16 Mar 2022

A paragraph from this recent study jumped out at me:  ( Pearlman Shapiro, Marit et al. “Breastfeeding and contraception counseling: a qualitative study.” BMC pregnancy and childbirth vol. 22,1 154. 25 Feb. 2022, doi:10.1186/s12884-022-04451-2)

“Among women who attended a prenatal visit at Montefiore, more than one-third did not return for a postpartum visit, highlighting a barrier to contraceptive initiation in the postpartum period [21]. In April of 2014, New York State Medicaid began allowing hospitals to be reimbursed for LARC devices placed during an admission for delivery. Immediate postpartum LARC has been available to all patients since July 2014.”

As a maternity nurse for decades, I witnessed disparities in reproductive care when the topic was contraception. Generally, White women with private insurance went home with their baby without pressure to select a method of contraception. It was the adolescents, the immigrants, the Black and Brown women, and those receiving Medicaid, who were often pressured into accepting LARC before hospital discharge, sometimes being asked about it as many as 8 times during a 36-hour hospital stay. I am still hearing from doulas that these practices continue today.  There is a eugenic quality to care.

For a long time, I was complicit because I shared the paternalistic attitude, “we don’t want those women to get pregnant again.”   As a nursing student in the late 1960s and early 1970s, I was acculturated to defer to the judgement and wisdom of the doctors, all of whom were male.The scenario often looked like this: the doctor would come into the room of a mother who had given birth within the past 24 hours. He would stand over her while she was lying down in her postpartum bed and ask,  “You don’t want to have another baby, do you?”  What person who has just worked to get a baby out of her body can even imagine going through the process again?? Her reaction was an aghast or horrified, “No.”  “Okay, here’s your shot of Depot.” Period. There was no dialogue.

It took dealing with my insecurity and fear of retaliation, along with my increasing ability to really see what was in front of me that enabled me to let go of the paternalistic attitudes that were the foundation for my early nursing career; I was trained to follow physician’s orders. Fortunately, I have expanded my perspectives and seek to make amends.

What is interesting to me in the above quotation is the lack of curiosity about the reasons one-third of women do not return for a postpartum visit. Why is that? Do they dislike how they are treated? Do they have time or transportation? Do they lack understanding of the importance of follow-up care? Does the care they receive encourage them to continue to engage? No one asks these questions.  Instead, the dominant system seeks to enforce its will on the extremely vulnerable, in the early days after giving birth.

What do you think?





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