Continuing the "What I learned On My _____ Rotation" - series (if you missed them, you can read about my experiences in Internal Medicine here, and Pediatrics here!), I thought for my obstetrics and gynecology rotation I'd do something a little different. I thought I'd write about something that became crystal clear after my five week practice.
Never ask a 30 year old woman why she doesn't have children.
Besides being an incredibly personal and invasive question, it's also rude. And unnecessary. As a sixth year medical student in Finland, I had the privilege of working as a substitute specializing doctor in the Obstetrics and Gynecology ward in Mikkeli Central Hospital with my own outpatient clinic patients.
Gynecological patients can be anywhere from 18 to over 90 years old. Obstetric patients are typically healthy, under 40 year old women. The diversity of the typical day at work kept me on my toes and interested. Interested in not only the science, but the patients themselves. Their stories. Their personal challenges. Some women desperately wanted children and tried for years on end to achieve pregnancy, while others unintentionally became pregnant. One day I was counting and measuring ovarian follicles on the ultrasound in hopes of a successful IVF treatment. Other days I was terminating a perfectly healthy pregnancy. The variety seen in one work day was emotionally draining and mentally challenging. Many of my fellow students and colleagues agree that obstetrics and gynecology was certainly the most emotionally driven practice yet. From administering hormones to stimulate ovulation to administering contraception, the paradox seen in a typical work day was something I can imagine requiring years of experience to get accustomed to.
This constant patient variation made me realize how truly every woman is different. Sometimes I came home thinking about how unfair the universe is. Why are some women following doctors orders to a T and end up having a child with heart failure, while another woman recklessly caring for her pregnancy end up with a beautiful, healthy baby. Why did some couples try for years on end to get pregnant, while others were adamant about using birth control but still had an accident and got pregnant. These are the questions people ask in church. These are the bigger 'Why' questions that no one has answers to. This is why you should never ask a woman why she doesn't have children.
Naturally bringing children into the world is a decision that in 2017 should be entirely up to the couple. But in addition to this seemingly obvious right, there are undeniable external pressures as well. Cultural, societal, and family pressures, some influences we can control, others we can't. The ones we can control are the questions we ask women. Questions like, "Soooooo, tick tock, am I right?"
The one thing that doesn't typically come up in Christmas parties is the topic of infertility treatment. Before asking someone if they've thought about starting/adding onto their family, remember there are people out there going through multiple rounds of hormone treatment, taking massive tolls on their body and mental health, all while costing tens of thousands of dollars. Infertility treatments are becoming increasingly popular among couples trying to conceive, which makes the probably of someone in your close circle going through such treatment quite high.
In addition, it's estimated that 1 in 6 pregnancies end in miscarriage. Miscarriage is astonishingly common, and a major emotional burden not typically discussed at Christmas parties.
"You just don't know what true love is until you have children."
Shout out to all those perfectly happy couples who decide not to have children!
"Sorry I'm late, I was... oh wait, you wouldn't understand, you don't have kids."
Childless person discrimination is real. What about all those child-free men and women getting excluded from the family oriented discussions at work and social events? Just because they didn't pop one out doesn't mean they don't want to hear about little Tommy's backflip in gym class.
"You're going to be a crazy cat lady if you don't have kids!"
Now perhaps the only valid argument yet. Studies show women who don't procreate tend to have psychiatric tendencies and increased affection towards felines.
Let's go into the holiday season with an open mind and remember not everyone wants babies. Also, some may want babies but haven't been able to conceive.
As a rule of thumb, how about keeping the personal questions in the 'if they don't bring it up, neither will I' -category. There are just too many risks of making such questions sound like a personal attack, rather than a genuine concern. Sometimes we just don't know the full truth, other times, it's just none of our damn business.
Happy holidays from the OBGYN department!