Letting your garden grow

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“I’m sorry, I haven’t shaved.” Delivered sheepishly, with a cringe.

Le sigh.

I know it’s been awhile since I was in college (I mean, not THAT long <cough>), but let me just say that the scorched earth look was uncommon back in my day.

However. I like to think of myself as a hip old. I read Jezebel. I tweet. So I get that the social mores of grooming from my day are a thing of the past. It’s all about the prepubescent look now. Got it.

Or is it?

*****

There are upsides to this trend of complete hairlessness. Well, um, so there’s one. Crabs, a.k.a. pubic lice, that notorious entity of teen nightmares, is practically nonexistent today, rendered obsolete by a wave of wax and razor blades (wow, so that’s not a completely terrifying image). When I finally saw my first case ever last year, I was actually a little excited, with that thrill that comes with the discovery of a rare and endangered creature. I know, I know. JUDGE.

But the quest for bare skin doesn’t come without a price. Razor burn, ingrown hairs, folliculitis, microtrauma from waxing and shaving, and oh so much more… And, I dunno, all those many hours dedicated to lady area maintenance that could be redirected towards…saving the whales? World peace? Kardashian marathons? Take your pick.

I’ve heard the back and forth – it’s all porn’s fault! it’s my choice, and it’s hygienic! – but I can’t help but feel as though this trend is working against us ladies more than for us if you feel as though you need to apologize for being a smidge grown out when you come see me for your Pap.

*****

But. BUT! There are signs that the pendulum might finally be swinging the other direction.

Recently, those leading arbiters of classy, American Apparel, created a window display with mannequins wearing both domestic-construction spandex-cotton blend and full bush. Bold move, AA.

Seriously though, pubic hair’s been all over the news lately. (Pun not intended! I mean it, now THAT would be unhygienic.) You might have missed the articles in Slate and The Guardian, but you can’t deny the legitimacy of the New York Times. If the gray lady is deigning to write not one, but two, pubic hair trend pieces, you know it’s both a legit happening and maybe a year or two behind.

So there you go, ladies. Feel free to shave or not shave, wax or not wax, but please, at the very least, know that regardless of the choice you make, you should never feel the need to apologize for it.

The A Word

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Hey, health care providers:

It’s time to get comfortable talking about abortion.

I mean it. And not just the women’s health care providers.

Nope, what I mean is this: You, me and every generalist we know should get comfortable talking about abortion.

Why? For one, because it’s really, really common. Nearly one-third of all women in the U.S. will have had at least one abortion by the time they’re 45. So if you choose to remain willfully ignorant about what to tell your patient when she comes to you with that unexpected positive pregnancy test, looking for a medical professional to talk to her about her options, you are failing her you’re unable or unwilling to provide her with the comprehensive, respectful, judgment-free evidence-based care she deserves.

If your options counseling begins and ends with awkwardly and wordlessly handing over the phone number for a women’s health clinic, I’m talking to you. If you continue to associate Plan B with “RU-486” (and you’re still calling it “RU-486”), I’m talking to you. If you have trouble getting your mouth to form the word “abortion”, either to patients or colleagues, I’m talking to you.

Because NOT being able to talk about abortion with the familiarity and comfort with which we discuss a million other medical conditions and procedures relegates abortion to this hidden, unspoken corner of medicine and society, reinforcing the concept that abortion is dangerous and rare. Which – HELLO – it’s not. Not even a little bit.

(And all of this makes it easier for activists with too much time on their hands to continue making progress in their increasingly successful push to marginalize abortion access out of existence.)

So.

If there’s even a remote possibility that your clinical role includes caring for patients with a uterus, being willing and able to talk to them about abortion when they need you to MUST be part of the package.

*****

Here’s an initial, too-brief list of online educational resources for health care providers seeking to learn more about medication and surgical abortion. If you know of others that you think need to be added to the list, can you send them my way, pretty pretty please?

http://www.guttmacher.org/sections/abortion.php – the penultimate org/website for abortion and access trends and data

http://www.arhp.org/professional-education/medical-education-opportunities/archived-webinars – ARHP’s on-demand webinars, several of which review medication abortion and award CE/CME

http://www.prochoice.org/education/resources/index.html – NAF’s list of educational resources for health care providers

Much thanks to Chelsea Polis (@cbpolis) for:

http://www.teachtraining.org/

https://exhaleprovoice.org/pro-voice

(Happy belated birthday, Roe. Here’s hoping you’re around for at least another 41 years.)

Impatience

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I get it. We all have somewhere to be.

But waiting a few extra minutes for a clinical appointment isn’t the same thing as a long line at Sbux.

Our appointments are scheduled in tidy 20 minute chunks of time, as if all the work it takes to listen to a patient’s story, perform an exam, come up with a diagnosis, discuss the plan, write the prescriptions and lab orders and referrals and then maybe, MAYBE, write the note couldn’t possibly take more than this randomly assigned amount of time.

In reality, things don’t work that way. Patient care takes the time it takes, and exactly how much time that might be is impossible to predict with 100% accuracy.

Sometimes, a visit is straightforward, and this 20-minute guess isn’t too far off: your colds, your strep throats, your uncomplicated UTIs.

But what about the patient with a constellation of nonspecific and/or seemingly unrelated symptoms over several months? Something that requires a little detective work?

What about the patient with a list of 4-5 separate problems, all of which need to be evaluated here and now, and fine, why not, since by the time you’ve asked enough questions to determine whether some of these list items are non-urgent enough to be rescheduled for another visit you’ve already done most of the work anyhow?

What about the patient presenting for the first time with an eating disorder? Or suicidal ideation? Or a sexual assault? Do you really think it’s appropriate for their clinician to enter that visit with a clock ticking in his or her head, rushing the history and exam, and then at some predetermined time chirping “Welp, time’s up! Good luck with all that!”

This is not an academic question. This stuff happens to clinicians all day, very day. It happens to me all day, every day. It’s the nature of the job. And so when one of these particularly challenging situations presented itself in my office earlier this week, did I rush the patient through her impossibly difficult story? Did I even look at the clock once? OF COURSE NOT.

But did that mean I was crazy behind for the rest of my patients that afternoon? Uh, DUH. Obviously. I can’t make extra time materialize out of thin air. I can’t be in two, or even three, rooms at once. Believe me, I wish I could. Because that would be spectacular. For so many reasons.

I suppose I’m writing this because I’m tired of being asked to do the impossible. I’m tired of being measured by all the wrong benchmarks. I’m tired of getting heaps of attitude when I’m running late because you know what, I was providing care for another human being in need of care, dammit, and spending that time with them was the right thing to do. Sorry, but one person’s suffering means more to me than another’s inconvenience.

Wait, no. Not sorry.

Shouldn’t the quality of the care I provide mean more than how long someone waits to see me? Isn’t the part of the visit that really matters the part that happens AFTER the visit begins, rather than before?

Can’t everyone just be a little more patient?

The selfish mom’s breastfeeding manifesto

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I’m no hero.

This is what I want to say every time someone compliments me on my decision to breastfeed.

I’m lucky enough to live in a time and place where most of the people around me seem to recognize the value of breastfeeding. I live in a blue city, in a blue state, and this set of circumstances seems to have conferred upon me and mine a certain level of protection from the anti-nip police.

It’s actually more common to find myself fielding unsolicited accolades. Total strangers have stopped in the course of their otherwise busy day to let me know how great they think it is that I’m breastfeeding my son. It’s so brave, so profoundly GOOD of me to give him this gift. Breast is best. BREAST IS BEST!

And as much as I love being the recipient of flattery (why yes, I AM brilliant and selfless and let’s just add flawless while we’re at it, thanks for noticing), I can’t help but end up feeling a little disingenuous. Like when your boss gets up in front of the entire office at the all-staff meeting to formally thank you for leading the effort to plan the holiday party, when really all you did was spend less than 5 minutes on a cheap looking flyer. You give a sheepish aw-shucks grin while everyone turns to look at you and clap politely, while internally you’re feeling more than a little embarrassed and thinking “what if they knew that I just threw this thing together using a template in Word and some cheesy clip art?”

Because here’s the thing. Even though there are lots, LOTS, of legit reasons to breastfeed – apparently my children will end up healthier and smarter and less likely to live in my basement into adulthood all because of a little lactation (I’m sure I have those sources somewhere, just give me a minute to find them…) – my main reasons are purely selfish.  I breastfeed because I’m lazy and cheap.

What? IT’S THE TRUTH.

I can barely remember to leave the house with my wallet and keys; I can’t imagine maintaining my sanity (such as it is) in a world where I’d most likely be constantly failing my infant by ending up in some random public place without the bottle, or nipple, or formula, or formula-dispenser-thingie, or un-sketchy water, or any of the other little accoutrements that make formula-feeding possible. No matter how much of a mess I may be at any given moment, I CANNOT forget or misplace my boobs.

And I’m seriously one of the cheapest people I know. I will walk to hell and back on my lunch break for the promise of some free food. Even if it’s just a platter of those gross wrap things with unidentifiable spreads and meats inside. If there’s free coffee to be had, I will stubbornly pour myself a cup, even though I’m already jittery and overcaffeinated and the thought of yet another cup of coffee makes me nauseous. Because it’s free.

And guess what’s not free? Formula.

Boob milk, on the other hand, is completely, 100% free. I get to feel like I’m sticking it to The Man on a DAILY BASIS. I love this, all of this. More of this please, Mother Nature. If I could somehow create a bunch of other expensive kid-friendly food items de novo from my body with little to no effort (those overpriced baby puffs would be lovely, but that’s just a suggestion), I would be all in.

Now, I totally get that there are many women who have a variety of very, very good reasons for not breastfeeding. But I also think there’s a bunch of us who may want to, or may have wanted to, but decided that they just weren’t quite up to it. They just weren’t quite…enough.

And this is where I think the breastfeeding worship becomes problematic. The second we feel compelled to canonize every mom who chooses to breastfeed, it sends a message to the rest of us that successful breastfeeding is only obtainable though painful feats of self-sacrifice, and loads of effort, and possibly more than a little blood, sweat and tears, after which you are handed your trophy and halo for all to admire.

But breastfeeding shouldn’t be hard. I’m not gonna lie, it may be tough in the beginning, when some of our less with-it babies may struggle to figure it out (I’m looking at you, kid #1). But it shouldn’t be something we look upon with such reverence that it intimidates all the average ladies that weren’t planning on angling for supermom status out of giving it a fair shake.

Now there is, of course, an unequivocally awesome side benefit to all this boob worship: the growing support for making it even easier to do something that should be one of the easiest things in the world. Free breast pumps for everyone (thanks ACA!). Protected time and space for pumping at work. Laws protecting the rights of women to BF in public. Public approval of giving the side-eye to anyone who says things like “so how long are you planning to breastfeed?” or “are you sure he’s getting enough?”

So let’s keep doing all we can to collectively make breastfeeding as easy as possible. Because when presented with an option that speaks to both the selfless and unabashedly selfish sides of each of us, most of us are far more likely to choose it.

I’m as selfish as the next human. I want what’s best for my baby, and my family, and, y’know, the universe, but I also want what’s best for ME.

So that’s what I’m going to say the next time a well intentioned stranger sees me pull out my boob at Starbucks to quiet down my squealing baby and starts chatting me up about how great it is that I’ve chosen to breastfeed:

Thanks, but I’ve got to be honest. I do this for him, but I also do this for me. See this overpriced gingerbread latte? I’m choosing to pay for that instead of a bottle of formula. Because gingerbread lattes are ridiculously tasty.

Breastfeeding as a selfish act. Own it. Celebrate it. Love it.