Feminism and medicine

[Faffertea]

A lot of recent threads have made me feel very angry and somewhat disillusioned about what I can do to change the situation for women. I’m not well versed in feminist literature or allied to any political party. But I am a doctor. And the stories I hear from women about how they are treated (or not) and the things they put up with due to their female biology is maybe something I can help with and so try to improve the lives of my sisters.
So, if you have a problem due to your female biology that you’d appreciate some input on then please join the thread.
I’m not suggesting I offer specific medical advice because I don’t think that’s appropriate without being fully aware of someone’s medical history but hopefully I can make some suggestions to help.
From my own perspective, and despite being a doctor, I had to research and fight and argue to get evidence based treatment for intractable hyperemesis when pregnant with my son. No woman should have to do that.

What sort of doctor are you, OP?

As a doctor myself, I would just like to remind everyone that people offering medical opinions on social media, may not be who they say they are. Also that even people who are doctors do not necessarily have expertise outside of their own speciality.

I’m a GP with additional diplomas in women’s health. As I said in the first post, I’m not suggesting I offer specific medical advice as that would be potentially unsafe and inappropriate. My thought was more along the lines of helping women advocate for themselves.

Sad to see you haven't had any response to this thread, OP. The idea behind it is great.

Not so much a question for myself, but do you have a view on pain relief in childbirth? Maybe I am wrong but I understand that mammals prefer to give birth in quiet, dark environments which birthing centres try to replicate. However, while birthing centres might offer a pool or a tens machine they do not offer an epidural for fully effective pain relief, which must be given in a hospital.

Hospitals provide a medicalised environment which does not provide the calm setting of a birth centre.

Also, have there been any developments in pain relief in childbirth in the last 40 years or so? Epidurals clearly have their downsides and I wondered what changes and improvements there have been to assistance in the birthing process?

I haven't (yet) given birth myself but the whole approach to childbirth seems to be very disjointed.

I guess I'm just after your opinion, really.

One thing that infuriates and saddens me are the stories on this forum about the treatment of many women in childbirth. There seem to be multiple instances of criminal assault - and frankly that’s what it is when a medical practitioner continues with an action when they have been told to desist and the patient has expressly withdrawn their consent. It seems that more training in the law is needed for doctors. Or is it that they are aware of the law but don’t care as they rely on people not complaining?

@Coyoacan

Sad to see you haven't had any response to this thread, OP. The idea behind it is great.

I think it is sensible to be wary when a new poster appears, asking women to share gynae concerns.

Hopefully the OP is who she says she is - in which case it's great that she wants to help women advocate for themselves - but, after the poo troll, various period trolls etc, it's no bad thing to be cautious.

I have absolutely no idea about the poo troll and I don’t think I want to! Given the types of people who monitor this section of Mumsnet I am not happy to openly post my name or GMC registration details here but will PM directly for posters who want to.
To answer the questions so far:
Edge I don’t know a huge amount on this topic I’m afraid as it’s been the best part of 10 years since I worked in a hospital. However, I think there have been advances in the use of epidurals in labour to try and make them ‘lighter’ so that they give pain relief without reducing mobility. I think the difficulty around environment is because of the kind of monitoring that is required of a woman and her baby once an epidural has been given. I know some areas have moved away from using pethidine too because of the degree to which it can affect the baby if given shortly before delivery.
Twoglasses Our healthcare system is set up very differently to a lot of places who don’t tend to have the extensive role of General Practice that we do so on the whole we don’t have specialists managing everything related to an organ system/body part in the same way. I think the privatised system that other countries also plays it’s part. If your income is dependent on billing patients for appointments than naturally you tend to generate work and want them to have regular check ups. From a gynaecology point of view I don’t think there is an evidence base to say that a regular examination from a gynaecologist would lead to better detection of disease or improve outcomes in health. Having said that I would live it if women were more empowered to know what is normal, what’s normal for them and what needs assessing. I see a number of women every year who have put up with horrendous periods, prolapses, menopausal symptoms or pelvic pain because they’d be taught to think that suffering is normal and it’s not! We also need to move away from a medical model that means that when a physical abnormality isn’t evident on examination or investigation we dismiss women’s symptoms and concerns.
In terms of raising concerns or queries with your doctor I would encourage you to do so if it’s something that’s bothering you. If you have a good relationship with a GP then start with them. If you’re not sure who to approach have a look at your surgery’s website. Staff are usually listed on there and these days often list their special interests. Additional training for GPs in gynaecology or family planning diplomas are often listed as DFSRH or DRCOG.
Evelyn I agree wholeheartedly. I think it’s a symptom of the wider disregard for women as having autonomy over their own bodies and in the disregard we as a society have for women’s understanding and knowledge of themselves.

Hi OP, I am not sure if this is the sort of thing you are looking for, but this is about menstrual pain and other debilitating symptoms (fainting, nausea etc)

• I have had two periods in my life of very debilitating menstrual symptoms (lasting a few years each, coming and going for no apparent reason) and have had very belittling advice from GPs about it and no real treatment. I know this is not uncommon. What do you think could be done about this? or is this the best that 21C medicine can do?

• I've been working during these times, and I've managed other women who have had very severe symptoms too, and whether for myself or for my team I have never had an understanding from senior management that this is not a made-up issue. Doctors' notes have made no difference. Women who don't suffer this way, as well as men, can very often think that women who are at home vomiting and fainting are just swinging the lead. Is there some way that managers can be made to understand that this is a real and common problem?

Although raising awareness or building real equality (accounting for physical make-up) into employment law is not the responsibility of doctors, I can't help but see a connection between the dismissive GPs I've asked for help from with this, and the managers who see it as made-up non-issue. what do you think about that?

Op - we cross-posted

" I see a number of women every year who have put up with horrendous periods, prolapses, menopausal symptoms or pelvic pain because they’d be taught to think that suffering is normal and it’s not! "

How can that change, and who should be changing it?

to be clear - "they'd been taught to think that suffering is normal" I agree with that but not just as a general principle - "Oh I won't bother someone with this, it's probably normal" - but in many cases they have actually been told about those exact symptoms that you think should be treated, to go away. What are women to do? how can change happen?

I was on a waiting list for physio for a long time with SPD after the birth of my second child. I fought to get on the list as I was literally told that it was impossible that the pain would last for long once I was no longer pregnant. it was obvious to me that something was out of place and needed to be physically manipulated. i was struggling to walk and after 10 months of this I burst into tears of pain and anxiety about how I was going to manage my commute when I went back to work. I was told to take ibuprofen and when I said that this would not correct the underlying issue, which was that there were bones literally in the wrong place hindering my movement, he didn't seem to know what I meant by "underlying issue". (the physio fixed it to 85% better in 5 minutes when I eventually got to see her.)

Who needs to do what differently?
how do we get there?

I have absolutely no idea about the poo troll and I don’t think I want to! Given the types of people who monitor this section of Mumsnet I am not happy to openly post my name or GMC registration details here but will PM directly for posters who want to.

I really would caution you against Pming your name and Reg to posters. You have no idea who they are either. The monitoring types can be very sneaky.

What about the other way round? Ask women on here what they wish had been different about their experiences, and then use that out in the real world to:
1)Modify your own practice (if need be)
2)Share learning points with your colleagues
3)Model good practice to GP registrars, FY2s, or students coming through your practice
4)Incorporate into teaching sessions for trainees or students

It might do some small good locally, and would probably be great for your appraisal!

I think you've had good advice from PPs about not sharing your name/GMC details to anyone for the reasons given above and also the demise of of a GC activism group when a group member decided to share membership details.

I know there are some good discussions from time-to-time but it might be helpful to have a running thread about medical misogyny (as alluded to in Criado Perez's Invisible Women ) and the profound lack of relevant data to drive the revision of relevant diagnosis, treatment and management guidelines for the versions of the NHS in the 4 nations.