decision. Her reality is that she and her husband wanted a third child, tried to conceive unsuccessfully, and made the difficult decision together not to continue to try. She left that appointment angry and was too much in shock at the time to be able to think clearly to tell him it was not his business. Patient 2: Female, childbearing age, went to the dermatologist for a rash. During the visit, the doctor said to the patient, “You’d better get on it.” She asked what he meant, and his reply was that she’d “better hurry up and start having children, or she’d regret it.” The patient’s reality is that she and her ex-husband tried unsuccessfully to conceive for over three years. It led to a breakdown in their relationship, depression, and eventually, divorce. Patient 3: Postmenopausal female with no children went to her primary care office for an annual exam. On review of her GYN history, the nurse practitioner said that she couldn’t imagine not having children, that the patient had no idea what she was missing, and that she (the NP) would have done anything necessary to conceive. The patient was asked a single question about her GYN history: She was asked to confirm what she filled in on the form that she didn’t have any children. No other GYN history was asked. This patient’s reality is that she went through years of trying to conceive. She and her husband went through multiple evaluations and rounds of IVF. They traveled across the country to see experts. After five years of no success, she and her husband decided they could no longer keep trying. They couldn’t go through the heartbreak they experienced after each unsuccessful round of IVF again. Each of these women left angry and in tears. Each was triggered by questions and comments that had no clinical relevance. About 10 percent of U.S. women ages 15 to 44 experience infertility or difficulty staying pregnant, according to the CDC. 1 in 4 have experienced a pregnancy loss. Approximately 20 percent of women reach the age of 45 and do not have children, with about half of them being in that position by circumstance – meaning that they are childless, not by choice. These numbers are estimates because accurate data isn’t available. In part because of the shame and stigma that society attaches to infertility and childlessness. There is no fix for all situations of childlessness. That IVF will always be successful is a misconception. That IVF is an option for everyone is incorrect. That adoption is the answer is also not true. There is a myriad of reasons why a woman may be childless, some of which may have nothing to do with infertility. Having 1 or more children is not a guarantee against secondary infertility. Those struggling with infertility, a pregnancy loss, having fewer children than they had wanted, or who are childless, not by choice, are struggling with pain and grief. The pain of pregnancy loss takes longer to recover from than the physical recovery. In fact, even when someone has a child after a pregnancy loss, the pain and grief often don’t go away regardless of when in the pregnancy the loss occurred. The same is true for those who have children but first experience infertility. The pain is also never-ending for those who are childless, not by choice. The decision to have children is one of the most personal decisions anyone can make. The timing of fertility and how many children are equally personal. The decision to be child-free is private and not made for someone else to judge. I’d like to think that the conversations described were part of getting to know the patient and establishing rapport. If that’s the case, there are other ways to get to know someone. These conversations were commentary about personal situations, and the first two had no relevance to the clinical situation. The third case would have been clinically appropriate had the patient been asked how she felt about being childless and then made the appropriate referral (as this patient was continuing to struggle with her childlessness and needed support) rather than making incorrect assumptions and placing judgment. I’d also like to think these were rare, isolated situations and that we’ve come farther in women’s care. Unfortunately, that’s not the case, and situations like these are more common than one would expect. This issue has nothing to do with the gender of the person providing care. It has nothing to do with degree or role in health care. The problem is also not limited to the country’s area or the community’s size. These scenarios are reported by women regularly across the country and across the spectrum of progressive to conservative, rural to urban, and small to large communities. No matter how far we’ve come, women are still judged by fertility status but shouldn’t be. If it’s clinically pertinent to ask about reproductive health, then yes, absolutely ask … in a respectful way. That doesn’t mean judging personal decisions or situations – it means asking pertinent questions and responding with an assessment of the need for support. Make appropriate referrals when that support is needed. Don’t assume. Everyone has their own story. If it’s not clinically pertinent, then stay out of my uterus. Source
