Reproductive coercion outside the domestic relationship

Image: joinonelove.org

The image at left is designed to set the scene for what reproductive coercion might look like between a man and a woman in a romantic relationship. It’s fairly easy to define what that looks like, right? But what happens when the person doing the manipulating isn’t the romantic partner, but the care provider? Is it as easy to identify then? Are we hesitant to call it what it is? 

“We’ve all heard this scenario: mom receives the happy news that she’s pregnant and all is well until the anomaly scan. A little too early to tell, could be something, might not be. As much as you like your doctor, you aren’t comfortable with making a decision before you have all the facts and he is going on about how your baby surely won’t have any quality of life and you feel pressured to terminate. You’re not sure what to do - you mention seeking a second opinion and he gets mad, which makes you feel even more pressure to make a decision. What if he’s right? More importantly, what if he isn’t?”

Or….

“We’ve all heard the scenario: mom is getting close to delivery and just wants this baby out! She agrees to a cervical check to see how things are going, but this one is super painful and feels different than all the others. Later she experiences some light bleeding and loses her mucus plug, which scares her. Afterward, she realizes her doctor did a membrane sweep without her permission, without so much as a word of explaining what she was doing ahead of time.” 

According to ACOG, “Reproductive coercion is a form of domestic violence where behavior concerning reproductive health is used to maintain power, control, and domination within a relationship.” 

Reproductive coercion in a romantic relationship can be defined as:

• poking holes in the condoms to increase the likelihood of pregnancy (and can be done by either the male or the female partner)
• refusing to wear a condom or lying about birth control use 
• otherwise tampering with birth control

It also involves manipulating in some way the outcome of her pregnancy and includes:

• pressuring her to remain pregnant
• pressuring her to terminate a pregnancy 

But did you know that it can also happen outside of the domestic relationship and often takes place in the doctor’s examination room and in hospital maternity wards every single day. While many women have been pressured by their partners to terminate pregnancies, unfortunately it’s not unheard of for doctors to do it to patients, too, especially when a terminal fetal diagnosis is involved. 

Don’t be afraid to seek a second opinion. If you’re facing a tough diagnosis but aren’t absolutely sure if you want to terminate, go somewhere else. If your doctor balks at this idea, it is a RED FLAG. 

Since reproductive coercion in a romantic relationship includes altering the outcome of a pregnancy, I think it’s safe to say that this is probably the most common form you’ll see in a doctor-patient relationship. Why are we not seeing it for what it is? If it’s considered manipulation for a woman’s boyfriend to alter the outcome of her pregnancy in a way she doesn’t want, why not a doctor? 

It probably looks a little like this:

• The pregnancy has been going textbook perfect and delivery is imminent. Suddenly there are a million things going wrong, she is literally one day overdue, and before she knows it she’s been booked in for an induction she said she didn’t want but feels like she has no choice in the matter. 
• Mom is being induced and isn’t sure why and the doctor won’t really answer her questions about it. She also has no idea what to expect or what they’re going to do to her. 
• The pregnancy has been going great and the doctor has assured her she can walk around in labor, go into labor on her own, and will try her best to honor everything on mom’s birth plan. Then suddenly mom is pressured to induce, is told that she can’t get up out of bed, can’t walk around, and none of her birth plan wishes are honored. 
• The doctor pressures mom repeatedly during the pregnancy to induce, even in the absence of any medical condition, gives conflicting or confusing advice about what could be happening, and uses intentional language to scare, manipulate or coerce the patient. 

This poor woman's doctor is coercing
her into an induction with confusing
fluid level measurements, is arguing with
her about her due date and refuses to change
it even though by the mom's calculations
it's significantly off, and has even
gone so far as to involve her family
physician to manipulate her into
consenting. She went on to have a lovely
birth after standing her ground
and stated that the only augmentation
she had was having her water broken. 

Just like in a romantic relationship, it can include:

• getting angry, impatient or condescending when you ask questions, want more information or time to think it over or express a desire to seek a second opinion 
• pressuring you to terminate when you don't want to or aren't sure, and using manipulative, condescending or threatening language if you refuse, want to wait or seek a second opinion
• pressuring you to consent to a cesarean when you have reasonable requests to avoid one and threatening you if you don't 
• pressuring you to consent to vaginal exams when you don't want them, and threatening you if you refuse 
• pressuring you to make a decision without all the facts and refusing to give you unbiased information to make the best decision for you 
• refusing to administer permanent birth control because of age, marital and childbearing status even when you have expressed a clear desire to not have children or are done having children
• being forced to have a court-ordered induction or cesarean when you are of sound body and mind and have refused 

Threats can look like:

• calling the police to have "welfare checks" without serious justifiable cause
• calling the police to have you forcibly removed from your home
• threatening to call CPS on you if you refuse interventions 
• threatening to drop you from their practice even though you're making perfectly reasonable requests 

I can’t tell you how many times I’ve heard this scenario happen: moms who have no idea why they were induced and they felt like they had absolutely no choice in the matter. You often see these people on internet forums, asking other moms “is this right? Is this normal?” 

“I am almost 39 weeks and at my last OB visit the doctor said my cervix is only finger tip and the baby is floating. The doctor also told me that there is an 80% chance of a c-section because the baby is not engaging and my pelvis may be too small. This is my first child and I really do not want a c-section.” - prncssjenjenn

“I am currently 38 weeks and 4 days pregnant. My little girl is 7.5 pounds. I am 1.5 cm dilated and experiencing no contractions of any sort…I had a doctor appointment on Wednesday and she told me that if I did not go into labor by September 12 (my due date) they would induce the same night or the morning of the 13th.” - AutumnRMcG

“I am 40 weeks pregnant and my doctor is already talking about inducing labor at week 41 if there is no baby. I object to this as I have no medical problems thus far and during my non-stress test, the baby is doing perfectly. I am not understanding her reasoning…I do not want to get into a boxing match with my doctor, but my husband and I both feel that when the baby is ready she will come. Again, I have had a perfect pregnancy and no reason to be talking about an induction. What is the best way to handle this?” - palesa2678

The underlying emotion in all of these comments (and many more in addition to these) is stress. It becomes a game of “how can I trick this baby into coming as soon as possible to avoid making my care provider mad/being asked one more time to induce/made to feel guilty/basically being forced into something I don’t want to do?” It’s stressful enough just to read their comments; it’s even worse when you have to live it and think about it 24/7 until your baby finally arrives and every appointment potentially turns into a battle of wills. Why is just saying no not an option? Why is it so hard? 

The point is, no one can predict what can happen: sometimes things unfortunately do happen and no one could predict or prevent it. Sometimes none of your fears or the doctor’s threats come to fruition, thank goodness. But the time it takes to get through that event can really mess with your head and coercion, manipulation and bullying don’t help. No one has a crystal ball, not even your doctor. 

If ACOG can readily define what reproductive coercion looks like in a romantic relationship, why can't they do it in a patient/doctor one? At best they offer platitudes about "guidelines," "recommendations" (which do not translate into "rules and regulations," contrary to popular opinion) and patient autonomy, and essentially give doctors a choice as to whether or not they choose to follow them. Unfortunately, it would seem the patient herself is not afforded the same luxury. 

More reading: ACOG Practice Bulletin 664, Committee Opinion on Refusal of Medically Recommended Treatment During Pregnancy 

Improving birth by breaking the silence

The topic of childbirth is one that women - often those who don't even know each other - often freely engage in. We find ourselves sharing the most intimate details with strangers on what is often the happiest day of our lives. And for some, one of the most traumatic.

But it seems like if your outcome is anything less than happy, women suddenly don't want to hear about it. And when you question the actions of your doctor, or express anything less than total and complete gratitutde to your doctor, then you're attacked, criticized, made to feel like you're selfish for wanting something more or think you're smarter than the physician.

And yet, sometimes these stories still make it out, have a voice, are heard above the din. When "Kelly," the mom who had an episiotomy and was cut at least a dozen times by her physician, told her story, many women did come out of the woodwork. They shared their equally horrifying experiences, told her she wasn't alone, said the same thing had happened to them. It was terrifying and yet vindicating at the same time, knowing that finally these women are confident enough to talk about what happened to them. And with the number of them growing as more and more comments were added and the article continued to be shared, it was clear there were more of than them than not. And it was abundantly clear, even to those who are not involved in birth advocacy, that there is a shocking pattern of abuse in obstetrical care.

If you ask your mother, grandmother or great-grandmother what her birth story is, she may or may not be able to tell you. She may not remember any of it, drugged into oblivion with medication she may have felt at the time she neither wanted nor needed. While things have improved somewhat since then, it's not all that much, considering you still hear these horror stories. Women were given few choices then and to some extent, still aren't, with sometimes well-meaning and sometimes downright cruel care providers making choices for them on their behalf. These pictures continue to give us evidence of that.

I have seriously told women who were not
comfortable laboring at home to either labor in
the parking lot or the lobby but not necessarily
check in. That way you're close to the hospital,
but still on your "own time." How pathetic is it that
women even have to resort to doing this?
I can totally understand where she's coming from.
Photo used with permission from ImprovingBirth.org

Isn't that the truth. Remember Nurse Jenna's
post lightyears ago about "why you need
Pitocin in labor?" This was basically her
justification of it - they need to free up
beds. It's all your fault that you're not
laboring at home longer, even though
we care providers make you feel like it's
the most dangerous thing in the world to
do so. (To read the article, click here.)
Photo used with permission from ImprovingBirth.org

Coercion can often be another hallmark of abusive practices. And as some find out, they agree to the procedure only after much pressure and bullying, only to read in their chart later something entirely different.

The "maternal request" cesarean is often the result of
mom agreeing to a c-section after finally giving in to
bullying, scare tactics, and tremendous pressure to do so
from her physician.
Photos used with permission from ImprovingBirth.org

I am not at all surprised that this is a female physician. I
had similar experiences with one in my OB's practice and
found many of them to be far more condescending and
rude than the male doctors.
Photo used with permission from ImprovingBirth.org

When people say "Just trust your doctor" I think
of situations like this one and it makes
me want to throw up.
Photo used with permission from ImprovingBirth.org

I urge you to go through Improving Birth's FaceBook gallery. Maybe there is a situation that speaks to you or you have one to share - please do so. Maybe you personally have never experienced this and were completely unaware that such a thing existed. It is time for women to stop being shamed into silence and forced to accept something that is "normal" when it really isn't.

More information:

Improving Birth - Advocates for Evidence-Based Maternity Care 

Submissions will be accepted again soon - to submit your entry, click here. 

Why do women choose "risky" births?

Whenever a tragic birth outcome makes the headlines, especially if it's perceived as "risky," I know women ask themselves, "How can a woman do this? What on earth was she thinking?" It's hard not to, but much of the time, I can totally understand why.

The death of any baby is tragic, and I guess hindsight is 20/20 when you pronounce the death "unavoidable." In the case of this Australian woman, who was attempting a VBAC at home after two cesareans, she was summarily lambasted for not following the advice of her doctor and "internet advisers" were blamed for giving her false information on what she should do. One woman said, "I blame the 'variation of normal' crowd." (The woman's baby was breech.)

Contrast that to this story, of an American woman who died of complications following her sixth cesarean section. No is blaming her for her risky decision to have so many cesareans, as I'm sure she took her doctor's advice - and I highly doubt he/she was pleading with this mother to "please have a VBAC! It's safer!"

What's the difference, really?

Why is accepting one death - that could have also been avoidable - okay, but not the other? Imagine if the Australian woman had decided on that third cesarean, perhaps going on to have more children and more cesareans, and ending up like the woman who died? Are we saying that's just an acceptable risk that you take and "so what?"

I see it as merely shifting the risk. The more you discourage VBAC in women who've only had one prior cesarean, especially in those who desire larger families, the more you end up hearing stories like this. It seems like our medical community, and society at large, is perfectly willing to believe in dangerous paradoxes - namely, that VBAC is dangerous and cesarean section is "perfectly safe." Many commenters were disgusted that she went against the advice of her doctor and attempted a VBAC, which was unfortunate; but for many women who do take that advice, you better believe their doctor can churn out just as much misinformation as that sandal-wearing hippie natural birth advocate you so despise. How is being the opposite side of the same coin any better?

Add the fact that very few hospitals receive an official "Mother-Baby Friendly" designation (not that that matters, I guess) or can seem to be supportive without treating mom like brainless chattel and it should be easy to see why women choose an alternative birth. How many times have you heard that it's damned-near impossible to have a normal, let alone natural (gasp!) birth in a hospital setting? I'm not saying it can't be done, just that it's usually difficult and you have to really work the system (which has quite a learning curve, let me tell you).

For those who frequently bitch about how reckless or crazy women are after disastrous home births, what are they doing to make hospital births more hospitable? Oh wait - they're usually the ones that tell you to just "let go of your anger and get over the 'birth experience' - just deal with it." I'm guessing they've never once cracked open a book that details some of the absolutely barbaric birth practices that "modern" obstetrics have put women through* over the generations, and for what? To be treated like a human guinea pig? Or the formidable, unmentionable "physicians" who like to demonize all women for even thinking about a home birth, much less having one - are they making stunning strides and initiatives to support women in a comfortable, accommodating hospital atmosphere? Or just complaining about it and publishing the names and addresses of those women who've lost children in home births?

I'm not sure how I managed it, but I had a VBAC in 2006 and sort of fell into an OB's practice that would actually "let me" do it. I don't think I had any clue how difficult it is for some women to have one. If I hear someone say "just find a supportive OB and hospital with lots of experiences in VBAC" one more time I'm going to scream. Because it's definitely not that easy.

From the ICAN website.

If you look at this list, many are rural hospitals or in smaller towns. And many are hospitals in large cities. I'd like to know how you are just going to up and "find a supportive hospital" when they don't seem to exist. If you live in the boonies, your options for supportive hospitals and OBs or midwives is probably pretty limited, and I'm willing to bet the cesarean and induction rates at those hospitals that serve rural women are through the roof. ACOG Guidelines be damned; they aren't offering up an attorney, birth doula or physician to see you through your VBAC - which means the "guidelines" they issue do little to help the patient if a doctor can just pick and choose which guidelines to follow.

(*And for the record, I'm not intimating for one second that before modern obstetrics, women didn't suffer or go through torturous experiences in order to birth children, sometimes with disastrous results. But I think our glorification of modern medicine might be, at times, misguided and perhaps glosses over  its sordid history and past failings.)

More reading:
The "C" in ACOG stands for "castrated"
Tori Spelling and cesarean complications: why we need to hear about it

Newsflash: Pitocin could harm your baby

For some of us, the idea that Pitocin is not exactly a walk in the park is nothing new. So when this official proclamation came from ACOG, a lot of people were like, "Well, duh." 

Apparently this is "the first study of its kind to present data on the adverse effects of Pitocin use on newborns." Considering how deeply entrenched its use has been since its inception as the drug we know today, I find that incredibly shocking.

Unfortunately it seems like either those who swear up and down that it's the Devil's poison end up getting it, or those who are warned "don't induce!" often find out the hard way that in many cases, yes, it does suck as badly as everyone said it would. (Although obviously this is not the case for everyone.)

Back when my niece was expecting her first child, she said she was not planning on inducing but asked for advice about it. I tried to offer my opinion without sounding preachy, and a many of her friends said that in their experience, it was terrible and to avoid it if she could. I don't know what happened, but the next thing I knew, she was getting induced, had a hellish labor, and now apparently doesn't want any more children. *sigh*

What I've noticed is when people are asking about Pit, there are usually tons of people who relay their experiences - some okay, some great, some perfectly horrific and the stuff of nightmares. I'm not one to try and scare women by propagating horror stories, and whenever I speak of this stuff I try to be as balanced as possible. But I can't help but notice that usually, all the dissenters are ignored, their advice chucked to the curb and the mom is induced, sometimes with not so happy results. Sadly, it seems like those who filter out what they don't want to hear seem to have the worst time of it.

Either that, or one of two things happen: a dozen people say, "Well, I had it in labor and did just fine," as if they refuse to believe there is actually a problem. Or, they list the numerous reasons why they needed it in a defensive tone, which is kind of sad. Again, for some women, it's what they need and can really benefit them. But for everyone? I don't believe it.

I think some women get defensive because their hackles immediately go up and they miss the part where, again, it says that for some women, it can be a life-saving, very important drug to have on hand. I also wonder if they are in denial that their doctor could ever give them something that might be unsafe, completely trusting them with their own wellbeing as well as their unborn baby. I'm not necessarily saying that they aren't acting in your best interests, but rather questioning why this needs to be standard fare in so many hospitals today. One source suggested that approximately 81% of women receive Pitocin either to augment or induce labor. 81 percent?!

And because it's become so commonplace, it's perceived as unequivocally safe, a perfectly normal and acceptable routine of labor. If you question it, I highly doubt your doctor or nurse is going to calmly say, "Oh, you don't want it? Okay, that's fine." Administration protocols seem to vary by hospital and doctor, and while some appear to follow perfectly reasonable guidelines (especially the idea that if this isn't working, let's send mom home), others are outrageous - as expressed by nurses who work with these people, not just "natural birth hippie chicks."

From a popular internet forum for nurses. Click to enlarge. 

Some things to consider:
• Sometimes inductions and Pitocin use are completely necessary and the best thing for both mom and baby. If at all possible, perhaps suggest a gentle induction that can get things started in a minimally invasive way. Remember that in first-time moms, inductions can increase the risks of cesarean, although sometimes this is unavoidable. (Pre-eclampsia is a good example.)

• Sometimes it is not necessarily the best course of action but is given anyway. Know that you have rights. Some women do say that while they refused it during their labors, they had it given to them anyway; perhaps hiring a doula or having a birth advocate present with you may help. Some reasons for its use are dubious at best, and can cause more harm than benefit. (For an example, click here.)

• Get all the facts prior to an induction and ask lots of questions. If your doctor starts talking about an induction early on as a matter of course, this could raise some major red flags.

• Throughout its history, it has affected different women differently. This can depend on a number of factors, including how aggressively it's administered. While it can have many benefits, it is not without risk to both mother and baby.

More reading:
Pitocin side effects
Five ways Pitocin is different than oxytocin

Childbirth education is important!

Someone shared this meme on FaceBook and I totally loved it, because it was so true: (click here for full text)

It's been said that women spend more time researching and shopping for major appliances than they do their birth options. And when it comes to your wedding day, you go to great lengths to make sure everything turns out just so - even though it sometimes doesn't - spending countless hours in preparation.

I once heard someone say how when a wedding doesn't turn out as planned, when a detail doesn't work out the way you wanted or it pours down rain during your beautiful outdoor ceremony, people are sad for you. They express regret and sympathy for you that "your big day" might have somehow been marred. Yet, when your plans for childbirth are totally derailed or you feel that you were denied something during the process, they basically tell you to "deal with it!" or "Get over it, you don't get a medal!" "That's just the way it is, so what?"

They wouldn't tell you that if your bridesmaid ditched you a week before the wedding, or if the cake was the wrong flavor.

With a good childbirth class, it can not only help you prepare for that big day, but fully realize just what your body is capable of - as well as help you realize that sometimes, the routine practices in maternity care are not always evidenced-based, or the "best" thing for everyone.

Would you want a cake decorator to say, "You must have a chocolate cake. That is the only flavor that's any good, and even though you're allergic to chocolate and don't like the taste of it, I'm making you a chocolate wedding cake!"? Probably not. Just like flavors of a wedding cake, there are options in childbirth; you just have to know what they are.

There are all kinds of childbirth classes. Fortunately I had a great one with a nurse midwife who herself had had normal births and a VBAC. She discussed a wide range of options, the realities of choosing them, advantages and disadvantages. What she did not do was paint a picture that said, "You are a bad person for choosing to have an epidural!" Nor did she act like they were terrific and every woman should have them and no woman can ever make it without one.

I chose the long, six-week whatever class, because there was a lot to learn! Some choose the condensed, intense version that is over and done with in a few hours. Personally, when you consider that it seems like many women don't fully understand the process of childbirth and what it entails, it sounds like the long version might actually be a better option. It's hard to work that out with busy schedules and work, etc. but this is your body - and your baby - we're talking about here.

Would you buy a brand new car or go on a cruise without spending time and effort researching it? Hopefully not.

When it comes to birthing options, especially VBAC, it seems that not many women know they do have options. Studies have shown that women often choose the mode of delivery that's preferred by their doctors - which likely means a lot of physicians are influencing their patients to choose a repeat cesarean. Unfortunately, many are limited because of the hospital they plan to deliver at, where VBAC is either banned or there is a de facto ban (meaning, the hospital "lets you" attempt one but no doctor will agree to attend you. Especially with regards to cesarean section and induction, childbirth education can mean all the difference. What are the risk factors? What does the procedure entail? Sometimes you cannot always count on your doctor to tell you this information up front. And I can't even begin to tell you how many people I've heard say, I'm being induced tomorrow and I have no idea what to expect! Does their doctor not tell them anything? Do they do any of their own research?

I once sat in on a childbirth education class and was extremely disappointed to find people talking and chattering amongst themselves when the instructor mentioned risk factors for cesarean section. Ladies, don't ever think "This will never happen to me." Sometimes it happens for very necessary reasons that are beyond our control; sometimes it could have been avoided. I think prevention is key - and sometimes the very things we consent to in labor can often be risk factors in cesarean delivery. It's hard to focus on future births and how they might be impacted by decisions and choices you make today, but that's pretty much how it often works. How can you truly give informed consent when you aren't fully informed?

I don't ever want to blame a mother for not being "educated enough" about the process. Sometimes you have all the facts and it's still not enough to prevent something from happening. But being educated about the process and feeling capable of making informed choices and educated decisions can often help tremendously when it comes to accepting with the outcome.

Did you take a childbirth class? Did it help you or not?

Tori Spelling and cesarean complications: why we need to hear about it

It seems like everyone wants to hear about celebrity baby gossip. And with Tori Spelling's recent birth complications in the news, it's something we should be hearing about.

At the very least, Tori Spelling's
post-cesarean complications could
be an important vehicle for raising
awareness about risks of c-section and
the importance of adequate
informed consent. 

As Spelling underwent emergency surgery for complications after her fourth cesarean, the media was slightly abuzz about why it's such a concern, as they should be. I was elated that finally, finally someone was beginning to question the high c-section rate and how repeat cesareans can pose dangers for women. Not that I would ever wish those repercussions on anyone, but to have it happen to a high-profile celebrity, someone who's face we recognize, whose births are highly publicized - is perhaps instrumental in getting our attention when it comes to a very important topic that few people seem to really understand.

I don't know about Tori and her marriage, don't watch her show, or know what her motivations are, but it sounds like she wants a large family. She is in the minority, as more women are stopping after two children and therefore are not often exposed to the risks of what that number of c-sections can do to the body. Whether it's one, two or four or more, it always carries risks - but obviously with four surgeries under your belt you're going to be exposed to more risk than someone who's only had two. It's unclear, though, whether women really 'get' why this is important to understand - because many of them spend much time digging Spelling for 'not using birth control' (even though someone commented that yes, she was using it, and yes, it did fail). Some speculate that she did initially consider a VBAC, but decided against it when her first and second births were also close together (which can bring additional risk).

Instead of bashing her for having lots of kids, not 'getting fixed,' etc. etc. it should make us question why she wasn't encouraged to have a VBAC after her first birth, especially if she wanted more children. Although close births do pose a unique set of complications when considering VBAC, this is probably one case where why her first cesarean occurred is important to know: did she have a medical condition? Was she 'too posh to push' or did she simply want to schedule the birth? Who knows. Preventing the first scar is key, but sometimes it's not that easy, especially if you aren't sure how many kids you want. It's hard to gear up for a future birth when you're barely finished with the first one, but knowing before you get that uterine scar just how it could impact future births is very important.

After the birth of her first son, Liam, Tori said this:

"I had a c-section...One of the biggest misconceptions is that celebrities have C-sections because it's easier. If I had a choice, I would not have. The recovery is much worse." 

To me, it almost sounds like her doctor was a "once a cesarean, always a cesarean" type of person. And while I'm sure there is some strong-arming going on when it comes to pleasing a celebrity client, these women are no different than we are: if a doctor tells you a VBAC is "unsafe, dangerous, and your uterus will shatter" then you are just as prone to believe it's true as any of us might be.

I'll never forget it: that's what Anna Nicole Smith reported that her doctor told her before the birth of her daughter, born by scheduled cesarean. That her "uterus would shatter," as if it's made of glass, as if one tiny contraction could forcibly blow the entire thing up like a bomb. I was so sad for her, because she naively believed him, much like any of us probably would have.

Some articles surrounding Spelling's complications ask an important question: are doctors doing enough to inform patients about the risks of cesareans? I was happy to see that headline, because I argue wholeheartedly that they're not. If you were scheduled for brain or open heart surgery, would a doctor simply tell you, "Everything will be fine, trust me! It's totally safe!" and walk away without so much as an explanation of the procedure? Highly doubtful.

I know my own physician, whom I saw for two of my three pregnancies, definitely did not. I still remember clearly our conversation prior to the birth of my first baby, who was breech: to his credit, he didn't schedule the cesarean until the week of my due date, but never went over any risks - if he did, I probably would have left the office that day in a panic instead of nervous excitement about the arrival of my child. Thankfully I did go into labor days before the surgery, which meant my baby (and most importantly, my body) experienced labor on its own, which is critical for future births. Yet I had no idea just how important that was at the time, because I was naive and very uninformed. No thanks to him.

When I became pregnant with my second child, my doctor gave me a 'choice' of what I wanted to do: the cesarean route, which I was already familiar with and had survived (isn't that a benchmark of just how casual our approach is to it?) or a VBAC, then proceeded to tell me that it could be dangerous and he'd had two women rupture on him. I decided the word 'rupture' sounded very unpleasant and I wasn't even going to consider it for a moment. Duh. What an idiot I was!

As my pregnancy progressed, I decided maybe having a VBAC wasn't such a bad idea. My primary motivation for choosing one was a) my baby wasn't breech and b) I wanted to avoid a potentially horrific recovery like I had with the first. I was terrified to tell him my intentions, because I had just three weeks until my due date. I stammered my way through our office visit, my husband at my side, while he proceeded to again tell me just how dangerous VBACs were and "I have one patient who's on her fifth cesarean!" I will never forget those words. That's when I asked him, "Well, what about this? That? Or this?" He had to concede that yes, those were definite risks to multiple cesareans. But reluctantly.

I know I'm not the only one. I've read so many accounts from near-panicked women that are on the eve of their inductions: "What should I expect? What do they do? Is this really necessary?" Something is clearly wrong with this picture. Either we trust our doctors too much, feel completely incapable of asking them questions, or they are completely inept at adequately informing their patients of risks and benefits to procedures. It shouldn't be a "don't ask, don't tell" policy; even if the patient says she has no questions, you should probably go ahead and tell her anyway. If she doesn't even know what to ask, then she's probably not even thinking about what could happen, what should happen, or what doesn't even need to happen.

I asked people on Facebook if they were induced or had cesareans, did their doctor cover the risks of the procedure? Of those that answered, all of them said "no."

It doesn't help that many doctors will discourage you from 'reading too much.' The internet be damned, because that means you're a religious follower of Ricki Lake and she only wants women to give birth in bathtubs. *eyeroll* Here, here's a copy of What to Expect When You're Expecting, now please - I don't have time to go over all the risks with you because there are none and it's perfectly safe so have a nice day. Does that sound like informed consent to you? Me neither.

So it's not a wonder Tori Spelling has had her fourth cesarean, and I don't think she should be blamed for it, either. Not because she's "old," or "a breeder," or any of those things. Stop blaming the person who just trusted her doctor, as you often blindly tell her she should. Start blaming the people who knowingly put vulnerable, often inadequately informed people at risk. Stop enabling the very system that allows this to happen.

Book Giveaway! The Immortal Life of Henrietta Lacks

What an amazing, heartfelt book. The book details the life of Henrietta Lacks and how she became the unwitting progenitor for landmark advances in medicine - and yet never saw a penny for any of it. Among the book's timely topics are HPV and cervical cancer as well as the raging debate over informed consent - especially for the indigent.

Read more about the book here: Amazon.com review

If you'd like to be eligible to win a copy, post a message in the comments section with your name and contact information - please make sure you either leave an email address for me to contact you, or enable your profile to receive email so I can reach you if your name is picked. This is very important - because even if you leave a comment, if I can't contact you then you won't be eligible. Comments must be received by noon Monday, March 6, 2012. 

Good luck!

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 [3–7]."

(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. 

Scheduled 11/11 births should expose broken maternity system

Photo: Hilde Vanstraelen/
www.biewoef.be

Yesterday we heard of loads of special births on November 11 - from inductions to planned cesareans to doctors offering cash to patients if they'd deliver on that landmark occasion. Today, the details of these births surface: cue the Pitocin IVs!

A Groton, CT mom delivers her baby after her doctor "decided she needed to have her labor induced." The baby weighed just over 7 pounds. As the clock neared 11:11, her "sisters started yelling, 'Push, push!'" (Side note: they'd make great L&D nurses, I bet.)

A number of births were mentioned in this article, including two "natural" births and one planned cesarean:

But in Colorado, Cayson Childers’ birthday wasn’t left to chance. His parents ensured his arrival by scheduling a Caesarean section for Friday, and then doctors were able to make the operation work right at 11:11 a.m.

The casual attitudes about surgical birth mentioned here almost make me want to puke.

This Syracuse, NY baby was delivered because the doctors thought it was "big." The child weighed 7 pounds, 13 ounces. The delivery was originally scheduled for the following week, but was moved to Friday. Don't want to put on an additional six or seven ounces in the meantime, right? Way to play it safe.

Adriana Jones, of Baldwinsville, was originally scheduled to have her baby, via Cesarean section, next week. But because the baby was big, Jones’ doctor recommended the delivery take place sooner.

The planned C-section was rescheduled for 11:30 a.m. Friday, but Dr. Suzanne Bartol-Krueger was able to get Jones in a little earlier. How kind of you, doctor!

It's important for me to say that really, I'm not so much criticizing these moms. They made their decision to go ahead with induction or cesarean plans, no doubt at the advising of their physician. Did they make the best decision? That's not really for me to say. But stories like this, and the media's reaction to them, make me kind of shake my head a little because it does several things, in my opinion.

First, it is often met with very casual attitudes about surgical and induced births. Both can be perfectly safe, if done for the right reasons. Sometimes, those reasons are clear, and sometimes not.

Many of these articles often feel the need to clarify whether they were vaginal or cesarean births, which is something I suppose readers are dying to know: did this happen all on its own or what? In any other situation, no mom should really have to justify how her baby came into the world. Some would argue that these women shouldn't either, but it should raise some eyebrows about what constitutes "medical necessity" these days. And when a birth wasn't cesarean, the media usually says it was a "natural birth," which we can probably translate as simply a vaginal birth. Is it news when the IV is hooked up and mom is pumped full of Pit in order for that baby to be born, practically dragged kicking and screaming into the world? Or when mom is laboring normally on her own after going into spontaneous labor? While some people will say, "Who cares?" it's clear there is quite a difference.

I can see how these timely births would start a new Mommy Wars debate: Why can't I schedule a birth on a special day like this? Does it have to be natural to count? Why not have a repeat cesarean because of this? Many argue that mom should have a choice of how she gives birth, even if it means something like a planned cesarean section for no reason other than she wants one. Fine, as long as you are well-informed of the risks and benefits of doing so, and get your information from someone other than a well-meaning but clueless friend or a doctor who is happy to oblige because it means he can finally go on vacation. Of course, you'd do it anyway, I suppose, but I can at least respect a truly well-informed decision. Doing it simply because you're effing miserable and 36 weeks and "It's time! The baby is practicing breathing movements!" is just stupid. But to each her own.

Really what this does is expose the often suspect practices in modern maternity care that have escalated exponentially in the last few decades. My mom told me of my 1974 birth, "The doctor told me he absolutely would not induce because of the risks and rushed in from a dinner party to deliver you while wearing a tux." Nowadays we hear, "Induction is perfectly safe. I don't want to have to come from my dinner party and deliver you while wearing a tux." What a change in thinking.

Are we accepting a woman's right to choose where and how she gives birth, but only to a point? If she wants to put her baby and body at risk, there are probably no shortage of physicians willing to accommodate her wishes. I hate to be a party pooper, but blasé attitudes about surgical and pushed births are what makes people say, "So what? Who cares? So she wants to have a cesarean for absolutely no reason. Isn't that her right?" Like in my last post, I think the birth of a baby is always something to be celebrated, but these kinds of births so far remove us from the frame of 'normal' that we don't even know what it means anymore. We can schedule hair appointments, meal reservations and oil changes: why not birth?

OB bribes mothers to deliver babies on 11/11

"I'll pay you if you give birth before midnight tonight!" 

As we approached the landmark "11/11" this week, I'm sure all of us were waiting to hear "miraculous birth stories!" of babies that "happened" to be born on November 11, 2011 at 11:11 a.m. (or p.m.) Most of us are jaded enough to realize that no, usually none of these babies just happen to come into the world at such an auspicious moment all on their own, and when you read more details on many of these births it's no surprise that they are either planned cesareans or inductions. Yay.

The birth of a baby is always a joyous occasion and something to celebrate. But I cannot imagine actually planning the date, no matter how close I was to my due date, just to have a "fun birthday" like this. Kind of takes the magic and suspense out of it, you know?

So one Iowa OB has decided, back in February, actually, to put money into a savings account for those patients who delivered on 11/11. Oh, how nice! Helping baby to get a good start in life with a tidy sum saved up in an account just for Junior. Excuse me while I go vomit.

So far, he's had two scheduled cesareans lined up and one induction. Surprise!

In just reading between the lines, I get a few creepy suspicions about Dr. Valone. Two of his patients are repeat cesareans because "they delivered that way in the past," which sounds like he is not very pro-VBAC. Perhaps his idea of informed consent about surgical births and the dangers of VBAC includes, "Well, I could pay you to deliver your baby by repeat cesarean on November 11. How about that?" His fees, according to the article, range from $900 to $2,000, "depending on the case and the insurer." Financial incentive much? Does this almost sound like "the better insurance you have, the more I charge" to you?

Further down in the article, it says he will deliver two more women by induction "whose pregnancies have reached full term." Full term, to most people, is 37 weeks. His comment, "We're doing it proactively rather than just waiting to see what happens" sounds like he pushes the big baby scare tactic. How much do you want to bet this patient is not very close to 39 weeks? $2,000, maybe?

One of his patients, a young 20-year-old mother has passed her due date by THREE DAYS and is awaiting induction today. This is her first child. I fear for this woman, for many reasons. I hope she has a vaginal birth, but honestly - who can say? The article also says things like, "Natural birth proponents urge women to avoid the medications that induce delivery unless there is a strong medical reason to take them," but Dr. Valone assures us all that "it's safe" and you're better off if they go that route (meaning, "Take the Pitocin!") rather than trying to start their labor at home.

No sources, no nothing that indicates that Dr. Valone perhaps is a c-section, induction-happy doctor who is basically bribing women to give birth before the clock strikes midnight (or five p.m., which is probably the end of his shift). And these women are eating it up like candy, which is nauseating, at best. Yeah, it's their choice, but when you're presented with the possibility of a wad of cash and the assurance that "It's safe and you're better off!" how can you resist?

I would hope that offering financial rewards to patients in order to force their births to take place (or coerce them) would be considered, at the very least, unethical. When you blab in the media about doing such a thing, you'd better be willing to offer sound proof that they do, in fact, have some medical condition (besides a prior uterine scar) that means this induction or cesarean was necessary; otherwise all those hospital bans on elective inductions and cesareans don't mean a thing. I'd love to think an official from ACOG, and perhaps the Iowa State Medical Board, would be questioning this doctor on his choice of practices and perhaps taking a look at medical records. But then again, I doubt anyone will bat an eyelash.

Didn't have to dig very hard to find this one.

'Tis the (flu) season

Ahh, fall.... cooler temperatures, changing leaves, and ... sneezing?

Judging from the bombardment of ads I see everywhere, it must be flu season. I wouldn't know, since the last time I think I had the flu, I was about nine years old.

Given my propensity to question authoritative figures (especially if they don't give me much of a good reason to listen), I've been on heightened alert for things like ads, billboards, and even register tape reminders about getting my flu vaccine. And I'm also paying attention to things like high drama, scare tactics and all-out pandering to the lowest common denominator to coerce, convince and cajole us into getting the shot.

These two billboards are sitting in a corn field down the road from my house. I sped by them one day, almost scaring my family as I nearly hit the brakes in disbelief.

Marketing technique #1: Using big, scary-looking font. That really gets their attention. (As a graphic designer, I'm all about the fonts.)

Technique #2: Make ambigious statements that make the average passer-by say, "Well, they say it's safe, so it must be." Never mind that there are no sources or mention of risks at all (there isn't that much room, anyway).

Technique #3, perhaps the best one of all: Use the cute, smiling kid to tout your product. Nothing says "I got vaccinated and I'm just fine!" more than the grin of a pigtailed child.

This one is bold, yet sly, at the same time. The urgency (in that big, bold font) is almost implying that health officials are lying in wait for you to pass, stopping your vehicle and asking for documentation that you have been vaccinated. Notice, though, the interesting use of a cell phone and truncated (if not totally annoying) "internet speak" that often appeals to the younger generation (those whippersnappers!) - who seemingly are more healthy than those who are most at risk for the flu, like the elderly and those with compromised immune systems.

Saying "Stop the flu before it stops you" is implying that something bad - really bad - might happen if you don't get the shot. You might be miserably ill, perhaps even miss school or work - for at least a week, maybe not even. That sounds bad. Like it might stop me. From going to work. Yeah, okay.

Target, I noticed, is offering some kind of flu shot program and is touting it left and right - I saw banner ads on their website as well as on my register receipt after making a purchase. Their marketing technique is a little more subtle, sort of giving you a gentle nudge - rather than screaming in your face like the county government does. How ironic.

"Your timing is perfect - we have flu shots! So give it a shot - come on, you know you're skeptical and riddled with fear but too afraid not to get one, so just go ahead! Dooooo it!"

This one offers you a $5 gift card if you get the shot.
Bribery works wonders. 

Now, again, if you're already ill and have a compromised immune system - like the elderly, for example - I can agree that the flu might present more serious complications for you and it's probably worth getting protected. Some say the flu vaccine can cut the risk of serious complications and death in older people up to half.

However, there is some speculation that perhaps the vaccine doesn't work as well in older people as once thought. Although it's anecdotal, I know my grandfather got the flu vaccine every year and, if I remember correctly, still got the flu. This is possible, as the vaccine admittedly does not work for everyone - it's estimated to be ineffective for about 30 percent of the population, apparently. Perhaps for my grandfather, he was one of that 30 percent. And after his last flu vaccine, my mom said, he just wasn't the same - and it was all downhill from there. He eventually died a few months later.

Could it have been from complications of the vaccine? Who knows. We probably will never know, and it seems like if it doesn't reach out and smack you over the head literally minutes from getting the vaccine, most health officials are completely unwilling to correlate the two. Perhaps because that would scare more people away from getting the shot, ya think?

This article from the Washington Post acknowledges that the government, especially, has often used fear as a heavy-handed scare tactic to "encourage" you to get vaccinated. There is probably a lot of wheeling and dealing going on behind the scenes - perhaps from the pharmaceuticals industry - to ensure that you keep buying what they're selling. If more people realized they were being used as tools perhaps they would second-guess waiting in line for two hours on a rainy afternoon to get that much-coveted flu shot.

I remember seeing a huge line of people at the mall one year, complete with security guards standing by - and wondered, "Are they buying concert tickets or something?" Then I looked at the crowd - which mostly consisted of older people in wheelchairs, and realized, They're waiting for the flu vaccine. As far as the elderly are concerned, there is some data to suggest that actually, many of them are already immune to several strains of flu - including H1N1 - because of living through past epidemics. Which means you waited in line for nothing, basically.

"Lab tests showed that some adults, particularly those older than 60, had antibodies against the new strain, but Dr. Anne Schuchat of the CDC cautioned against reading too much into the finding. 

"We don't know yet what that will mean in terms of actual immunity or clinical protection," she said on a conference call with reporters.

Which means, don't get too excited - just keep getting that flu shot. If we had a crystal ball (or lots of money to do additional tests) perhaps we'd find that more people wouldn't get H1N1 in the first place. Unfortunately the cost of blood draws might equal the cost of the flu shot. 

Common myths about the flu pervade, according to this article. Health officials say "It's impossible to get the flu once you've been vaccinated," (because the shot doesn't contain the live virus), but actually it is - because either you're part of the percentage in whom it was ineffective or because the particular strain you got is not even included in the vaccine. So you got the shot and go the flu.

The article also says that side effects of the flu shot are a "myth." I don't really consider listing soreness at the injection site and a case of the sniffles to be adequate counsel on the true side effects, which are no doubt uncommon but still exist. Several sites say that Novartis, the makers of Fluvirin, admit in their package insert that possible side effects can include paralysis and Guillain Barre Syndrome, which can cause paralysis and even death. However, the one package insert that I found lists it as a possible side effect, but only in connection to the 1976 swine flu outbreak, in which an elevated number of cases were reported after people received the vaccine. In other words, it sounds like they use that case as a scapegoat and want to distance themselves as much as possible from the possibility, perhaps in hopes that you'll say, "Oh, that happened 35 years ago - I don't need to worry about that."

The article, titled "Flu: You're not immune," ponders whether getting the flu can improve your immunity. 

“The natural immunity you build is usually more durable than the immunity you acquire from an injection,” acknowledges Dr. Raymond Strikas, associate director for an immunization program at the Centers for Disease Control and Prevention. “However, why run the, albeit small, risk of a serious illness when it is much safer to get the vaccination?”

The language many flu vaccine advocates use sounds serious, their tone warning - as if you are completely incapable of making the decision on your own free will. "Getting the flu is not a good idea," says one American Medical Association specialist. Of course you'd say that; you work for the American Medical Association. "The primary reason is that the influenza virus undergoes antigenic variation, so on a yearly basis the strain undergoes change." That's a fancy way of saying, according to the article, "Getting this year's flu doesn't necessarily prevent you from getting next year's flu."

(It also means getting this year's vaccine doesn't protect you from this year's flu, either, if you get infected with a strain that isn't included in the shot. You kind of glossed over that part.)

Reading between the lines here, I'd say even the CDC guy reluctantly admits the risks of "serious illness" are rare. Glossing over the reality of it, he basically eases into the guilt trip and encourages you to get the shot, even though it might not make a difference either way. 

The Cochrane Review did their own study, which basically found:

Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.

Rather surprisingly, they also acknowledged that nearly half of the trials were "funded by vaccine companies" and "company-sponsored influenza vaccine trials tend to produce results favorable to their products..."

The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies.

Something to think about before you get your next flu shot.