Womanhood doesn't have to be so painful

The medical misogyny in reproductive healthcare

1A funny thing happens when the people around you know that you’re a feminist writer: Women come out of the woodwork to talk to you. You get emails and DMs, pulled into corners at parties. And women tell you things. Secrets, sometimes, but more often what they describe as small, veiled outrages: Things they’ll often hasten to add are not a big deal in the broader context of a world on fire, but felt, to them, like a shock, or a deep unfairness.

I’m 38 with a graduate degree and living in a big liberal city, which means that I am in squarely in a demographic of women who are now having babies. And that means that the things women talk to me about are increasingly related to childbearing. These conversations are largely happening with extremely savvy and successful college-educated women living in large urban centers; women who have more resources and power than the overwhelming majority of women have ever had in the history of the world. And yet over and over again, I’m hearing variations on a theme: A basic refusal of care, especially around pain, when it comes to pregnancy and childbirth. Or perhaps more pointedly: Care that treats pregnant women as incubators instead of human beings, and doctors who seem to assume that because motherhood means sacrifice, it’s ok if women suffer.

The stories I’ve heard include women who have been refused care for months for everything from a hernia to a serious and painful dental emergency because they were pregnant. This seems to be the default: Unless something is threatening your life, many health care providers simply won’t treat pregnant women even for otherwise treatable conditions that cause a tremendous amount of pain. It makes sense to give pregnant women a clear understanding of any risks posed by treatment, and certainly many pregnant women will decide that treating a condition while pregnant is simply too risky. But too many health care providers seem to have decided that any risk to a pregnancy is too high, instead of giving pregnant women an accurate picture and letting them decide for themselves.

The stories I hear also come from women who gave birth by C-section — major abdominal surgery, it should be said — and who were given acetaminophen to manage their post-surgery pain. This is increasingly the standard of care, something doctors brag about. And don’t get me wrong: I don’t think doctors need to be throwing opioids at postpartum women. But there are a lot of women who give birth via having their entire abdomen and a major internal organ opened up and then sewed back together whose pain afterwards is not adequately managed by Tylenol, but who are treated as drug seekers if they ask for something stronger. And again, the stories that I’m hearing are coming from some of the most privileged women on the planet; if they’re being treated poorly, how do you think it looks for women with fewer resources and less power?

And of course I have my own story, although it’s far less extreme: Like thousands of women, I have an IUD, and getting it inserted is the worst pain I have felt in my entire life. I was screaming in pain in the doctors office and eventually begged her to stop, saying I’d come back another day because I could not tolerate any more (she said ok, but if I could do three more seconds it would be over, and I agreed to push through). Afterwards, I walked out onto the street and almost passed out; I had to come back in and ask to lie down in an empty room until I could walk. The word “trauma” gets thrown around a lot in ways that I think make it increasingly useless, but I’ll say that that experience made my body feel like the site of a trauma (that’s one way to do birth control, I guess). I’m not alone there — lots of women say their IUDs were painful for weeks or even months — and yet overwhelmingly, the suggested pain management is “take Tylenol.” It’s also true that many women find IUD insertion to feel exactly as advertised: A pinch or a discomfort, not hot searing incredible pain. But would it have been that hard to offer a local anesthetic, like all doctors do for vasectomies?

We also know that serious postpartum pain and serious postpartum health complications affect millions of women, but are dismissed by doctors as simply part of the process of having kids. A 2015 study found that a quarter of postpartum women still found sex painful a year and a half after giving birth; a more recent one found that a year after birth, almost half of mothers had issues with urinary incontinence and 77 percent had persistent back pain; huge numbers of women live with undiagnosed tears in their pelvic flood muscles or fractures in their pubic bones from giving birth. These pervasive, serious, and painful conditions, though, are routinely written off as simply the natural consequence of having a kid. And fair enough, they are indeed the natural consequence of having a kid — but we don’t accept treatable serious pain and deeply disruptive physical problems as “natural consequences” of the many other things humans do that get us impaired or injured.

Underlying all of this is an assumption that womanhood, and particularly motherhood — or the avoidance of motherhood, and the desire to have sex for pleasure — demands sacrifice. And surely motherhood, and good parenthood generally, does demand sacrifice — but we don’t have to make that sacrifice wholly unnecessary, offered up simply because that’s what mothers do, and demanded of women even when there are better, less painful options. We don’t have to accept the old story of pain as Biblical punishment for female curiosity and freedom, of physical suffering being indelibly tied to womanhood ever since Eve took a bite of the apple.

Even though most women who give birth got pregnant in one basic way, we treat motherhood as de-sexing and all-encompassing. That a mother might want to have sex that is pleasurable and not physically painful, or that she thinks it’s a real problem if she’s peeing on herself, well — that’s the price of having a baby; of course your body changes. That a pregnant woman may not want to spend months in unnecessary pain in exchange for avoiding an infinitesimally small risk to her fetus, well — what kind of mother is she? That a woman seeking to avoid pregnancy so she can have sex for fun might object to the wholly unnecessary pain of the most effective contraceptive method, well — I think you know what people feel about a woman like that.

Insurance routinely doesn’t cover the most effective surgical procedures to restore a woman’s sexual organs to their pre-childbirth state, even if childbirth left a woman no longer able to experience the sexual pleasure she used to. (Insurance, let’s note here, overwhelmingly covers Viagra, a medical intervention for men whose sexual organs no longer work the way they used to). There is virtually no drug safety information out there for pregnant women — 91 percent of drugs do not have any reliable safety information about their effect on pregnancy — and as a result, pregnant women routinely forgo necessary medical care, which can do more harm than good.

Pregnancy is overwhelmingly treated as a separate status, something that makes women both more and less than human. It’s why women who use drugs while pregnant have been criminally prosecuted for actions that would not be crimes if they were not pregnant. It’s why issues that would be taken seriously and treated in men — incontinence, painful sex — are brushed off as unimportant when mothers experience them.

It’s outrageous that our healthcare system has built in the assumption that motherhood demands the physical sacrifice of pain, and not just in childbirth but during pregnancy and long after (and of course there also exists a huge industry of people insisting that treating pain in childbirth isn’t simply a rational individual choice, but rather a morally dubious and “unnatural” decision — never mind that women dying in childbirth is among the most natural things in the world). It’s outrageous that women are essentially told that pain is simply the set cost of something else you want — a child, a sex life without a child.

When women tell me these stories, they are almost always punctuated with, “but it wasn’t that bad” or “I know I’m lucky to have a healthy baby” or “it wasn’t that big of a deal” or “it’s just a small thing.”

I disagree. It was that bad. It is a big deal. And it’s not a small thing at all — it’s a huge thing, drawing in everything we believe about women and mothers, and all of the lies and indignities and acts of neglect women are taught to accept.

xx Jill

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