Mel at Stirrup Queens wrote a post recently about a question that's been out there for a very long time -- should OB/GYN offices have two waiting rooms, one for pregnant people and one for not? It brings up interesting points, like whether or not separate waiting rooms would actually be compassionate, or if it would feel even more "othering." It made me think about my experiences with OB/GYNs throughout the years, and how each office made me feel, and my comment length turned into post material, so here are my thoughts.
Early OB/GYN Experiences
My first annual exam was when I was a teenager, I don't remember exactly when but I feel like early teens? I had a woman doctor at the time who was a pediatrician but also could do gynecological things, and what I remember most was that in my VERY FIRST experience with stirrups and speculums, she asked if it was okay if a group of interns were in the room, and I said, "ok, fine, the more the merrier" (I'm pretty sure those were my exact words), because it was awkward enough to begin with and why not make it more so for the sake of education? I had this doctor through at least the start of college, and she prescribed me birth control not as much for sex (although in college that became a need) but because my periods were so damn irregular. Like, could be 45 days, 60 days, 120 days, as long as 9 months before I would get it, and then it would be a 2-week horror show. The Pill definitely helped, but it also masked a lot that would come up later.
My next OB/GYN was my mom's adult one, and he was a dick. Very much the stereotypical "I am a doctor so I know what I'm doing and I'm going to make you feel like you don't know anything about your own body." This is a doctor who asked me questions that I didn't realize at the time were fishing for PCOS symptoms, which by the way I HAD PCOS, but were not at all compassionate to the fact that I was young and self-conscious about those things. One of two horrible memories is having him ask if I had excess body hair, and I said "um, no" but then when he did the exam he said with disgust, "YOU CLEARLY SHAVE YOUR BELLY BUTTON AREA" and didn't understand that this was a source of shame, but didn't add anything to my chart. Sigh. Second horrible memory -- he finally listened to me that I had horrible pelvic pain and did a laparoscopy to explore for endometriosis, didn't find any, and seemed pissed at me, saying, "Well, there's nothing there. Some women just have pain." EW. So I lived with pain, even with the Pill, for well over a decade with no answers and no one who seemed to even want to look for answers.
The Next OB/GYN Office I Remember, in my 20s and early 30s
I went to an office where the doctor was female (I was like NO MORE MALE DOCTORS, THANKYOUVERYMUCH), but she was also pretty no nonsense and fairly blunt. She did help me with finding different versions of the Pill that helped with breakthrough bleeding and migraines. I didn't have an issue with her. UNTIL.
When I met Bryce and we got serious, I asked about my fertility, around 32. Well, actually, I asked about his fertility and brought in copies of old sperm data from when he had tried IUI with his ex-wife to no avail (with his consent, of course). She looked at it and said, "oh yeah, I can write you a referral to a fertility clinic for testing and things, you'll likely just need some basting." Which is one hell of a way to suggest that artificial insemination was going to be our first line of attack in the babymaking process. In a way though, I appreciated the bluntness because it meant that we wouldn't have to suffer through trying on our own when that was clearly a no-go.
So, we got a consultation when I was 33, before we got married, so we could start right away. And the first year of IUI was, of course, fruitless. Because in addition to the male factor, I had PCOS, which blew my mind that LITERALLY NO ONE HAD DIAGNOSED despite my having a zillion markers for it. I guess because I didn't 'fess up to shaving my bellybutton? WTF.
Every appointment after that I grew more and more aware of two things -- the waiting room that was clearly designed with young families in mind (toys, a coloring table, loads of pregnant people) and then that the bluntness of my doctor was actually a complete lack of empathy. She kept saying at each appointment, "still not pregnant yet?" and when I explained all the developments and then the Great Embryo Whittling phenomenon, she was like "That's so WEIRD. I would have thought this would have worked for you by now." Needless to say I found a different doctor, but after too many appointments that left me in tears.
The Pregnancy Shrine Office
I had recommendations from others that there was another office, that was a little woo-woo, but that the doctor was very compassionate and fertility-conscious. So I jumped ship and went there. Because, no one has figured out yet (at least at the time I went through it) that if you are getting poked and prodded extremely regularly by a fertility clinic full of OB/GYNs, MAYBE THEY SHOULD ALSO DO YOUR PAP SMEAR SO YOU ONLY HAVE ONE SET OF SPECULUMS TO DEAL WITH.
I was fully in denial of our situation and 100% thinking that we were going to get pregnant, that we were closer all the time, despite the ectopic and then the miscarriage, so the decor didn't bother me. At first. Basically, you walked in to a spa-like atmosphere, replete with a fountain and soothing music, but if you looked around... it was full of paintings, statuary, friezes... all representative of pregnancy and breastfeeding. Which I'm guessing doesn't bother you too much when that is your experience and it's all very typical, but for me it was insanely painful. They did, however, have two waiting room areas, and I asked to go to the alcove one after a few stoic appointments where I was overwhelmed by sensory stimuli taunting my barrenness. it still had one frieze, but just one. Three other problems with this office -- first, after my miscarriage, while explaining where I was at with egg donor and all that, I was in a room right next door to someone hearing their baby's heartbeat for the first time. The walls were thin so I could hear the swoosh swoosh swoosh that I never heard (and never would), but also the happiness. It gutted me. Second, I came in and who had joined the practice? THE BLUNT DOCTOR. Holy crap. Noooo. All I could think was, if I get pregnant and anyone in the practice can deliver, I DO NOT want this lady in my business. Third, in an attempt to not drive to Buffalo all the time, I had a partnership with this office and the Buffalo clinic where I could do initial monitoring in Rochester. This was after egg donor failed, so I was back to my own eggs but with donor sperm. It was my first cycle with the new clinic, and I tried to explain that I was prone to OHSS and that the dose of injectibles they had me on was too high too fast and I was in danger of being cancelled, and while the OB/GYN office was lovely they really were very new to monitoring multiple eggs at once at the IVF scale, and that first cycle was cancelled, just as I'd predicted. I ended up sucking it up and driving to Buffalo to have an actual Reproductive Endocrinologist check on my eggles for the next year. I decided that it was too awkward to keep going to this practice after a while, and it felt the doctor became a little more invested in my future pregnancy than my actual ladyparts health. So, I switched back to the practice I'd been at with the blunt lady since obviously she wasn't there anymore.
Old Practice, New Doctor, End of Treatment
Not going to lie, the toys and pregnancy/baby magazines and beatific pregnant people waiting for another peek at their precious cargo hurt SO MUCH MORE this time around. But I was seeing a very kind and understanding doctor, who was actually male, but LISTENED and was compassionate when I was reduced to sobbing about our increasingly dire and then nonexistent treatment. This doctor told me that he used to do private adoptions, that he would match up people and use a local attorney, and it was too bad he didn't do that anymore but that he was sure adoption would "work" for us. (Side note: this type of private adoption now horrifies me because of reading stories in Adoption Unfiltered by Sara Easterly, Kelsey Vander Vliet Barnyard, and Lori Holden; and also American Baby by Gabrielle Glazer. Those arrangements were often ethically nebulous and resulted in a lot of trauma.)
It was through this office that I tried progesterone-based Pill for period management, which didn't work, and Depo Provera, which totally didn't work, and he eventually referred me to a local doctor who was known for a highly successful procedure called endomyometrial resection, which was one better than ablation since instead of burning and having a relatively high failure rate, this was surgically removing the entire lining plus the root layer of muscle, and had very high rates of success and prevented hysterectomy. HAHAHA.
A New Practice, Just GYN, HALLELUJAH
I went to this new doctor with the new procedure he'd been doing, and while there was definitely a sense of "I am very godlike and amazing" that proved prescient to later events, he listened and he agreed to do the resection. Which was BRUTAL, but gave me relief for about a year.
What was amazing about this practice, that I went to exclusively until I had to leave for ethical reasons, was that it was JUST GYN. It was also a center for reproductive choice, so if you were there and you were pregnant, there was no beatific bump-patting at all, because typically there was no bump, because you were there for termination. Which explained the bulletproof glass in front of the reception area, which was a little nerve-wracking because the waiting room wasn't nearly as protected, but it was worth it.
Unfortunately, two things happened. My resection failed spectacularly: lining grew back about 2 years in, and when your uterus is scarred on purpose and your cervix is covered, there is no escape hatch for blood trying to escape, so you basically have contractions. It was horrible. My choices were a) do another resection or b) have a hysterectomy. Oh, 100% Door # 2. At this point I said, "I am squarely in the camp of it something weird can happen, it will happen, so I'm not going through that again just to have it fail again. Get that nasty pear out of me." So I did, which irritated the doctor visibly as he was in the business of preventing/delaying hysterectomy, so I couldn't help but feel that I was a disappointment somehow, but the hysterectomy was AWESOME and I don't regret it at all. And, I kept going to that office, because they were a GYN office and I enjoyed very much that it wasn't pregnancy-focused.
Problem #2 that resulted in my fleeing the practice, was that I was scrolling in my Google Feed, and an article came up with my doctor's face on it. Apparently DNA ancestry testing resulted in a whole bunch of people finding out that their parents used a sperm donor in the 1990s, and while they were told one thing, the person who ACTUALLY donated the sperm without anyone's knowledge was....my doctor. Oh FUCK no. It made international news. It did not result in him losing his license. It did result in some lawsuits. But I also was like, I CANNOT continue going to this doctor. So I asked around for recommendations, and jumped ship. AGAIN.
The Current Practice: The Best of Everything
I went back to a female practice. And this practice is great, because they listen, they are thorough, but they are not hugely pregnancy focused. There's the occasional poster, but that's it. They actually see more people for gender care than for pregnancy. Which I appreciate on many levels. I am far more likely to be in the waiting room with a trans man than a pregnant woman. And everyone in this practice reads my chart. They know my story. I don't have to rehash it all the time. The waiting room is bright, and welcoming, and part of a larger complex of services. I love this office.
So that's it, my timeline of OB/GYN offices. I think what I wish was that there were defined practices for different needs, different specialties -- so you go to one when you're younger and need sexual health and period health, and one when you are in childbearing years if you are childbearing, but with two doors, one for pregnant people and one for people who are not yet (and may never be), and one for perimenopause to menopause, because your needs are different then. Maybe it could be like my current practice, and there's a different office space in a larger complex that can meet all those needs, but compartmentalized. It just blows my mind that pregnancy is a pretty small part of women's healthcare over a lifetime, but it becomes 100% the focus of so many practices (thank you, pronatalism). And, to boot, I would love for people who treat younger women to have an eye out for fertility-related problems and to be knowledgeable about period dysfunction and the implications. I could have been saved a lot of grief if I'd been seen by someone competent in when things go wrong with your reproductive system, well before I tried to have a baby.
I wonder if this Practice of the Future is even economically viable, but gracious I would love to see that. A sort of integrated medicine for gynecological needs. I definitely would have benefitted from that, and I know I'm not alone. Thank you, Mel, for getting me thinking on this!
