Archives: Dr Atticus

Permanent birth control: tied up in knots

Knots

Dr Atticus is jaunting around Europe on his annual sojourn, so I’m to see a locum for my regular check-up.  I get an inkling of the type of appointment we’re in for when he asks for my sample jar. I don’t think anyone has asked for my “wee wee” in four decades.

It does make me wonder, this certain generation of obstetricians who really don’t seem to like women, who patronize them at best. (I’m oldish, too, Imma be generationalist if I want.) All this bloke has to do is go through the steps: check my blood pressure, have a little feel of my bump, and test that “wee wee”. But no, he has bigger plans for my visit.

“So I guess this is it for you, then,” he starts.

Brilliant deduction. Yes, my partner is planning his vasectomy as we speak, I tell him.

“Why? You should be having your tubes tied,” is his immediate response. I have known this man for less than five minutes. Note: not “why aren’t you”, but “you should be”. Interesting.

I explain that I do not want to have a tubal ligation. That a close family member, one whose genetic and obstetric profile is virtually identical to mine, suffered some heavy-duty negative side-effects after hers. I do not add: dude, I have had two caesarians (and am about to embark on another), from necessity, for this family. Daddyo is more than happy to even the ledger a little with a procedure that can be done in a doctor’s surgery with the assistance of local anaesthetic and, later, a bag of frozen peas.

A vasectomy and tubal ligation are not identical procedures. Comparing them is not a straightforward appraisal. But this doctor seems to think that, since they’ll be “in there” doing a caesarian, I may as well go ahead and seal my fallopian tubes, too.

He tells me that my fears are completely groundless, that tubal ligation is safer than a vasectomy, and that it can decrease my chances of future ovarian cancer. (To be fair, a meta-analysis of 40 studies supports this.) He cites a study that followed a group of women who had their tubes tied, and another group whose husbands have had vasectomies. He tells me that both groups reported heavier bleeding as they got older: “It’s just a part of ageing, nothing more”. I get the feeling he trots this one out frequently.

This doctor has no idea about my medical history; in fact, he doesn’t even seem to have looked at my contraception, or caesarian, history on the file in front of him. (If he did, he’d read that I’m a “bleeder”, that I’ve hemorrhaged after varied surgery.)

He declares all is well with baby; actually says I’m a “wonderful incubator”. Since a sense of humour has been absent so far, I can’t assume that he’s joking. I wonder if any patient has ever hit him.

He frequently drives the conversation back to having my tubes tied.

I feel railroaded. Bullied, even. “I will consider it,” I say. “Fuck you,” I think.

I will mention this conversation to my obstetrician next visit. However, not for the reason this man wants me to.

Now there are many places to research these two options. You can do the Google, too. Try a question like “Is a vasectomy safer than tubal ligation?” There’s even a Facebook page for Post Tubal Ligation Syndrome.

I’ll copy one summary below. It’s from a site called Male Health Centre.

Once you’re confident that you’re ready to put your reproductive years behind you, there are two options: vasectomy (male sterilization) or tubal ligation (female sterilization). Vasectomy makes you sterile by cutting the pipelines (the vas deferens) between the testicles and the penis. These small tubes are located just under the surface of the scrotal skin, and it takes less than 15 minutes in the doctor’s office to snip them and seal the ends under a local anesthetic. 


Tubal ligation involves cutting and tying a woman’s fallopian tubes, which are well below muscles and other tissue in the abdomen. It requires a general anesthetic and a hospital visit.


A couple of statistics might make the differences even more clear:
  • Fatalities per 100,000: tubal ligation = 3.51; vasectomy = 0
  • Approximate cost: tubal ligation = $2,500; vasectomy = $750 – 850
Vasectomy is simpler, safer, cheaper and takes less time to recover from than tubal ligation. Their failure rates are just about the same: 1 in 2,000.
KnottedVasectomy: lower risk. Lower cost. Is somewhat reversible. Importantly for me, it involves my partner taking contraceptive responsibility.

As I leave, he has another shot.

“If it were me, I’d be having my tubes tied.”

“You don’t have any tubes to tie,” I reply.

“Yes I do, and nobody’s getting their hands on them.”

He says this. Seriously.  How dare we women expect our menfolk to sacrifice their gonads in the name of birth control?

What a prick. Good manners hold my tongue (which surprises me, too) and I walk out.

 

And then I realize: if I go into early labour before my regular doctor gets back, this is the jerk who will help deliver my child. Please hurry home, Dr Atticus.

Surfing the small stuff: third trimester torments

So far, I’ve been fortunate to avoid the bigger complications of some pregnancies, like gestational diabetes or public tracksuit-pant wearing, and other, lesser ones such as varicose veins or delivering an actual crying infant.  But, third trimester, third pregnancy has returned me some old nemeses.

 

Drama: Heartburn.

Why is it the moment I finish eating breakfast I need to bend over to do something essential, like pick up a dirty sock or dislodge ninja Lego from between my toes? Oh, that’s right, because I have a couple of pre-teen sons. And I’m yet to learn: bend before breakfast, not after.

Pregnancy-related heartburn isn’t just reserved for those special moments felt immediately after eating. No, it’ll save itself for the moment you’re drifting off to sleep, too. Or when you’re out in public attempting that thing that some call “pre-baby date night” (but others may call “let’s sit in an overpriced restaurant and bitch about our son’s useless teacher while I gaze bitterly at your alcoholic beverage”).

Solution: Quick-eze, the old-fashioned chalky tablets that come in a roll (not the useless chewy squares). Bought in bulk, crushed up, and mainlined.

Drama: Restless legs.

Restless legs are an utter motherfucker. You’ve just got your ample bulk arranged in its pillownest, you’ve bum-shoved the notpregnant person sharing your bed over to their allotted edge, and you’ve finally fallen asleep after your third toilet trip. Right as you hit the good REMs, it starts. Niggle, niggle, niggle, that junky’s cursed feeling of ants sneaking around inside your sciatic nerve casings.

Solution: Waking up. Walking around the fucking house. They say magnesium supplements can help, too. Stretch your legs a little during the evening And drinking more water. So if the restless legs don’t raise you, the bladder will. Checkmate.

Drama: Curious foot spasms.

This one’s a personal treat. Following spinal surgery, I had a minor neural after-effect, resulting in an occasional night-time left foot spasm (varying in intensity from a big toe standing up, unbidded, at right angles, to the whole Daniel-Day-Lewis-Academy-award-winning left foot and leg spasm). Of course, pregnancy exacerbates this. If my hormonehorrorshow didn’t have a go at such an easy target, we’d be almost disappointed. Over a few months, the hormones have progressed a minor nighttime ballet of restless legs and freaky toe spasms to a major choreography. The growing fetal weight pressing down on the base of the sciatic nerve way up there in that slackening pelvis does its bit, too.

Solution: Not being pregnant. Failing this, keeping well hydrated. Pilates. The magnesium helps. It’s most effective taken just before bed. An unexpected side-effect of taking magnesium at night is its effects on dreams. Apparently it can act as a bit of a psychedelic neurotransmitter, resulting in crazier dreams. I don’t make this shit up.

Because pregnant women need to experience even crazier dreams.

Oh, and a couple of weeks ago I started visiting a chiropractor (even though I’d sworn off the creatures) who specializes in old knocked-up broken women. She’s pretty much stopped the spasms. So maybe I should have mentioned her first.

Drama: Shortness of breath.

I’ve never claimed any level of aerobic fitness, but panting at the top of two flights of stairs was a scary revelation – and that was a couple of months ago, before there was even much of a bump to bitch about carrying up the stairs with me. I was almost relieved when Dr Atticus advised that rather than pitiful fitness, I could blame pitiful hemoglobin levels. You know, pregnant ladies need more iron, hemoglobin carries oxygen in the blood, low hemoglobin means less oxygen getting around the body. It was all the hemoglobin. Nothing to do with the lack of fitness.

Of course, now, with a bump encroaching on valuable lung space, there’s another dimension added to the breathlessness. Now, it’s also about internal organ real estate.

Solution: Iron supplements. Stand taller. Surrender.

Drama: Tiredness.

Tired, mid-40s pregnant woman? Quel surprise.

Solution: A nap. Right now.

 

Off to Dr Atticus

The morning before I visit my obstetrician, in my head, I run through a medical history since last time I saw him (nearly 8 years ago). It takes a while.

Bring on the tests.

It’s reassuring to visit my doc. We both agree the priority is chromosomal tests. (And I’m itching to get an all-clear, so I can tell my family about this baby — and stop sucking in my stomach!)

I visit the pathology center in the hospital to organize a non-invasive test: it’s called iGeneScreen, and it has to be done on a certain day so the blood can be couriered to the airport to the USA. It tests for Trisomy 21, Trisomy 18, and Trisomy 13. I could also find out the sex, which I decline. I’ll also have a Nuchal Translucency Scan, so I book that in for three weeks’ time.

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