Healthcare often exists in dichotomies: over-medication and knife-happy doctors versus pseudoscience, fetuses versus babies, and reproductive technology versus midwifery and home births. The truth is, however, that reducing health issues to reductive binaries patronizes patients, limits our options, and helps to strip us of our agency. This is especially true for those of us seeking reproductive healthcare. Discussing reproductive health with our providers, our friends, our family, or are peers is often uncomfortable; periods gross people out and conversations about miscarriage are discomfiting to many people. Journalist Jennifer Block and psychotherapist Julia Bueno want to change that.
Their new books, Everything Below the Waist: Why Health Care Needs a Feminist Revolution and The Brink of Being: Talking About Miscarriage, respectively, unpack how medical misogyny, conservative politics, and stigma back those seeking reproductive healthcare into a corner. Both books examine how we’re censored, shamed, and then given a menu of false medical choices that won’t actually help us get well. So many of us are unwilling participants in a racist, sexist, and transphobic culture of care that measures our worth based on if we’re able to reproduce. I talked with Block and Bueno about reclaiming narratives about our reproductive health, understanding our options, and approaching reproductive healthcare with the nuance it deserves.
Miscarriages, infertility, endometriosis, and even periods are all so ubiquitous, but still so stigmatized and taboo. That juxtaposition has an impact on the conversations we have with each other and our providers about these issues.
Julia Bueno: I’ve written a book that actually says, “Let’s talk about this,” and the whole thrust of my book is prizing it out of the shutters. Let’s think and talk about [pregnancy loss] in normal terms. Yet, I’ve had journalists or [readers] approach me quite gingerly and ask, “Is it okay if I ask you this question?” Quite a few people have whispered the title of my book to me.
[In her recently published book about her infertility journey], Canadian feminist journalist Alexandra Kimball [wrote about] being at a social event with her partner. She was sat [at] a table next to a woman who she’d never met before. This woman asked her the usual question, “Do you have kids?” And she honestly said, “Well, actually, I’ve just had my..” I can’t remember whether it was her third or fourth miscarriage. And Kimball [said] she might as well have ripped out her bloodied womb and thrown it on the table.
Jennifer Block: We are so much more comfortable talking about controlling women’s bodies than we are talking about women’s bodies as [Julia and I] do. So much of this traces back to the history of how medicine, [especially] obstetrics and gynecology, developed. In my book, I call it a hostile male takeover of a female profession that in America was largely populated by Indigenous women, Black women, immigrant women. Midwives [and] women in people’s families recorded the process; men were not allowed in the birth chamber. And in the beginning, doctors were certainly not welcome. But they, professionally, wanted a piece of this. They started medical societies, and they said, “No, it’s safer if you have a doctor. It’s safer if you have these instruments. It’s safer if you’re in the hospital.” The reality is they didn’t come with any more knowledge or expertise.
Marion Sims is often referred to as the father of gynecology. He experimented on several enslaved women, and we can’t even imagine what they endured. The Cesarean section and other surgeries were pioneered on enslaved women’s bodies in the Americas. That’s the reality. [Modern] gynecological surgery is so focused on cutting into and removing a uterus specifically, but [also] other female sex organs. That goes for surgery across the board, but the uterus is cut into and removed more than any other organ, regardless of sex, in the United States. We have a very high hysterectomy rate here.
Julia Bueno: [It has been] really fascinating to learn the weight of that history. That’s something that I come up against a lot in talking to [the] women who I treat. It’s the kind of masculinized, pejorative language that has come out of these cultures that land on women very harshly. I’m the proud owner of an incompetent cervix. I’m not quite sure [if] my cervix is hostile, but it might be. My pregnancies have failed, and after one of my miscarriages, I was told to wait for a product of my conception to leave my body.
There’s a patronization too. When I was 21, I was seeing a doctor who didn’t know how to treat my endometriosis. One day he said, “We can try this drug but if that doesn’t work, we’ll consider removing your ovaries.” It was so glib. So many people, myself included, have wanted to discuss a hysterectomy as a treatment or a cure for reproductive pain, but doctors resisted. Doctors say, “You’re too young. You might want children.” It seems that doctors are resisting critical care because of cultural norms about childbearing.
Jennifer Block: The idea is that the uterus has one purpose: [bearing] children. I’ve talked to young women who were begging for a hysterectomy [because] they felt like that [would] solve [their] problems. And they [were met with] all this resistance. “Oh no, you might want children. You’re going to change your mind.” The physician was making decisions about that based on their fertility. On the other hand, hysterectomies [are] suggested to women over 40 [for] a number of [reasons]. One woman I interviewed agreed to a hysterectomy with ovary removal just for a digestive problem.
Julia Bueno: That begs the much bigger question about educating and training doctors. What is going on in their training? How holistic and empathetic is it? How much time is devoted to not seeing the body as a pathology or as a machine that needs to be fixed?
Julia, when I was reading your book, I was thinking about how infertility is often the byproduct of the poor care that precedes it.
Julia Bueno: In my book, I address repeatedly hearing stories [about] women [not being listened to]. That [also] happened to me. Who knows their body best? We do. [Yet], women’s voices and intuition [are] being overrun and ignored, and when women [do up] speak up, [we’re] being shut down. So, yes, that’s definitely something that comes up a lot.
What gets me is that these treatments and medications really better the lives of the people who use them. My IUD has been a game changer for my cyclical pain, though there are awful side effects—mood swings, weight gain, and nausea. There’s so much we have to endure to get the desired result, and in a lot of ways, we’re expected to just suck it up.
Julia Bueno: This speaks [to] research priorities. For example, the United Kingdom formally inaugurated a miscarriage research center in 2016. It has a large portfolio of research going on, but hello! [It’s] 2016, [and] women and couples [have been] going through enormous physical and emotional pain for years. At the same time, menopause, endometriosis, [and] all of these reproductive issues have been ignored. Patients go through every single thing in the pharmacy before finding something that works. This is what we go through.
Jennifer Block: One thing that I talk about in my book is [the] baggage that we in the modern, pro-choice, feminist world [bring in]. Some folks ask, “Is it feminist to question the pill?” You get framed as some kind of conspiracy theorist if you question these treatments and their side effects. Or it gets put in the alternative medicine category [and] it’s not studied. We only trust what comes out of our ob-gyn’s mouth. Well, the fact of the matter is a lot of what’s routine care [for] ob-gyns has not been adequately studied or is not even evidence-based. It’s not even based on what the evidence says.
Julia Bueno: Isn’t a lot of this about informed consent and informing us with a nuanced and appropriate, respected, and properly-researched set of treatments? It speaks [to medicine] not trusting us, the woman, to know what’s right for her body, or her lifestyle, and for her story to tune into. But having informed consent is crucial and not to be patronized.
One theme that comes up in your book Julia is the nuance involved in understanding that you can mourn a pregnancy loss as the loss of a child and still understand that an abortion is not killing a baby. This is another area where we see some patronization: People who can become pregnant are more than capable of appreciating the nuance that people who live with infertility understand the importance of safe and legal abortion, and that abortion advocates understand the trauma of pregnancy loss.
Julia Bueno: It goes back to respecting the individuals, and in this case, we’re talking about a woman, her truth, and her relationship with her pregnancy, which is, to be tautologist, exquisitely unique. It is hers. I started this work in a less than pro-choice position. But the more and more I work in pregnancy loss, the more and more convinced I am of pro-choice and the myriad meanings of a pregnancy to the woman.
They don’t exist in different worlds: A body that can get pregnant, have an abortion, and have a miscarriage. So putting abortion and pregnancy loss on a binary isn’t rooted in reality.
Jennifer Block: It comes from the anti-abortion movement in the United States passing legislation specifically trying to separate the fetus, the embryo, and even the fertilized egg as something that deserves its own set of rights. Then we end up surveilling [and] incarcerating pregnant women for having miscarriages. On the other hand, it also means that women are being court ordered to [have] Cesarean sections or to [be on] bed rest. [These expectant parents are] being threatened with Child Protective Services if they decline an intervention or if they’ve decided to have a home birth. We’re not just women who have abortions or women who have babies. Women have all of those things.
Let’s talk about the emotional trauma that comes with providers not being their patients. You might develop a distrust for doctors or start to believe that they can’t fix you.
Julia Bueno: The stakes are so high. If my dentist doesn’t know how to fix my tooth, that means far less to me than, “Can I have a baby or not?” or “Why do I keep losing babies?” You’re right about using the word “emotional trauma.” There is so much emotional investment that can heighten the faith that you want [to] project on to the doctor. You want them to [be able to] fix it.
Jennifer Block: it’s incumbent upon doctors to be more human. The best-case scenario is [for] a doctor [to] admit when they don’t know. It’s also something that consumers need to think about, too, because we’re stuck in the “doctors know best” paternalistic and patriarchal paradigm. We say medicine has reformed [and] we [practice] shared decision-making now, but ideologically, a lot of us are still looking to our doctors as authorities [with all the] answers. We put MDs at the top of the pyramid of authoritative knowledge. The doctor knows the most, they have the most expertise, and other health professions are under the top of that pyramid. I don’t think that’s serving us.
You have the most information about what you’re experiencing. You may not have the expert knowledge and expertise of a specialist who knows what’s going on at the cellular level. But patients have a lot of information about their bodies, and that’s especially true in the maternity care realm.