S11.E02: Episode 2

[susannah]

5 hours ago, caitmcg said:

The American College of Obstetrics and Gynecology classifies both tubal ligation and vasectomy as sterilization, notwithstanding the potential for reversal, which statistically speaking is hardly a guarantee of potential fertility. This is why, even now, it can be hard for childless women of reproductive age to access tubal ligation: there’s an assumption that they may decide they want a child and regret it.

 

That could happen, but it is not up to the doctor to decide to do it or not.

[caitmcg]

1 hour ago, susannah said:

That could happen, but it is not up to the doctor to decide to do it or not.

Unfortunately, that’s not how it works in practice.

[susannah]

3 hours ago, caitmcg said:

Unfortunately, that’s not how it works in practice.

Are you speaking for all doctors? It is up to the patient to make that choice, and if the dr she goes to won't do it, she is free to go to another one.

[Nialla]

2 hours ago, susannah said:

Are you speaking for all doctors? It is up to the patient to make that choice, and if the dr she goes to won't do it, she is free to go to another one.

And in most cases, another and another, if they're lucky enough to live in an area with options or have transportation. The idea that a woman may change her mind and/or have a husband who wants kids is very much part of the equation for doctors, even though it shouldn't be.

Women who have health conditions that would be improved with a hysterectomy are often put off in their 20s and 30s by their doctor in some cases, but also by insurance (US). They'll say it's not life threatening, so even if you find a doctor you'd have to pay for it out of pocket.

[EllaWycliffe]

4 hours ago, susannah said:

re you speaking for all doctors? It is up to the patient to make that choice, and if the dr she goes to won't do it, she is free to go to another one.

Except that depending on where you live, it may not be easy or affordable to simply go to another doctor. In the United States for example, in order for the surgery to be *covered by insurance* your doctor has to agree that your surgery is medically necessary. If they don't, then you have to pay for EVERYTHING and your insurance covers nothing. And yeah, tubal ligations on healthy women who have not had children are very often not considered medically *necessary*. Going to a different doctor can involve travel expense depending on where you live, that doctor will have to accept your insurance AND its still possible they might deem your request for tubal ligation medically unnecessary. Its not as simple as the patient snapping her fingers and the operation happening.

[Good Queen Jane]

15 hours ago, caitmcg said:

The American College of Obstetrics and Gynecology classifies both tubal ligation and vasectomy as sterilization, notwithstanding the potential for reversal, which statistically speaking is hardly a guarantee of potential fertility. This is why, even now, it can be hard for childless women of reproductive age to access tubal ligation: there’s an assumption that they may decide they want a child and regret it.

Even women with children. Years ago I had a client who had 5 children by the time she was 25. She begged to have her tubes tied when she delivered her 5th child, but the (male) doctor refused, saying she was too young for the procedure and Medicaid wouldn't cover it.

Edited March 31, 2022 by Good Queen Jane

[Cetacean]

1 minute ago, Good Queen Jane said:

...but the (male) doctor refused, saying she was too young for the procedure.

Male physicians (heck, males in general) continue to want to rule female reproduction.  It hasn't changed all that much from the 60's.

I foresee the newlyweds becoming more of a force in community affairs.  They have something of a unique situation since both have outreach activities that put them in contact with a large variety of people and associated needs.  However, I wonder if their ethnicity would have been an issue in England in the 60's.  We know that Lucille has had issues in the past.

[EllaWycliffe]

8 minutes ago, Cetacean said:

However, I wonder if their ethnicity would have been an issue in England in the 60's.  We know that Lucille has had issues in the past

I don't *need* to see an ugly racism plot but honestly I really don't believe everyone was so sunshiny pleasant about race in 1960s East End London. Not if my now elderly relatives are anything way to judge. Its funny, a British show I watched as a kid, The Tomorrow People, was set in London in the early 1970s (and was *filmed* in the early 1970s) and there was at least one plot where the black female teenager Elizabeth was stalked and almost beaten up by white hoodlum teens while walking home one night... because yeah, she was black. It was kind of depicted as ugly but to be expected. And this wasn't a show with American consumption in mind so I have to assume things weren't so rosy for black people in London back then. 

[Rootbeer]

5 hours ago, susannah said:

Are you speaking for all doctors? It is up to the patient to make that choice, and if the dr she goes to won't do it, she is free to go to another one.

No she isn't speaking for all docs.  I say this as a doctor who as recently as this week, agreed to perform a sterilization on a woman who is 29 and has no children and doesn't want any.  I certainly make sure they realize that it is permanent and that there are long acting contraceptives like IUD's and implants that are just as effective but easily reversed. I also make sure they know that, if some day they change their mind, it can easily cost $10,000 or more for a reversal, that reversals are successful maybe 50-75% of the time so it may not work, and that I know of no insurance plan that covers it.  That is what informed consent is about.  

I've tied tubes multiple times for women who had no children, as long as I feel the woman is fully informed, I am ok with doing it.  I also point out that there are 3 big risk factors for regret after a tubal ligation: 1. if the woman is under 25 years old, 2.  if she has 2 or fewer children and 3. if she has just given birth within the last few months.  I do decline to tie tubes if 2 of the 3 are present because there is an 80% chance she'll regret it; but, once there aren't those issues, she is free to come back and ask again.

In the episode, it seemed obvious that the social worker was being awfully pushy and that there was no rush to allow the woman to decide.  In another few months with a newborn, she might rethink her feelings about more kids.  On the show, it seems clear that the midwives sort of operate in a vacuum.  They take care of the woman for the pregnancy but there is no ongoing discussion as to her overall health and wellness.  Nowadays, every pregnant patient I see gets a discussion at some point as to her plans for future fertility and information as to what is available so she can make an informed decision.  Just as I talk about weight loss after delivery, immunizations, Pap smears and whatever else needs to be part of her ongoing health care.

Quote

Years ago I had a client who had 5 children by the time she was 25. She begged to have her tubes tied when she delivered her 5th child, but the (male) doctor refused, saying she was too young for the procedure and Medicaid wouldn't cover it.

As you probably know, this is incorrect.  Medicaid will cover a tubal ligation if the woman is 21 or older and has signed an informed consent at least 30 but no more than 180 days in advance.  The federal consent specifically emphasizes that the procedure is permanent and cannot be considered reversible and that the eligibility for federal assistance is in no way connected to the procedure.  I once tied the tubes of a 21 year old.  I did it right after she delivered her 4th child.  She was using crack and was arrested for prostitution on several occasion.  The baby's father served as her pimp and was also using.  I happened to have her case as part of my list when I took my board exams to become certified.  The examiner asked me why I tied the tubes of a 21 year old.  I gave him her story and told him that I felt she was never going to be able to climb out of the hole she was in unless she stopped giving birth every year.  He nodded and moved on to another topic.

Edited March 31, 2022 by Rootbeer

[Rootbeer]

1 hour ago, EllaWycliffe said:

Except that depending on where you live, it may not be easy or affordable to simply go to another doctor. In the United States for example, in order for the surgery to be *covered by insurance* your doctor has to agree that your surgery is medically necessary. If they don't, then you have to pay for EVERYTHING and your insurance covers nothing. And yeah, tubal ligations on healthy women who have not had children are very often not considered medically *necessary*. Going to a different doctor can involve travel expense depending on where you live, that doctor will have to accept your insurance AND its still possible they might deem your request for tubal ligation medically unnecessary. Its not as simple as the patient snapping her fingers and the operation happening.

Actually, tubal ligations are known as 'elective sterilization' in medical terms and are covered by virtually all insurance plans.  It makes no difference as to the woman's age or past history.  If a doctor thinks it is not 'medically necessary', he or she will refuse to do it.  The Affordable Care Act (Obamacare) requires that all insurance companies pay for contraception for all clients including tubal ligations.  The only exceptions are religious organizations that object to contraception (the Catholic Church) and more recently, businesses whose owners object (Hobby Lobby and Chick Fil A).  The insurance is informed and precertifies payment before the surgery takes place.  

[caitmcg]

7 hours ago, susannah said:

Are you speaking for all doctors? It is up to the patient to make that choice, and if the dr she goes to won't do it, she is free to go to another one.

I wasn’t speaking for any doctors, as I am not a physician. I was citing multiple media accounts from the US, Canada, and Australia documenting women's experiences being refused tubal ligations based on doctors' personal judgments, in response to the assertion that it’s not up to the doctor to decide. Most of them did have to visit multiple doctors over time, per the articles, before receiving the surgery.

Edited March 31, 2022 by caitmcg

[OtterMommy]

Okay, folks...let's direct the conversation back to the episode.  If you would like to continue the discussion of surgical contraceptive options, please do so in the Small Talk thread.

 Thanks!

[3 is enough]

Add me to the list of those who are frustrated with Sister Monica Joan’s yo-yo dementia.  That just isn’t the way the disease progresses. I lost my mother to dementia last October.  In a little over four years she went from living on her own to not even being able to feed herself.  The disease stripped her of every last shred of dignity and she did not deserve that fate.  Honestly I would prefer no dementia storyline, but if they must they could at least be accurate.

[Leeds]

On 3/28/2022 at 5:14 AM, Dehumidifier said:

Why didn't Miss Higgins call the office and tell them she would be late to work because she was burgled?

Maybe because she was tied up at the police station?

On 3/30/2022 at 8:46 AM, MultiMunkee said:

I agree, the way they have dealt with dementia has been offensive. I had rather they had handled it realistically, but, since they haven’t, I hope they just forget it, rather than having Sister MJ be charmingly confused when it suits the plot. Dementia is relentless 

I agree that it hasn't been handled realistically, but I wonder if it's because the producers/writer didn't realize how popular the show would be and how long-running it would become.  

 

[Badger]

Apparently, it's true to what happened in the books.  Sr Monica Joan could be lucid and making bon mots (usually at the expense of Sr. Evangelina) one moment and confused the next. 

 

[Rootbeer]

7 hours ago, Badger said:

Apparently, it's true to what happened in the books.  Sr Monica Joan could be lucid and making bon mots (usually at the expense of Sr. Evangelina) one moment and confused the next. 

 

I think it's a bit of both.  The original books, written by Jenny, only covered a brief period of time.  As I recall, she worked at Nonnatus for less than a year before segueing into hospice work.  Certainly, in the early stages of dementia, there can be moments where someone could be more lucid and able to participate in conversation.  So, in Jenny's brief tenure, she probably did see some flashes of the old SMJ.

However, the show has now covered a decade of life in Poplar and, since TPTB wanted to keep SMJ as part of the cast, they've had to fudge on the facts of her dementia.  In real life, she probably would've deteriorated and died after just a few years.  

Edited April 4, 2022 by Rootbeer

[Badger]

 

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Ignore the spoilers tag.  For some reason, I can't delete the post and I can't delete the spoilers tags.

I think Jennifer Worth was a midwife for a couple of years although I agree it was a very short part of her nursing career.

Edited April 4, 2022 by Badger
added material

[EllaWycliffe]

1 hour ago, Rootbeer said:

However, the show has now covered a decade of life in Poplar and, since TPTB wanted to keep SMJ as part of the cast, they've had to fudge on the facts of her dementia.  In real life, she probably would've deteriorated and died after just a few years.  

I recall this happening actually in the books - the "real" SMJ had pneumonia from one of her "walk around in the middle of the night" episodes, recovered rather dramatically due to antibiotics and then passed away at around 90

[Shermie]

So Miss Higgins is Sheldon now?

I recall Miss Higgins and Nurse Crane having a special dinner together (Christmas?) and they both had particular, non-traditional items they wanted for that dinner. So Miss Higgins being a bit finicky isn’t new. And really, anyone who lives on their own for a long time gets set in their ways with routines and such.