Why I don't go to the OB anymore

As the news of team doctor Larry Nassar's sentencing makes headlines and his victims are finally being heard, it makes me fearful of their futures as they potentially enter their childbearing years. How will they ever trust a doctor again to care for them?

Awhile back I visited my gastroenterologist for a yearly follow up, and the assistant taking my medical history gasped when I said I hadn't been to an OB since my eight-year-old was born. She asked me why and I'm not even sure I responded. A friend gasped when I told her the same thing, and that I hadn't had a mammogram despite being 43, and she said her doctor has been ordering them for her since she was 35 despite being low risk.

To the intake nurse who was shocked and probably thought I was being irresponsible with my health: do you really want to know why I haven't gone? How much time do you have?

My very first gynecologist when I was college-aged was nice, she took the time to answer my questions and explain procedures. She also treated one problem effectively; the other, not so much. Not much questioning going on, just creams and this that and the other that made it worse.

The second guy, more cream. A cream that basically makes it feel like you're lighting fire to your skin. Not even sure what he felt he could accomplish with that. When I relocated out of state and saw someone else, the nurse gasped audibly when I told her what he gave me and couldn't imagine why he did that.

Soon I would start having children. The next practice I was in involved a doctor who had only recently had his license reinstated, I found out later, because he had made inappropriate sexual remarks to a patient. He's also the same guy who inaccurately told me that my child was vertex, even though I knew he wasn't, and argued with me. This was probably a major turning point in my pregnancy because we could've likely attempted a version at this point (they never offered, not once). But no, he remained breech, undetected, until I was about 37 weeks. Another physician in the practice did an internal on me - which now I wonder was really her stripping my membranes despite my child not being in a head down position - and determined that he definitely was breech, which was confirmed by ultrasound two weeks prior to my delivery.

When I had the baby, the first thing I said when my primary OB checked on me in the hospital was, in a super groggy state, that "all my children would have to be born this way." How naive and uneducated I was, and he knew it, because he didn't correct me.

When I got pregnant with my second, I was still naive and uneducated. He presented me with a choice at my first appointment: have a repeat cesarean or try for a VBAC. What little I had heard about VBAC sounded dangerous, and I told him so, that I felt I would just have another cesarean because "that was safer." He didn't correct me.

When I was nearing delivery with my second, I had an epiphany. Not only was she not breech like her brother, but I was more informed in my delivery options and just pissed off enough to exercise them. I remember vividly the appointment where I told my husband he had to come with me to break the news to my physician, who would not be happy. As if he was my daddy or something. The doctor already had a bit of a nervous stammer and it came out even more during that appointment. My husband was not pleased and shortly after that expressed his outrage and hatred for the doctor, who literally told me "I have one patient on her fifth cesarean and she is doing fine" when I confronted him about why he was downplaying the risks of repeat cesarean and making VBAC sound so terrible. That was his idea of informed consent. In response to this mystery patient that probably didn't even exist, I said, "Well, I don't want that to be me."

One of the midwives in his practice, upon hearing my plans, said, "I do not want to be doing this." Whatever happened to those caring, supportive midwives I kept hearing about?

I finally left that practice at the beginning of my third pregnancy, when another midwife in the practice basically made it sound like it was "my choice" to go through with it, despite the possibility of catastrophe. In other words, my fault. I left there in tears and never went back. It was not my first horrible interaction with her.

The next physician's group employed no midwives. Just doctors who bullied, coerced and lied. The lead physician in the practice examined my "little problem" and immediately tested me for herpes, even though I knew it would be negative. It was. He also didn't tell me what he was doing it until he had literally torn a piece of my labia off and it was over. He billed my insurance, I'm sure, but never asked me for permission to do the test.

At one point during that pregnancy I felt there was one doctor in the practice I could trust. That trust quickly eroded when, during a particularly lengthy conversation, she was having a tough time getting me to give up my hopes of avoiding another cesarean and then admitted she herself had had three of them. And then billed me for a 'consultation,' despite not having told me of what she was doing and the fact that my insurance was supposed to cover my office visits in full. This same office had billed me one other time for observed swelling as being "outside the scope of pregnancy care," despite it being quite common in pregnancy, in summer, and especially after the patient is being forced to wait in the lobby for over an hour to be seen.

One doctor in the practice worked hard to get me to consent to a cesarean for high blood pressure a week before my due date. I really wanted my baby to come on his own, hopeful that it wouldn't be a surgical birth. I quickly refocused and hoped it wouldn't be a cesarean done by her, praying that she wasn't on call. She had already scared me into thinking he was big after taking almost no time to measure me properly, sending me for an ultrasound where the lovely technician basically told me very politely that my doctor was full of crap.

When I was admitted for observation, the same doctor called my room repeatedly to harass me. When I finally answered the phone after several tries, she angrily asked, "Do I have to come down there?" like I was a disobedient child.

A resident had been counseling me yet again on the dangers of VBAC and told me the rate of rupture was 10%. I cringed inside and found myself shriveling in fear, as if I couldn't possibly stand up to their tactics. I remember thinking to myself, if I am going to preach to countless women about being advocates for themselves and their babies, it needs to start with me. I then told him he had his decimal point in the wrong place.

This same practice also had at least one nurse on staff who was downright nasty, even making a negative comment about my baby after he'd been born. I don't even remember what she said, but knew it must've been bad if the old lady receptionist apologized on her behalf, embarrassed.

When I came back for my six week checkup, I felt off. Not depressed, but just blah. The physician blankly stared at me and asked, "Are you depressed?" "Not that I know of," I answered, but wasn't exactly sure what to tell him. He told me he was obligated to ask and then ordered bloodwork and went on his way. The blood work revealed that I had a thyroid problem, which he also didn't know anything about, and I went untreated for probably another 18 months.

So I haven't been back. It's been over eight years and I know I should go, but I'm terrified. Waiting to be asked, "why'd you wait so long?" and subjected to a battery of bullshit I probably don't need, same as before. Only now it's a new game to play: when can we schedule your mammogram? I hate to tell that friend who's doctor ordered them at age 35 - but that's not even evidence based care. So when you transition out of childbearing to perimenopause, you're basically trading one set of fears over bad care for another.

When my online friends would talk about having a close-knit relationship with their OB or midwife, who is caring and listens to them so well, I realize I have never had that, not once. That I can't relate to that on any level whatsoever and now have an overwhelming sense of needing to watch my back. As if navigating the waters of "birth outside the box" wasn't stressful enough, now you have to worry about menopause and cancer this and cancer that. Being subjected to the same crap time after time despite countless studies - some of which that are at least a dozen years old - that suggest it's not really the best way, but seemingly take decades to implement, all the while receiving gasps and stares because you're dangerous and irresponsible. It makes me want to punch the Susan Komen Foundation in the face.

So this is what I want to tell someone when they ask why I don't go. And there are millions of women who have had it much worse than I. I know there are good, caring and supportive care providers out there but as of yet, I just haven't found them. I'm hoping that Larry Nassar's victims will.

Free-Range Kids

You probably remember in 2008 (has it been that long already?) when columnist Lenore Skenazy let her son ride home by himself on the NYC subway system. Then she wrote about the experience.

News outlets and TV shows picked up the story. Many were outraged; some thought it was totally awesome. I had mixed reactions. While NYC is one of my favorite cities, even I couldn't probably navigate my way to the subway; but then again, I've never lived there and traveled it every day, either.

I guess as a mom I consider myself somewhere in the middle. We live in a semi-rural area, on a school campus, actually - which is a great little community with lots of nice sidewalks to bike on and kids to play with. Our backyard butts up against the quadrangle, and once my son turned five, he was allowed to bike by himself. He knows his boundaries - like he's not to go on the "black parts" (which are parking lots and access roads, simply because there are some assholes living on campus who decide to treat them like a local freeway and drive too fast). Anyway, for a kid, it's probably heaven to trawl around on your bike, feel the wind in your hair... (if that's possible while wearing a bike helmet, at least).

I try not to think about the random groups of people who occasionally rent buildings on campus for such varied things like athletic tournaments and Buddhist retreats. I try not to think about how quick and easy it is to access the freeway from our house, leading to a major US city and eventually, the Canadian border.

I also think of the places I went on my bike - crossing four lanes of traffic in a busy town, for instance - and how if I had been hit by a car, my mother wouldn't have even known where I was. (We were visiting relatives at the time.)

I grew up a child of the late 70s and 80s, with stories about Adam Walsh making the headlines. He would have been about the same age as me, just a few weeks apart. Later it was Polly Klaas (who was abducted from her own home), and Amy Mihaljevic - a Cleveland area pre-teen who was kidnaped from a shopping center after being there, alone. Her body was recovered in the county next to the one I grew up in.

Jaycee Dugard, whose name recently made headlines after emerging from captivity after nearly 20 years, was kidnaped from the school bus stop, within eyesight of her stepfather and her own home.

I thought to myself, Where was Adam Walsh's mother when this happened? According to this Wiki article, she

let him watch a small group of older boys play video games at a Sears store in Hollywood, Florida, while she walked a few aisles away to shop for a lamp. When Revé returned to the video game section about seven minutes later, Adam and the group of boys were gone.

A few aisles away? What the heck?!

This story reminds me of one I read not long ago about a boy who was sexually assaulted in a public library, while the place was open and his mother sat not far away. (Apparently this isn't the first recent case of this, either.)

Skenazy thinks parents are overprotective and paranoid much of the time, and I suppose in some ways, I agree with her. Every day for an entire school year, I'd watch one mom pull up in her minivan and wait in the driveway for her son to get done with class so she could shuttle him someplace. This at a boarding school, where her son is supposed to learn life skills and how to function as a young man in an environment without his mother hovering over him. She was the true definition of a "helicopter mom," one who refused to admit that her son had anything to do with his troubles at school.

Like Skenazy, I want to instill in my children a sense of responsibility and self-reliance. But I think some unsupervised activities - like the subway ride - might be taking it to extremes. And to assume that any parent who doesn't believe in letting their kids go "free range" is one who immediately rushes to kiss all boo boos of any magnitude, no matter how big or small, is pushing it.

In an age where the "attachment parenting" philosophy is embraced - often by people who think cribs are dangerous and letting your child cry for even "one minute!" is torture on their delicate feelings and emotions, I'm not sure where "free range" fits on the spectrum. My children haven't, as far as I can tell, exhibited any signs of emotional detachment because I let them sob in their crib for exactly two minutes 45 seconds, which sounds a lot less dangerous to them than a chance encounter with a stranger who had ill intentions.

I remember a couple summers ago being at the mini golf course with my husband and our kids. Suddenly a strange boy appeared, hanging out with us a little like he wanted to join in. My husband and I looked at each other like, "Where did he come from?" and looked around for a set of parents who appeared like they belonged to him. There was a small group way on the other side of the course, and a couple of others who looked detached and uncaring. Then he disappeared and that was that. I thought to myself, What if we had been crazy people who wanted to kidnap their child? Aside from the fact that we had our own children with us, it's not uncommon for women to accompany men in their quest to pick up kids - as was the case with Jaycee Dugard's disappearance. (In some ways I think it makes a child more willing to come to a stranger, because a woman is perceived as caring and "safe.")

Skenazy says parents need to relax, because hey - crime is actually at an all-time low. It's actually our perception of crime that is greater. That may be true; statistically the numbers might be down, but it might not be what people are actually seeing when they look out their windows at night. I also wonder what percentage of crimes - from petty theft and vehicle break-ins to rape - go unreported. (Some sources estimate that roughly 60 percent of rapes go unreported.) Some people acknowledge that depending on the level of crime, the police may be called but won't even come to the scene if the estimated damages don't reach a certain amount; otherwise it's not even worth their time. That still makes it crime, though, doesn't it?

Lower crime rates are one thing; but crimes against children are sort of in a separate class by themselves. You take your average criminal and ask him how he feels about child rape, and I bet he'd tell you it's pretty bad. Those who commit heinous crimes - like Jeffrey Dahmer, for instance - are often reviled and hated even worse than 'regular' offenders, taken to task accordingly, it seems. (Dahmer's crimes were so bad, I guess, that the prison population decided to save taxpayers money and do away with him themselves.)

I'm sure Skenazy doesn't advocate putting your children in dangerous situations deliberately, but perhaps her ideas of dangerous are different than someone else's. Her "Take Your Children to the Park and Leave Them There Day" is set for May 21 - although some parents I know won't be leaving their kids. One mom told me that some wackjob stranger has been randomly hiding razor blades along the slides and other playground equipment - for a grand total of 30 found - so that children can cut themselves. She also notes that her small US city has had four abductions attempts while children walked to school, two of which resulted in sexual assaults.

I think people automatically think it's only the "country bumpkins afraid of the big city!" who are the paranoid ones. Maybe; maybe it's because crime now spreads to outlying areas that were once deemed "safe." Not far from my house is a beautiful rural park that unfortunately has also been the target of three suicide attempts within about a year's time, and is also rumored to be a favorite spot among those seeking illicit sexual encounters as well as drug trades. All within the confines of our idyllic little "safe" suburb.

Like it or not, things are not the same as they used to be. Yes, crime has always existed, and crimes against children are nothing new. Perhaps the media is responsible for making us more afraid because we now hear about it all the time. I'm not totally sure I believe this, though. I think offenders are getting more brazen; defying sex offender laws and setting up camp close to schools, for instance, flying under the radar. Because I volunteer at my son's school, I am required to take a workshop and regular refresher courses in identifying sexual abuse in children, and was subjected to interviews given by child predators in what they looked for in victims. Unsupervised, or what they probably consider poorly supervised, children are probably at the top of the list.

But perhaps the biggest place for child predators is online - something that didn't even exist 20 or more years ago when "we were kids." Online chat rooms and porn are the new battleground in the fight for your child's safety and give people even more access than ever before.

In some ways, I see it as a gradual decline in morals and a degrading of society that contributes to why our kids can't have their anal parents just get off their backs already and let them be kids. Yes, in typical kid fashion, they'll experiment, do dumb stuff, and occasionally get burned. When I look around, though, part of it is our own faults - because a difference of opinion on how to raise children has produced parents who let their kids listen to music that's totally inappropriate for their age level; where a fascination for Justin Beiber and Hannah Montana is cultivated and thought to be "cute" in kids who aren't even in kindergarten yet; in young girls who are marketing targets for the fashion industry and encouraged to wear heels and dress beyond their years. Where are the parents? Who knows. Maybe a little too free range?

Every generation says, "Wow, I can't believe what kids do/say/think these days." I'm sure if you compared successive generations from 1900 to the present, there would be some major heart attacks going on over behavior that is considered prudish by today's standards. Bring a gun to school in 1950 and you'd get laughed out of school, one old guy told me. Then again, a classmate of my dad's (who graduated in the late 1950s) decided to take that one step further and shoot his parents in cold blood.
Perhaps crime and abuse are really more prevalent today; maybe not. One thing is for sure, though: the challenges and dangers our children face are changing and getting more and more complex. This isn't 1963 anymore, Lenore.

More reading:
Roger Ebert - Raising Free Range Kids
Online Child Predator Statistics

Keeping Our Children Safe: Child Predators

I've always said that should if anyone tried to harm my child, in this way or any other, that he (or she) would be missing a significant number of limbs. I was once again reminded of this point today as I attended a child sex abuse workshop at my son's school. 

The video featured the testimony of victims, their parents, and the abusers themselves. At one point I literally wanted to reach through the television and strangle the bastard who sat there and detailed some of his exploits, including the fact that he had been abusing children since he was ten years old, and only got caught when he was 36. Horrible imagery raced through my head - the what-if's, the near-misses, who knows what. This is literally my worst fear as a parent. 

At first I thought the workshop sounded like a chore and I was dreading it. But I left there with a renewed sense of protection not only for my own children, but for other kids, too. And it helped me realize that even though a background check sounds extreme, or suspicions might be unfounded, you never know. Who wants to take that chance? I have nothing to hide; have at it if you feel that it's going to make your school all that much safer. After all, my son is just one of the many kids who will pass through its doors, and I'm glad they're doing that much more to make him safe, too. 

While I've had "the talk" with my son about this before, after this presentation I realized just how much more I needed to include in that talk. Like, not always is the perpetrator a stranger. Many children are molested by people they know, whether it's a friend or even a family member. The key point here is that the abuser often gains the trust of the entire family and community too, not just the child. So he (or she) has everyone fooled into believing it could never happen because they are so trustworthy, so upstanding - how could that be possible? Adults can often put blinders on to this behavior and ignore red flags and warning signs until it's too late. 

Which brings me to another point: not always are the abusers male. We tend to lump strange-looking men that we don't know into the possible child molester category, which isn't really fair: women can be molesters, too. One of the young victims on the video was actually abused by her female teacher. 

And not always do the abusers fit the typical disheveled, strung-out look that we might often associate with them. Both of the male abusers featured on the tape looked fairly normal, with normal interests, just like you and me. The one said he coached girls' softball for 15 years, played Santa at Christmastime, and operated a roller skating rink where children often congregated. The other was a parent who had children of his own, and when kids came over to play, he considered it an open opportunity to violate them. 

My husband and I are pretty hyper-vigilant about where our children are when we're out in public, who they're with and what they're doing. I've often wondered if I was paranoid or too over the top, but have decided I don't care - it's my job to be paranoid. Many times we've discussed different situations and scenarios that someone might pose, like getting into the car with someone, even if they offer you lots of candy or Thomas trains, which my son loves. Inappropriate touching is another subject I've recently broached, and also emphasized after seeing the video that it's not always adults, either, who engage in this. After all, the one abuser, as I mentioned, was ten when he started molesting children. His first victim was a five-year-old, the same age as my son. 

One predator admitted that he targeted children who met a certain age criteria and looked a certain way. I felt my skin crawl as I thought of my daughter, who fit his exact description. Another said he often looked for children who had a poor family life and who lacked a father figure, and typically those children are often lonely and seeking attention. Sadly, those kids' parents are the ones who need to hear this stuff the most in order to protect their children during a difficult time in their lives. 

Some takeaway points I left with and plan to share with anyone who will listen are this:

• Know where your children are, and who they are with. This reminds me of when we witnessed a small boy my son's age wandering around the mini golf course we were playing at the other day. He followed us for a couple of holes and then wandered off again, hopefully back with his family. How could they let him be so far away without concern? Were they even paying attention? I can't help but think this would have been a prime opportunity for someone with horrible intentions. 

• Limit access to your children. Whether it's through physical contact, the Internet (which is another topic entirely) or some other medium, there are plenty of outlets that predators are perfectly willing to take advantage of when parents let their guard down. The presenters also mentioned screening of volunteers like us, but included babysitters as well - people who we willingly let into our homes. 

• Know the warning signs of abuse, not only in children, but the abuser as well. Behavior changes and inappropriate touching are signs your child might exhibit, as well as not wanting to go certain places they normally would enjoy going to. Abusers might be people who want to spend a lot of time with kids and avoid adult interaction. They may also exhibit other inappropriate behaviors like wanting to be alone with kids or giving gifts to manipulate them. Don't always expect them to be overt signs like hugging and touching. 

One thing that really struck me with these people on the video was that they had no remorse for their actions. They seemed to actually be justifying their behavior, in a sense. They blamed the parents for not being attentive and recognizing the warning signs, completely absolving themselves of any guilt in the matter. One of them said he was only arrested after he turned in film to be developed that had nude pictures of his victims on it, and the developer called the authorities. One can ask, What was he thinking? The program emphasized that these people think the rules don't apply to them, that they are above the law somehow. Whatever the case, thank God for his stupidity, or who knows what would have happened. 

• If you suspect suspicious behavior, don't be afraid to come forward. And encourage your children to do so, also, if something happens to them. Talk to your kids, and, more importantly, listen to what they're trying to tell you. This sounds pretty obvious, but one victim on the tape was abused by a priest, and members of the parish had been suspicious of inappropriate behaviors leading up to the abuse. After the proverbial you-know-what hit the fan, they only then came forward to say they had suspected something. Well, where were you when all this was going on? I wondered. Better to face a bit of embarrassment than completely ruin the life of a child to protect our own egos and reputations. I could never live with myself if I noticed these signs and yet did nothing about it. We have a job as adults to protect children, and if we misstep by accusing someone who isn't really guilty, we can issue our apologies later.