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Paternalism in Navy Medicine, or Why Don’t I Have Any Say About My Uterus?

August 29, 2011

I find it really obnoxious when I go to a doctor — any doctor, not just military or Tricare-ified — for an issue with my finger and am asked before any other medical question when my last period was.

I find it even more obnoxious how little say I have over the function of my girlie bits.

Back in the day, when I was childfree, I asked what it would take to get a tubal ligation during a visit at the Pride of Navy Medicine, Balboa Hospital.

Doc: Your file says you don’t have any children.
Me: Nope.
Doc: Typically they want you to have two before you make that decision.
Me: Kids are the spawn of Satan. I do not like kids.
Doc: No kids?
Me: That’s right. What will it take to get a tubal?
Doc: Therapy.

The doc explained that I’d have to see a psychiatrist first, and then they’d consider allowing me to nuke the possibility I could pollute the gene pool. But, said the doc, with my list of medical issues, there was nil possibility I could become pregnant anyway, and since the issues were persistent, I really didn’t even need a referral to the psychiatrist (unless, I inferred, I fell into a deep depression over not being able to conceive).

I never did understand this strange fascination the medical community has with my ability to procreate. I’m downright confused by the military medical community’s seeming insistence than I be a human incubator as often as my uterus and ovaries will allow.

This really became an issue for me when the assurances I received as to my infertility were proved horribly, terribly wrong. Turns out my list of medical issues was actually just one issue, and that one issue is resolved with exercise and a low-GI diet. Imagine my shock when, after hiring a personal trainer and strictly following her ungodly diet, two–count them! two!–pregnancy pee sticks turned positive on me.

I eventually got over my shock, sometime around his fifth birthday.

Not a year after my elder sprog came bleating into the world (literally, as he was a preemie, and his cry sounded like a baby goat, which was cute and horribly terrifying at the same time), my ovaries decided it would be HIGH-larious if they popped out another viable egg in spite of my lack of exercise and not-so-low-GI Weight Watchers diet. Luckily for that sprog, he turned out cute enough that I decided not to sell him on eBay.

When I got pregnant with younger sprog, I decided Something Must Be Done. I hadn’t wanted any, and here I was about to have my second. This would not stand. So I thought back to that fateful convo with the lying doctor who said I didn’t need to worry about a tubal. She said I had to have two. I was about to have number two. I went through all the paperwork I’d gotten from Bethesda and saw something about opting for a tubal during a C-section. I didn’t want a C-section, but my first pregnancy had ended in one because of serious complications, and my health was headed in the same direction during that second pregnancy. I had a fair to middling chance that I’d end up on the operating room table.

I called to ask the doc about this. “You’ll have to take a class at Bethesda, but it’s just two hours, you sign the paperwork, and then if we do a C-section, we’ll do the tubal ligation at the same time,” said the doc.

Mother. Loving. Woot.

I called the designated phone number to sign up for the class. The woman gave me the time, date, and location for that wonderful class, two months away (and–whew!–the last one before my due date). I showed up early, intent on not screwing up my chance to skewer my innards. When I sat in the waiting room, I noted how loud it was. There were a metric ton of preggers and their service members sitting there with me.

The one next to me had a gleeful look. “So this is your first?” she asked.

I thought that was an odd question. “Nope, my second,” I said.

She gave me a really weird and slightly nasty look, and turned away. She didn’t speak to me again.

I thought that was even more strange. Until we were called back for the designated class, for which I was registered.

It wasn’t Let’s Wrangle Our Fallopian Tubes and Hogtie Those Biatches class.

It was the new parents orientation. You know, how to put a diaper on your kid. How to feed them. When to feed them. How not to be a scumbag of a parent.

I was so embarrassed. No wonder that gleeful pregger acted like I had freaking leprosy.

I left, naturally, and asked on my way out when the Getcher Tubes Tied class actually was.

The week before.

What. The. Hell.

Cut to a few weeks later. My health sitch had totally spiraled at this point, and the docs were telling me they’d take the first opportunity to induce labor. Then they got their excuse. The way things went, I opted to just get the C-section to avoid the complications and issues we’d had during the first sprog’s entry into the world. I jokingly said how nice it would be to get the tubal I’d tried to have. The doc gave me a weird look and asked for an explanation. So I provided.

The doc said, “Let me talk to the other surgeons. Since you have another child and have taken all the steps except for the class, I’m okay with doing the tubal anyway. But we’ll have to make sure everyone else is.” She implied it was an ethical concern.

Color me confused. Ethical?? Whatevs. Go corral the surgeons and twist some arms. Only one surgeon had concerns, and she came to speak to me personally. I received the following list of questions:

  1. Are you sure this is what you want? Absofreakinglutely.
  2. Are you sure? Absomotherfreakinglutely.
  3. What if you change your mind? I won’t.
  4. What if you want other children? I’ll adopt. ‘Cuz, yanno, there are tons of kids out there who need homes.
  5. What if you want your own children? 1) My genes suck. Why would I want my “own” children? 2) What kind of scumbag mom would I be if I considered adopted sprogs not my “own?”
  6. Are you sure? Woman, do you see me with an exploding eye and a possible stroke on the way? How the hell is this something I’d want to repeat?!

She was okay with my responses at that point. But then, the piece de resistance! She basically asked my husband if she had his permission.

YodaMan is intelligent. His response was something along the lines of, “She’s an adult. Why are you asking me?”

I got my tubal. Thank the ever-loving gods. I just had to have two sprogs and my husband’s permission first.

Apparently, at least in the milspouse world, we have about as much right to our reproductive freedom as Saudi women have to theirs. Which, IMHO, is awesome.

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24 Comments leave one →
  1. August 30, 2011 1:32 am

    Or you can be 40. I never thought I’d be eager to turn 40, but the DAY AFTER, I’m marching my butt in that office and demanding my gawd-given right to a tubal. Not to make you feel bad, but when I was a 25 year old, nearly homeless, single mother of one sprog and I BEGGED my civilian doc to approve a tubal, she basically wagged her finger at me and told me to cross my legs. So evidently it’s about being a woman, not a milspouse. Not that mil-docs don’t come with their own special brand of asshattery, just that MDs in general are witless quacks.

  2. kimba permalink
    August 30, 2011 2:05 am

    Yup, that’s crap.

    FWIW, when J arranged for his vasectomy, the doc emailed me from the ship (he was underway for the procedure) to ask if I was on board with his decision. I fought the urge to say, “It’s *his* body, for crissakes!” but instead, I just consented. I suppose they don’t want husbands coming back from a cruise with a surprise vasectomy, and I’m sure this policy, like everything else the military does, is 100% reactive. But still. Oh, and when J attempted to have the procedure in his 20s, when he was married to wife #1, he was told he was too young to make the decision.

    Of course, he didn’t have to take a class, or get counseling. And as you know, we have no kids, and J’s in his 30s. So there’s a wicked double standard for sure, but the spouse permission thing, ridiculous as it is, goes both ways.

    That said, I’m betting you can’t get a tubal ligation while you’re underway, permission or no.

    And really, a class? I wonder what that lesson plan looks like…

  3. snarkynavywife permalink*
    August 30, 2011 8:42 am

    To clarify: My husband went in to start the vasectomy process, just in case I ended up not getting a C-section (and, therefore, no tubal).

    They did not give him the third degree.

    They did not require my permission.

    They did not require counseling or class for him.

    After maybe fifteen minutes spent at the appointment, my husband had the appointment line phone number and a prescription bottle with 30 oxycodone tablets. (BTW, after my C-section, the Navy docs generously gave me 10 oxycodone tablets. 30 pain meds for a tiny incision on the scrotum in outpatient surgery; 10 pain meds for major inpatient surgery on the abdomen. Does this make sense in some strange, alternate universe?)

    Maybe it isn’t standard across the military medical system, but there does seem to be a bit of a double standard present there. There’s also ageism, as Kimba points out, and an insistence on procreation. I’m sure there’s an issue in the civilian world with this, too, since the threat of a lawsuit forces civilian docs to CYA at every turn. Perhaps that tidbit is what makes this so frustrating to me: the fact that we can’t sue a Navy hospital for doing a tubal or vasectomy without the spouse’s consent, yet there are still these egregious hoops we have to jump and dance through.

  4. August 30, 2011 8:47 am

    It’s not just military docs. It’s every doc I’ve ever dealt with. Even with a family history of cancer in the lady bits, I can’t convince a doc to remove my spare parts. They wouldn’t even agree to a tubal until I was at least 30 – kids or not. What baffles me is that people can make decisions to have children and take care of them before 30, but not make health care decisions regarding their own bodies?

  5. August 30, 2011 6:03 pm

    I agree with kimba, most of this is probably reactive. Doctors are tired of being sued, so if you’re willing to jump through enough hoops and sign enough papers, you’re likely not to come back with a lawyer in a few years. Of course, I remember how condescending mil docs were, even when I was an active Army soldier. I wanted the pill at one time and was asked if my husband, also military, was aware of my decision. I asked if they had legal reason to inform him? Of course, he did know, but I sure as hell didn’t think it was any of their business to ask me about that, or him. The mention of ‘legal’ got my prescription filled. What a pain in the a**… and really, people actually WANT more government managed health care?? How? When we already have such a screwed up example (VA and military clinics) that should cause us to run screaming?!

  6. kimba permalink
    August 31, 2011 3:35 am

    Back in the 60s, my aunt was granted an annulment based on her then husband’s failure to reveal that he’d had a vasectomy, even while she was going through many invasive and uncomfortable fertility treatments. Not that this makes the permission thing ok with me, but these things do happen. (And ew. What a tool.)

  7. September 12, 2011 5:05 pm

    Amen to you!!! I have known since I was 23 that there is no way I will ever want a child but yet I am lucky enough to have a closed cervix making it almost impossible to get prego without medical intervention. The sad part is, it isn’t just the military doctors, it is all doctors that won’t even consider letting a woman get her tubes tied until she has popped out a basketball team or is to old to be having them. I can get fake boobs, all my fat sucked out my butt and added to my lips, but I can’t have any say in my own choice to not breed? It isn’t right.

  8. JoAnne McPherson permalink
    September 12, 2011 5:07 pm

    I am on the Army side of things. I once needed a procedure of a female type and even though my husband had been deployed for 4 months, they insisted on waiting until after my next monthly courses to rule out the fact that I may be pregnant. I mean, what? I obviously A: Cheat on my husband or B: Lie about being pregnant or C: both? I recently had a friend who was asked when the first day of her last period was. She is in her 70s. She replied: March 23, 1983. Or was it the 24th? LOL I love her.

  9. laurie permalink
    September 12, 2011 5:31 pm

    tubal ligation requires abdominal surgery is not reversible in most cases men getting snipped is easy reversible in most cases that is probably why the fuss

    • Air Force Infidel permalink
      September 13, 2011 12:25 am

      I was always under the impression that the vasectomy was less likely to be successfully reversed.

  10. oregonbean permalink
    September 12, 2011 6:02 pm

    Hmmm. . . psychiatric consultation for even mentioning the desire to tie those babies tight? I find it ironic, because I am willing to bet that if I wanted fake ta-tas, no one would blink an eye; I wouldn’t need my husband’s blessing, no one would demand I see a psychiatrist and take a class, and I cannot imagine a surgeon summit to discuss the ethics of it all. Come to think of it, isn’t going to someone other than the adult patient, and divulging medical information a violation of HIPAA, unless said patient has given written permission for that sort of release of information?

    Sadly, I don’t think it’s strictly a military medicine thing. I’ve seen on and off-base providers about some girlie concerns of mine, and I honestly feel as though I’m talking to a brick wall. Nevermind that it takes an act of (insert deity here) to get a referral to a specialist, and in some cases I’ve been flat out denied because some lazy practitioner thought I was just stressed out(does that show up on ultrasound?), but just when I feel like I’m making real progress, the orders drop and we move, and the reset button on my healthcare is magically reset.

    I once had two separate appointments with the same provider, a week apart. Obviously no one was looking at those first days of last period, or they thought two separate periods in the span of a week was normal. Why don’t they just ask me if I think I might be pregnant, or better yet, ask me if I’ve noticed abnormalities or if anything is concerning me, so that I at least get the impression that someone cares.

  11. Concerned Navy Nurse permalink
    September 12, 2011 7:56 pm

    This post has been circulating through some of my Navy friends via Facebook, and as a Navy Nurse working in Labor and Delivery, I have to say I find this a little disturbing. I first would like to apologize that you had a frustrating experience, and hope that your further experiences with Navy Medicine are smoother and less annoying. Perhaps it’s the particular facility in which I work, but every time we have a mother deliver, the OB/GYN or Midwife who has delivered said baby will ask the her, “What have you thought about for birth control over the next year?” If they say nothing, we counsel them on the risks to their body for getting pregnant within a year of this most recent delivery. If they say oral pills, we make sure they are on the right one for them and their breastfeeding/family plan. If they state they would like a tubal ligation, we advise that we cannot do anything until 6 weeks postpartum, as it is an infection risk and detrimental to healing to have elective procedures done so soon after delivery. I have NEVER heard a provider tell a patient they had to undergo psychological counseling or receive permission from their husband to receive something that is for her body alone.

    They do have to be careful because some women become quite upset when 1. the tubal doesn’t take and they get pregnant again or 2. the tubal takes and they decide 5 years later (after being adamant they’re through with pregnancies) that they want this one last child. Millions of dollars are spent each year on both elective procedures and the reversal of elective procedures, so I do agree it is prudent for each provider who would be using their license to perform any procedure to make absolutely sure it is safe and a sure decision for both parties. Is it a paternalistic practice to be this careful? Perhaps, but having my own license to practice nursing, I kind of understand. I wouldn’t want to do something elective only to have it come back and bite me in the behind later on down the road. OB/GYN’s and Midwives have to carry medical malpractice insurance (yes, even in the Military most do so, as a safety net) that is enough coverage for each delivery they perform PLUS the next 21 years of each child’s life. That’s quite a bit!

    My point is, I am sorry you had the run around, but please try to be understanding of the strong culture of patient safety and high litigation in the field of obstetrics. It is not a perfect system, but what system is? Please remember, it’s the military providing free health care, not the sandwich line at the Subway. While we always want to get everything we want, we can’t always receive non-life saving procedures just because we want them.

    • snarkynavywife permalink*
      September 13, 2011 2:36 am

      I do appreciate you taking the time to respond. I definitely learned some tidbits that change my perspective a little.

      But I still don’t understand the attitude I’ve encountered so many times in the last seventeen years. Even if it’s industry-wide, and even if there are legal reasons, I still dislike the paternalism and the idea that someone who doesn’t know my body and life like I do can make these sweeping decisions based on ageist and often even sexist assumptions.

      Having been treated poorly in L&D (e.g. shouldn’t I be consulted before a doctor sticks a glorified spork up my cookie and breaks my bag of waters?! at the very least, shouldn’t I be told that’s the plan of action, if they’re not even going to allow me any say?!!), I’m particularly sensitive to comments that discount my autonomy and my ability to make decisions regarding my reproductive health. I’m a little bothered at the idea that my health care is free (it’s most certainly not), and I’m a lot bothered that my personal medical history and lifestyle preferences converging on one optimal procedure can be compared to a Subway line. Free (not so much) or not, should Navy medicine really have the goal of providing cookie cutter care to every patient, regardless of their medical needs? Maybe I’m wrong, and maybe the fact that the care is so low cost is the reason Standard Template Health Care is implemented without a thought for the individual. Is this the “you get what you pay for” adage in action?

      Again, I very much appreciate your perspective. I had no idea y’all have to carry insurance, too. And I’m quite appalled that you could be sued even after the patient has signed thirty different types of consent forms for an elective procedure. That sucks some pretty mighty balls.

  12. Lumpy permalink
    September 13, 2011 12:33 am

    An Ensign buddy of mine went into the Navy Doc to get a vasectomy at 24, the Navy Doc told him no he wouldn’t do the procedure. My Ensign Buddy already had two kids and didn’t want to have a third. So, she can whine all she wants, but she is getted treated like everyone else. Navy Med treats us all like dirt, get used to it. And, it has gotten worse over time, as Navy Med treats you like an E-1, regardless of rank.

    • snarkynavywife permalink*
      September 13, 2011 2:19 am

      And of course, you can whine all you want about how officers are treated like E-1s.

      Regardless, is it okay for the Navy to tell anyone how they can deal with their reproductive health? Is it the Navy’s business at all, excepting where it affects readiness? And wouldn’t the Navy providing sterilization to those who want it alleviate a lot of readiness and personal financial issues? So back to the focus of this, aside from the whining, natch: How is the reproductive status of my uterus or your Ensign buddy’s nutsack any of Navy medicine’s business?

      Universal paternalism is not helpful. Just because we all are treated like brood mares and studs doesn’t make it okay.

  13. kimba permalink
    September 13, 2011 2:18 am

    “Please remember, it’s the military providing free health care, not the sandwich line at the Subway.”

    With all due respect – and I do mean that – the military doesn’t provide free health care. The military offers a benefit package that includes health care for members and their families. That health care is earned, not given as a gift.

    • snarkynavywife permalink*
      September 13, 2011 2:37 am

      Which also costs us out of pocket. Monthly from the paycheck for the shittier service, and per visit for the less shitty service.

      • kimba permalink
        September 13, 2011 2:48 am

        Yes.

        The notion that we get “free” health care and “free” housing are widespread outside of the military, and I don’t think that perpetuating these myths helps the civilian world understand military life at all.

        I do sympathize with military medical personnel and civilian employees of military health care. I’ve no doubt it’s a tough job. But the level of care we receive and the ethical considerations Snarky raises should in no way be impacted by what it is assumed—incorrectly in some cases, as it turns out— we pay for it.

        • September 13, 2011 2:58 am

          Exactly! You really do not get anything for ‘free’ … somebody somewhere is paying. When civilians whine about wanting ‘free’ national health care… I do not know whether to get angry, or hang my head in shame over their stupidity. There is NO such thing as free national health care. I do believe we need reform in all health care, but I spent 10 years in the military with military health care, then and since I have been exposed to the failings of VA health care, and I lived in the UK for 3 years and learned how awful their ‘free’ national health care really is. We do NOT want that!!!

    • snarkynavywife permalink*
      September 13, 2011 2:38 am

      And PS, I will love you forever for no other reason than you use that avatar. You. Rawk.

  14. kimba permalink
    September 13, 2011 3:12 am

    For the record, I believe in universal coverage and I loved the NHS (I lived in Scotland for two years). Military health care isn’t run well, but that doesn’t mean we can’t create something that is.

  15. Concerned Navy Nurse permalink
    September 13, 2011 7:49 pm

    What I mean by “Free” is that it doesn’t cost $1000 premiums every six months. Being active duty myself and married to a Marine, believe me when I say I understand we earn our health care and make sacrifices. I merely meant we don’t always have a say in a system much bigger than ourselves, and something that still is provided, despite our sacrifices. And if you still have concerns with how you were treated in any Navy Medicine facility, you should definitely leave a comment card on the ICE system, as they really are looked at for process improvement. My L/D staff, including my doctors, corpsmen and nurses, try to treat EVERYONE like an Admiral, not an E-1.

    • kimba permalink
      September 14, 2011 2:39 am

      CNN – As far as I’m concerned, individual treatment providers aren’t the issue. You guys work hard under what I can only assume are difficult, understaffed and undersupplied circumstances. I’ve been treated courteously and professionally by all of the non-Tricare staff here at our MTF; I have no complaints about their professionalism at all.

      The system, on the other hand, is a disaster. Unexplained, reactive policies; constantly changing rules about who can be seen and when; a horrid record-keeping system; policies that make it clear that dependents aren’t trusted to manage their own records/care; waiting rooms overflowing with patients due to overbooking; doctors/nurses/PAs PCSing in and out constantly (I don’t even have a primary care provider at the moment); phone numbers that are inaccessible and/or change constantly – the list goes on and on. I’m sure you see it every day. I don’t want to give you the impression that I blame medical personnel for these things.

      But, Snarky’s point is a good one. Adults are responsible for their own medical decisions. I understand your perspective, and that insurance situation does sound dreadful, but birth control decisions (including tubal ligation and vasectomy) are private, and up to the individual. And since Tricare/military health care doesn’t offer a full range of reproductive care, they ought to do what they can, within the boundaries of the patient’s wishes, to avoid unwanted pregnancies.

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