Stop mansplainin’ women’s incontinence and sexual dysfunction!

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We get it, men. You think C-sections are “bad” and you think it is your responsibility to protect us silly women from — heaven forefend — actually choosing to have one. That’s paternalistic enough, but you really cross a line when you start mansplainin’ urinary incontinence and sexual dysfunction to the women who endure them.

The recent outburst of mansplainin’ was precipitated by publication of the paper Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. Note that the paper is only concerned with long term risks and does not consider short term risks and benefits. The principal finding of the paper is that the long term risks of vaginal birth (pelvic organ prolapse and urinary incontinence) dwarf the potentially deadly long term risks of C-section. For example, the risk of pelvic organ prolapse is 10,000% (yes 10,000%) higher than the risk of placenta accreta in a subsequent pregnancy.

Can you imagine a male physician telling a man that incontinence and impotence are no big deal?

In reviewing the paper, Swedish obstetrician and professor Stefan Hansson had the temerity to write, and The Conversation had the audacity to publish, this:

Women are well aware of the discomfort and embarrassment associated with urinary incontinence and have an understandable fear of sexual dysfunction. But despite the reported findings that suggest decreased risk with a caesarean delivery, these problems are manageable, treatable and, importantly, not life threatening.

Pardon my language but WTF??!!

Can you imagine a physician telling a man facing treatment for prostate cancer that incontinence and impotence are no big deal?

The reason it’s called incontinence is precisely because it ISN’T manageable. Urine spurts out when you cough or sneeze because childbirth has damaged the muscles of the pelvic floor, the muscles that hold the bladder and uterus in alignment to each other.

When these muscles are damaged, the pelvic organs can slip through the middle of the pelvic floor. This is known as prolapse. When a pelvic organ like the bladder prolapses, it distorts the relationship between the sphincter that controls release of urine from the bladder into the urethra. Although the sphincter itself has not been damaged, it nonetheless prevents the woman from “holding” urine. It works well enough that urine doesn’t constantly dribble out of the urethra, but when the intra-abdominal pressure is dramatically increased as occurs during coughing and sneezing, urine squirts out (stress urinary incontinence).

When the muscles of the pelvic floor are damaged, the uterus can prolapse into the vagina or even through it to protrude outside the vagina. That can make sexual intercourse difficult and painful

In both cases, the damage may not be immediately apparent. It may not appear until menopause when ligaments are weakened by the lack of estrogen and the pelvic organs begin to drop between the muscles. A woman who has had no problem for 20+ years after the births of her children may gradually develop uterine prolapse and/or incontinence as she enters menopause. And both will last for the rest of her life which is typically decades more.

What does Dr. Hansson mean when he says that urinary incontinence and uterine prolapse can be “managed”? He means they can be camouflaged by various measures including wearing bulky incontinence pads or putting a pessary (similar to a very large diaphragm) into the vagina to literally hold the uterus up though obviously that can’t be done during intercourse. He means that women can make it a point to immediately identify the location of the ladies room wherever they go and position themselves near it. He means that women can undergo painful surgery (generally including hysterectomy) to return the bladder to natural function.

Hansson continues:

There are, however, life-threatening risks associated with a caesarean delivery on subsequent pregnancies, including increased risk of miscarriage, stillbirth and problems with the placenta – such as placenta praevia (the placenta covering the birth canal), placenta accreta (when the placenta grows too deep into the wall of the uterus) and placental abruption (where the placenta partially or completely separates from the womb before the baby is born).

Yes, the consequences of a C-section for subsequent pregnancies can be life threatening, but women are entitled to know and entitled to base decisions on the fact that the risks of pelvic organ prolapse and incontinence dwarf the risk of deadly outcomes in subsequent pregnancies.

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Hansson isn’t the only man to fail to mention the relative risk of pelvic organ prolapse to accreta in a subsequent pregnancy. Neel Shah, MD offered his thoughts in a long Twitter thread, including:

The most compelling long-term risks of cesareans have a common mechanism–uterine scarring–which can cause some uteri to rupture and others to hemorrhage uncontrollably in future pregnancies with deadly consequences.

And:

This worries me in the U.S. where … placental disorders caused by uterine scarring are “one of the most morbid obstetricians will encounter” and we are seeing “dramatically increased incidence”

But here’s the issue, Dr. Shah. I doesn’t really matter what you are worried about. Women are fully functional human beings perfectly capable of and completely entitled to weighing the risks and benefits for themselves … and choosing maternal request C-section if that’s what they prefer.

Perhaps most offensive example of mansplainin’ came when Dutch obstetrician Jos H.A. Vollenbergh reached out to me on Twitter to share his thoughts about my icon array illustrated above:

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This sounds like a ‘Keep Your Love Tract Honeymoon Fresh – Have A Caesarean’ tract.
Not really my favourite…

Way to mansplain’ women’s sexual dysfunction to women, Dr. Vollenbergh! You should be ashamed of that remark and you should have apologized when I called you on it.

I have no particular love for maternal request C-sections. I never had one, wouldn’t want one and did virtually none when I was practicing. But it’s NOT my decision; the decision belongs to each woman choosing for herself.

Urinary incontinence and sexual dysfunction are life altering complications of vaginal birth. They are not easily manageable and for most women the only truly effective treatment is surgery. It is only right that the woman whose life will be altered gets to decide how.

And we definitely don’t need men deciding for us based on what they think is best.

  • LivingTheDream

    I’m new this this community, but I’m so relieved to have found it. I have a complicated reproductive history, currently G3P2A0 with a bicornuate uterus and incompetent cervix. My little loves were born at 24 weeks and 6 days and 32 weeks respectively. VBAC was totally unrealistic for both deliveries. Despite the associated difficulties my neonates faced, my CS. deliveries were without complication. I’ve healed beautifully with no complaints to speak of. I acknowledge fully the requisite risk associated with ANY surgery and in particular a CS, but to propose that those risks, which are rare (and even rarer in the case of a controlled, preplanned CS), merit more consideration than the more common if less life-threatening complications of vaginal delivery presupposes that I’m incapable assessing the difference between say: the risks associated with flying vs. driving. In a crash, I’ll more likely die in an airplane crash than a car crash, but how common are plane crashes really?

    And that’s to say nothing of risk mitigation like patient education and proper follow up. I was keen to signs of infection, particularly, and I was well managed postoperatively. Within 48 hrs of both deliveries I was discharged and taking Naproxen PRN for pain control. I was with my babies doing what I could for them. I have never had the luxury of a birth plan, and to be completely sincere, I do not plan to have one with this my final pregnancy. I am responding to circumstance to the limited degree my body is able. I am more than happy to have another CS and in a small way diminish the chaos I’ve come to associate with child birth.

    As unbelievable as it sounds for the birth coach I was forced to meet recently (to realign my flawed thinking by wellmeaning busybodies), the OR is the only place I’ve ever felt safe while pregnant, the site of my cerclages, spinal blocks, and CSs. It has been a refuge and not–I challenge ANYONE to reeducate me–representative of failure or weakness on my part. And had the worst happened and one of my boys not survived or sustained injury or ill effect, I would sleep at night peacefully because I know that the OR was the best chance I could give them. I merely pity those who would look upon my choices and question my motives.

    Re: the love track. Forget all the completely real and chronic complications delineated in the article. Even if a woman elected to have a CS because she felt the associate risks were an acceptable trade off to prioritizing her sexual satisfaction, that’s entirely her business. I work in ED medicine and I’ve seen women risk death and loss of her child for a home birth UNASSISTED because she didn’t want to “get shots.” So, frankly doctor man, I hope your urologist doesn’t give a moment’s thought to your sexual function when he resects your prostate; after all, what a ludicrous consideration in matter of life and death.

  • Thanks for your better content.

  • mabelcruet

    OT a bit-a female family member asked me about problems she’s been having for years. I’m a pathologist and my patients are about 6 inches long, so the last time I did anything gynae related was a lifetime ago. Long term constipation, recurrent piles and she has to push on her bottom (I think she means perineum) to poop. She doesn’t have any urinary incontinence, but to me this sounds like a rectocele. She’s had it years-no recent change but she finally decided to see her GP and all he’s done is tell her to eat more fibre. Any useful suggestions? Is surgery the way to go, or is there any sort of physio would help?

    • moto_librarian

      Her problem sounds very similar to mine. I do have a rectocele, and have to splint to have a bowel movement. The fiber idea is good – Metamucil was recommended by the uro-gyn as a way of helping to manage the issue by making bowel movements less firm and more consistent. Regrettably, physiotherapy only helped with urinary incontinence, and my doctor told me that there’s just not much that can be done other than surgery. I think I’m going to trial and interstim device to see if that will help with the urgency issues, but only repair of the recotcele will fix the underlying issue.

      • mabelcruet

        Thanks-shes been struggling with fibre, it’s not the easiest to eat in huge amounts. I introduced her to chia seeds, so she’s eating those in yoghurt, I also suggested flax seeds but she didn’t like the texture of those. She’s not that computer literate, but I’ve got her onto pinterest and she’s working her way through various high fibre diet pages. She wants to avoid surgery, so hopefully when the high fibre diet and healthy eating start embedding in, things will improve a bit.

  • CSN0116

    Lead MFMs at Mt. Sinai Hospital in Ontario, Canada will not allow women to have elective primary cesareans with modi twins, wherein vaginal deliveries can go sideways and cause damage very often. And wherein 50% of planned modi vaginal deliveries end in cesarean anyway. Despite the hospital’s own website stating they perform maternal requested cesareans. All are men. The head trained in Ireland. I fight them all. the. time.

    • mabelcruet

      I had a run in with an obstetrician trained in Ireland about that time-he was of the opinion that there was no fetal anomaly that was incompatible with life. His argument was that babies with anencephaly could be liveborn, and even if they only breathed for a second, that second was life, and so we should never offer termination on the grounds of lethal fetal anomaly because there was no such thing. He was a utter wanker.

    • ukay

      Good ol‘ „symphysiotomy“ Ireland.

      • CSN0116

        Sick fucks.

  • oscar

    I reread this post this morning and am stunned all over again by the lack of empathy of the obstetricians who were quoted. I was talking about it with my husband last night and he reminded me of when he was working in a hospital in the north of Holland and told a Dutch ob-gyn that I was having an elective CS. The man snickered condescendingly and said, “Oh, she’s just scared.”

    Umm, no, dear, I was INFORMED!

    And once informed (and the Dutch doctors and midwives added nothing to this), I decided I’d take the tiny risk of placental problems in subsequent pregnancies over the much larger risk of getting my nether regions and the quality of my life wrecked. The fact that elective CS is safer for the baby than trial of labor was also a very large part of my decision.

    • ukay

      What does he mean with being scared? Do they give out orders for exceptional courage in the face of labour?

      • The Bofa on the Sofa

        Remember, c-sections are awful, traumatic experiences to be avoided at all costs and are the easy way out to avoid going through vaginal childbirth.

        • The Vitaphone Queen

          Duh!!!

        • ukay

          Thanks for putting me back on track.

  • AnnaPDE

    Semi off topic: Any recommendations on how what to look for in pelvic physiotherapy, and possibly even providers in the Brisbane area? My former co-worker who went for natural birth, did everything she was told to prepare and still ended up pretty torn up is looking for a way to get her pelvic floor back into good shape. She doesn’t have serious issues now, but it’s not 100% and she’s seen what prolapse is like.

    • lsn

      I would ring the physio dept of whichever hospitals do tertiary obstetric care and ask for recommendations. If it would be easier get a referral from a GP to them and ask then – unfortunately if it’s anything like Melbourne there is a long waiting list to see them. She could also try the Australian Physiotherapy Association and ask for practitioners from them. Good luck to her!

  • borkborkbork

    The complications that arose during my four day natural labor would have led to my death, and that of my child. While the hospital midwives were pressuring me to keep laboring, I was begging to be transferred for the surgery that would end up saving our lives. I wasn’t thinking at the time about how a cesarean would keep my pelvic floor intact and prevent incontinence, it was just a nice bonus.

    In hindsight, I realize that I’d rather be dealing with recovery from abdominal surgery and caring for a newborn than incontinence and caring for a newborn. There’s already enough diapers to change.

    #NoRegrets

    • borkborkbork

      Have to add, in spite of being fairly healthy and athletic, I had mild incontinence all through my adult life. Apparently it had something to do with my uterus just naturally being in a funny position? I’d pee a little -or a lot – when I coughed or sneezed, or went running, and I felt like I had to go all the time…

      That went away after my C-section. However the surgeon put things back together and stitched them up, it fixed the problem. Yet one more reason to feel grateful for modern medicine.

      • Empress of the Iguana People

        Hooray!
        I actually have better continence after my 2nd child (born vaginally, ripped twice, but my 2nd set of stitches were done better.)

  • Empress of the Iguana People

    And then there’s the part where “honeymoon fresh” implies you didn’t have much (or any) sex beforehand. I’m a late bloomer and have only had sex with one man, but we were together 8 years before we got married, and we certainly had our share of fornication. Doctors should not slut-shame people.

    • Roadstergal

      I didn’t even think of that. I thought he meant ‘nulliparous,’ but you’re right, that phrase clearly means ‘virginal.’

      What a creepy motherfucker.

    • AnnaPDE

      And let’s just take a moment to notice that he doesn’t even start to consider that while the not-so-honeymoon state he thinks of is a lack of perfect tightness and thus slightly reduced enjoyment for the man, for the woman intercourse becomes actually painful and not enjoyable at all.
      But hey, when was the woman’s pleasure at all relevant in considering vaginas…

    • C.

      Not to mention that it’s medically inaccurate. Doctors should also know how a part of the body that half the population has works.

  • ArmyChick

    What a clown. I am 33 and from time to time I suffer from stress incontinence. If I cough too hard, I pee myself. I don’t mean just a little either. I cannot hold it. It wasn’t caused by child birth as I had a c-section. But it is so embarrassing. I’ve peed myself while out with family, at restaurants. You name it. Manageable? My ass.

    • Amy Tuteur, MD

      Pregnancy itself increases the risk of incontinence, but vaginal birth increases it further.

      • ArmyChick

        If I only knew…

  • StephanieJR

    My gran is in her eighties. She’s had three children, and now has a ‘wandering bladder’, which, along with her various other health problems, including diabetes and arthritis, makes for a pretty miserable nights sleep. We’re currently trying to manage it through tablets and controlling her liquid intake. She can’t have anything after six at night now, and can no longer have caffeine in her tea. For fuck’s sake, the poor woman can’t have a decent cup of tea, and she has to put up with this bullshit?

    • Heidi

      Yes, incontinence can definitely effect a person’s health beyond just not being able to control going to the bathroom. I worked on a med/surg floor for a couple of years, and sadly, it wasn’t unusual to receive a patient from a nursing home who was being treated for stage IV bedsores. Bedsores that bad were almost always on the coccyx (I can’t recall a heal or elbow bedsore that bad) and I can’t recall one time it wasn’t with an incontinent patient. A patient’s prognosis is poor once a pressure ulcer like that occurs. Of course, when someone is approaching death, I realize healing abilities go downhill and skin begins to degrade much more rapidly so perhaps we can’t completely blame the bedsore, but I can’t imagine the excruciating pain they cause.

  • fiftyfifty1

    Ugh. I am dreading menopause. I will be really up a creek when my tissues start to atrophy…

    • Empress of the Iguana People

      I’m of two minds. Prolapse is bad, but the psycho state caused by my PMDD is bad, too.

    • Who?

      Loving that hrt. Plumps everything up like a dream…

  • Women matter – not for the use of men, or as vessels for producing children but in their own right. They deserve the right to make an informed decision with respect to their health and what works best for them. While it is encouraging to see pelvic organ prolapse and sexual dysfunction at least being recognized as a potential outcome of planned vaginal delivery – we are still a long ways away from a balanced conversation as the responses demonstrate. There are still big gaps in what is or isn’t considered as part of this decision, including the impact of birth trauma on the psychological health of women. When will we move away from worrying about the trend in the rate of cesareans, and start worrying about the trend in the quality of life of women and their families?

    • Sarah

      Yes well, if you wanted your sexual function and continence to matter, you should’ve thought about that before having the temerity to be born female.

  • Sarah

    Obviously none of you slags have any right to want to keep your love tract honeymoon fresh either. Perish the thought.

    • Roadstergal

      Mom, do you ever get that… not so Honeymoon Fresh feeling?

      We went scuba diving on our honeymoon. So my love tract was full of fish pee.

      • Sarah

        I think that’s probably acceptable provided you went on to deliver vaginally. Otherwise you’ll get shamed by one of the brobstetricians.

        • momofone

          When I read these mind-blowingly stupid comments/tweets/etc. from people who want to dictate other people’s choices, I am so grateful for my OB, who happened to be male, who couldn’t have been more professional or less shame-focused. I have no idea what his personal beliefs about breastfeeding or vaginal birth or MRCS were, because he apparently thought those were irrelevant in the context of our professional relationship. He had the crazy idea that what was happening medically was the first priority, and the crazier idea that if #1 was going well, I could choose how I wanted to proceed. Almost like I could know what I wanted or something!

      • Empress of the Iguana People

        We didn’t get around to much of that; we spent ours visiting our parents (whom we hadn’t seen in 10 months, the longest stretch in our lives at that point) and the first night in a hotel, there were a couple guys in the next room who were very, um, enthusiastic. Bit of a buzzkill, that.

  • attitude devant

    I had a partial third-degree laceration with a forceps delivery in 1990. I am still in my fifties and have been incontinent of flatus for almost thirty years now. It is not fun. I avoid gas-producing foods as much as possible and if I cough or sneeze (or dance, or even sometimes just walk) I take care to make some kind of sound that will cover up the sound of my gas passing. I cringe when people talk about farting as something rude and deliberate. I HAVE NO CONTROL OVER IT, and no one knows better than I the limitations of surgical repair.

    At the time of the forceps delivery I was very grateful to the OB who did the high rotation and helped me avoid a cesarean because I had swallowed the idea that a c/s was an undesirable outcome. Now, with my huge cystocele and my barely-controlled urinary incontinence and my marginal fecal incontinence and my complete gas incontinence I wonder what the hell I was thinking.

    • Tigger_the_Wing

      You have my empathy, and thank you for sharing. My emergency forceps delivery was thirty-five years ago, with similar outcomes. Even a complete hysterectomy and two bowel surgeries have failed to fix a thing. In what world is it better to avoid one surgery, even if it leads to many more in the future?

      • AnnaPDE

        Oh but that later surgery is different because it’s not an evil unnatural C/S and wimping out of good, honest birth.

        • Abi

          Not only that, but it fits nicely with the short termist approach to budgeting that blights the NHS. As long as it’s not coming out of “our” budget, who cares if some other department has to pick up the slack several times over? Quality of life doesn’t even come into it. That’s the cynical side of this but the saddest aspect of all is how the system uses supposedly woman friendly ideological guff to disguise what is really happening.

    • Anon For This

      Wait… are other people able to control FARTS? They don’t just… HAPPEN? Like… that’s normal?

  • Roadstergal

    The more I think about it…

    Dr T writes a piece going into the magnitude differential of risks and notes that a woman needs accurate information delivered in an understandable fashion to choose what works best for her own goals, values, and risk tolerance.

    Jos thinks she’s saying that women should choose Caesarean all the time.

    It says everything about his state of mind, doesn’t it? In his mind, a doctor’s job is to choose what’s best for his patient and present the data so that she ‘chooses’ what he wants her to. It’s not his job to give accurate information and facilitate an informed decision. That’s the only way he got the 180-degree-wrong message from Dr T’s piece.

    What a paternalistic jackass.

    • oscar

      I saw several Dutch Ob-Gyns when I was pregnant with my first kid. My experience with them (and the dreadful midwives I encountered) led me to go across the border into another country for an elective CS. Paternalistic is totally the word for their attitude. That was 17 years ago. It seems the Dutch Ob-Gyns haven’t changed at all, and this one looks like a young bloke too. How depressing.

      • Roadstergal

        A Dutch co-worker of mine had the traditional Dutch homebirth experience with her first baby. When the moms in our group were having the water-cooler birth discussion, she mentioned that it was so unbelievably agonizing that she had to wait until she couldn’t remember it well anymore to have her second daughter.

        What a system – something that traumatic is only recorded on the books as a successful, uncomplicated vaginal birth.

        • oscar

          How terrible. I heard many such dreadful stories when I was in the Netherlands. My husband and I told everyone we could that I was going to have/had had an elective CS. We really wanted to counter the homebirth crap that had been pushed on us so remorselessly.

          Many people were really disapproving but quite a few people quietly told me their nightmarish stories. Like the woman I met on the bus who said her daughter has Erb Palsy because she got stuck in the birth canal and had to get yanked out. Her child was 9 and was still extremely badly affected. The woman started crying when I told her about my elective CS. She said she would have had an elective CS in a heartbeat to spare her kid.

          And my friend who was in labor for 4 days and was, like your friend, so traumatized she decided not to have any more children.

          And a squash partner, who couldn’t play sports anymore after the birth of her son because she was so torn up and couldn’t control her bowels anymore. The last I heard, she was on her third op.

          There were just so many stories. It makes me so angry that it’s probably still going on.

          • ukay

            Good God. My midwife was always raving about the Netherlands and how great the whole system was. I would always zone out when she started about it. The Netherlands are a midwife’s wet dream. How can you put women through such suffering when you have the option not to.

            Don‘t you have to pay extra when you want to give birth in a hospital there? Terrible!

          • Charybdis

            But, but, but…..the universal health care! It’s supposed to be better, right?
            /somewhat sarcastic

          • ukay

            Well, it is a big plus if your child e.g. needs intensive care and you do not leave the hospital bankrupt etc.
            If I remember correctly the sum was small,it just seemed crazy that it was not an equivalent option to homebirth.

          • Roadstergal

            It’s odd how so many civilized countries with decent single-payer care do so much better than the US in so many areas – and then just go wonkers around childbirth. It’s like The Big Exception, somehow.

          • ukay

            Maybe because of midwife centered care?

          • oscar

            The Netherlands is an exception in Europe. I delivered my first in Germany and they certainly did not have the home birth thing going. They weren’t too keen on elective CSs either (the ob and his midwife who agreed to do mine told us we had to pretend to the rest of the hospital staff that we were travelling through when I started laboring and that the labor stalled and I needed a CS) but home birth was definitely not encouraged.

            I live in France at the moment and they’re not into home births either, as far as I can tell (all women I’ve talked to think it’s irresponsible to give birth at home).

            The Netherlands is an outlier for historical reasons. In the 1600s, when barbers started doing surgery and actually started to occasionally save the lives of women in complicated childbirth (and make money), they immediately began to marginalize the midwives, who had been doing all of the childbirth care up until then. The barber-surgeons put so much pressure on the midwives, who they portrayed as ignorant money-hungry slatterns (love the projection), that many major Dutch towns started forcing midwives to undergo training and earn a certificate before they could attend births.

            This had the unintended effect of legimitizing midwifery, with the result that when men were more-or-less entirely running the childbirth show in other countries (starting in the 1800s), midwives in the Netherlands had formed a sort of guild and were educating other midwives. As a result, Dutch midwifery had quite some social standing and legitimacy by the time another historical factor turned up.

            In the 1970s, Gerrit-Jan Kloosterman was the leading obstetrician in the Netherlands. He was an extremely charismatic professor in Amsterdam who straddled the field of obstetrics in NL. He was also unusual in that he often went on the radio and TV and engaged in public discussions about various gynecological matters (including abortion) in a sharp but courteous manner. He was a giant in Dutch obstetrics. Importantly, he insisted that birth “is a normal event” and believed strongly that “a normally progressing pregnancy should not end with a birth in the hospital and not with a gynecologist.” He was the father of the midwife-led care model that was operating in NL in 2000, when I got pregnant.

            He died in 2004. The vast majority of the older gynecologists in NL probably trained directly or indirectly under him. Perhaps the questions that are currently being asked in NL about home births are because Kloosterman’s influence has waned since his death and more skeptical views can be aired without significant professional consequences.

            Sadly, however, Dr. V’s dumb tweet suggests that too many Dutch obs are still walking in Kloosterman’s footsteps.

          • oscar

            Back in 2000, at least (it may have changed in the meantime but Dr. V’s ridiculous tweet now makes me doubt it), you never saw an obstetrician unless there was a medical indication. Everything went through midwives and you were expected to give birth at home without painkillers. I have talked about this before on this blog but when the midwife allocated to me explained this, and I asked, in an incredulous tone, “I presume that means no painkillers?!!”, she pulled out a rectangle of black rubber and showed it to me. I looked at it uncomprehendingly and she said, “It’s to protect your dental work during labor.”

            Righty-o, then! I then said that I was considering an elective CS and she immediately said,””No one in Holland will perform one.” She wrote on my medical notes, “Mrs oscar and her husband are a bit ‘anders’.” ‘Anders’ means other than, not normal.

            She was right, though, pretty much no one would perform an elective CS.

            To answer your question about costs, at 7 months pregnant, another midwife told me that there was a (female) ob in another part of Holland who MIGHT agree to do an elective CS. However, we would probably have to pay the full costs. I said, thanks, we’ve already got it covered. There was NO way I was birthing in that country by then.

            And by the way, they did NOT then perform routine ultrasounds or testing for fetal abnormalities (don’t know if that’s changed). My midwife in fact didn’t even like performing Doppler because she thought it was upsetting to the baby! I had to get my first trimester blood test and 20 week ultrasound done under false pretences: I said that my sister had a Down syndrome child at the age of 21, which wasn’t true.

            Man, what a crap system.

          • ukay

            Thank you for taking the time to type all this out, it is worse than I expected. So shocking they do not perform regular ultrasounds to ensure the health and safety of the baby. What if it needed medical attention after birth? Here, some midwives peddle the notion that ultrasound is dangerous for the babys hearing and heats up the amniotic fluid. With midwifery in crisis here they always swoon over the Dutch model.
            The midwife centered model is always sold as giving more control back to women when withholding info and leaving them in debilitating pain has rather the opposite effect…

            OT: My midwife gave me info on an alternative approach to Vit K. Apparently they used to give low dosage Vitamin K over weeks in the Netherlands, but that did not have the same effect as the higher dosis 3 times.

          • Hannah

            I’m in the UK and spend my time raving about my ELCS as well to try to counter the narrative. Although it’s only recently I’ve begun to admit it was because I didn’t trust the hospital… I was too scared to admit that before, but as time goes on, if we don’t talk about it then it goes unchecked, so I do. Women here genuinely don’t realise that they’re receiving substandard care, so I talk long and loud about how it was the right choice and I kinda loved it. Also about loving formula and my rage at the lactivism, but that’s another post.

        • fiftyfifty1

          And this is yet another reason why the homebirth rate in the Netherlands is dropping so fast.

      • oscar

        And now I’m remembering this beauty.

        When I was researching the pros and cons of elective Cs and trial of labor while I was pregnant in the Netherlands, I found an article written by a Dutch Ob-Gyn called Jos Roosmalen. It was in the BMJ, I think, and his argument against elective CS was that women in first world countries shouldn’t be allowed to get elective CSs because then all the ladies in developing countries would want one, and that wouldn’t be fair because CSs were less safe in those countries!

        I mean, WHAAT?!

        • fiftyfifty1

          WTF? We better not drink either, as water is less safe in those countries.

          • Roadstergal

            I mean – that IS the message of the lactivist community. Since formula isn’t safe in countries without access to clean water, we shouldn’t use it in countries that have clean water.

          • Mariana

            I had never thought of their message like that. It is even crazier than I had thought.

          • Sarah

            Or live, since living is also less safe in most developing countries.

        • Tigger_the_Wing

          Well, of course. Only men are autonomous, thinking individuals. Women are a collective with a common hive-mind, right?

    • TheArtistFormerlyKnownAsYoya

      Not only that she’s saying women should choose caesarean all the time, but that they should do so to preserve the “love tract” – when sexual function wasn’t even mentioned by Dr. T. Prolapse, schmolapse you silly ladies! Quit thinking about sex all the time!

  • momofone

    “Love tract”? I don’t believe I have one of those.

    • Roadstergal

      She’s young, she’s beautiful, she has huuuuuuge… tracts of love…

      • Charybdis

        I don’t know if having a huuuuuuge… tract of love is what people should aspire to have.

      • KQ Not Signed In

        “Someday, all this will be yours.”

        “Wot, the curtains?”

        • MaineJen

          “But mother-”

          “Father!”

          “But father-“

        • Roadstergal

          That movie was so beautiful…

    • Charybdis

      Isn’t that a song by the B-52’s?

      • KQ Not Signed IN

        TIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIN ROOOOOOOOOOOOOOOOOOOOOOOOF!

        INCONTINENT!

        Wait, no.

        • oscar

          Thanks, that really made me laugh.

          • KQ Not Signed In

            Here’s to hoping it didn’t also make you pee.

  • biteycat

    Oddly, my super crunchy childbirth coach told our class that if there was forceps talk, a c-section was probably the better outcome. She was pretty clear those things could mess you up.

    • crazy mama, PhD

      My crunchy-leaning birth instructor said the same thing.

      • Abi

        A few of them do admit this. What they fail to grasp, however, is that nothing you can do as an individual will make the slightest difference to your risk of needing them. They are just too attached to the idea that it’s all about how relaxed you are/how much hypnobollox you’ve done/ the colour of the curtains, etc. It’s maddening.

  • Roadstergal

    “Love tract?”

    Worst B-52s parody ever.

    Also, Jos is the worst OB ever. Keep that fucker away from my genitals. Especially if he can’t refer to them by their actual goddam names.

  • Heidi

    No, what he’s implying is that women only want to be continent and not have sexual dysfunction for the sake of men. Newsflash Vollebergh, it’s not the case for many women including myself. I do not want to leak urine or feces for me. For me, even having to wear pads, like after childbirth and once during a miscarriage, is very uncomfortable and irritating. After childbirth, my husband was not the one negatively affected. I was the one who had pain and less pleasure. It might be petty, but he must be awful in bed if that’s how he thinks.

    • AnnaPDE

      So what about the “continence challenge” for the male providers spouting this crap? Roll the dice to determine what kind of damage your imaginary vaginal birth has caused, and then replicate those effe by some little botox injections in the respective sphincters etc. Then enjoy the wonderful world of pads and embarrassment. Don’t worry, it’ll wear off after a year or so, in contrast to tge real thing.

      It’s less dangerous than the Tide pod challenge and more useful, too.

  • TheArtistFormerlyKnownAsYoya

    Oooooh, what a disgusting man this Vollebergh is. THAT is what he took away from your article? Good job shaming women for their sexuality Dr. V, so progressive of you. The implication is that women would “keep your love tract honeymoon fresh” for men, and this is shallow and flighty of them. The idea that a woman might want to enjoy her own sexuality either never enters his little peabrain, or if it does he thinks this is shallow and flighty also. I’m sure he doesn’t however have a problem with Viagra.

    • Or with prostate surgeons taking every precaution to preserve sexual function in men. After all, what’s a bit of incontinence and/or sexual dysfunction, am I right?

      • momofone

        Exactly. Totally manageable (maybe not satisfactorily, but hey) and definitely not life-threatening. No biggie.

      • Sue

        As I said in the comments on The Conversation, there IS a lot of discussion about the complications of prostate surgery – both urological and sexual. The big difference, though, is that prostate surgery generally occurs in older men, while childbirth occurs in young women.

        If a women develops her complications in her thirties, she may have fifty or more years to live with them.

    • Heidi

      I similarly commented before I read your comment. So true!

    • oscar

      Yeah just EEEWWWWWW to what Volleberg said. My mouth literally fell open when I read his tweet.

      • TheArtistFormerlyKnownAsYoya

        Me too! My jaw actually dropped!

    • AnnaPDE

      This article looks at the question of female vs male sexual pleasure from a #MeToo perspective, but I think its main point perfectly applies here as well:
      http://theweek.com/articles/749978/female-price-male-pleasure

      TL;DR version: Typically “Bad sex” mrans “meh orgasm” for men and “painful with zero pleasure” for women. But as women are socialised to ignore their discomfort and the male scale gets applied by default, women’s pain and lack of sexual enjoyment is ignored, while serious efforts go into maximising male pleasure.

      • TheArtistFormerlyKnownAsYoya

        I had seen this article last week, great piece. The doctors above are all embodying this attitude – women don’t care about sex, sex is for men, women’s discomfort/pain is normal and we don’t need to do anything about it. I’m 7 months pregnant and getting over pneumonia, experiencing stress incontinence from the deep chest coughs. I can’t imagine living with this for life – it is totally unacceptable that men responsible for women’s health care are trying to gaslight us into thinking it’s ok.

      • oscar

        Thanks for that article. It’s right on the mark. The author doesn’t mention pain in (and after) childbirth though. I suspect that also adds to the conditioned trope that women have to endure pain.

      • The Bofa on the Sofa

        I’m not following the topic her, but your comment reminds me of things from a guy perspective.

        Q: Describe the worst blow-job you ever had?
        Guy Answer: It was wonderful

        Similarly, ask a guy to describe the worst sex he ever had.
        Answer: he had an orgasm

        That answer might have the additional “too soon” but still, he had an orgasm.

        Sex that didn’t result in an orgasm? Oh dear, you did it for an hour and didn’t cum….

        Sure, guys will tell you about times when sex was better than others, but to call it “bad”? Nah….. “Bad sex” for guys means “not often enough.”

        It’s like that guy in Roxanne who was telling Charlie (Steve Martin) about having sex with Roxanne (Darryl Hannah) and how he was all nervous and “couldn’t do it…the third time.” I mean, how do us guys even cope? It’s awful….