Midwives of the Revolution

Explorations, analysis, and reflections on women's health, midwifery, and politics from a feminist, marxist lens


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The Loneliness of the First Trimester

On Thursday, I was pregnant. Seven weeks and six days of gestation. This was a very carefully timed, meticulously planned, and surprisingly quickly achieved pregnancy. On Thursday, I was happy. I had attended a meeting after work, hearing a report back from a protester that had been in the streets of Ferguson, Missouri, and analysis of police violence and the new phase in the struggle against American racism and police terrorism.

And then, I was bleeding.

I didn’t know, I couldn’t know, at first, if I would be the one in two women with first trimester bleeding, or the one in ten pregnant women overall, that would have a miscarriage, or spontaneous abortion. But I knew enough to identify that sign of bright red bleeding that doesn’t stop, when I had no risk factors for other causes of first trimester bleeding, meant I was losing this pregnancy. 

And so, by Friday, I wasn’t pregnant any more. 

And, since I’m not allowed to take any days off work until I’ve been at my job a complete six months (and I’m just three weeks shy of that), I went to work caring for women on Friday, while my uterus emptied. I felt myself bleeding while listening to a young mom’s baby’s heartbeat for the first time, celebrating with her and her beautiful partner. I patiently explained the speculum exam to a terrified young woman, and did a six-week postpartum checkup and got to coo over her gorgeous baby. I counseled an older woman on the risks and benefits of sterilization versus long-acting reversible contraception. I tried to have a normal day, when I wanted to be home, mourning. 

It’s only Saturday, and I’m still pretty devastated. I was supposed to attend my city’s SlutWalk protest, where a year ago, I had given a rousing speech tearing apart sexism. I wanted to be standing with my sisters and comrades in the streets. But more so, I need to heal.

***

I have been musing quietly about the loneliness of the first trimester since I peed on the stick weeks back and had the delightful moment of reading “pregnant” on the digital screen. The feeling was so different from the myriad other times in my life when I had taken the test in anguish — especially the one other time when I had a positive result, in midwifery school, and knew I was going to have an abortion. I was, this time, elated. 

But there is convention in our society to stay quiet about that positive pregnancy test until the second trimester, regardless of which choice we plan to make about the pregnancy. We know that people won’t really understand the complexity of our feelings about the pregnancy, and that we don’t want to tell everybody the bad news, if we end up needing or wanting an abortion, or if the pregnancy ends in a miscarriage. And so we tend to suffer through many discomforts of the first trimester, in silence.

I remember telling some of my comrades and friends what was going on, when I had the unplanned pregnancy years back. Because I am part of a community that embraces reproductive rights, I was fortunate that it was fairly easy for me to tell people at the time that I was planning an abortion, or that I was still dealing with some of the medical issues related to my abortion the few months after it started. I have since publicly spoken out about my abortion many times, working to de-stigmatize the experience that three in ten women will experience before the age of 45

Telling abortion or miscarriage stories can be a powerful way to break the silence. But it will take more than telling stories to break the stigma.

Telling abortion or miscarriage stories can be a powerful way to break the silence. But it will take more than telling stories to break the stigma. Art by Favianna Rodrigeuz, Just Seeds Cooperative

At that time, however, I didn’t talk openly about what was going on outside my activist network. But I did have a fellow midwife student classmate and friend who turned out to have an unplanned pregnancy at the exact same time as me. We turned to each other one day after class with our secrets: “I’m pregnant.” Neither of us felt good about it. We were both in the first of our two year program, and planned to go full time. There was no time for pregnancy, birth, and parenting, and both of us had partners that were full time graduate or professional school students. It was terrible timing. We each made different decisions, however. I ended my pregnancy, while she continued hers and is parenting this beautiful child, who is almost three now. 

The other difference between us was that none of our classmates knew that I was pregnant or had an abortion, while they eventually found out about hers, when she started showing and eventually had the baby during the program. We both knew that even in a midwifery program, people weren’t emotionally intelligent enough to deal with a sister midwife’s pregnancy to respond appropriately to our news. So we both kept quiet, attending class while coping with our own pregnancy challenges.

I have wondered sometimes if we would have felt that way if we were attending school in a more politicized or radical time, say at the height of second or third wave feminism. Interestingly, I was able to talk about it with my faculty and preceptors, who all had trained as midwives in more political times and were very accepting of my decision.

If a group of midwife students can’t be mature enough to be present with each other during pregnancy, who can be?

***

This time around, I spent much of the initial weeks of pregnancy being silently excited. I talked about it with few people: my mother, my partner, my nurse-midwife team, and one friend, whom I had asked to be my birth doula. It was strange not revealing the news when talking to friends and family about this big thing that was going on in my life. Many times, I wanted to tell more people. It was humbling to now be experiencing life as a “pregnant patient,” much as I had appreciated the experience of being the “abortion patient,” knowing that this would make me a more compassionate nurse-midwife.

And I continued with my life — bicycling, gardening, going to protests, working long hours, cleaning my house — while thinking about the little life growing inside me. Fantasizing about the home birth I expected to have in early April with the fabulous team of midwives I had chosen to care for me. Talking with my partner about changing the guest room into the baby room over the winter. Getting excited about the cousins our baby was going to have, given that my sister in law is pregnant with her second, and my brother and his wife might be trying to conceive soon. Planning with my partner how we were going to cleverly announce my pregnancy on Facebook and to friends in person. Looking forward to the excitement and congratulations we could expect from family, comrades, and friends. And trying to imagine what it would be like to meet that tiny creature my partner and I had created. 

***

I was starting in some ways to relish the privacy of the last couple of months. It has meant more time for introspection, self-care, and focus. I have needed that inner space to deal with some significant changes to my body and my changing life priorities. 

Like sobriety. I chose to stop drinking around the time that I believed I was ovulating, in the first cycle we tried to (and did) conceive. I genuinely enjoy beer, wine, and the occasional cocktail, but since beginning my new job for the last few months at my job, I had also relied on that delicious glass of wine after work to help me unwind. Being sober means having to actually face all the trauma I see at work, and process it in some other way. And this is a pretty drug- and alcohol- heavy society we live in, so not drinking or partaking in any drugs can be pretty challenging, socially and personally. I have loads of patients that aren’t able to cope with life without substances, and continue drinking and using (marijuana, mostly) during pregnancy. Like many women facing the prospect of complete sobriety for 40 weeks, I worried that I would be tempted to drink and felt guilty for even thinking it might be hard to stop.

Fortunately, I have felt pretty good about not drinking and have enjoyed the challenge of sobriety. But I also dreaded social situations in which I would normally be drinking, worried someone would ask why I am not having my customary glass (or three) of wine. What would I say if someone suggested I was not drinking because I was pregnant? Would I choose to tell them? Would I lie? Would I tell them I didn’t want to talk about it? Fortunately it never came up. (For the record, peeps: Don’t ever ask someone if they are pregnant! They will tell you if they want you to know!)

Another major chemical change occurred in my body as I prepared my body for pregnancy by weaning myself off the anti-depressant I had been taking the last few years. That drug had really helped me through some major difficulties the last few years, from completing my midwifery program, to facing my midwifery board certification, to an extended job search, to the major transition of this new and difficult job I eventually landed and accepted. I am fortunate that my depression is well enough managed, and I am stable enough to face stress without the help of this wonderful pharmaceutical product or alcohol. Mostly I owe that to years of therapy and yoga practice that have enabled me to access pretty decent coping skills, along with an extremely supportive partner. Nonetheless, it felt very difficult to stop drinking and to stop taking this antidepressant at the same time. In hindsight, I may have done it a little differently, but it worked out OK. 

Mainly, the changes in my body with the new pregnancy made me feel extremely vulnerable. I knew I had little control over if this pregnancy would continue successfully or not — knowing what I do about rates and causes of miscarriage. For the first few weeks, I could hardly believe I was really pregnant! Every trip to the bathroom, I feared seeing blood on the tissue paper. Every little tiny cramp or feeling in my pelvic area felt like it could be something wrong with the pregnancy. And since I only experienced momentary twinges of nausea, I looked forward to them, as proof that I was in fact pregnant. I caught myself looking at my breasts in the mirror and sometimes touching them to make sure they were really growing, and tender enough. Loads of women face extreme nausea and vomiting in the first trimester and are completely miserable, whether or not the pregnancy is desired or if she plans to continue it. I’m fortunate I was at least feeling well. 

And when the proof was there, out of nowhere — sustained bright red vaginal bleeding, cramping, and passing tissue — it was clear that it was all over, in a flash. One day, a pregnant patient, the next, a “miscarriage patient.” And I had to believe there was nothing I could have done differently. It wasn’t my fault. It just wan’t going to work out this time. 

***

These are some of the things we don’t talk about when we talk about pregnancy, planned or unplanned; desired, undesired, or ambivalent; spontaneously aborted, continued successfully, or electively aborted. These are some of the things we don’t talk about because we have internalized the messages of the war on women. This war psychically imposes a social and cultural expectation that all women naturally 1. want to become a mother and should embrace every chance at motherhood, no matter the circumstances; and 2. adjust and cope in a healthy way to the emotional and physical challenges of pregnancy. And if they don’t, there is something wrong, or even criminal in her thoughts or actions. Yes, lawmakers have proposed criminalizing miscarriage. Yes, every year, dozens of laws in every state of the United States are proposed and pass regulating women’s bodies and restricting abortion. Yes, laws primarily aimed at Black women  criminalize drug and alcohol use in pregnancy (see Dorothy Roberts’s Killing the Black Body).

Yes, this impacts popular opinion, and shapes how people–even and maybe especially women themselves–understand and talk about pregnancy, abortion, miscarriage, and motherhood. And mostly creates the circumstances for not understanding what it is to be pregnant, or how to empathize with a woman who is pregnant, or wants, does not want, or who cannot achieve pregnancy or parenting. 

***
I was grateful I was pregnant on Thursday, and still sad that I’m saying goodbye to that little embryo that I hoped would become a fetus and eventually the baby I would get to parent. I am nervous about what happens next. Will I be able to get pregnant again right away? What kind of loneliness and fear will I face the second time around? Will I make it past the eight week mark next time? Will my readers and friends respond compassionately to this post? 

I feel like I’m in a good enough place emotionally to be able to share my miscarriage story, alongside my abortion story. And like coming out about being queer, or about having had an abortion, I hope that by telling my story, I can contribute to de-stigmatizing something that our deeply misogynistic society doesn’t understand. 

But it takes more than being able to tell the story, for those of us for whom it is safe to do so, to change cultural values around pregnancy and sexuality. We have to end the war on women if we want to shift people’s consciousness and foster solidarity with the challenges people face during pregnancy and parenting. How could we do that? It means opposing every state/federal/local law and institutional policy that aims to decrease women’s bodily autonomy and impose control over women’s sexuality. It means being in solidarity against every form of sexual violence and coercion. It means fighting to end the New Jim Crow. It means demanding comprehensive sexual education for all children. It means standing up for a living wage, the right to union representation, and dignity on the job. It means building a movement for immigrant rights and to tear down the borders. It means calling for free quality childcare and the valuing of care work. 

Some of these things might seem far-fetched and maybe even only tangentially related to my story. Maybe you think I am coming out of left field?

But there used to be a saying in the women’s movement that really meant something, though it has ceased to bear any resemblance to its original meaning: “The personal is political.” In its best sense, it meant that our personal struggles as women or as women of color, weren’t ours alone, but a reflection, or a symptom, of the broader racism and sexism in society. In the era of neoliberalism, we are meant to see our problems as isolated from each other’s, and mostly as a reflection of our own personal weaknesses and inner failings.

More and more, however, I am seeing my personal struggles as intimately related to the structures of social oppression, and I’m tired of bearing them alone. When I fight against the war on women, or against the war on the poor, or the war on people of color, it’s personal. It’s deeply political, as well, but when I think about the circumstances of my reproduction, it’s also deeply personal. 

***

The last women’s movement, like the civil rights and Black Power movements, changed culture dramatically — but throughout my entire lifetime, the right wing has undertaken a sustained attack on the progress those movements made possible. It is my hope that we can build new social struggles from the ground up, that take up some of the demands I mentioned above, and more. Yet most of all, my hope and my argument is that the voices and demands of ordinary people as we struggle with our “personal” issues must be at the forefront of these movements — rather than the tepid Democratic Party politicians and NGO leaders who have been too afraid about upsetting the right wing that they have done nothing but compromise while our rights are under attack.

After all, it was- not well-meaning liberal politicians that made Roe v. Wade possible, but the fact that women took to the streets to tell their own stories about illegal abortion and forced sterilization. Those movements put women first — not the careers of politicians or career “activists.” Change happened, then, and it happens now, from the bottom, up. Or, as the late, great historian Howard Zinn put it, “What matters most is not who is sitting in the White House, but ‘who is sitting in’ — and who is marching outside the White House, pushing for change.” 

I don’t think the first trimester, or any part of pregnancy or parenting, has to be lonely. I know that people can develop deep empathy and solidarity with each other’s struggles — and we see a glimmer of that in every mass movement, from the revolution in Egypt to the capitol occupation in Wisconsin, to Occupy Wall Street, and even how people looked after each other in the immediate aftermath of Hurricane Katrina. We have to foster that in our communities as much as we can, but more so, we have to organize movements for reproductive justice that put the demands, voices, and strategies of ordinary women and other people who can get pregnant at the forefront.

Being part of those social movement traditions is what makes me feel a little less lonely as I grieve my lost pregnancy and look forward to the future. 


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Some Things I Have Been Thinking About in the Realm of Reproductive Justice

I wouldn’t be a very good Marxist or feminist midwife if I didn’t have some things to say about what’s going on in the world. But once my first three months of the new job were over, I finally had energy to do more political work, and therefore have had less time for blogging.

I am trying to carve out more time to write on this forum about the ongoing war on women, and what people of all genders and political persuasions can and are doing to fight it. I wanted to share just a few things here about what I’ve been thinking about, and that I hope to explore more in later, more in depth posts.

Hobby Lobby Protest

The Hobby Lobby decision prompted immediate protest at the grassroots

First, the Hobby Lobby Supreme Court decision of last month irked me more than I can say. It was an insult to science and to “freedom” and to women’s bodily autonomy. And so everything I wanted to say about it was published over at SocialistWorker.org, in this piece: “The ‘Freedom’ to Deny Women Healthcare.” I have more to say on the resistance to that decision, especially how defensive everyone is about contraception, but that will hopefully be developed in another upcoming article in that publication.

Also, I follow with great interest the ongoing legal battles over forced surgical birth, and their connection to abortion and other reproductive rights in this country. I really liked this piece, and laud Jennifer Goodall for her courageous stance for normal birth after c-section: “Pregnant Women Warned: Consent to Surgical Birth or Else.” Women losing the right to how they give birth is intimately connected to the right to contraception and abortion — another topic I look forward to exploring more in this space and others. 

Obvious Child

You must see this film. #ObviousChild

On a lighter note, I LOVED seeing Obvious Child in the theaters on its brief stint in my city. What a *fabulous* and hilarious comedy about abortion, of all wonderful things. There is nothing so wonderful as a bunch of sex-positive, abortion-positive, pro-woman people dealing with an unplanned pregnancy in a very real way on the big screen. I have heard people say that if Knocked Up or Juno were about abortion, there wouldn’t have been a story. But guess what — you can have a story when an unplanned pregnancy results in abortion (like half of all unplanned pregnancies do in this country) — that story just happens to then focus on the woman herself. Revolutionary. 

Finally, I am sick to death of the divisive commentary that passes for analysis about why the LGBT movement has made strides, while the war on women continues. This disturbing piece from the Daily Beast, “Ten Reasons Women Are Losing While Gays Keep Winning” has its response from yours truly coming up quickly. Suffice it to say that biological determinism has no role in progressive analysis, and apology about abortion is what got us further entrenched in the war on women, and will not provide our way out.

* * * * *

Too many teasers? Sorry. Let’s say this is my way of holding myself accountable to myself and my readers. It shall be written!


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Abortion should be available on demand, without restrictions, for everyone who needs it. I believe that while society still places limits on what a woman may or may not do with her own body, while women’s sexuality and reproduction are still in effect controlled by the state, any discussion of equality or empowerment is a joke. – Laurie Penny

Sums it up.

http://towardfreedom.com/51-global-news-and-analysis/global-news-and-analysis/3542-abortion-should-be-free-safe-and-legal-for-everyone 


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Happy Mother’s Day!

Happiest of Mother’s Day to all you mamas out there. When judging mothers is something of an American pass-time, I hope you can enjoy this day and be celebrated!

***

Throughout the history of the women’s movement, there are been elements that have used an appeal to womanhood, to motherhood, to build movements for peace and justice. I’m not one to celebrate essentialist notions of gender, or to presume there is anything innate to women that should make us more peace-loving than other genders. But my political stance on that withstanding, I do want to take a minute to share some history from that side of the feminist movement — the radical anti-war mamas who started the tradition that is now known as Mother’s Day. 

Here’s a poem that serves as a rallying cry to mothers to oppose the Franco-Prussian war:

A Mother’s Day Proclamation
Julia Ward Howe, 1870

Arise then…women of this day!
Arise, all women who have hearts!
Whether your baptism be of water or of tears!
Say firmly:
“We will not have questions answ
ered by irrelevant agencies,
Our husbands will not come to us, reeking with carnage,
For caresses and applause.
Our sons shall not be taken from us to unlearn
All that we have been able to teach them of charity, mercy and patience.
We, the women of one country,
Will be too tender of those of another country
To allow our sons to be trained to injure theirs.”

From the voice of a devastated Earth a voice goes up with
Our own. It says: “Disarm! Disarm!
The sword of murder is not the balance of justice.”
Blood does not wipe our dishonor,
Nor violence indicate possession.
As men have often forsaken the plough and the anvil
At the summons of war,
Let women now leave all that may be left of home
For a great and earnest day of counsel.
Let them meet first, as women, to bewail and commemorate the dead.
Let them solemnly take counsel with each other as to the means
Whereby the great human family can live in peace…
Each bearing after his own time the sacred impress, not of Caesar,
But of God –
In the name of womanhood and humanity, I earnestly ask
That a general congress of women without limit of nationality,
May be appointed and held at so
meplace deemed most convenient
And the earliest period consistent with its objects,
To promote the alliance of the different nationalities,
The amicable settlement of international questions,
The great and general interests of peace.

Here’s a great post outlining the story: http://www.thedailybeast.com/articles/2014/05/11/the-radical-history-of-mother-s-day.html 

***

And on a lighter note, I’m looking forward to spending today with my Mother, who is ever my hero and my inspiration. I hope you, dear reader, have a restorative and beautiful day. 


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“There are so many places in the world with no healthcare–how could our patients have all this access but not show up?”

This is a common refrain from my collaborating physician, a woman who has worked in this community for decades and whose spirit betrays her lack of ability to maintain empathy. I’m not sure what she had to begin with, but now it is worn pretty bare.

It was hard to imagine those first few weeks. It can’t be that bad, I thought. Most people probably have some level of interest in taking care of our health, have some buy-in. Especially pregnant patients, right?

***

Every week, there are patients who show up toward the end of pregnancy, realizing it’s time to have the baby, having not been in prenatal care for months, maybe at all. They know they need to get the baby out. But they didn’t come in for their second trimester anemia follow-up, the anatomy scan ultrasound, the diabetes screen. They didn’t necessarily take their prenatal vitamins and likely haven’t been eating healthy. Maybe they were smoking weed or drinking or having high risk sex. They don’t know if the baby is going appropriately or if the baby is “okay,” but they come in…they come in.

Everyone I work with, even those who have been working in this community for years, still seems surprised that our patients don’t reverence prenatal care the way they did, or the way they think everyone should. “I went for every one of my prenatal appointments, I took my vitamins, I showed up, why can’t these people?”

“These people.”

And it’s true. In the narrowest sense, all pregnant patients in my state can get prenatal  care. For undocumented mamas, it can be more difficult. No public health clinic is going to turn you away, that I know of. And for our patients, getting insured, getting Medicaid, is possible. Not saying the state doesn’t make you jump through hoops that may at times be humiliating and exhausting, but in theory pregnant women at least can get insured. But at least there is some assurance that the state will cover the cost of your care. It’s free!

And then there is coming in.

There is, of course, a wide variety of reasons patients don’t come in until midway through the second, or even until late in the third, trimester to establish care or to pick up where they left off after the initial dating ultrasound. I can’t pretend to understand all that goes on outside the clinic, in my patients’ lives, but I can say that moralizing about patients not showing up doesn’t actually help get them in the door or make them feel welcomed when they do show up.

No, this isn’t a rural community in subsaharan Africa, where there isn’t modern medicine. Oh, here, we have it all! We are in the heart of a wealthy American city!

***

…A wealthy city in which fifty public elementary schools were just closed, almost all in black and brown neighborhoods; in which the majority of my patients only ever see white faces in their health clinics, maybe their kids’ schools, and in blue uniforms; in which there are few grocery stores and terrible transportation systems in the neighborhoods that are majority people of color; where in some areas youth are tracked into the criminal injustice system and in others, they are offered the world.

When the City doesn’t really give a shit about you, doesn’t value your basic human needs, let alone your higher aspirations…why would you necessarily adhere to the proscribed regimen of care for the baby you are carrying?

And even in these terrible circumstances, most of our patients are active participants in their care — they show up, get excited each time they hear the baby’s heartbeat, they worry when anything isn’t normal, they ask great questions about their bodies and the life growing inside of them.

But just as you can’t compare yourself, who did everything “right” when you were pregnant, to the few patients that don’t show up for care, you also cannot compare these “delinquent” patients to those mamas in the (other) third world who would be so grateful to have access to the kind of care that our patients take for granted.

And what if your managed care Medicaid company has you tied to your primary care provider at a clinic where every time you meet with the doctor, you feel like she doesn’t have time for you, doesn’t explain where your cervix is, doesn’t follow up on your look of bewilderment with a simple question about how she can help you understand?

I might not keep showing up either.

***

It is frustrating and scary as hell to be a prenatal care provider in those situations. When you accept a pregnant patient into your care so late, you just don’t know what you’re going to get. Intrauterine growth restriction? Fetal alcohol syndrome? Uncontrolled gestational diabetes? Preterm labor? You feel like you’re scrambling to catch up, to find out what is going on physiologically, with the pregnancy, and what motivates the woman carrying the pregnancy. You worry she might expect everything to go perfectly, while it appears she hasn’t done her part to reduce risk, since you haven’t seen her for so much of her pregnancy. You might become the type of provider you swore you’d never become. You might not even recognize yourself after years of seeing the same social problems reflected in the faces of your beautiful young patients.

Until we fight for and win from the system quality affordable housing, excellent free public education, decriminalization of our youth and of blackness, safe and affordable food and water, expansive mass transit, and a single payer health care system, the circumstances under which we utilize any and all of these basic human needs will be less than ideal. And so will our provision of such care and services.

I look forward to working in healthcare in which women’s and children’s lives will be truly valued, and in which we will collectively trust, not scrutinize–but also, enhance–women’s decisions and lives.

For now, I am grateful for having a worldview that helps me find empathy alongside righteous rage against the system. I’m grateful for education that gave me the tools to provide evidence based care, so I can continue working to do my best for patients as they show up in my clinic, whenever they’re at in the lifecycle. I’m grateful for lunchtime office yoga or forest preserve walks that preserve my sanity. And I’m grateful for intersectional (anti-racist, anti-sexist, environmental justice approach) social and economic movements in the city, country, and world, that can make things better inside and outside the clinic walls. Because good lord, things need to get better, soon.


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Sad Vaginas

Vaginal infection is a major reason that women visit the gynecology office (Brown, Hess, Brown, Murphy, Waldman, & Hezareh 2013; Overman 1993). I knew that going into midwifery. But my god, I never thought I would see so many sad vaginas every clinic day. My patients have a lot of vaginal infections. I spend a lot of time with patients talking about why for optimum vaginal health, less is more. Many have heard before that they “shouldn’t” douche, from other healthcare providers — but even among those patients for whom this is not a new idea, they continue intravaginal practices and don’t necessarily know why they shouldn’t.

This raises two issues for me as a nurse midwife and a feminist — the social roots of intravaginal hygiene practices (IVHP) and how providers educate –or don’t- — their patients about their own health.

Why do women douche? 

Many women tell me they feel they need to get clean after menses. They don’t like the residual menses they feel might be hanging around when the bleeding stops, and in particular they worry about the smell. They also think it will help them prevent infections. Commonly, my patients douche because their mothers, sisters, and grandmothers had and taught them these practices. But as one patient asked me this week, “why would they sell all that stuff if it’s so bad for you?” Good question.

And since Summers Eve re-vamped and expanded their product line beyond simple douche products to an impressive array of “yoni” personal products, these commodities are hipper and more attractive to consumers than they have been in a long time. Image

In a small (141 participants) prospective cohort study of sexually active women 18-65 years old in Los Angeles, researchers found that 66% reported IVHP, 49% of whom admitted using an intravaginal product (other than tampons) and 45% of whom reported intravaginal washing (Brown et. al 2013). This washing could include vinegar, water, soap and water, or commercially available products (Brown et. al 2013). One 2004 pharmacy journal reports that the reasons for these IVHP vary according to geography, racial background, age group, and rates of sexual activity (Pray & Pray 2004). According to Pray and Pray, African American women inherit IVHP from their mothers, while white women learn these habits more from advertising.

There is nothing wrong with your vagina

Wherever women get the specific idea that they need to use special products and habits to keep the vagina clean, smelling like roses (or lilies or citrus or island splash!), no one who lives in a wretchedly sexist society should be surprised that any woman would get the general idea that there is something wrong with how her normal healthy vagina smells, tastes, etc. But if women in modern capitalism can’t be trusted to decide if, when, and under what circumstances she gets pregnant, labors/births babies, and parents — wherein, for instance abortion is expensive, unavailable, often provided under non-compassionate conditions, and women are shamed for considering or choosing abortion (and even using birth control, these days!) — why could they be trusted to take care of their own vagina they way nature made it?

As a matter of fact, the vagina has its own beautiful environment that does all the work you think a douche might do for you — keeping your vagina clean — all on its own, when you are healthy. The vagina likes to be nice and acidic, which is made possible by a wide variety of anaerobic and aerobic gena and species (Overman 1993). Acid-producing bacteria like Lactobacillus keep in check the more basic bacteria that cause the common infection bacterial vaginosis (Overman 1993).

When you douche, you are likely to wipe or wash away the “good” bacteria, leaving lots of room for the “bad” bacteria to take over, causing you bacterial vaginosis (BV). Studies have not shown a direct correlation between douching and BV — for instance, infrequent douching may not directly cause BV (Brown et. al 2013). Overall, however, douching may increase a woman’s risk of contracting a sexually transmitted infection, or HIV if she is exposed to those pathogens, developing pelvic inflammatory disease, or be associated with preterm labor and birth when performed during the second and third trimester of pregnancy (Brown et. al 2013; Pray & Pray 2004).

Then there are all the products designed to make the vagina smell like something it’s not. All the deodorants, sprays, wipes, external washes, creams, and powders designed for vulvar application may place you at risk for yeast infections or irritation, but even if they don’t, their very existence and success on the market contributes to the cultural perception that there is something wrong with your vagina in its natural state. And it makes individual women feel bad about their bodies in a very particular way. As this wonderful columnist for Essence wrote: “There is nothing wrong with the totally natural, completely unaltered smell of your va-jay-jay in its normal state. (Our “down under” isn’t supposed to smell like summer linen, fruits, or fresh mint)” (Lucas, D. L. 2011).

Well, society doesn’t really value anything “natural” about women except for our bodies’ ability to 1. sexually excite men and 2. bear and mother children. So, we are meant to buy cosmetics, sexy clothes, enjoy pole dancing for exercise, be ok with making less money than our male counterparts, do more housework, assume primary responsibility for childcare, etc.

So if we do everything else to bend to society’s desires for who we are as women, why shouldn’t our vaginas be part of that package? As the “EVEangelist” over at Summer’s Eve reminds us, ”It’s time for a shower inventory. If you’ve got a cleanser for everything but your vaginal area, it’s time to make room for our pH-balanced Cleansing Wash.” Products for everything! You are not good enough as you are!

(As an aside, a simple, non-scented soap to cleanse the vulva should do the trick! Avoid body washes and avoid washing in the vagina itself.)

Don’t get me started about the pseudoscience and fake pro-vagina crap over at that website…Barf.

…Until there is

Not all vaginas are going to be happy all the time. And vaginal health isn’t just about products you do or don’t put in them or any sexual pleasure/stimulation a vagina might be party to. Vaginas are part of the female body, which may have lots of experiences that can enhance or hurt vaginal healthy: like diet, exercise, sexual consent, history of abuse or assault, body size, and emotional stress.

But none of those things can be rapidly fixed with an over-the-counter product that makes claims that it will fix up your vagina, unless it is medicine designed to treat a real infection, like intravaginal treatment for yeast infections. And I am all for trying things yourself, DIY, and taking care of yourself using health knowledge grounded in non-commercially biased information like that which is found in, say, Our Bodies, Ourselves and Guide to Getting It On. But douching and using these so-called yoni products that are making some CEOs rich over at Hate Your Vagina, Inc. isn’t gonna help.

Where the provider comes in

I’m glad when patients come into the clinic for evaluation of vaginal discharge because it allows for patient education. I like talking to patients about the difference between healthy and abnormal vaginal discharge, and what a healthy vagina might look/smell like, versus what could put it at risk for infection.

And that’s why I’m glad I’m a midwife (do I say that in every post?). Midwifery is about meeting women where they’re at, and working with them to achieve desired health outcome. Women really are the best expert in their own body/experience, and I am just there to facilitate her reaching her optimum health. When women tell me anything about their health habits that I may think is unhealthy or possibly harmful, my first question is “tell me more about that.” If you want to help a patient/client change a health habit, you need to know what motivates her to either continue or change. This is what we do for smoking cessation, nutrition or exercise promotion, and especially for sexual health risk reduction.

This gets back to my initial observation that many patients know they “shouldn’t” douche (or do lots of other health behaviors deemed unsafe/unhealthy, but I digress), but most don’t know why. When I explain to a woman how wonderful her vagina is and how douching disturbs that beautiful environment, she is more likely to understand her own anatomy and how to promote her own health. My hope is that instilling pro-vagina sentiment can also clear the way for greater acceptance of vaginal delivery of medication and contraception and to an increased motivation to use condoms/protect the goods from more dangerous infections and disease. We shall see.

Really sad vaginas

 

A much riskier health habit than douching, though douching may compound the risk, is practicing unprotected sex with someone whose infection status you don’t know, or having multiple sexual partners, having a partner who has multiple partners, anonymous sex or sex when high or drunk. (You can look forward to my forthcoming Condoms, Part II post for more on that.)

Actually sad vaginas have infections like trichomonas, chlamydia, gonorrhea, herpes, warts, and syphilis. Many of these have no symptoms or barely noticeable symptoms, but none of those can be treated with douching, and all of them require diagnosis and treatment in clinic. And someone who gets one of those infections is at higher risk for sexual transmission of HIV and hepatitis.

I guess a part of me understands that when my patients who are at risk for STIs douche, they may be trying to cleanse themselves of STI risk. (Fortunately, the old myth that douching can prevent pregnancy is much less prevalent these days.) And even here, I can find a good instinct. Douching may not get the desired results (a healthier, happier vagina), but it is a health habit, and I think providers need to recognize that patients do want to be healthy.

Toward a world with happier vaginas

I don’t blame individual women for buying into the crap that the vaginal hygiene industry sells them, any more than I blame women for using makeup, enjoying fashion, partaking in gossip and petty shit among women, or being in abusive relationships, for instance. These are all symptoms of a sexist society, and individual women who make these “choices” are operating in a false set of choices we are allowed to make in capitalism. Sexual liberation (or for the sake of this post, happier vaginas belonging to happier female bodied people) is about a lot more than lack of vaginal infection/STIs, but I do think that would be a good start.

Health care providers–not just midwives–can play a role in that by promoting and practicing in line with Dr. George Tiller’s call to trust women. We need to stop blaming women when they make “poor” choices about their health in a society full of so much sexism, racism, and class inequality. And we can take part in every social movement that confronts sexism, misogyny, and inequality, because health isn’t just about what happens in the exam room — it is determined by the world we live in, and we have to fight for a world that values women and allows for people to make the best possible real choices about our lives and our health.

References:

Brown, J. M., Hess, K. L., Brown, S., Murphy, C., Waldman, A. L. & Hezareh, M. (April 2013). Intravaginal practices & risk of bacterial vaginosis & candidiasis infection among of cohort of women in the United States. Obstetrics & Gynecology 121(4), 773-780. doi: 10.1097/AOG.0b013e31828786f8

Lucas, D. L. (July 21, 2011). Real talk: feminine care 101. Essence. Retrieved 04/14/2014 http://www.essence.com/2011/07/20/real-talk-feminine-care-101/

Overman, B. A. (May-June 1993). The vaginal as an ecologic system. Journal of Midwifery & Women’s Health 38(3), 146-151. doi : 10.1016/0091-2182(93)90038-I

Pray, W. S., & Pray, J. J. (2004). Douching: perceived benefits but real hazards. US Pharmacist 29(1). http://www.medscape.com/viewarticle/490338