Medicalization of Pregnancy
Flea (RIP) used to talk about the medicalization of childhood–that kids don’t just run the spectrum of normal variation, that everything nowadays has to be a diagnosis or a pathology that requires treatment. I’ve started to come across the same thing in pregnancy.
There’s this strange phenomenon that several of the docs, nurses, and assistants have commented on–that women will come in, having missed their periods, taken several at-home pregnancy tests, all positive, and still want or need the doctor to “deem them” pregnant. (Plus often a number of the pregnancy changes: nausea, vomitting, breast tenderness, bleeding gums, etc.) Just seems strange that in some ways we’re so out of touch with our bodies–or at least the “natural” changes of them–that we need some “authority on bodies” (doctors) to concur with our own diagnosis.
I guess you can take this a step further and apply it to a lot of common complaints: a weird twitch somewhere, a strange sensation. In some ways it makes sense–you see plenty of patients who wait too long before they see a doctor for what turns out to be a heart attack, or cancer, or stroke, or out of control diabetes–and you wonder how they could possibly have waited so long. And on the other hand, you have people coming in for weird aches and feelings that are just typical, natural weirdness of our bodies.
Sometimes I wonder if a lot of the extremes are due to the break up of the extended family, and the more migratory lives of people. Had a newly-pregnant woman been living with her parents or grandparents, the mothers would just immediately recognize, “Duh, you’re pregnant.” Likewise, the guy who looks green and is clutching is chest might be convinced to seek medical care if his family members urge him to.
I don’t know what the interactions are that you’re having, but what you’re describing sounds completely normal to me.
Prenatal care – even pre-pregnancy care – is constantly drilled in to women as an essential component of a healthy pregnancy. If a woman doesn’t get weighed and ultrasounded by a medical person, her baby will probably be born underweight and maybe even die. So obviously stethoscopes and ultrasound wands have some magical properties beyond the obvious ones of measuring.
And when does pre-natal care start? If pre-pregnancy care is supposed to be a good thing, then presumably pre-natal care should start with the first missed period. How does a woman go about that other than by presenting herself to a doctor as soon as she thinks she might be pregnant?
This isn’t just about incompetent women who don’t trust themselves to be pregnant (or carry a healthy pregnancy to term, or deliver a baby) without a medical stamp of approval. It also comes from medical texts (pre-ultrasound) that state that pregnancy is not diagnosed until the doctor hears the fetal heartbeat.
If one doesn’t present oneself for a medical blessing at the beginning of pregnancy, then exactly when does it become appropriate? Are women supposed to just know when a doctor thinks they should see them? Perhaps it’s anticipated that the doctor who says ‘Yup, you’re pregnant all right’ is going to follow that up with ‘and you should come back every ___ often for checkups, starting ____.’ Is that an unreasonable expectation?
If the puzzlement is just about how patients present themselves, asking whether they might be pregnant instead of announcing it, well… some of us have seen doctors in the past. Not all doctors like patients to make their own diagnoses. Some of them are pretty clear that diagnosis-making is the exclusive domain of the doctor. If the guy clutching his chest shows up saying ‘I’m having a heart attack!’ the doctor won’t take his word for it. She’ll say something like, ‘I’ll be the judge of that’ and do some tests.
Completely appropriately.
Patients know the etiquette in a doctor’s office. DO NOT SPECULATE ABOUT WHAT’S GOING ON WITH YOUR BODY. No matter how certain you think you are. You let the doctor make those determinations for you.
Look, I’m not anti-doctor. I have one myself, who I like and trust. I’m related to some very fine specimens of humanity with MDs. But that doesn’t make the doctor-patient relationship free of ambiguity, and I’m not sure why the fact of the ambiguity is not being respected here.
It also comes from medical texts (pre-ultrasound) that state that pregnancy is not diagnosed until the doctor hears the fetal heartbeat.
I think you mean intrauterine pregnancy, not pregnancy at all.
Patients know the etiquette in a doctor’s office. DO NOT SPECULATE ABOUT WHAT’S GOING ON WITH YOUR BODY. No matter how certain you think you are. You let the doctor make those determinations for you.
Totally disagree. I frequently ask my patients “What do you think is wrong with you?”
I never described these patients as incompetent. Just an interesting observation.
But note, Graham, that even if as enlightened doctors of tomorrow we’re told to ask it, we’re supposed to ask “what do you THINK is wrong with you?” and not the very different “what IS wrong with you?”
I’m with Alison here. My sense from other medical professionals is that patients who know too much are viewed with suspicion. They’re viewed as drug-seekers or psychiatric patients. So “good” patients learn to play dumb.
No, I mean pregnancy. Missed periods, swollen breasts, nausea and 1970′s urine test results all have other possible explanations. A fetal heartbeat does not. Ergo, until the doctor hears your baby you only think you’re pregnant.
I’ve always thought it must be a very difficult thing to say ‘let me be the judge of that’ tactfully to someone – and it’s something that doctors have to do a lot. Some do it well and compassionately, others seem impatient and annoyed. I try not to create a situation during an appointment that would cause me to discover a doctor’s talents in this area. I would rather focus on whatever it is I’m there for, and not divert energy into little games about who has standing with respect to the goings-on of my body. It’s just about making an appointment as efficient and agreeable as possible for everyone.
So I don’t claim knowledge. It wouldn’t add anything to the interaction.
I don’t see anything strange at all with a patient declining to make positive statements about diagnosis to a doctor. That’s not a patient’s role.
… more. Sorry.
No, you didn’t describe women as incompetent. That’s my word, and while I chose it for its legal connotations it was probably not a good choice.
And now you have me thinking. I was positive that only a doctor could tell a woman she was pregnant, but you might be right about the intrauterine bit. I read that text before you were born, so while I recall the impact it had on me I admit to fuzziness in the details. Point.
Finally, you say “Totally disagree. I frequently ask my patients “What do you think is wrong with you?””
Even if I were to accept that ‘What do you think is wrong with you?’ is equivalent to ‘What is your diagnosis?’, my point is that not all doctors will ask that question or mean it in that way. Maybe… 60% of doctors? are perfectly happy to accept patients’ self-diagnoses and make patients feel smart for having thought of them. But how do I know the one I’m seeing isn’t one of the 40% who will curl a lip slightly? How do I know I’m seeing you and not some other nice young man who will bristle? Nowhere in my first comment did I say anything about all doctors. Just… it happens.
With good OB’s in short supply, there’s a much more practical reason for wanting an MD’s “stamp of approval” on a pregnancy: if I don’t book my first prenatal appointment as soon as I have a missed period, the OB of my choice might not have room for me on his schedule. Basically, the run to the doctor is to hold my place in line.
Graham, just about every consumer-level website out there on pregnancy tells women to contact their doc as soon as they think they are pregnant. Pregnancy *and* childbirth are extremely medicalized, and along the whole continuum women are encouraged to rely on their doctors – does that woman really need an induction? Do 30-50% of babies *really* warrant a c-section? Is the lithotomy position really ideal? Getting in to the doc for confirmation of pregnancy is but one first step in a long, medicalized road through pregnancy. IMHO. ;)
I was recently pregnant- and I just wasn’t sure what to do when I got the positive test. I went to my family doc who had me pee on one of their sticks to confirm the pregnancy and then they referred me to an OB- but I didn’t see her until I was 10 weeks along (this is standard). In retrospect the family doc visit was a waste of a co-pay. But when you’re pregnant you feel you should do something right away. From a public health perspective it would make more sense to see a woman earlier on in the pregnancy as that first trimester is when it is the most crucial to avoid alcohol, smoking, etc.
I had a totally natural labor/delivery and it was wonderful. My OB was AWESOME and didn’t even break my water or anything- she actually SAT quietly in the room while I was laboring and just let me determine when I was ready to push, etc. I felt totally safe to be in a major medical center in case something went wrong while I avoided all unnesscessary medical interventions…So I felt so encouraged that there can exist a beautiful balance between the medical world and natural processes when it comes to pregnancy and birth…Not all OBs are overly medical.
I think the question of when to go to the doctor is pretty universal, actually. It’s not just pregnant women. Does that mean that having a cold or diarrhea has become over-medicalized too? I’m confused as to what “over-medicalized” even means.
[...] in his post Medicalization of Pregnancy, explains how the modern world wants to diagnose even their pregnancy. At the end, he questioned if [...]