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Friday, February 24, 2012

Facebook censorship reaches a new level of absurdity

If you're a natural birth and/or pro-breastfeeding advocate, you've likely heard about Facebook's ridiculous stance on breastfeeding photos - and how they frequently leave up images that show half-naked women doing anything but breastfeeding. But lately their ironic censorship has reached a new level of battshittery.

Photo credit: Seana Berglund
This photo, showing a woman's placenta, was removed. According to a leaked document, these are guidelines on content Facebook finds objectionable: "Depicting the mutilation of people or animals, or decapitated, dismembered, charred, or burning humans...Photos and digital images showing internal organs, bone, muscle, tendons, etc. Deep flesh wounds are ok to show; excessive blood is ok to show.... Crushed heads, limbs, etc. are ok as long as no insides are showing. ... Note: No exception for news or awareness related content."

I can appreciate that when it comes to certain issues, Facebook has a conundrum on their hands: intent can mean a lot when it comes to what you're posting. And obviously the placenta is an internal organ, but there is nothing threatening about a life-giving organ such as this. Unfortunately, it seems like when it comes to this policy, Facebook has it bassackwards: "crushed heads" are okay - I can't think of a context where that's necessary except in gory accident photos or some kind of horror film exposition - but the placenta is not. What?

And how can images of internal organs, bones and tendons be a good thing? If they're used for educational purposes, in which they're done all the time. So in their minds, a medical textbook - or educational photo such as the one above - is wrong. Not even news photos - taken by someone who obviously thinks the reader can gain some insight from seeing it - is appropriate, according to them.
But, in an ironic twist, the photo from a pro-life group showing "what an abortionist does" was removed - presumably because yes, it shows a mutilated, dismembered .... wait a minute. Human? Can we call it that? Since some argue that up until a certain point the fetus isn't a human being, or a "person," what should we call it? If, in fact, it's not a human being, then it should be allowed to show under the "excessive blood and crushed head" rule, maybe? Insides are showing, yes - but again, if it's not technically considered a human, then what?

Whew. I think we're stepping into dangerous territory here.

Which brings us to the next image. This one was removed as objectionable content, presumably flagged by users, and then reinstated - with an apology - from Facebook.

This content, posted by Dutch physician Rebecca Gomperts, clearly shows how a woman can abort her fetus by taking misoprostol, or Cytotec.

Several things bother me about this, and I feel that Facebook is ridiculously libelous in reinstating, and apologizing for removing, this content.

Whether she's a physician or not, Gomperts has no business offering this information in the form of a profile photo - presented like a prescription - to a woman she's never even seen before. She has no idea the age, health condition or anything, really, about the audience she's reaching, and whether Cytotec is really appropriate for them or not. Drug allergies? Sorry, no clue. Whether you're really nine weeks along or not? Nope. Not sure of that either. And her suggestion to see a doctor only if complications arise is essentially asking another physician to finish what she started - for good or bad.

Both in the profile photo and on her website, she advocates lying to medical staff - something that could interfere with your care, depending on the situation. And I'm not sure that doctors are all that stupid that they won't figure something out. If you're not telling them the truth, how can they adequately care for you?

Not only that, but it's laughably insane that she makes presumably desperate and troubled women think that they can just walk into any pharmacy around the world and demand this product. Depending on who's reading it, the dispensing laws could vary greatly. One could probably get it over the internet without a prescription, which is illegal, and possibly dangerous - in that you can't really guarantee what product you're taking, or who it came from, by ordering in online. And ironically, her website warns against doing that because of the risk of receiving a fake product. God only knows what could happen then: either it won't work and you'll still be pregnant, or it could do some serious damage to your health. I hear another giant can of worms opening somewhere...

After taking the pills, you are supposed to take a pregnancy test within three weeks (at which your fetus presumably would be a maximum of 12 weeks old, which could dramatically change the course of treatment if you were still pregnant). What do you do if the test is still positive? Call Dr. Gomperts?

Oh yeah, about that. Up until a few years ago she'd probably be in the middle of the North Atlantic on a ship, offering medical abortions to women from various countries who seek her care. I'm not even going to go there - except to wonder what kind of follow up care these women received to make sure everything really went as planned. Does she care? Would she just hand you over to someone else? Or would she wait around to make sure it's all the way it should be? If you regret your decision, which some women actually do, will she offer post-abortion counseling? Probably not, as she'd likely be halfway across the Atlantic by then.

For "practical" reasons, she stated that she didn't perform surgical abortions on the ship, presumably because she didn't have the resources. Her reasoning was because it would require about 20 minutes per woman, and for legal reasons they didn't want to be out in international waters that long. (Not, I guess, because they really wanted to make sure you were okay after the procedure.)

I'm not arguing that if a woman really wants to do this, she'll do it anyway. What I do find extremely alarming is the detached, remote attitude of this doctor - and how it presumably insinuates that this woman will be alone, on her own, in her decision, with possibly no support. If something goes wrong, who is to blame? Gomperts? Facebook, because of the bad outcome? How are they going to handle the potential liability? Misoprostol does have a failure rate and some women will need further procedures in that event. Even though it's a small percentage, it's a very real risk. And it's also never been FDA-approved as a standalone abortifacient.

It's important to note that just as it can happen in a laboring woman, a uterine rupture, although rare, can happen when inducing abortion with misoprostol. At the very least, this can cause excess bleeding, and possibly impact future pregnancies, should you decide to want additional children. And some factors, according to one reference, site the rising cesarean rate as a factor, ironically:
"Uterine rupture with the use of misoprostol has been reported more frequently in multiparous women and in women with uterine scars. It is more often observed at term than in the second trimester [3]. The rate of caesarean births has been on the rise, it has lead to and increasing numbers of women with a uterine scar seeking TOP [37]."
(Interestingly they mention the risk of rupture at term, something few OBs are willing to do when it comes to inductions of labor.)

The subject of the case report was a 27-year-old mother of two with no prior uterine scar who sought a termination (referred to as TOP) at 10 weeks, based on her last menstrual period. (Ultrasound revealed she was really 16w5d instead.) After having an incomplete abortion with the use of misoprostol, she went back for a follow-up procedure, where it was found that she had sustained a uterine rupture and 50 ml of blood was noted in the abdomen and the woman was prepped immediately for surgery.

Now, as rare as that can be, can you imagine going through that as a scared, lonely teenager - by yourself? Based on information you found on the internet?

Surprisingly, as far as I can tell in the black hole of Facebook rules and regulations, there is no rule against dispensing medical advice on their site. Which means I could presumably tell people how to use any type of drug to do anything, whether it's legal or not, and whether it's truly "safe" or not. I'm obviously not a physician, but why should that stop me, according to their rules? And haven't we all, at one time or another, seen, heard or witnessed a physician giving very bad advice? Just because they have a medical degree does not make them perfect. It doesn't even mean they always, absolutely know what they're doing.

After Gomperts' ship was sunk, so to speak, she decided to offer pills online through her website. A physician would ask the patient, someone living in a country where abortion was illegal, about two dozen questions over the internet to check for contraindications and the pills were shipped out in a plain envelope.

The issue of prescribing without even seeing the patient is still a problem. If you're a woman living in a country where you can be prosecuted for having an abortion, what happens if you take these pills and something goes wrong? Will you avoid the doctor because of the fear of getting in trouble? Will Gomperts' organization face prosecution because they prescribed you - even after answering those 20 questions - a medication without seeing you? What if the person is lying, out of desperation to just get it done and over with?

The bottom line in Gomperts' profile photo is that it's irresponsible. It glosses over the need for crucial follow up care and doesn't stress the reasons why you should seek it, especially if the misoprostol was ineffective. And it doesn't adequately address the risks associated with it, or the potential failure rate (which is between 10-15 percent). How is this adequate informed consent?

Again, if you want to do this, you're going to do it anyway - I'm not denying that. But to ignore the possible complications of doing something like this is irresponsible, and I bet if it were any other medical predicament besides this, we'd be up in arms. 


Kathy said...

The possibility of uterine rupture, when taking misoprostol, is something that cannot be understated. According to WHO guidelines (I think it is, and possibly also the package insert), URs have been known to occur from 9 weeks onward, which means that, as you said, if a woman is greater than 9 weeks and either doesn't know, doesn't care, or doesn't think it will happen to her, and uses this medication, she can suffer a uterine rupture.

The one good thing I'll note about that doctor's instructions, is that at least she doesn't suggest putting the tablets in the vagina -- several women have died from that. It seems that miso in the vagina can cause or aggravate a probably-unknown infection and increase it to lethal proportions.

The Deranged Housewife said...

This very real, often understated problem is exactly why it's important for a woman to know exactly how far along she is - which is best determined by ultrasound. When they argue against ultrasound as subjecting the woman unnecessarily, I think they completely miss the point and the danger it could present to the woman.