"Our Bodies Our Selves: A Course By and For Women" First Edition, Second Printing, 1971 April

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OUR BODIES
OUR SELVES

A COURSE BY AND FOR WOMEN

NEW PRINTING OF

TABLE of CONTENTS

Ll tase [nindution. oe earerey Paget me
ZL fratomy and Fhytlogy oo ov ccc cnce ca cee ve fOage 4.
HO Secuclity PAGER Ns
HH = Some Myths about WOMEN... oe e ce ee eee AGE 25.
DC Venarenl Distase’ oe ee és as
Hl Birth Control .. 035s: ase
W ADOP ELON oo ios Mae on Ce b1,
ME Pregnenty 2. ic a, ee rr he
48 Prepared CHM DOE 88.
4. Fost Partum 0. na
A Medical Institutions... 2.0.0. v ere ccee es age 123,
AL = Women Medicine, and Capitalism i oe ee a aig be
~ —

THE FIRST PRINTING SOLO 50 FAST WE HAVEN'T HAD TIME
70 REVISE THE PRINTED COURSE. WE ARE WORKING ON
REVISIONS WHICH WE HOPE WILL BE REROY FOR THE FKP
PRINTING. WE WANT T@ AOD CHAPTERS ON MENO-
PAUSE AND GETTING OLOER ANDO ATTITUCPES To
CHILOREN (CHILD REARING ALTERNATIVES, SINGLE
WOMEN HAVING CHILOREN, ADOPTING, 442 NoT
HAVING CHILOREN ). WE WANT TO EXPAND THE EXST-
ING CHAPTERS TO INCLUDE MORE ON, MONOGAMY ,
HOM 0 SE KVALITY, WOMEN'S DISEASES ANDO HYSTEREC TOMES
THE RELATION BETWEEN MENTAL ANO PHYSICAL HEALTH,
NUTRITION ,E7C., ETC.

Wou.d You LIKE To MAKE SUGGESTIONS, WRITE UP YOUR
OWN EXPERIENCE , OR OTHERWISE WORK ON THE COURSE?
PLEASE WRITE US. THE COURSE (5 WHAT ALL OF US MAKE IT.

write: Co NEW ENGLAND FREE PRESS
791 TREMONT STREET
BOSTON, MASS. O28

FIRST PRINTING : DECEMBER 1970 | a g
SECOND PRINTING : APRIL 19°7/ i 4

Although most of the papers evolved through group discussions, the following
people wrote up the papers:

Anatomy and Physiology — Nancy Hawley, Toni Randall, Abby Schwartz
Sexuality — Jane deLong, Ginger Goldner, Nancy London

Some Myths About Women — Joan Ditzion 4
Venereal Disease — Fran Ansley | 4
Birth Control — Pam Berger, Nancy Hawley, Abby Schwartz

Abortion — Carol Driscoll, Nancy Hawley, Betsey Sable, Wendy Sanford
Pregnancy — Jane Pincus, Ruth Bell .
Prepared Childbirth — Nancy Hawley 4
| Post Partum — Paula Doress, Esther Rome, Marty Ruedi
Medical Institutions — Nancy Mann, Barbara Perkins 4

Women, Medicine and Capitalism — Lucy Candib

q
published by 4
Boston Women’s Health Course Collective
and

New England Free Press

order copies from, and make checks payable to

New England Free Press
791 Tremont Street
Boston, Mass. 02118

bulk discount: one-eighth off on orders of 10 or more

Course Introduction

One year ago, a group of us who were then in women’s liberation (now most of us consider ourselves
members of Bread and Roses) got together to work on a laywoman’s course on health, women and our
bodies. The impetus for this course grew out of a workshop on “‘women and their bodies” at a women’s
conference at Emmanuel College in Boston, May 1969. After that, several of us developed a question-
naire about women’s feelings about their bodies and their relationship to doctors. We discovered there
were no “‘good”’ doctors and we had to learn for ourselves. We talked about our own experiences and
we shared our own knowledge. We went to books and to medically trained people for more information.
We decided on the topics collectively. (Originally, they included: Patient as Victim; Sexuality; Anato-
my; Birth Control; Abortion; Pregnancy; Prepared Childbirth; Postpartum and Childcare; Medical Insti-
tutions; Medical Laws; and Organizing for Change.) We picked the one or ones we wanted to do and
worked individually and in groups to write the papers. The process that developed in the group became
as important as the material we were learning. For the first time, we were doing research and writing
papers that were about us and for us. We were excited and our excitement was powerful. We wanted to
share both the excitement and the material we were learning with our sisters. We saw ourselves differ-
ently and our lives began to change.

As we worked, we met weekly to discuss what we were learning about ourselves, our bodies, health
and women. We presented each topic to the group, gave support and helpful criticisms to each other
and rewrote the papers. By the fall, we were
ready to share our collective knowledge with
other sisters. Excited and nervous (we were
just women; what authority did we have in mat-
ters of medicine and health?), we offered a
course to sisters in women’s liberation. Singly
and in groups, we presented the topics and dis-
cussed the material; sometimes in one large
group, often in smaller groups. Sisters added
their experiences, questions, fears, feelings, ex-
citement. It was dynamic! We all learned to-
gether.

One original version of the course was that we
as a group would give the course to a group of
women who could then go out and give it to oth-
er women. To some extent, that is what hap-
pened. After the first time around, those of us
who had worked out the course originally, plus
women who had taken the course, got together
in an enlarged group to rewrite the papers so they
could be printed and shared, not only with women
in Boston, but with women across the country.
Other women wanted to learn, other women’s
health groups wanted to compare and combine
our work and theirs.

So after a year and much enthusiasm and hard individual and collective thinking and working, we’re
publishing these papers. They are not final. They are not static. They are meant to be used by our sis-

ters to increase consciousness about ourselves as women, to build our movement, to begin to struggle
collectively for adequate health care, and in many other ways they can be useful to you. One sugges-

tion to those of you who will use the papers to teach others: the papers in and of themselves are not

very important. They should be viewed as a tool which stimulates discussion and action, which allows

for new ideas and for change. Often, our best presentations of the course were done by a group of wo- 5
men (we could see a collective at work — in harmony, sharing, arguing, disagreeing) with questions ae
throughout, and then splitting the larger group into smaller groups to continue talking about whatever i
part of the topic that was especially relevant to the women in that group. It was more important that _ a

we talked about our experiences, were challenged
by others’ experiences (often we came from very
different situations), raised our questions, expres-
sed our feelings, were challenged to act, than that
we learned any specific body of material.

It was exciting to learn new facts about our bo-
dies, but it was even more exciting to talk about
how we felt about our bodies, how we felt about
ourselves, how we could become more autonomous
human beings, how we could act together on our
collective knowledge to change the health care sys-
tem for women and for all people. We hope this
will be true for you, too.

This course should grow and include other topics,
such as menopause, divorce, child care, strengthen-
ing our bodies (diet, exercise, karate, etc.) — topics
important to the group of women giving and taking
the course. The material has been and should be ’ oe
used in ways other than a course. A course is only ede © a
one way of spreading the word. |

We want all your ideas, comments, suggestions,
criticisms, etc.

Power to our sisters!!

Nancy Hawley, Wilma Diskin, Jane Pincus, Abby Schwarz, Esther Rome, Betsy Sable, Paula Doress, Jane
de Long, Ginger Goldner, Nancy London, Barbara Perkins, Ruth Bell, Wendy Sanford, Pam Berger,

Wendy Martz, Lucy Candib, Joan Ditzion, Carol Driscoll, Nancy Mann, Hester Butterfield, Marilyn Slot-
kin, Linda Borenstein, Martha Reudi, and all the other women who took the course and read the papers.

5 3

In reading or teaching this course you may need additional information, pictures, or charts and models.
There are bibliographies in several papers and most public libraries carry illustrated books in sections like
Sex Education and Young Adults. You can probably avoid spending money on them. The following
three books, not in most libraries, have some of the best illustrations and information:

A Child is Born: The Drama of Life Before Birth in Unprecedented Photographs, A Practical Guide for the Expectant
Mother, Dell Publishing Co., N.Y.

Birth Control Handbook, Box 1000, Station G, Montreal 130, Quebec (25¢); also available (ten or fewer rat only)
from New England Free Press, 791 Tremont St., Boston, Mass. 02118 (10¢)
Understanding, Ortho Pharmaceutical Corporation, Raritan, New Jersey

You can get more information, posters or plastic models from:
the nearest Planned Parenthood office
International Planned Parenthood Federation, 111 4th Ave., New York, N.Y.
Ortho Pharmaceutical Corporation, Raritan, New Jersey
Educational Department, Tampax Incorporated, New York, N.Y. 10017
Health-Pac, 17 Murray St., New York, N.Y.
Women’s Abortion Project, 36 W. 22nd St., New York, N.Y.

The above are very different kinds of people. Don’t forget that Ortho and Tampax are capitalist or-
ganizations, pushing their own products for profit; nevertheless, their educational departments put out
some excellent stuff. Planned Parenthood pushes population control and birth control pills.

The local Planned Parenthood can give you the name of the local Ortho representative from whom you
can try to get birth control kits (with Ortho contraceptive products). It helps to have a physician call
for you. P.P. can also give you the names of gynecologists who may give or sell you different 1UDs. It
is also good to have the names or doctors to whom you can refer women.

It took a long time to put together this course, but we don’t consider it a finished product. As more
women use, teach, and learn from the course, it must be expanded and revised to meet our needs. We
plan to continue our work and want to have a second edition ready to be printed in six months to a
year. The course will be best changed by the corrections and additions sent by those who use it. So

send them in: Boston Women’s Health Course Collective, c/o New England Free Press, 791 Tremont
St., Boston, Mass. 02118

high heeled shoes which are unhealthy and also keep us in our place (we can’t run). Our physical limi-
_ tations are actually more apparent than real, however, and exist today because we don’t have the oppor-

x heart), enclosing the heart, located just beneath the breast bone. There are two pleural cavities, each

Anatomy and Physiology

Our society has traditionally valued the mental over the physical. Those who contribute to this hier-
archy calling the mind noble and the body base do humanity a great disservice. It denies our physical
selves. The results are particularly damaging to us as women who are defined as more or less mindless
and thus stuck with being “‘base”’ bodies. A “‘base”’ thing is not worth knowing about, striving to feel
good about, so we grow up ignorant, misinformed, unprepared. Only when we are very young can we
enjoy using our bodies, playing outdoors and running, and throwing tantrums sometimes when we feel
like it. As we grow older, every part of our body is used against us. Nearly every physical experience
we have as a woman is so alienating that we have been filled with extreme feelings of disgust and loath-
ing for our own bodies. Every part of our body is an area of real or potential disgust to us — armpits, a
faces, vaginas, buttocks, stomachs, breasts. The slightest so-called “imperfection” is a source of very 4
private anxiety and fear that we dare not communicate to each other because we are taught to think 2
we are the only ones that feel these things. And the objectified disgust we have for ourselves we feel “a
towards other women and we are filled with disgust at the thought of her (our) body under the clothing
(armpits, vagina, etc.)

Our society adds insult to injury by demanding that that the truly ““womanly”’ woman be soft, some-
what weak and awkward — in short, physically unfit. We contribute to this by, for example, wearing

tunity to develop ourselves, and men and the pressures exerted by our male-dominated society tell us oa
what is good, what is bad (a strong woman is considered ‘‘masculine” and undesirable as a woman). We
want to become physically healthy, strong, and enduring through exercise, proper eating and training
(like karate) and proud of our bodies. Pride because we feel good ourselves, not because we look good
for others.

What are our bodies? First, they are us. We do not inhabit them — we are them (as well as mind).
This realization should lead to anger at those people who have subtly persuaded us to look upon our
bodies (ourselves) as no more than commodities to be given in return for favors. In fact we feel we
are commodities because our bodies, in toto and dismembered, are used to sell products — useless,
mind-destroying products that make millions for businessmen. Our legs, busts, eyes, mouths, fingers,
hair, abdomens, and vaginas are used to sell stockings, bras, fashions, cosmetics, hair coloring, a multi-
tude of birth control products that men would not consider using in any form, powders, sprays, per-
fumes (again to make us smell “‘nice’”’ for men because our own smells are not good enough), and such
obscene things as deodorants for our vaginas. Consequently we view our bodies and those of other wo-
men according to how closely they ‘“‘measure up” to the sexist standards of the society. But our bodies
are unique because they - us - will never occur again. Love for ourselves and other women, both of
which we have never been allowed to experience, begins to surface when we refuse to objectify ourselves
any longer and stop depending on the nowhere identity we have been forced to subsist on for so long.

As women, knowledge of our reproductive organs is vital to overcome objectification. We have been
ignorant of how our bodies function and this enables males, particularly professionals, to play upon us
for money and experiments, and to intimidate us in doctors’ offices and clinics of every kind. Once we
have some basic information about how our bodies work by talking and learning together and spreading
the correct information, we need not be at the total mercy of men who are telling us what we feel when
we don’t or what we don’t feel when we do (it’s all in our minds!). (Going together in small groups to
doctors to support each other is incredibly helpful to us and works wonders of “humility” on the minds
of many doctors.)

The purpose of this paper is then to help us learn more about our own anatomy and physiology, to
begin to conquer the ignorance that has crippled us in the past when we have felt we don’t know what’s
happening to us. The information is a weapon without which we cannot begin the collective struggle
for control over our own bodies and lives.

The body contains four major cavities. (These cavities are actually filled with organs and fluids: they
aren't to be thought of as huge holes or hollows.) One is the pericardial cavity (peri=around; cardial=

enclosing a lung and located deeper in the chest towards the back. These three cavities are protected by
rib cage and breastbone. Finally there is the peritoneal cavity, containing most of the viscera, enclosed
and protected by the bowl-shaped bony pelvis.

The pericardial and pleural cavities are separated from the peritoneal cavity by the diaphragm. This
is a sheet of muscle which extends from the solar plexus (wishbone) to an opposite spot near the back.
It aids in contraction and expansion of the pleural cavities enabling the lungs to empty and fill.

The viscera include digestive organs (stomach, small intestine, liver and gall bladder, pancreas, large
intestine or colon, appendix, and rectum), excretory organs (kidneys, ureters or the tubes leading from
kidneys to bladder, the bladder, and part of the urethra or the tube extending from bladder to outside),
adrenal glands, and some reproductive organs (ovaries, oviducts, uterus).

The organism (ourselves) is composed of many systems (digestive, reproductive, etc.). Systems are
composed of various tissues, and tissues are composed of similar kinds of cells. When you eat steak, for
instance, you are eating fat (a type of connective tissue) and meat (muscle tissue). The four main tissues
are epithelium, connective tissue, muscle and nerve. :

Epithelial tissue is composed of cells which are placed very close together. It may vary in thickness
from one to several cell layers. Epithelium gives rise to sweat glands, mucous glands, sebaceous glands
(secrete oil; responsible for acne), endocrine glands (adrenals, pituitary, thyroid, etc., all of which secrete
hormones), exocrine glands (e.g. part of the pancreas which secretes digestive enzymes), and hair follicles.
It also covers and lines structures. As skin, it covers our body, and as mucous membrane it lines our
mouths and the rest of the digestive tract. Mucous membrane also lines oviducts, vagina, urethra, blood
vessels — any hollow organs or parts of organs. It also covers them (e.g. stomach).

Connective tissue is characterized by few cells spaced widely apart. As the name states, connective
tissue connects organs and tissues with each other. These cells secrete various compounds into the
spaces around them, forming the tough substance of cartilage, ligament, tendon and bone and the more
delicate substance of fat and mesentery. Mesenteries are sheets of varying toughness which not only con-
nect organs to one another but which carry blood vessels and nerve fibers from one place to another.

The cells composing muscle tissue can contract when they receive nervous impulses. We move about
by using our voluntary musculature. Involuntary muscle, present in such places as digestive tract and
uterus, causes peristalsis and labor contractions.

The cells of nervous tissue can generate, transmit and receive impulses. The autonomic, or indepen-
dent, division of the nervous system controls involuntary processes such as digestion and heartbeat, and
the central division supplies our skeletal musculature and performs other functions not pertinent here.

The rest of this chapter will cover the reproductive system. If you wish to study the other systems,
they are dealt with in the appendix. The first part of the discussion of the reproductive system will con-
cern anatomy; the second part will deal with ovulation.

Many of the reproductive organs of women and men are similar in origin and in function; they are
homologous and analogous to each other. Homologous organs are structures with a common origin, de-
veloping from the same embryonic tissue. If they have the same function, they are considered analo-
gous, the implication being that organs with a common ancestry do not always have a similar function.
Studies have provided some interesting homologies: ovaries and testes (also analogous), labia majora and
scrotum, clitoris and penis (also analogous), bulb of vestibule and bulb and adjoining part of corpus spon-
giosum penis (also analogous), Bartholin’s glands and bulbourethral glands (also analogous). What is more,
the embryonic gonad (sex gland, from the Latin “‘gone”’ or seed) is “‘indifferent”’; that is, it will become
male or female depending on the chromosomes and hormones present at the time.

The gonads have a dual function in both sexes. The ovaries produce female germ cells (eggs) and fe-
male sex hormones (estrogen, progesterone). They are about the size and shape of unshelled almonds,
located one on either side of the body (see diagram). Each ovary lies in a mass of fat which cushions and
protects it. The funnel-like end of an oviduct (Fallopian tube) extends towards the side of the ovary

OWED i 095 RRO SEES RB — Site
Foe eee ea . :

from which the eggs are released (see diagram'this page). (It is significant that there is a gap between
each tube and the corresponding ovary: very rarely an egg will be fertilized before it can enter the tube,
and an abdominal pregnancy will result.) The length of each oviduct is about four inches. Whereas the
ovaries are connected to uterus and tubes only by ligaments and mesenteries, the tubes actually open
into the uterus. Each opening is so small that only a fine needle can penetrate it.

The uterus (womb) is about the size of a fist. This thick-walled, hollow, muscular organ lies in the
lower part of the peritoneal cavity between bladder and rectum (see diagram): ‘The bladder is beneath
the abdominal wall, the uterus is behind the bladder, and the rectum is nearest the backbone. The cavi-
ty of the uterus is compressed from back to front into a mere slit. The narrowed part of the uterus is
called the cervix, and this protrudes into the vaginal canal. You can touch your own cervix; it feels
like a large nipple with a small dimple in its center, extending from the top part of the vagina way towards
the back. The uterus changes position during the menstrual cycle, so where you feel the cervix one day

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may be slightly different from where it will be the next! The entrance into the uterus through the cervix
is very small, about the diameter of a very thin straw. This is the little dimple that you feel in the mid-
dle of the “‘nipple’’.

The vagina extends from just behind the cervix (where it ends blindly as the fornix) to the outer geni-.
tals, or vulva. Like the uterus and cervix, the vagina is between bladder and rectum (see diagram), and
is positioned such that when you are standing or sitting or squatting it extends towards the small of the
back (remember your Tampax instructions: ‘“‘point it towards your waist’). Its walls are ordinarily in
contact; i.e. its space is potential, not actual. Its length may average some 3% inches but it is capable of
considerable distension. Its lining is thrown into folds which flatten out as the vagina expands in inter-
course or childbirth. Feel your own vagina with your fingers and you may be able to feel the folds. You
may also be able to feel some feces in the rectum, through the “bottom” wall of the vagina.

The basic plan of tissue organization is the same in oviducts, uterus and vagina. The innermost lining
in each case is mucous epithelium. In the vagina it is quite thick, as this organ undergoes wear and tear
in intercourse and childbirth. It is not glandular in the vagina, but is in the uterus. In the tubes, as men-
tioned, it is ciliated. The next two layers are composed of involuntary muscle, thickest in the uterus,
whose muscular contractions must expel the baby at term. The last layer around each organ is a thin
sheath of epithelial tissue.

The external genital organs all together ;
are called the vulva (see p. 16). The pubis }
is a rounded fatty covered mass in front
of the pubic symphysis. (The pubic bones
are part of the hip girdle; where one meets
the other is termed a symphysis. In the
diagram, the pubic symphysis is labeled
pubis.) Next come the hair-covered labia
majora, or major lips. They protect the
more delicate inner structures. When they
are opened, the labia minor or minor
lips are seen, extending from the clitoris SEX ORGANS OF FETUS 47 8 WEEKS
back to the sides of the vaginal opening. When SIFFERENTIATION FIKST OCCURS <I
Each minor lip divides into two portions. on
One part passes above the clitoris to meet the lip on the other side, forming the clitoral hood. The other
part passes beneath the clitoris and attaches to its undersurface, forming (with the other lip) the frenu-
lum or base of the clitoris. You will understand this best if you examine yourself with a mirror. |

The clitoris is homologous with the penis, and has analogous functions of erection and orgasm. Erec-
tion occurs when blood flows into hollow areas within an organ, causing turgidity and consequent stiffen-
ing. The hollow areas in the man’s penis and in the woman’s clitoris are called corpora cavernosa (literal-
ly, hollow bodies). The clitoris has two corpora cavernosa, each surrounded by involuntary musculature
and connective tissue. Like the penis, the clitoris is composed of shaft (from root to tip) and glans (the
glans clitoridis is the tip of the clitoris, from the Latin glans or acorn; the glans penis is the acorn-shaped
tip of the penis). In a woman the shaft is hidden under the hood, but the glans protrudes, looking like
a small bump. If you are not sure of the location of your clitoris, feel your outer genitals until you hit
upon the most sensitive spot. This is pretty sure to be the clitoris. The clitoris is richly supplied with
nerves. For a discussion of the history of society’s attitude towards this organ, we refer you to Ruth and
Edward Brecher’s excellent summary of the Masters and Johnson findings (paperback, An Analysis of
Human Sexual Response, Signet T3038, pp. 144-145).

The vestibule is the cleft between the minor lips and behind the glans clitoridis. It contains the uri-
nary (urethral) and vaginal openings (orifices). The urinary opening is just between clitoris and vagina,
and its position accounts for the occasional irritation felt when one urinates after extremely vigorous or
prolonged intercourse. The vaginal opening is beneath the urinary opening. The perineum, or perineal
region, is the tissue between vagina and anus; this is what is cut in an episiotomy (the cut to enlarge
opening for childbirth).

The hymen (cherry, maidenhead) is seen in a virgin as a thin fold of membrane situated at the vagi-
nal opening. Usually a Tampax can be inserted in the partial opening that remains, and of course men-

- remain after it has been broken.

strual fluid is shed through that opening. The hymen may be entirely absent even in a virgin, however,
and when present may assume many shapes and degrees of thickness. There are little folds of tissue that

The bulb of the vestibule is the name given to two elongated masses of erectile tissue, placed one on
either side of the vaginal opening and meeting in front of it. This tissue becomes turgid (swollen) when
a woman is sufficiently aroused, contributing to a tightening around the penis.

Bartholin’s glands are two small, rounded bodies on either side of the vaginal opening, in contact with
the hind end of each mass of erectile tissue (the bulb). They are not easy to.see. They contribute very
little to vaginal lubrication during intercourse. :

We emphasize that you take a mirror and examine yourself. Touch yourself, smell yourself, even
taste your own secretions. After all, you are your body and you are not obscene.

In intercourse, as the man’s penis moves in and out of the vagina, the minor lips are alternately stretched
and relaxed. This is most evident when the two masses of tissue composing the bulb of the vestibule are
erect (i.e. when the woman is very much aroused and the vagina is tightened around the penis). Since
the minor lips form the clitoral hood, they move back and forth over the sensitive glans clitoridis, stimu-
lating it so that - under optimal conditions - orgasm occurs even though the penis does not directly con-
tact the clitoris. Many of us can’t have satisfactory orgasm through pentration alone, however, many of
us want direct manual or direct oral stimulation of the clitoris. Either indirect or direct stimulation is
perfectly normal; if you can’t have orgasm through intercourse alone, as many women cannot, you should
not feel inadequate or ashamed of demanding direct stimulation.

Ovulation: A follicle, seen in the diagram on page 44, is a hollow ball of several layers of cells. In the
case of a Graafian or mature follicle, there is an egg cell in the center. The ovary contains thousands of
follicles, but only about 300 will become mature. The others are termed atretic (their development is
abortive); yet they perform the essential function of secreting constant low amounts of estrogen. The
diagram shows the sequence of development and decline of a Graafian follicle (as well as picturing an
atretic type). Each month one follicle (occasionally more than one), under the influence of hormones,
starts growing out of its resting immature state. It develops various cell layers, one of which starts secret-
ing estrogen, and matures an egg cell in the center. It also moves towards the surface of the ovary. At
some point it breaks through the ovarian surface, ruptures, and expels the egg. Another layer of cells in
the ruptured follicle then starts secreting progesterone. The follicle is now called a corpus luteum (liter-
ally, yellow body, referring to the yellowish fat in it when it is almost completely degenerated). When

it declines, under the influence of other hormones, it leaves a whitish scar on the surface of the ovary; it
thus is called corpus albicans (white body). The egg, meanwhile, is ejected towards the funnel-shaped
end of the oviduct and trapped by the funnelings. Peristaltic contractions of the oviduct, similar to
those of the esophagus which push food into the stomach, help the egg toward the uterus. The journey
takes about 6% days. If the egg has been fertilized, a process which occurs in the outer third of the tube,
not in the uterus, it sits at the entrance to the uterus for some 12 hours before implanting on the uterine
wall. 50% of the eggs implant on the front wall of the uterus, 40% on the back wall, and 10% on the
sides (these don’t do so well). There is a possibility that the fertilized egg may implant in the tube while
en route to the uterus. This is an ectopic or tubal pregnancy and requires surgery as the tube can rupture.
If the egg is not fertilized, it does not implant but is discarded in vaginal secretions (usually unnoticeable).
Fertilization, incidentally, is encouraged by waving cilia (hairlike processes extending from cells lining
the tubes) which sweep constantly in the direction of the ovary, aiding the sperm in their journey up the
tube. For some reason the cilia’s waving does not hinder the egg’s journey in the opposite direction, nor
does the peristalsis of the tube hinder the sperm from moving towards the ovary.

These are just the anatomical facts. But knowing these facts about our bodies is only one way to
know them and to begin to get in touch with ourselves. Other things to think about:

1. How do we make our bodies physically strong and healthy?

2. How do we develop our bodies to be physically independent and physically safe, especially from men?

3. How do we feel about our bodies (total body and particular parts)? Are we accepting of our bodies?
How do feelings about our bodies relate to our feelings about other things — notion of beauty, men, wc-
men, work, control of our lives, self esteem?

4 Does our self concept integrate a sense of our physical and mental selves? (conquering mind-body

separation)

5 How can we learn to repair our bodies and those of others in a variety of situations?

ac ae nee

Sexuality

This paper was written by a group of us in Wo-
men’s Liberation anxious to share our thoughts and
feelings about sexuality with other women. We are
experts only in the sense that we are women, and
women talking to women about their range of ex-

_ perience and insights has been more informative to
us than all of the How-To-Do-It, What-Is-It-All-
About books we have ever read.

The paper includes a lot of personal stories — ours
and our friends, because we felt that our own voices,
our own histories rang the clearest and truest and
helped us reclaim the mysterious topic of sexuality
as familiar and ours. There are sections in the p.'er
that deal with specific topics, such as celibacy an
orgasms, and an introduction that tries to place
sexuality in a larger social context.

We have written about sex because sexual rela-
tions between men and women are permeated with
myths and preconceptions that put the woman
down, and not because sexual relations are an ab-
solutely necessary part of a fulfilled woman’s life.
If the goal of knowing ourselves sexually were to
produce bigger and better spasms in orgasm, it would
have been a waste of time to write this paper. Or-
gasms are not that important in life. What is impor-
tant are loving, giving, free relationships between
people.

We are all so oppressed by sexual images, formulas, goals and rules that it is almost impossible to even
think about.sex outside the context of success and failure. The sexual revolution - liberated orgastic wo-
men, groupies, communal fucking, homosexuality - have all made us feel that we must be able to fuck
with impunity, with no anxiety, under any conditions and with anyone, or we’re some kind of up-tight
freak. These alienating inhuman expectations are no less destructive or degrading than the Victorian
puritanism we all so proudly rejected. Robin Morgan, a Women’s Liberationist in New York, says
“Goodbye to Hip Culture and the so-called Sexual Revolution which has functioned toward women’ s
freedom as did the Reconstruction toward former slaves — reinstituted oppression by another name.’

We must destroy the myth that we have to be groovy, free chicks. But it is insidiously embedded in
our culture. We are told we must be educated to understand that sex is not bad or dirty, that it can be
beautiful, fulfilling, and extremely pleasurable. Playboy, Newsweek, and almost all women’s magazines
are filled with such analyses of our sexuality. Great pressure is being put on us to be both independent
(what modern man wants a clinging vine?) and a sex-kitten at the same time.

Why is it that women still resist so much advertised liberation? Why is the advertising still necessary
some 50 years after the propaganda for women to enjoy sex as much as men began? Why do women and
men still think sex is dirty? Maybe they’re right. When women feel powerless and inferior in a relation-
ship it is not surprising to feel humiliated and unsatisfied in bed. Similarly, a man must feel some con-
tempt for a woman he believes to be not his equal. 1

“rigidity” or inadequacy in bed is not divorced from the social realities we experience all the time.
This male dominated culture embues us with a sense of second best status, and there’s no reason to ex-
pect this sense of inferiority and inadequacy to go away between the sheets.

SD A fr A RST eT
aa :

SEXUAL FEELINGS

Part of the reason so many people have problems about sex is because sexual feelings are considered
separate or different from other kinds of feelings we have. Sex has got to do with the body — that alien
part of us residing below the neck that has needs and responses that we don’t understand. But all our
feelings reside in the body. Fear usually makes its presence felt by your heart pounding, your chest feel-
ing caved in, your stomach turning. Joy is tingly — your head feels a little light, fingers and toes sort of
shimmer, and the rest of you feels warm and all in one piece. For some people anger feels like a pound-
ing in the head, hands feel tight and clenched and so on. So what’s the big to-do about sex? It’s all part
of the same body that we live in every day, that defines our feelings for us, that moves us around. It
can’t be mysterious or alien because it’s our own familiar house. A good stretch, running fast, breathing
deeply — these are all orgasms of a sort. They are as much a part of “‘sex”’ as that restricted set of activi-
ties that happen in bed and cause us so much trouble.

To make sex special, different, better, more important is to disown our bodies. It is like saying,
“you’re only good for me’’, “‘you’re only a part of me” when you perform on command in this usually
tense and phony circumstance. But our bodies are us all the time. And if this body, which is us, feels
sleepy or scared or cold in certain settings, it has its own good reasons for doing so. And we (our heads)
have no right to punish or reject it or let anyone else punish or reject it for not feeling differently.

The problem is that ‘‘sex”’ and all the preparations leading up to it and after it have nothing to do
with sex. “‘Sex’’ is about being a “‘real woman” — being that ridiculous caricature of a person that this
society tells us we had better become if we are to extract even the smallest amount of security, pleasure
and self-esteem from the world. It’s a sexual achievement exam. You make love to your judge, and it’s
pass/fail. And the irony of it is that it’s not even our test — they made up the rules and we swallowed
the lies and thought that if we “failed” it was our problem. What we need to do is get rid of all the stan-
dards we’ve previously used to measure ourselves, our sexuality. By talking to each other, taking support
from each other, we can set our own standards which will bear the mark of sanity and individuality.

i sini it ee eee ee

GROWING UP

It seems pretty clear to us as women that from the moment we’re born, we’re treated differently from
little boys. Our toys are different. Dolls instead of chemistry sets. Our clothes are different — little
dresses to be kept clean instead of sloppy pants. And slowly, over the years, a distinction is made between
boys and girls on every dimension. We’re emotional; they’re intellectual. They’re clumsy; we’re graceful
and dainty. They’re going to go on to become doctors and business men. We’re going to get married.

The most ambitious among us dreamed of nursing. They’re athletic. We’re domestic. They have an easily
wounded ego. We’re good at soothing. In short, men were socialized to think of themselves as intellec-
tual, aggressive and creative, while women are molded as passive, gentle, and emotional. OK, you say,
that’s not so bad. Separate but equal characteristics. We don’t think that’s true. We think we've suffered
by this characterization of us as passive creatures, noticeably in relation to our sexuality. We’re not sup-
posed to be interested in sex — that’s for men. We’re not supposed to admit it if we are — that’s dirty.
The ideal woman responds, she does not initiate. Men will act aggressively towards us sexually, and we
must worry about how to set the limits on the sexual encounter. We’re always so busy setting the limits
and holding off this powerful sexuality coming from him, that we never get a chance to explore our Own.
Our bodily functions and our own sexuality are always something of a mystery to us.

As kids. if we are caught masturbating or exploring a playmate, we’re told either to stop immediately, or
or questioned carefully as to what exactly we were doing. Certain ideas begin to make themselves felt —
like young ladies don’t do that sort of thing.

My three year old daughter and I were visiting my parents. We all sat in the living room. Lisa sat on the carpet holding

a paper towel tube to her naked vagina. ‘What would happen if I peed in this?’ she asked in her heaviest, gurgling,

teasing, curious voice. ‘Don’t do it, the pee will come out on the floor,’ was what I told her. My father was extremely

upset and told me afterwards that I had handled it all wrong. I should have scolded her and told her not to talk that

way. Not, he assured me, because he cared, but because there are some pretty small minded people out there who will

give her a rude awakening if she’s not trained now.

We also learn that physical affection is only acceptable in some relationships, but not in others:

When I was about seven or eight, I had this best friend Susan. We loved each other and walked around with our arms
around each other. Her older sister told us not to do that any more because we looked like Lesbians. So we held hands
instead.

When I was small, five or six, I wanted to lift my dress up and squirm out of my pants while lying on the floor watching
TV in front of my father. He sort of caught on and yelled ‘Don’t do that.’

We also learn that a woman’s bodily functions are mysterious and slightly smutty:

When I first got my period, my mother dragged me into the bathroom and told me to take off my clothes. I stood | 3
naked in front of her while she grumbled, ‘You can have kids now so you better be careful.” :

When I first got my period I came and told my mother. She slapped me across the face, and then congratulated me.
Later she told me the slap was an old custom.

The books I sent away for explaining menstruation arrived in plain brown wrapping. My father got to them first, and
taunted me by holding them over his head so that they were out of my reach.

The messages go on and on. There’s something shameful about our bodies, our sexuality. It shocked.
and angered our parents, scared us, and added to the growing sense of alienation and mystery we had
about our bodies. The messages go on, in different societies, wearing different disguises. In some tribal
societies, women are isolated in special huts built outside the community grounds, while they menstruate.
They are taboo. Anyone looking at them, caught talking to them, is courting death. The Jews write that
a woman is unclean during her period and caution men not to have sexual relations with them during that
time.

By the time we’re teenagers, we discover that there’s only one norm for beauty. A commercial norm
that sold products to us as we agonized over breasts, hair, legs, and skin that would not measure up. ‘
Again we are left with shame and anxiety. We have body smells and our feet are too big. We lose all
respect for our own uniqueness, our own smell and shape and way of doing things. We buy vaginal
deodorant, and read Cosmopolitan articles on the Six Ways to be Sexy.

All of this leaves us feeling ashamed and ignorant of our bodies, not wanting to explore them to find
out what feels good, what we like and when. All of this leaves us unable to tell the men we sleep with
what to do to satisfy us.

They’ve got us coming and going. First we’re supposed to set the sexual limits, deny our responses,
and hate our looks. Then, within a few years we’re supposed to be experimental and libertine. The
more orgasms we have the closer we come to being “real” women. Jump in and enjoy it. That’s a lot
of confusion, and it’s no wonder that so many of us still have serious questions about who we are and

what we want.

Oe ee Ue; MR Rr eT
Bad a aga i a eae

—
MASTURBATION

We had a house with old plumbing. The bathtub faucet sprayed a hard stream of water out on an angle. I learned to
masturbate with it, had orgasms at 7 or 8 with it. One day, when I was under ten years old, my mother surprised me
going at it. She said, ‘What are you doing?” ‘‘Just washing myself.” “Oh.” I was totally freaked out that she didn’t
know. I figured it must be something pretty queer if she didn’t know.. I figured I was part boy and pure queer, and
certainly a sinner.

When my father went to the hospital with an infection and there was talk of his having a leg amputation and dying
if that didn’t work, I got real scared and guilty. I figured it was happening to him because I was masturbating, or at
least because I hadn’t confessed to my mother. I was sure he would die if I didn’t.

We all heard that masturbation was bad and we all felt guilty about doing it. But some of us did do it,
which means it must have felt good. Taboos did keep some of us from learning about it until we had sex
with men.

I was 14 or 15 years old, and a virgin. I was sitting cross-legged on my bed one day, and became aroused by memories
of petting with my boyfriend, and having orgasms. I was also aroused by the sex smell I was exuding. I suddenly
realized that I could do to my clitoris what he had done. I masturbated for the first time, had an orgasm, and wasn’t
so sure that what I had done was right.

Either way, playing with ourselves didn’t feel natural. When we got older, we got sold a myth that mas-
turbating would keep us from enjoying sex with men — it would “‘fixate”’ us. But statistics say that wo-
men who masturbate are more likely to have orgasms in intercourse than those who didn’t.

eccrine aii

Masturbation is not something to do just when you don’t havea man. It’s different from, not inferior
to, sex for two. It’s also the first, easiest, and most convenient way to experiment with your body. It’s
a way to find out what feels good, with how much pressure, at what tempo, and how often. You also
don’t have to worry about someone else’s needs or opinions of you. The more you know about your
body, the easier it is to show someone else what gives you pleasure.

To masturbate you have to know something about your body, and in particular about your clitoris
(klit’-o-ris). This is a small round ball of flesh located above the opening of the vagina, and it is the cen-
ter of most sexual stimulation. It functions like the penis in the man. When it’s rubbed up and down
rhythmically, you get excited. The clitoris is where all female orgasms happen, whether by masturba-
tion, intercourse, or fantasy.

Some women masturbate by moistening their finger
(with either saliva or juice from the vagina) and rub-
bing it around and over the clitoris. The amount of
pressure and timing seems to vary among women.
Some women masturbate by crossing their legs and
exerting steady and rhythmic pressure on the whole
genital area. A smaller number learn by developing
muscular tension through their bodies, resembling
the tensions developed in the motion of intercourse.
| Some ways of doing this is by climbing up a pole or
a rope or even chinning parallel bars. Other tech-
niques for masturbating include using a pillow instead
of a hand, a stream of water, and electric vibrators.
Some women find their breasts erotically sensitive,
| and rub them while rubbing the clitoris. It’s nice
sometimes to make up sexual fantasies while mastur-
1 | bating. Some women like to insert something in the
HW | vagina while masturbating (like a finger or vibrator),

i but few women get more satisfaction out of vaginal
penetration than they do from clitoral stimulation.”

If you have never masturbated, don’t feel you are
confined to these techniques. Finding what you like
to do is what it’s all about.

VIRGINITY

i | The “‘cherry”’ that is to be every man’s prize on tak-
| ing a virgin symbolizes a traditional conception of the

i | i | | : male-female role. The woman is to be nurtured, wa-
HH tered, trimmed and cared for like the most delicate of

: | eae cherry trees, raised in the anticipation of the moment

Li] when the fruit will be juicy and ripe. Then it will be
11 ‘plucked’, “‘ravished”’, consumed by the man, for whom all this preparation was actually intended. The
| more delicate the tree, the more satisfying the deflowering.

Few of us would choose to look at ourselves this way. It would be a sign of great alienation to see
ourselves not as people, but as sexual objects, as trees with cherries. Yet the concept is so imbued in our
/ culture that few men can entirely avoid it. We make ourselves pretty for men. We take #nfinite pains
| with the curl of our eyelashes, with our hair. In many ways, our daily actions reflect the fact that we
| | have accepted and internalized this conception of ourselves as sexual objects.

Virginity — the constant preoccupation of teenage and college women — has its base in our percep-
tion of ourselves as objects for the eventual enjoyment or consumption of another. One asks oneself
not “What will be best for me—spiritually and physically?”’, but “What will they (other people in gen-
eral, but especially one’s future husband) think of me?’”’ To use one’s body in this way, as a physical
pledge of the appropriateness of one’s conduct in the eyes of others, is to deny oneself in the most basic
way. Certainly there are many valid reasons for not going to bed with a man, but the preservation of
one’s hymen is not one of them.

Men traditionally have made a big production of the bursting of the hymen. Marriage manuals spend
chapters on it. Pornographers go wild over it:

At length by my fierce rending and tearing thrusts the first defences gave way, and I got about half-way in... as I oiled
her torn and bleeding cunt with a perfect flood of virgin sperm: Poor Rose had born it most heroically, keeping the
bedclothese between her teeth, in order to repress any cry of pain... I now recommenced nly eager shoves, my fierce
\\ lunges, and I felt myself gaining at every move, till with one tremendous and cunt-rending thrust I buried myself into

a | her up to the hilt. So great was the pain this last shock caused Rose that she could not suppress a sharp shrill scream,
| but I heeded it not; it was the note of final victory and only added to the delicious piquancy of my enjoyment... I
| drew her to a yet closer embrace, and planting numberless kisses on her rosy lips and blushing face, which was wet with
aS tears of suffering which the brave little darling could not prevent from starting from her lovely eyes, I drew out the head
Bs and slowly thrusting it [sic] in again: my fierce desires goaded me to challenge her to a renewal of the combat. A smile

of infinite love crossed her lovely countenance, all signs of past pain seemed to vanish, and I could feel the soft and
juicy folds of her cunt. . i

This episode, with all its ingredients - the man’s energetic thrusts, the difficulty of penetrating the bar-
rier, the woman’s screams and half-faints, the man’s triumph and the woman’s blissful acceptance of her
new role - are repeated ad nauseum in most pornography. In The Pearl, the scene occurs at least 24
times. This, in perhaps a gentler form, is what men have been brought up to expect in their first sexual
relations with a woman.

Even sadder, and much more subtle, is the way we have come to accept the inequality between the
sexes as the norm, and are disappointed when we do not live up to it. Most of that passage is a total
misstatement of the way it usually is when the hymen is broken. The hymen isa pliable membrance,
often perforated, and easily stretched. First intercourse often takes place with no pain at all. The man
need not be a battering ram; the woman need not scream and faint. ‘The mythology distorts reality to
make women seem more helpless and men more aggressive than they are, even in today’s society.

Why are we urged and expected to feel such pain? Marriage manuals give hints on how the husband
can reduce the pain of penetration, but when there is no pain at all, a note of apology creeps into the
text. The husbands are assured that the hymen might have been stretched or broken accidentally, in
horseback or bicycle riding (unlikely, by the way: the hymen is often stretched before intercourse, but
rarely broken). These books hardly ever suggest that a man is not due his quotient of pain. For the pain
is what keeps the two unequal.

It is the easiest thing in the world for a woman to stretch her own hymen by inserting a finger into the
vagina and periodically exerting a little pressure on the sides of the entrance. By the time she can insert
two fingers, there is practically no chance of any pain during intercourse. This stretching process also
is usually painless. For many women, it happens quite naturally in the course of petting before they ever
have full sexual relations. Some women go to a gynecologist and have him stretch the hymen, but this
seems less desirable to us because it looks to an “‘expert”’ for a “‘skill’’, leaving us once again three steps
removed from knowledge of our own bodies.

Simple as it is, most of us don’t think of stretching our own hymens because we-don’t have any infor-
mation, we are uneasy at examining our own bodies, and, most important, we are afraid of depriving
men of their drop of blood. We are afraid of having our offering questioned, as not pure enough. The
idea of men and women coming together as equals, with neither “‘offering” greater than the other, rarely
occurs to us.

It may seem incredible that most of us are so ignorant on the subject of our hymens, a portion of our
anatomy which literature and popular culture makes central to our identities. But this is only one of
the ways in which we, by cultivating our ignorance, have set the stage for a relationship with men in
which the man sets the terms of the confrontation (by demanding an offering of pain), leads the way
from “ignorance” into “knowledge” (thus reinforcing as “teacher” the already inherent inequality) and
guides us from our sheltered life into the real world (preserving his own role as the key to that exciting
real world). In this process, we often abdicate to the man the definition of our role in the sexual rela-
tionship. Because we have no knowledge on which to base our own judgment, he determines the defini-
tion of what we should be and feel.

ORGASMS

There has long been a common misconception, still present today, that there are two different kinds
of orgasms, one achieved by stimulation of the clitoris, and called a “clitoral orgasm” and the other a
“vaginal orgasm” brought on by the penis moving in and out of the vagina. The first was thought to be
achieved by masturbation, petting, and intercourse, if the clitoris was stimulated directly. It was con-
sidered to be an “immature” kind of orgasm, related to early sexual experiences, while the vaginal or-
gasm was thought to be more “‘mature”’ and to be the ultimate sexual experience for a woman.*

There is in fact no difference in the kinds of orgasms women have, either by masturbation, petting,
or intercourse. In intercourse, it is the stimulation of the clitoris by the area above the penis which
brings on orgasm, along with the pressure on the clitoris that comes from the muscles surrounding it
which are moved by the motion of the penis. This does not mean that all orgasms feel alike, and it is
probably because intercourse is usually a longer activity and more emotionally intense that many wo-

AN RN Sy
MY a
{ Qk \

men thought that the orgasms they had that way were physiologically different.

This false distinction between clitoral and vaginal orgasms was elevated to “‘scientific truth” by Freud
in an early book called Three Essays on the Theory of Sexuality in 1910. Freud was convinced that the
pleasure little girls got from playing with their clitorises was of a ““wholly masculine character’’ (what-
ever that means). Being a man, he assumed that the vagina, into which the man puts his penis, was the
true female organ of sexual response. Consequently, he considered stimulation of the clitoris infantile.
He proposed that women spend the rest of their lives in the admittedly difficult task of transferring
the center of their sexuality from the clitoris to the vagina. The task was difficult, indeed, because it was
physiologically impossible. Yet as late as 1951, modern Freudians were still saying that since the mass
of women could not afford five sessions of psychoanalysis a week for two years, “female frigidity”’ (de-
fined as the inability to have that special “‘vaginal’”’ orgasm) was “‘a mass problem” which “unfortunately
was not to be solved.”

Fortunately for women, two scientists, Masters and Johnson, have finally proved Freud wrong. They
observed 382 women and 312 men not only during masturbating and intercourse, but also during “arti-
ficial coition’’ — a laboratory procedure that makes accessible to direct vision and to recording on mo-
tion picture film, internal changes observable in no other way. What they found was that all orgasms
happen in the same way — in the clitoris.

Despite all this scientific evidence, male psychologists persist in treating the orgasm as a subject they
can have their own personal theories about. The damaging and degrading images of women that these
theories project can best be shown by quoting from one of them. Alexander Lowen, a well-respected
psychoanalyst, wrote a book, Love and Orgasm, after Masters and Johnson published their results.
Here’s what he has to say about our sexuality. The comments in parenthese and emphases are ours.

The problem [?!] of orgastic potency in a woman is complicated [??!!] by the fact that some women are capable of

experiencing a sexual climax through clitoral stimulation. Is a clitoral orgasm satisfying? [Is a penile orgasm satisfy-
ing?] Why are some women capable of having only a clitoral orgasm? These questions should be answered if we are
to understand the problem of orgastic impotence in the female.

Most men feel that the need to bring a woman to climax through clitoral stimulation is a burden [!!t*]. If it is

done before intercourse but after the man is excited and ready to penetrate, it imposes a restraint upon his natural

i ee

17
desire for closeness and intimacy. Not only does he lose some of his excitation through this delay, but the subsequent
act of coitus is deprived of its mutual [??!!] quality. Clitoral stimulation during the act of intercourse may help the
woman to reach a climax but it distracts the man from the perception of his genital sensations, and greatly interferes
with the pelvic movements upon which his own feeling of satisfaction depends. The need to bring a woman to climax
through clitoral stimulation after the act of intercourse has been completed and the man has ip his climax is
burdensome [oh no!!] since it prevents him from enjoying the relaxation and peace which are the rewards of sexuality
[sigh .. .]. Most men to whom I have spoken who engaged in this practice resented it.

I do not mean to condemn the practice of clitoral stimulation [you just did] if a woman finds that this is the way
she can obtain a sexual release. Above all she should not feel guilty about using this procedure [after listening to

you???]. However, I advise my patients against this practice since it focusses feelings on the clitoris and prevents the
vaginal response. It is not a fully satisfactory experience and cannot be considered the equivalent of a vaginal orgasm.

The sex Lowen describes was pretty clearly all done for the man’s pleasure. Clitoral stimulation gives
a woman her most intense sexual pleasure. Yet giving a woman this pleasure is considered a distraction,
a burden, a drag on male satisfaction, a restraint. We are to serve the sexual needs of the man we are in
bed with and look upon our own satisfaction as something that detracts from the power and intensity of
his orgasm. Lowen comes down very strong for a vaginal orgasm. And no wonder. With it, the man can
continue to believe in his Superman masculine powers to satisfy a woman in some mysterious inner
chamber of her body that only he can reach, while maximizing his own pleasure because he doesn’t have
to be “‘burdened”’ by the knowledge of her frustration.

It is astonishing to be so totally disregarded by Lowen. In a paragraph supposedly about women’s or-
gasms, he talks exclusively about male burden, male pride, male pleasure, male resentment and then has
the audacity to tell us not to feel guilty for seeking our own pleasure. How frightening that he can use
his moral authority as an analyst to tell women not to go after clitoral stimulation and to write a book
whose only effect is to make us deny everything natural about what we need and then make us feel we’re
frigid or neurotic. There are:a lot of Lowens around. They charge a lot of money, write a lot of books,
and it will be a long time before our sexuality is written the way we know it.

First we’ve got Lowen telling us what we’re not allowed to do, then we’ve got the pornographers and
a lot of romantic novelists telling us of the ectasy awaiting us. An orgasm is not a mystical experience,
it is a physical experience, and here’s a description of one.

What happens to the body during orgasm can be divided into four parts. First there is the excitement
phase, beginning with the moistening of the vagina. The nipples on the breast become erect, and the
breasts increase in size. Other muscles tense, and a rosy glow called a “‘sex flush” appears on the skin.
Excitement is followed by the plateau phase, although it would be hard to say exactly when one phase
stops and the next begins. Now the rate of breathing increases. Muscle tension is heightened. Most
dramatic is the swelling of the tissues around the outer part of the vagina, which makes the width of
the vagina half its normal size, and able to grip the penis. The clitoris elevates like a male erection and
the inner lips change in color from pink to bright red. This color change means that the orgasm is going
to occur in about a minute if stimulation continues.

Orgasm itself is the third phase. There is a feeling of intense pleasure as the vagina goes into rhythmic
muscular contractions until the intensity tapers off. The number of contractions vary with the intensity
of the orgasm. The uterus also contracts rhythmically in wave-like motions but this isn’t felt.

All the body’s muscles respond in some way (even hands and feet contract in a spasm). After the or-
gasm a kind of final resolution occurs. The swelling of the nipples subsides, sex flush disappears, and
the clitoris returns to its normal position. It may be as long as a half hour after orgasm before a woman’s
entire body returns to the state it was in before she was stimulated. If she has reached the plateau stage
without reaching orgasm, it will take much longer.

Orgasm can be a very mild experience, almost as mild as a peaceful sigh, or it can be an extreme state
of ecstasy with much thrashing about and momentary loss of awareness. It can last a few seconds, or
for half a minute and longer. There is, in brief, no right or wrong way to have one.

It’s still possible for some of us to know all of this and still not have orgasms. Here are some of the
reasons we think this still happens:

1. We don’t notice, or notice and misunderstand, what’s happening in our bodies as we get aroused.
We don’t pay attention to what turns us on. We’re too busy thinking about abstractions - how to do it
right, why it doesn’t go well for us, what he thinks of us, whether he’s impatient, whether he can last -

when we might as well be concentrating on the sensations, not thought.

2. We know what we want at a _ particular moment but we’re too embarrassed to indicate what it is
We’re especially unwilling to do anything to get our clitorises touched because we buy Freud’s line tha
liking it is proof of emotional underdevelopment. Sometimes we’re afraid that the guy will take it as an
attack on his manhood. Maybe he won’t and we’re too tied up to see that. But just suppose he does

take it badly and he’s upset. Should we play along with his hangup and pretend that what he’s afraid
of is real?

3. We are afraid of asking too much, asking for more than he can give, afraid he won’t hold out as
long as we want him to.

ih 4. We rush into it. Or let our partners rush us into it. We end up fucking with great intensity, swept
Hn | off our feet just like in the movies and swept under the rug when it comes to climaxes. If you’re getting

Hh passed by, it makes sense to slow everything down drastically and never escalate the situation without a
clear and pressing physical impulse that tells you to. At this point we tend to get afraid that something»

is wrong with us — the impulse will never come. At these times it helps to remember that you have your
Own pacing.

5. You’ve never had a climax, so you never will. This has no basis in physiology. The only physical |
feature common to frigid woman is that they don’t have a climax. When you’ve been feeling hurt,sad,

or angry about this for too long, you institutionalize it so you won’t have to deal with it any more. You
give up. You are hope-less.

iis ccilinemcencneted nett

6. You’ve been making it with the same guy for a long time and never or practically never been satis-
fied. You’re (naturally) angry at him for this and consequently you don’t want him. You continue to |
make it with him, but you’re not involved in it. You feel you’re being used. Maybe you’re right. More

likely he’d like to please you, but he doesn’t know any more about it than you do, and if you’re willing
to forget it, why shouldn’t he? After all, he’s satisfied.

a } | 7. You’re putting up with a lot that you don’t want in a relationship — an unfair share of the respon-
i ‘i aia sibility, a coldness and a distance, or a kind of cruelty. You’re angry, but you don’t fight for what you
Be want. Or you fight and lose, but don’t leave. You

A Sine sense you re losing, and you don’t know how to win.
BT | | You're resentful or “fucked over’’, a term which

PP RAH) | | says a lot about sex in these situations.

8. You expect to be instantly free and at ease
with guys you don’t know very well or feel very
| close to. Maybe some people are. If you’re not,
ng you're not, and you might as well start from there.

9. You get on the right track, but you expect in-
aN i | stant results. You don’t recognize how many bad
1 experiences you have to overcome. You get tense
) and you don’t give yourself enough time.

| | It is hard to feel relaxed and loving in bed when
| there are so many lies to overcome. But getting

[ preoccupied with the search for sexual success is
fila just another way to hurt yourself. If there are

fle times you'd rather just not deal with it, that’s cool
too.

FANTASIES

| I masturbated to this fantasy: an older woman whom I had never met entered a dressing room I was in. After a brief |
conversation, I placed her against the wall and explored her body with my mouth, First her breasts, then her vagina. |
As I fantasized this part, I had an orgasm. Afterwards, I felt very disturbed because making love to a woman had been
so intensely pleasurable and I was afraid of being “homosexual”, and because the woman I created was older and
| made me think of my mother. I would decide that it was a bad fantasy to have had, and that I was a little abnormal

for having had it.

I imagined I was sitting in a room. The walls were all white. There was nothing in it, and I was naked. There was a
large window at one end, and anyone who wanted to could look in and see me. There was no place to hide. There
was something very arousing about being so exposed. My heart started to pound and my stomach sort of pulsed in a
very powerful way. I masturbated while having this fantasy, and afk a 8 I felt very sad. I thought — I must be so
sick, so distorted inside that this image of myself could give me such intense sexual pleasure. It was more satisfying
than making love.

It feels terrible to have fantasies when the part we play in them threatens our self-image. We use them
to call ourselves names. Which is too bad because
those stories are pieces of us wanting to get listened
to, and we keep shutting them off because we’re
afraid of them, afraid that if we accept them as part
of us, then we’re “‘abnorma!l”’ or unlovable, or
worthless. We call these fantasies ““immoral’’ or
‘perverse’ so we don’t have to take responsibility
for the fact that we liked them. What does it mean
to ‘‘take responsibility”’ for our fantasies? It means,
for example, if we are aroused by an image of our-
| selves that is aggressive, we might at first prefer to
deny this. But eventually, we might come to feel
that aggressive sexuglity is acceptable and that only
some left-over myths about femininity have kept
us from expressing this kind of aggression. Or, if
being sexually humiliated is erotic, we might come
to question why it is that humiliation which hurts
in other situations is pleasurable in bed. What does
this say about how we feel about our bodies, or our
i “rights” in bed?

Fantasies tell us something about the reality we’re
in — who we’d rather be in bed with, what we’d
rather be doing, what we’d rather be feeling. Tak-
ing responsibility for them does not mean name
calling or self-hate; it merely means accepting our
feelings and then trying to understand them.

HOMOSEXUALITY

Between the ages of nine and eleven, my friend Judy and I would sleep over at each other’s houses about once a week.
We really dug each other. We’d touch each other’s breasts and vaginas with a lot of excitement. We looked forward
to playing sexually with each other, but knew very clearly that we shouldn’t get caught.

A few years later, I was playing with two or three other girls and we decided to play with each other’s breasts. I
participated, and with some excitement, but in contrast to my experiences with Judy, I was already feeling pretty
scared and guilty.

I was riding on a subway in New York and a sudden wind lifted the skirt of a woman seated across from me. She
wasn’t even young or pretty, but I was suddenly aroused. It scared me and confirmed my fears that my sexual prob-
lems with men were due to the fact that I was latently a lesbian.

I started reading Playboy when I was in college. My boyfriend used to buy it. A couple of times when I was alone, I
would flip to the centerfold and the other nude pictures and masturbate. Sometimes I would even put my breasts
against the pictures. I felt perverted.

Many of us have had some experiences like these — sometimes it’s just a vaguely arousing feeling
around another woman, or when looking at a picture. Some of us have even had some sexual play with
a friend. But for everyone these incidents were filled with tremendous anxiety and self-hate.

In retrospect, we are angry at being made to feel so terrified at such common childhood experiences.
Strong feelings toward anyone we care about have some sexual content to them. Besides, why not ex-
plore new and exciting territory with a friend?

i
4
yl

But look at the difference between the first memory and the two that followed. It’s very clear that
as we got older, we didn’t feel chummy and exploratory any more. Most of us felt perverse and sinful.

In some respects we were right to feel that way. We grew up ina culture that made us feel that the o
important aspect of a woman is her body. It made women into all boobs and thighs and holes to pene-
trate. Masturbating to an image of a Playboy Bunny is as aggressive and predatory as the men who leer
at us on the street. The all-American available girl. Play out all your fantasies on her or in her. Whata
difference from the friendly and genuine sexual contacts we had with each other as little girls.

I started reading Women’s Liberation literature when I was 25 and happily married with a year-old child. It shattered —
me. It was the missing link that helped explain the feelings of dependency and unimportance that still remained after
many years of therapy and struggle. A few months later, I left my husband. I wanted to be alone and get some
strength and identity. I began taking karate and started to get a crush on my female teacher. She was about my age,
and was very strong and wise. We never talked much, but I dreamt about her twice. In one dream, I had met her at
a party and we just sat next to each other talking and smiling. In the other, I found her badly beaten up and I held
her in my lap and nursed her wounds.

The woman who had this dream said that it had nothing to do with power, nothing to do with rape,
nothing to do with pornography, but it was still about sex. Many of us have these strong feelings for ;
each other. A woman we know who recently had a love affair with her friend said that it was the first |
time she felt like an equal in bed. The roles of submission and aggression disappeared. She never felt |
like she was giving in, or giving up. She didn’t have to pretend to feel things she didn’t feel. And the
sex was really good because each of them could sense what the other needed, just because they were
both women.

j
4
:

AN OPEN LETTER TO MY SISTERS

Why shouldn’t we be lovers? I wouldn’t suddenly begin to let you take me over and do your bidding. I wouldn’t try

to model myself after you. I could have loving and independence too. You wouldn’t mess me over in bed for lack of —
empathy with my body. I’d know me better by knowing you. I wouldn’t be afraid of being left, or feel jealous if

you were with someone else. I’d be more secure in our friendship knowing that we were touching each other because
we like each other. There’s plenty of loving to be made in the world — no need to fear for where the next good time

is coming from. Why shouldn’t we?. Not because we hate men, but because we love ourselves.

‘It’s very romantic to expect that all those hangups with men will disappear with women. But at least

il Sel bE eatin RS Niet ie

there isn’t that oid script to follow. There aren’t any ready-made roles to fall into. Whatever happens
will arise out of the situation and not out of some phony expectations. There will be times in our lives
when we will feel more sexual rapport with women: when we’re working with them, or living with them
or loving them. Sometimes that choice springs-from fear of men. Fears of rape, of powerlessness, of
humiliation are common and in our culture such expectations are realistic. An incredible number of
women - including middle class well-protected women - have had horrifying experiences of sexual abuse.
Out of fifteen women who discussed the topic recently, four had been raped. But violent attacks by
strangers are only a small part of the collective humiliation we all have felt.

One of my first boyfriends felt that I didn’t appreciate his penis enough. He forced me to kneel down so that my
face was at eye-level with his penis and then made me caress it so that it would become erect. As it began to rise
closer and closer to my face, I was supposed to tell him how beautiful and powerful it was.

My boyfriend wanted me to suck his penis. I didn’t like doing it because it made me gag. But he would keep pushing
my face down on it. The only way I was able to do it was to imagine I was standing in a field of carnations so that I
could keep my mind off what I was doing. This used to happen a lot.

I was making out with a guy I had been dating for awhile on a deserted island. I had told him that I didn’t want to
sleep with him. Suddenly he started taking my underpants off. I told him again, but he wouldn’t stop. I suddenly
realized that he was much stronger than me and I panicked. I started crying and yelling and he just fought harder.

Finally he stopped and said that he thought I was just teasing and that I had really wanted to screw all along.

“Frigidity” with men, or a turn toward female lovers is not surprising when the socially acceptable
heterosexual encounters have been so destructive. Psychologists call this abnormal. Fear of men, they
say, is abnormal. We say, each of us will have to draw our own conclusions, and deal with our own
fears. For some this may mean getting our bodies in shape so that we can fight with men on their own
terms. For others, it just means choosing the right male lovers. And some of us may just decide to
chuck the whole thing and express our love and sexuality with each other. It may be that what we need
to do in order to maintain our integrity as human beings is to move freely through these and other
choices given the circumstances of our lives at any particular time, and not be bound by myths and
taboos that keep us from doing what is right for us at each moment.

—"

22°
CELIBACY

Celibacy has helped a lot of women we know get closer in touch with themselves because it cleared
away the sexual distraction. Sexual relationships quite often produce a lot of anxiety. You question
yourself about why you didn’t come, or did he like it, or does he really like my body, or wouldn’t he
rather be in bed with so and so. It’s not that it’s always inappropriate to ask those kinds of questions;
it’s just that they take up huge amounts of psychic energy and leave you drained and unfit for other ac
tivities and thoughts. Always being into a relationship with a man leaves you defining yourself in
terms of the relationship. If there’s no man in your life, you

must be worthless.

My first reaction to being without a man was frustration and anger.

I wanted a man to sleep with. I thought, well, here I am feeling pret-
ty liberated sexually, and there’s no one to sleep with. The intensity
of that feeling was short lived. I thought less and less about being
with a man. I had very relaxed times with my friends during that
period. I was never tense and waiting for a phone call. I was not
afraid that I would lose someone. I didn’t have to think twice about
making plans with friends for dinner. 1 was free. I was not asexual
during this time. I was masturbating with much pleasure. I was hav-
ing different kinds of orgasms, some long and slow and rippley, oth-
ers short and jerky and tenser. I was exploring my sexuality in a way
I had not with men. I had the time and space for a lot of things. It
was easier to do the work I wanted to do because of my sense of me
being my only obligation. At this point I saw that my initial frustra-
tion at not having a man had to do with a judgment I was making of
myself. A man meant completion. Without one I could never feel
whole. After several months of celibacy, I was feeling pretty whole.
I was functioning on approval and good feelings that I supplied from
me to me.

We’ve found this experience to be common among women
celibate for a while. A friend of ours was celibate for two and
a half years. She didn’t masturbate, and she didn’t miss sex.

A lot of the stories we’ve heard talk about the growing ease
with which it becomes possible to move in and out of sexual
relationships. The anxiety of being left by a man diminishes
because being alone has been a positive experience. Which is
not to say that we’re recommending enforced celibacy for
everyone. Just that it’s not only not the end of the world,
some of us have even dug it.

MONOGAMY

So where does all this liberation and independence lead us? Away from the tight, all or nothing kinds
of relationships we’re used to having with men. Towards thinking of our lives as centered in ourselves
and shared in part by others. Towards more love relationships with more kinds of people because we
aren’t hemmed in and defined by strict roles. Out of the growing list of new options - men, solitude,
work, friends - comes less of a need to bank everything on him. It makes it easier to consider having
more than one love affair at a time, and easier to allow him the same option. We know a lot of people

who are trying to expand their monogamous twosomes to include three, four, or a community of people.

But giving up monogamy is giving up the way we know how to relate to men best. We’ve all been
geared to one man at a time as an Absolute Rule of Relationships. Most of the attempts to break out
of that make the people involved pretty anxious.

I was confused about what I wanted from the man I was seeing. I cared about him a lot, and really liked being with
him. I was also very much into Women’s Liberation and was reveling in feeling creative and independent on my own.

I felt some guilt about the times I chose solitude over intimacy. He had a very close relationship with one of my best
friends, and one day it seemed that :£ | allowed them to have an affair, I would have the best of both worlds. I
wouldn’t feel as troubled about the pitfalls of a tight relationship, while still being able to see the man I really dug.

I told them both, separately, that they should sleep with each other if they wanted to. When it pretty quickly looked
like they wanted to, I went to pieces. I told them later that I couldn’t handle the anxiety, and now wished very strong-
ly that it would not happen. They respected my wishes, but for a long time afterwards, I could not relax when the

three of us were together. I still felt that if he had slept with her, it would have been a rejection of me.

I had been living with a man for a year. We had a pretty loving and open relationship. There was suddenly a lot of
withdrawal emotionally and physically, and he wanted to sleep with other women. I felt too weak to leave him, and
besides he kept saying that he still loved me but that he didn’t want to be owned or to own me and he didn’t want to
deny his real feelings and impulses towards other women. The problem was I agreed with everything he said. I even
believed that sex between us would get better if I gave him some room to move, but I was terrified. He had a short
affair with a woman we both knew and it wasn’t as bad as I thought it would be. But I was very angry at him. Every
time he referred to her I could feel the anger rising and when he wasn’t around I was always afraid he was with her.

I was afraid he would meet someone else, or a few other people, and I would just be one of many. It all culminated
when he told me he wanted to sleep with my closest friend. It was doubly scary because she had been really helpful
to me during all the problems he and I were having. It sounded like he had all the answers. We all loved each other.
True. We had better times as a threesome than in any pair of two. True. He and she were attracted to each other.
True. We all should be lovers. Uh oh. Both she and I were intimidated by the rightness of what he had to say. We
found it hard to come up with any reason other than fear of change for not trying it. For the next month we were
together most of the time, feeling like three people in love, though they still hadn’t slept with each other. Unfortu-
nately, below the surface I was suddenly feeling competitive with her. We had been friends for ten years. She was
feeling pressured and angry at him, and he was wondering why we didn’t want to share his vision. We finally talked
it all out and understood that there was a lot of mistrust of motives and a lot of bad feeling building up. We clearly
aren’t ready for it.

We have a lot of theories about what we should do to live up to some idealized image of ourselves.
But it makes no sense to give up monogamy because that’s an impressive achievement, or because we
think we have to. Sometimes choices have to be made and getting out may be better than being a weak
link in a triangle not of our choosing. We’ll be in triangular or communal relationships when we really
want to be because they fill more of our needs and make us happy.

eee

24
CONCLUSION

Accepting the cultural stereotype that has for so long been imposed upon us, we see ourselves pri-
marily as sexual beings, If we look for fulfillment, it is to be fulfilled “as a woman,” and by thiswe
mean having children, raising a family, and having an orgasm every time we go to bed. A fulfilled wo-
man, or a “‘liberated’’ woman, in the popular mind, is one who radiates sex. | ‘

To accept this definition of fulfillment is to be forced into just the straight-jacket society would like —
to see us in. It means that when we think really deeply (and maybe despairingly) about ourselves and
who we want to be, we think mainly about our sexual competence. More women go to psychiatrists
asking how to have an orgasm than they do asking how to have fulfilling work.

It takes courage to redefine our priorities. It takes courage just to stop putting on make-up when we 4
think our face is unacceptable, let alone to actually make demands on a hostile world. We shouldn’t
hate ourselves for not having the courage when we need it — any women who has thought about her
own oppression would;understand. A lot of us have found that getting together with each other has

made it easier.

To any men who happen to read this: This pamphlet was not written for you. Please do not use it
as a marriage manual; please do not “try out” the “techniques” you think have been suggested here;
please do not suggest to your girl that she read it. If you do want to change your behavior and you are
living together, you might start doing half the housework. If you insist on being preoccupied with her
as a sex object and want to know specifically what you can do in bed, you might try to become more
open to her wants and needs. Listen to what she says, and if you can, do what she asks. In the long |
run you should try to change your own life, and the society, so that you can be pleased with and proud ©
of yourself without haying to exploit her. For either of the sexes to be free, both you and she must be

leading worthwhile lives.

But good relationships are difficult, if not impossible, if we don’t understand ourselves and our own
needs. Asking and being given, telling a need and having it fulfilled, free one to be able to give. This is
difficult, if not impossible, when men and women come together not as equals, but as the teacher and
the taught, the admired and the admiring, the assertive and the acquiescent. Good relationships must
be mutual. They must be built on each partner’s feeling as competent and in control as the other.

The goal of this pamphlet, and of the Women’s Liberation movement, is to help us move towards a
world in which human relationships can be more free, more satisfying. This means freedom from the

damaging effects of a traditional sexual caste system; it means freedom from class and racial oppression,

and it means freedom for all from want and from alienating work. k

No one can ever know the potential of humankind for goodness and for fulfillment until she has ex-
plored her own potential. And no one can fully appreciate the possibilities for change in society until

she has changed her own life. By looking carefully at our needs, and finding out how to satisfy them in 4

this world, we are fulfilling one part of ourselves and freeing the rest for other satisfying work. We are
learning what the world could be like for everyone, in all aspects of their lives.

This pamphlet ought to be more than an experiment in education. It ought to be the beginning, for
us, of a revolution.

FOOTNOTES

1. “‘Sexual Liberation’: More of the Same Thing”, by Roxanne Dunbar, in No More Fun and Games, Issue Three, was the source of many
of these ideas.

2. Girls and Sex by Wardell Pomeroy, Delacourt Press, was helpful to read.

3. “La Rose d’Amour”, The Pearl, A Journal of Facetiae and Voluptuous Reading, New York, Grove Press, 1968, pp. 253-4.

4. Pomeroy, op. cit. ;

5. Edmund Bergler, Neurotic Counter-feit Sex, Grune & Stratton, New York, 1951.

6. Alexander Lowen, Love and Orgasm, New American Library, New York, 1967.

7. Pomeroy, op. cit.

C=£#£}=$§'HE<==000=0zC}LZLHOO

Some Myths About Women

We know there is no universal defi-
nition of feminine behavior and charac-
ter. In some cultures the women are
the hard workers and in others the men
are. In some cultures pregnancy is re-
sented and children are an imposition;
in others pregnancy and children are
idealized. To a great extent each cul-
ture determines sex roles in its own
way and sets up its own mythology x
which embodies the culture’s ideas of
sex roles. Common myths about women
in our culture are that women are inferior
to men, women are sexually passive, fe-
males are the beautiful sex, and women
are to provide all the nutrient and caring
functions in the society. We have learned
these myths through institutions of our
society, especially the family, schools,
and media. We are beginning to challenge i
these myths and think of ourselves in
new ways. We believe that much behavior
and feelings that are considered feminine
no longer describe us. We are beginning
to define ourselves differently, and our
new self-definitions embrace a far broad-
er notion about what women are and
can be. In this chapter I want to explore
some of the prevalent myths that we
have outgrown.

What cultural myths concerning femi-
nine sex roles were we taught? How
did we learn them? Let’s begin with the
myth of women’s inferiority to’ men
and notice how it’s reflected in the fol-
lowing telephone conversation.

Salesman: Hello, Mom.

Mrs. Hunt: Yes, who is this, please?

Salesman: I’m from Prudential Life Insurance
Corporation. I understand you just had a
new baby.

Mrs. Hunt: Yes,

Salesman: What was it, a boy or girl?

Mrs. Hunt: A boy.

Salesman: So much the better!

Mrs. Hunt is silent. She is into Women’s Lib-
eration.

Salesman (giggles nervously): I guess his Dad
looks at it that way.

Mrs. Hunt is silent again.

The agent laughs foolishly again and launches
into his pitch.

You might think that the male bias re-
flected in the above conversation is a
relic of the past, but the conversation
transpired three months ago! In our

culture, primary distinctions between people are made on sex lines. One’s genital organs tend to deter-
mine the worth and the value of one’s behavior. In our culture women are devalued.

With this in mind Id like to cite two studies. The first is by a psychologist Philip Goldberg. He asked
women college students to rate a number of professional articles from each of six fields. Two equal sets
of booklets were collated — one attributed to a male author and one to a female. Each student was to
read the articles and rate them for value, competence, persuasiveness, and writing style. The identical
article received significantly lower ratings when it was attributed to a female author than when it was at-
tributed to a male. This was true for articles from traditionally male fields like law and city planning
but also for articles from fields usually considered female, like elementary school teaching and dietetics.!

In a second study by Matina Horner, women college students were asked to write a story based on the
following sentence. ‘After first term finals Anne finds herself at the top of her medical school Class. 27
The same sentence is given to men students but the name is changed to John. Most women’s stories des-
cribed Anne as an “unattractive acne-faced girl who is unhappy because nobody likes her’. Or they des-
cribe Anne as “wise enough not to make this mistake again on the next exam so that the men she likes
can do better’’.2 These studies do suggest that women have internalized a sense of second rateness, par-
ticularly with regard to doing meaningful and competent work in the society.

Most of the important, interesting, and creative work of the society that is recognized is done by men.
They are the writers, philosophers, artists, historians, engineers, doctors, politicians, lawyers, architects,
and administrators. True, some women enter into these male fields, but most women work in the home
as childrearer, and housekeeper or in related fields like teaching, nursing and waitressing. Also open to
women is work involving the ‘‘sexual sell’? such as modeling and prostitution. Our society puts us in
contradictory roles, some which we value like child-rearing, teaching and nursing and some which we
don’t, like “‘sexually selling’ ourselves. What angers us is that all the other capacities of women tend to
be underplayed or ignored and consequently women feel inadequate in other areas. And in a sense we
don’t have a choice. In colonial America this societal division of labor made some sense in that the
population had to be maintained and women had to bear many children, so they worked in the home.
Work outside the home involved physical strength; men are considered more suited for heavy physical
work. But in 1970 most work does not involve physical strength and can be done competently by both
men and women. Also women now have more time available for work since they use birth control to
limit their family’s size. Still, women are told they are not competent in fields outside the home and
have internalized this sense.

te ee ee

FE CO ES PRET SRS,

Since men do most of the innovative work in the society, it is not surprising that women find a male
point of view or bias in much of the writing, media, and social institutions that they encounter. A hu-
morous account of how male bias might appear in a biology text is written by Ruth Herschberger in
her book Adam’s Rib. She writes two accounts of human reproduction. One account is a conglomera-
tion of outpourings from “‘patriarchal biologists”. Here is an excerpt from that section.

The simple and elementary fact behind human pt apace is that a fertile female egg awaits impregnation in the

fallopian tube and the active male sperm must find the egg and penetrate it.
The female sex apparatus is a depression to receive sex cells; the male organs are advanced in order to expel cells.3

She then writes a fictitious “‘matriarchal biologists” account.

The simple and elementary fact behind human reproduction is that the active female egg must obtain a male sperm
before it can create a new life.
The male apparatus is a “tiny factory” which continually manufactures sex cells for the female reproductive system.?

In a similar way male bias is written into marriage manuals, sex education literature, and medical
texts. When we become aware of this dominant male point of view we begin to see male bias every-
where. Most novels have male as opposed to female sexual fantasies. Movies are directed by men who
see women through men’s eyes. A friend of mine notes how she was listening to a poetry reading of a
love poem from a woman to a man. The poem talks about how the woman desires the man’s body ina
sensual way. My friend notes how she became slightly embarrassed in that she never publicly heard a
love poem from a woman before. It is no wonder that women tend to view themselves through men’s

eyes since they have had very little experience hearing a woman’s point of view. And even when we have

heard a woman’s point of view, we don’t value it as much as a man’s.

Not only do women tend to view themselves through men’s eyes, but they view other women through
men’s eyes. An artist friend of mine brought her etchings to an art gallery to enter in an exhibition. The
male director told her that her work was fine but refused to exhibit her etchings because he was showing
too many women artists. My friend replied that she didn’t know there was a sex quota. At this point
the director’s female secretary replied, “Listen, Miss, didn’t you hear. We cannot accept any more wo-
men’s work.”

The vision of a male dominated world is of course reflected in the sexual roles that we were taught.
This brings us to our second myth — that women are sexually passive and subordinate to men. Let’s
look at a few passages from Seventeenth Summer, a teenage novel which nicely illustrates the myth.
Angis, the heroine, is a sensitive, serious, acne-faced girl who feels unappreciated and unnoticed. Dur-
ing her seventeenth summer Jack picks her as his girl. With Jack she becomes legitimate as a person.
She experiences this transformation.

It’s funny what a boy can do. One day you’re nobody and the next day you’re the girl that some fellow goes with
and the other fellows look at you harder . . . and the girls say hello. . . Going with a boy gives you a new identity.°

At another point innocent Angis notices couples parked in cars and expresses to Jack her bewilderment
as to what is happening. ‘He says, ‘You’re a good kid, Angie,’ and looks at her tenderly.’®

Let’s look at some of the attitudes reflected in the above passage. One attitude is that man is active
and woman is passive. It is Jack who finds Angie. He wakes up the Sleeping Beauty. Jack is the actor
and doer. Jack is the sexual initiator. Angie waits to be found. Angie is sexually asleep and numb.
Jack embodies energy and Angie receives of it. These are the sexual roles our culture teaches us. Men
are taught at puberty that they’ll begin to feel sexual, they’re allowed to masturbate (well illustrated by
Portnoy in the recent Roth novel) and to be hot for a woman. Overt sexual intiative and aggression is
encouraged. Throughout childhood girls have no overt acknowledgement of sexual organs except in re-
lation to urination and future childbearing. Rough physical play like tumbling, wrestling, and chasing
is discouraged. Girls are taught that they need sex less than boys. Their role is to restrain men and also
to respond to them. Girls tend to have little sense of their own sexuality since they are so preoccupied
with how men are acting. If they have a sense of their own sexuality they devalue it — it doesn’t count.

Unfortunately the relationship that ensues when boy meets girl is somewhat impossible. In the myth
the male has carte blanche to take the unwilling woman. Under his charisma she will yield and love it.
The man sets the stage and takes full responsibility for the sexual act and the woman succumbs. What
is missing is the notion that to have a sexual relationship both partners must be predisposed, actively
participate and have some sense of what their sexual needs and desires are. But women have been taught
to deny their sexuality throughout their childhood and adolescence.

Mu eee

What is also implied in this notion of a sexually pas-
sive subordinate female is that what satisfies a woman ~
is indistinguishable from what satisfies a man. This
leaves no room for women to define their own forms
of sexuality.. Recently this whole notion has been
challenged by Masters and Johnson. Their study
reached new conclusions about female orgasms. For
the woman the orgasm is centered in the clitoris,
whether resulting from manual pressure, OF indirect
pressure caused by the thrusting of the penis during
intercourse. The dichotomy between the vaginal and
clitoral orgasm is false.’ Since female satisfaction de-
pends on some clitoral stimulation a woman must
have some sense of her sexual self which is real and
different from a man’s for her to ask for or want this
experience.

Let’s return to Seventeenth Summer. A second atti-
tude is that a woman-needs a man to feel real.and so-
cially acceptable. Through her relationship with Jack,
Angie gains recognition by other men and women. A
woman is affirmed if she’s attractive and approved of
by men. Her desirability as a person depends on male
approval and not her own. This explains the poignant
search girls embark on during adolescence. By locating
themselves in strategic places in school and during sum-
mers, by befriending popular girls to “cash off of’, by
devoting much time and money to self-beautification
of face and figure, and by devoting all intellectual, emotional and physical energy to manhunting, girls
strive for their ultimate status, a man. The woman’s need for a man becomes perverted in that she ex-
pects him to provide her with an identity and a sense of worth which of course she ultimately has to

find for herself.

This myth has tragic implications for the emotional development of women, for relationships amongst
women, and relationships between the sexes. Women’s Liberation is trying to break down these myths
in order to find a more real way of being and relating.

Now we come to the myth that women are the beautiful sex. What is pernicious about this ideal of
feminine beauty is how it functions in the society. It seems to work against women in that we all are

‘demanded to be beautiful — an impossible demand that breeds insecurity in women. Nat only is it un-

fair to demand beauty from women as a group, but the standards by which we are judged conform to
white anglo-saxon notions of beauty and don’t incorporate other ethnic and racial groups’ ideals. No
wonder women tend to feel inadequate about their appearance.

Let me here quote a dialogue from a therapy session between psychologist Albert Ellis and a patient.

“How do you feel about yourself?” I asked

‘What do you mean?”’
“You know, your intelligence, ability to get along well with others, looks and things like that.”

“Oh, I guess I think I’m intelligent enough. And others like me well enough - I think - if I give them a chance to.”

“And your looks?”
“Awful.”

“Awful?”
“Yes, why my hips are too high. I don’t like them. And my back’s too thin and my shoulders, they’re not rounded

enough and - Oh - just everything, awful.”

Ellis talked with 27 women patients, ranging in age from 16 to 50, to investigate the possible rela-
tionship between women’s emotional disturbance and concerns about beauty. Every woman was con-
cerned about her looks. Ellis feels that half of these women would have fewer psychological problems
if they weren’t concerned with deficiencies of face and figure. He set up a control group of women who-
were not in therapy and all but one woman had feelings of inadequacy about her looks. Indeed we have
internalized society’s demand that we be beautiful and hate ourselves when we don’t conform to the im-

possible standards.

Advertisers of fashion and cosmetics industries
play on women’s vulnerability because their pro-
fit depends on women trying to compensate for
their physical inadequacies by purchasing pro-
ducts. Women are bombarded by industries’
advertisements in magazines, newspapers and
TV advertisements which look at women’s looks,
judge women’s looks, prey on women’s insecuri-
ties, and then offer beauty aides to compensate
for major and minor flaws. Women can buy
“d vaginal deodorants, falsies, make-up, plastic sur-
=| gery, wigs, hip-flattening or hip curving girdles

| and weight loss courses, to mention a few. As
soon as one “beauty problem”’ is solved, indus-
tries create a new flaw to be compensated for.
For example, it wasn’t until recently that wo-
men felt a need for false eyelashes or colorless
lipstick for the Natural Look. Women become
so hungup on this search for beauty that will
make them loveable, sexual, and acceptable that
they fail to realize that they are being manipu-
lated as consumers. This trend continues into
the seventies engulfing men as well. And why
this frantic search for beauty? Society makes it
impossible for us to function if we don’t. It
gets us aman and ajob. Why is this crippling
us? Because we are forced to be preoccupied
by how we appear to others rather than be
concerned by how we feel from within. We
would like the reverse to be true.

Now for the last myth that women’s work is in the home as homemaker and childrearer orinrelated “
nutrient, serving, and maintenance jobs such as nursing, elementary school teaching, or waitressing.* ‘es
This attitude is expressed in a letter written by a professional man which appeared in the Confidential .
Chat Column of the Boston Globe on March 6, 1970. Here are some excerpts. pa

My problem is how to persuade my wife, a junior college -
graduate, that it is her job to provide her family with'clean |
clothes, decent regular meals, and a reasonably clean home.
Recently she has built one of her hobbies into such a
time-engrossing thing that she actually hasn’t tinte £6r her
home or her family.”. ..1 thought hobbies were what you did
“in addition”. to tequired work in your spare time, not in-
stead of. | me Roles 2 ae
What protection does the modern husband have? Where
does he go wrong? Is the modern girl too emancipated? Is
sliding into bed between clean sheets every week too lavish
to even dream of? Is coming home to a wife who has given
_ of herself during the day for your comfort a Utopia?

Disillusioned and Disgusted.

We cannot know exactly what psychodynamics are
going on between this husband and wife, but it seems
that Disillusioned has made a common mistake in that |
he has equated his wife’s loving with housework and
- Child care. Rather than considering housekeeping and

24-hour childrearing as work, and rather menial work «

at that, and realizing that this work and family income

earning work can be divided up between marital part-. ot

chon “Mom, were you a sexpot?” ners in a multitude of ways, Disillusioned assumes it’s - tpoaee
D ony his wife’s duty to provide these services and that any - ee

LOOK 9-8-70

30 ; ia hanes
other interest that she has that does not concern the home must be subordinate.

When we begin to examine the role of housewife and mother, we can see why Disillusioned’s wife has
not found it totally fulfilling. A woman spends her day cooking, shopping, cleaning, laundering, ironing,
and house cleaning; a set of fragmented tasks that must be repeated daily. Life is a series of errands.
Often for middle class women, this takes place in a suburban setting which can be lonely since families
live isolated from each other. Also the urban and suburban environments are so spread out that a woman
spends much time in a car in order to accomplish what she has to do.

With modern birth control, we have the possibility to define ourselves as more than mothers. Even
though children give us pleasure, the role of mother is confining alone. Child care does not provide
women with meaningful life time work. What’s incredible is that so many women choose it. Why?

Part of the reason might lie in the fact that most jobs open to women, particularly uneducated women,
are more demanding and less interesting than being a housewife and mother. Another reason is that
middle class women find it hard to do housework and childrearing as well as independent work since the
society does not provide childcare centers. But most important is the idea that in our society all women
are expected to play this role and their motivation to define themselves differently has been suppressed.

Let’s see how women are told to become wives and mothers exclusively. A prime influence is parents.
Children emulate parents. Little girls begin to notice that mother is at home and daddy is at work; men
and women do different kinds of work. Schools influence sex roles. Educational institutions differen-
tiate the sexes and provide different education for boys and girls within the same classroom. Marked
sexual differentiation is made as early as kindergarten through the kind of games they play and the kinds
of toys they play with. Girls’ playing space is the Doll
Corner, an area where motor activity is restricted. Her
toys are dolls, household cleaning things, make-up sets,
food product sets and ironing boards. She gets the mes-
sage that taking care of baby dolls and doing housekeep-
ing tasks are appropriate behavior — just like mother.
Meanwhile boys have larger space to play in and are en-
couraged to be active and independent. They have
trucks, kites, models, and blocks to play with.

As girls enter elementary school they learn their sex
roles from books in addition to toys and games. Jamie
Kelem Frisof’s article entitled ‘““‘Textbooks and Channel-
ing’ analyzes the sex roles men and women play in
America as depicted in five Social Studies texts written
for grades 1-3. Here is a summary of some of the findings.
In the five texts combined men are shown or described in
100 different jobs and women in less than 30. Women’s
jobs serve people or help men do important work or do
work that was once done at home. On one page the child
is to match instruments of work with the worker. There
is one woman depicted and she had to be matched witha
shopping cart. Men go places, struggle against nature, di-
rect large enterprises, make money, and gain respect and
fame. Women have few jobs of interest so they might as
well be home. But their work at home as housewife and
mother is not considered work or as important as men’s work. The books lack interesting and competent
female figures. Even though girls do better than boys in elementary schools they are taught in these
years that their futures are limited.’

Another major influence in defining sex roles is the media: television, magazines and newspapers.
In the media the role of housewife and mother has been glamorized and romanticized. Major respon-
sibility for the over-glamorization of the housewife and mother role lies with the household appliance
and food industries. They’ve created the image of the happy housewife and make women feel unfemi-
nine and inadequate if they do not feel fulfilled in this role. Why encourage the woman to be at home?
Because women at home tend to be the best consumers and the industries want profit. So women are
manipulated by advertisements to believe that they will get a sense of identity, purpose, self-realization

7 and joy by buying things for the homes and staying at home. Rather than look for new means of ful-
fillment women buy the line and look for fulfillment at home.

We can conclude from this discussion that by the time a girl reaches her twenty-first birthday much of

| her motivation is directed to be wife and mother. Other roles are made to seem inappropriate or unfemi-
nine.

Women today are trying to break down myths concerning feminine sex roles that they were taught

» and are beginning to think of themselves in a new way. For this new self definition to be more than just
/ an idea we must work for changes in the society. Here are some possible changes in the realms of work,
education, and culture. (Some of these demands are listed in the Bread and Roses Bill of Rights.)

1. Childcare, by men and women, during working hours, provided by the employer and controlled
by the workers and the community.

2. Maternity and paternity leave for men and women with guaranteed return and no loss of pay or
seniority.

3. Increasing of part-time work and an end of discrimination against part-time workers.

4. Low grade work should be shared by men and women as well as housework. Housework should
be recognized as legitimate work which deserves pay.

5. Communities should provide free community controlled childcare centers.
Living environments must be redesigned to meet the needs of women.

Sex discrimination in school curriculum and texts should be wiped out.
Facts about sexual inequality should be taught in schools.

An end to advertising which manipulates women to buy products.

BOP on 1 ON

FOOTNOTES
. Goldberg, Philip, “Are women prejudiced against women?” Transaction, April 1968.

. Maccoby, Eleanor, “Is there any special way of thinking, feeling, or acting that is characteristically female?”, Mademoiselle, February
1970. 277. In her article Maccoby cites the Horner study.

} Ruth Herschberger, Adam’s Rib.

rer re

Ibid.

Maureen Daly, Seventeenth Summer, 1960 ed., p. 57.

Ibid., p. 39.

Ruth and Edward Brecher, An Analysis of Human Sexual Response, 1966.

Albert Ellis, The American Sexual Tragedy.

Jamie Kelem Frisof, “Textbooks and Channeling”, Women: A Journal of Liberation, Fall 1969, 26-28.

Ow ONAN SL

BIBLIOGRAPHY

Bem, Sandra L. and Bem, Daryl J., “Training the Woman to Know her Place: The Power of a Nonconscious Ideology”, Women: A Journal |
of Liberation, Fall 1969.

Brecher, Ruth and Brecher, Edward, An Analysis of Human Sexual Response, Signet, 1966.

Daly, Maureen, Seventeenth Summer, Dodd, Mead, and Company, 1960.

Ellis, Albert, The American Sexual Tragedy, Grove Press, 1962.

Freud, Sigmund, “Femininity”, New Introductory Lectures on Psychoanalysis.

Friedan, Betty, The Feminine Mystique, Dell, 1963.

Frisof, Jamie Kelem, ‘‘Textbooks and Channeling”, Women: A Journal of Liberation, Fall 1969.

Goldberg, Philip, ‘Are Women Prejudiced against Women?” Transaction, April 1968.

Hays, H. R., The Dangerous Sex: The Myth of Feminine Evil, Putnam, 1964.

Herschberger, Ruth, Adam’s Rib, Pellegrini and Cudahy, 1948.

Kagan, Jerome, ‘‘Acquisition and Significance of Sex Typing and Sex Role Identity”, Review of Child Development Research.
Komarovsky, Mirra, Women in the Modern World, Boston, 1953.

Maccoby, Eleanor, ed., The Development of Sex Differences, Stanford, 1966.

Maccoby, Eleanor, “‘Is there any special way of thinking, feeling or acting that is characteristically female?”’, Mademoiselle, February 1970.
Mead, Margaret, Male and Female, Mentor, 1955.

**The Woman in America’’, Daedalus, Spring 1964. See especially the article by Rossi.

Women: A Journal of Liberation, Fall 1969.

————
asa

33
Venereal Disease

Most kids in this country have probably heard something about venereal disease, or ““VD”’ as it is often
called, by the time they are in high school. You may have seen some scary films in school. Or you hear
words like “the clap’’, “morning drop’, “‘the Whites”’, ‘ta dose’’, or “‘pox”’, “lucs”’, “siff’, “Old Joe’’.
All of these slang expressions refer to one or the other of the two major venereal diseases: gonorrhea
and syphilis. These diseases are very serious, both because they can hurt you a lot physically, and be- :
cause they are so common right now in the United States. (More than a million people get VD every

year in this country.)

We in women’s liberation are writing this paper because we think VD is a dangerous problem that
everyone should understand, and because we think that most of the information about it that is gen-
erally available to people (especially to teenagers) is inadequate and slanted, with more preaching in it
than facts. In this paper we’ll first try to talk about the medical aspects of these two diseases: the symp-
toms, diagnosis, and treatment. Then we will discuss some of the “sociology” of VD: why it seems to
be getting worse instead of better..

How Do You Get VD? Syphilis and gonorrhea are two different diseases. The thing that they have
in common is that they are both caught in only one way: from having sexual intercourse with someone
who already has the disease. The germs for each of these diseases can only live for a matter of seconds
outside the human body. If they become dry or too hot or too cold, they die. Therefore, to spread to
a new person, these germs must be deposited on warm, moist surfaces (such as the lining of the genitals,
or perhaps the mouth, or on a break in the skin). This means that sexual intercourse, with a person of
the same or opposite sex, provides ideal conditions for the transfer of VD germs. They go from the
sexual parts of one partner to those of the other, and spread to other parts of the body from there.

This also means that the stories you often hear about catching VD from toilet seats, door knobs,
towels, dishes, etc., are false. People get VD from other people who have VD, through intimate sexual
or physical contact.

Can You Prevent VD? VD is not a disease like mumps or measles that you can only get once, and
after that you are immune to it. You can get VD over and over again. Also, there is not yet any shot
or vaccine to prevent VD. There is no sure way to prevent the transfer of germs from one partner to
the other during intercourse if one of the partners has VD. (Sometimes people wash themselves with
soap and water before and after intercourse. Sometimes the man will wear a rubber to prevent transfer.
These methods may help, but neither of them is completely reliable.)

However, VD is not difficult to cure once you have it, if you go to a doctor or clinic to get treatment
early. That’s why it’s so important to know the symptoms, and not be too hung-up to go and get help
if there’s even a slight possibility that you might need it.

SYPHILIS
Symptoms of syphilis

Syphilis is a very infectious disease that invades every system of the body. If treated, it can be cured;
if not, it can be disabling and fatal. Syphilis is caused by a small delicate germ of the “spirochete’’ fami-
ly (that just means it has a spiral shape). Once these germs have entered the body through intimate
sexual or physical contact, the disease goes through four stages:

1. Primary — The first sign of syphilis is usually a sore called a “‘chancre”’ (pronounced kanker). It
may look like a pimple, a blister, or an open sore, and it is usually painless. It probably will show up
any time from 9 to 90 days after the germs enter the body. This sore usually appears on or near the
genitals (where the germs entered), but it may appear on fingers, lips, breast, anus, or mouth. At this
primary stage syphilis is very infectious. The chancre is full of germs which are easily passed on to
others.

Sometimes the chancre never develops at all, or it may be hidden inside the body, and the infected
_ person doesn’t even know he has syphilis. This is particularly true for women, where the sore frequently

develops inside the vagina, or hidden inside the folds of the labia. In any case, this sore will go away all a
by itself, even if the person doesn’t do anything about it. But the germs are still in the body, increasing |
and spreading.

2. Secondary — The next stage occurs anywhere from a few weeks to six months later. By this time
the germs have spread all through the body, and there are many possible symptoms they may produce
at this stage. A rash may appear on the body (sort of like a food or heat rash, or like hives), or it may
be just on the hands and feet. Sores may appear in the mouth; joints may become swollen or painful,
and bones may hurt. There may be a sore throat, mild fever, or headache. Patches of hair may fall
out. Infectious raised areas may appear around the genitals and rear end.

This is the most infectious stage of the disease. If the person has open syphilitic sores on his body at
this stage (in his mouth, for instance), the disease can be spread by contact with these sores, even withow
sexual intercourse. This is a stage where syphilis “‘imitates’’ other diseases, and so the infected person
may think he has something else. Or the symptoms may be very mild, and the person hardly even no-
tice them. This stage usually lasts three to six months, but sometimes the symptoms of this stage can
come and go for several years. Just like the primary stage, it will disappear all by itself. But the germs
don’t go away

3. Latent — During this next stage, the outward signs of syphilis disappear, but the germs may be in-
vading various inner organs, including the heart and the brain. In the first few years of the latent stage
the disease may still be infectious, but after that it is usually not. The infected person can go along for
ten or twenty years, feeling perfectly healthy, not knowing a thing.

4. Late — This is the stage of the disease when the really serious effects appear. Depending on which
organs the spirochetes have attacked during the latent stage, a person may have serious heart disease,
crippling, blindness, or mental incapacity. Out of every 100 untreated syphilitics, 23 people will be
killed or incapacitated in this late stage of the disease.

Diagnosis of syphilis

Syphilis can be diagnosed and treated at any time. Early in the .primary stages a doctor can look for
subtle secondary symptoms (like swollen lymph glands around the groin), or analyze some of the pus
from the chancre if one has developed. Very soon then (usually by a week or two after the chancre has
formed, though it may take longer), the spirochetes will be in the bloodstream, and they will show up
in a blood test. From then on, through all the stages, a blood test will reveal the infection. It is usually
best to have at least two blood tests several weeks apart, even if the first one didn’t show anything, be-
cause sometimes the results are not dependable.

This blood test is given regularly just as a check in lots of situations. For instance, people who go to
give blood are always tested for syphilis. The blood tests required before legal marriage are also for this
purpose. (One out of every 90 people who take the marriage blood test is discovered to have syphilis.)
However, it could be used a lot more than it is now (at school or jobs, for instance, or whenever anyone
enters the hospital). In communist China, syphilis has been completely eradicated, and one of the main
ways they did it was by giving the blood test to almost everybody so they could discover who had
syphilis and then treat them. .

Treatment for syphilis

’ The treatment for syphilis is penicillin. It may be one big dose or a series of smaller doses for a short
period of time. It’s just that simple. It is important to have at least two follow-up blood tests to be sure)
the treatment was complete, since sometimes people have relapses. But the main thing to remember is
that the first three stages of syphilis can be completely cured, and even in late syphilis, the destructive
effects can be stopped from going any further.

Most states have VD clinics where you can get blood tests and penicillin free of charge. At these clin-
ics they usually ask you for the names of any people you have had sexual relations with since you got
the disease, so they can contact those'people and give them treatment. (This is called “‘case finding’’.)
They keep your name and the other name or names secret, and it’s usually a good thing to cooperate
with them. But if you don’t want to tell the clinic people the names, then it’s your responsibility to
get in touch with anyone you had sexual contact with yourself. It might mean life or death.

35
Syphilis and Pregnancy

If a pregnant woman has syphilis, she can pass the germs on to her unborn baby. The germs attack
the fetus just like they do an adult, and the child may be born dead or with important tissues deformed
or diseased. If the mother’s syphilis is treated before the 18th week of pregnancy, the fetus will prob-
ably not be infected at all. (Even after the fetus has gotten syphilis, penicillin shots will stop the dis-
ease, but it cannot repair damage that has already been done.) Therefore, it is very important that
every pregnant woman get a blood test for syphilis as soon as she knows she is pregnant. That way, if
she has the disease, she can be treated for it before she gives it to her child.

GONORRHEA

Unlike syphilis, which goes all through your body, gonorrhea is essentially a disease of the genit-
urinary organs. (Sometimes gonorrhea travels through the bloodstream and causes infection in the
valves of the heart, or acute arthritis, blindness, and even death. However, this is not too common.) It
is caused by a germ shaped like a coffee bean called a gonococcus, which works its way gradually along
the passageways of the genital organs. This disease can be transmitted to another person at all stages.
The symptoms of gonorrhea are different for men and women, even though the germ is the same. It
takes about two days to three weeks after gonorrhea germs enter the body for symptoms to show up.

Symptoms of gonorrhea in women

The first organs infected by gonorrhea in women are the urethra (the tube through which urine
flows out of the body) and the cervical canal (entrance to the womb). Very often, however, a woman
may not even know this infection is present. She might feel a little pain when she urinates, or she might
have a slight vaginal discharge. Then again, she may have no symptoms at all.

But if the disease goes untreated, various complications can arise:

—The glands in the genital area may become swollen and painful.

~The infection may spread up the urethra into the bladder and cause cystitis. Urination will be more
frequent and painful.

—The infection may spread to the rectum and cause proctitis,

—Most serious of all, it may spread and inflame the Fallopian tubes (tubes which the eggs move through
on their way from the ovaries to the womb). This is called salpingitis. The woman may feel no symp-
toms at all at first, and then suddenly have severe pain in her lower abdomen, on one side or both sides.
She may also have vomiting and fever. If a woman has a mild case of this, she may feel the same symp-
toms in much milder form over several months. Her menstrual periods may become irregular. If this
disease goes untreated, a lot of scar tissue will develop in the Fallopian tubes. They will become twisted

and narrow, so that the eggs can no longer pass through them. If this happens to both tubes, the woman
will never be able to have children.

If a pregnant woman has gonorrhea and doesn’t get treated before her child is born, the child’s eyes
can get infected during birth. In the past, this gonorrheal eye infection was a big cause of child blind-
ness. For this reason in the US now, the eyes of every new born baby are treated with drops to kill any
gonorrhea germs, just to be sure.

Symptoms of gonorrhea in men

It is much easier for a man to tell that he has gonorrhea. The symptoms for men are early, definite,
and obvious. At first he will feel a painful burning sensation during urination, and then a discharge of
whitish or yellow pus from the penis appears. This discharge is very infectious, and its germs may be
carelessly transferred to the eyes.

If the disease goes untreated, it may spread to the bladder and cause cystitis. Or it may spread to the
seminal vesicles or the epididymis (these are organs where the sperm are temporarily stored or where
they pass through). In this case it may cause a hard tender swelling in the man’s balls. This internal in-
fection will form scar tissue, just as it does in the woman, and it may block the passageway of the man’s
sperm, making it impossible for him to conceive a child.

Diagnosis of gonorrhea

There is no reliable blood test for gonorrhea. But it is not too hard to diagnose gonorrhea in a man.

There are usually so many germs in the discharge from his penis, that they can be seen and identified
under a microscope. If they cannot be seen right away, they can be kept in a laboratory for several days
and allowed to multiply. (This is called taking a “‘culture’’.) In a woman, though, it is more difficult.
The woman is much less likely to think she has gonorrhea in the first place, since she probably doesn’t
have any symptoms for a while. Also, the germs are spread out in her body more, and much harder

to find and identify. If a woman thinks there’s even a chance she has gonorrhea, or if she knows that
someone she has had sexual contact with has a case of gonorrhea, she should go to a doctor or a clinic
at once. Usually what the doctor will do is take a sample of secretions from her sexual parts (the cervix
or vagina) with a cotton swab. He will look at the sample under a microscope first to see if he can iden-
tify any gonorrhea germs. But almost always it will be necessary to allow the germs in the sample to
multiply for several days before they can be identified. Sometimes, however, a woman may have the
disease, and yet there were so few germs in the sample that they won’t show up in the test, even after
several days. Therefore, if a first test shows no germs, it is necessary to repeat the test to make sure.

Sometimes, if a woman thinks she may have gonorrhea, doctors will go ahead and treat her for it,
even if the tests don’t show anything, just because the consequences of the disease are so serious, the
tests are so unsure, and the treatment is so easy.

Treatment of gonorrhea

The treatment for gonorrhea, like that for syphilis, is penicillin. It usually involves one or two injec-
tions. The size of the dose has been increased over the years because gonorrhea germs have the ability
to build up resistance to penicillin. (Syphilis germs do not have this ability.) For this reason, doctors
are also experimenting with other antibiotics to see if they are effective against the spread of this dan-
gerous disease.

Syphilis and gonorrhea together

A lot of times a person will get syphilis and gonorrhea at the same time. If this happens and a person
doesn’t know it, he might get treated with penicillin just for the gonorrhea, for instance. The penicillin
will cure the gonorrhea, but the dose may only mask the symptoms of syphilis: it probably won't be
big enough to cure the syphilis. For this reason, anyone about to be treated for gonorrhea should also
get a blood test for syphilis before he gets the penicillin dose. Also, he should continue to have periodic
blood tests for syphilis for about six months afterward just to be sure.

1. If you notice any symptoms of VD in yourself, no matter how mild, you should go to a doctor or
a clinic at once. (Turn to the last section of this chapter for a quick check list of VD symptoms.) Don’t
panic, or feel guilty or embarrassed. For a list of clinics in Boston where you can go for free treatment
and tests, see the last section of this paper. Or you can go to a private doctor if you have the bread
(probably $20-30). In Massachusetts, if you are a minor, you do not have to have your parents’ permis-
sion to be examined and treated for VD.

2. If you have sexual relations with someone, try and find out if there is any chance they have VD
or have been exposed to VD recently. Don’t be embarrassed to ask. If two people care about each other
they should be looking out for each other anyway.

If you find out you have VD, don’t have sexual relations with anyone until you are well. If you had
sex with someone when you had VD but didn’t know it, you should tell that person right away so they
can get treated. It is especially important in cases like this for men to tell women that they might be
infected with gonorrhea, because the woman probably won’t notice any symptoms in herself until the
disease has already done a lot of damage.

3. Don’t depend on just one test. If the first test for gonorrhea or syphilis doesn’t show anything, -
make sure the doctor takes another one to be safe. Don’t just accept whatever he says. Some doctors

aren’t careful enough, and it’s your life, not his.

V.D. IS A SOCIAL PROBLEM

Once you know what a serious, even deadly, disease VD can be, and how easy the cure almost always

is, it really seems strange that it has not been brought under control better in this country. We saw be-
fore that in China syphilis has been completely ended. What about in the United States?

In this country, well over a million people get VD every year. (That means about 3000 new cases of
gonorrhea and 300 new cases of syphilis every day.) Approximately 4000 people each year die in the
late stage of untreated syphilis.

Not only are the numbers high. They are getting rapidly bigger. The number of gonorrhea cases went
up 35% from 1963 to 1969. That was a six year period. Then in Massachusetts last year, over a one
year period, the number of gonorrhea cases went up 15.4%.

About 12 years ago, people were saying that the VD problem in this country was almost solved. The
amount of VD had been decreasing since the Civil War, and it reached an all time low in 1957-58. How-
ever, ever since 1958, the number of VD cases has been increasing more and more each year.

This is what we call an epidemic. More people now get gonorrhea every year in this country than get
measles, tuberculosis, hepatitis, whooping cough, and encephalitis combined. Strep throat is now the
only communicable disease that affects more people than gonorrhea.

The other thing about this epidemic is that it is hurting young people worst of all. People 15-19 years
old get VD twice as often as other people. A recent study indicated that one out of every 50 kids in
that age group gets gonorrhea. Over half of all VD in the US (56%) hits people under 25.

Why is this? Why is it that things are getting worse and worse? In the first place, like most other
things, the VD problem is partly a question of money. Most government money right now is being spent
_ on “defense”’ to fight the war in Vietnam. Medical research money goes to a lot of things like fancy
operations for rich people or to develop chemical weapons like Mace. If this weren’t true, there might
be money available to develop a preventive vaccine for VD, or to figure out a simple screening test for

gonorrhea (this would be especially important for women). Also, more VD clinics and casefinders could
be paid for.

Another main reason that we see for the uncontrolled spread of VD is the whole set of up-tight atti-
tudes and laws about sex that exist in this country. On the one hand; just about every business in Amer-
ica uses commercial sex to sell its products. (Buy Ultrabrite, etc.) On the other hand, a lot of adults
treat sex as if it were something dirty and sinful that should never be talked about — especially in front
of kids. This means that a lot of kids - and girls especially - live under a kind of ‘“‘news blackout” about
their own bodies and their own sexuality. They are not told the basic facts about sexual life, reproduc-
tion, birth control — or, of course, about venereal disease. All sorts of crazy stories and superstitions
get spread. When people are told something, it’s usually to preach it and doesn’t help. For instance,
some of the movies they show about VD in the schools make it look like getting VD is a justified pun-
ishment for committing the “‘sin” of making love with someone before you are married. We know of one
high school teacher in Cambridge who once taught a lesson on VD in hygiene class. This was the entire
lesson (she didn’t say anything else): ““God punishes those who sin.”

In fact, it turns out that a lot of the people who should supposedly be helping to stamp out venereal
disease are really much more interested in stamping out “illegal” sex. Attitudes about sexual participa-
tion are changing, particularly among young people, and yet in 36 states of the union, it is still illegal
for a.minor to be treated for VD without his or her parents’ consent. Of course a lot of kids will go un-
treated because they don’t want to blow it with their parents. Even though they know that it is kids
who are getting hit the hardest by this epidemic, it seems like the people who make the laws care more
about punishing a kid for stepping outside their hypocritical rules than they do about saving his life.

Another example of this kind of attitude can be found in some of the public statements of Dr. Nicho-
las J. Fiumara, the director of the Division of Communicable and Venereal Diseases of the Massachusetts
Department of Public Health. He recently (March 1970) issued a statement saying how serious the in-
crease of gonorrhea in Massachusetts was. Then he said that one of the main reasons for this increase
was the existence and use of the birth control pill. He has also listed the Massachusetts anti-‘‘fornication”
laws as one good method for preventing VD. (That’s about as logical as saying that a good method for
preventing food poisoning is to outlaw eating.)

_ Both of these statements show that Dr. Fiumara is anti-sex before he is anti-VD, and he is especially
_ against the idea of women being free from the fear of unwanted pregnancy and being able to be in con-

trol of their own lives and bodies.

Dr. Fiumara and men like him should be fighting to build more clinics, to educate the public, to
break down the barrier of embarrassment and silence that surrounds the subject and prevents kids from
being able to take care of themselves as they should. Instead, he is sitting around denouncing the birth
control pill.

If we look carefully at the history of venereal disease, we find that its main epidemics aren’t so much
connected to women having control over their own bodies, like with the birth control pill, or with peo-
ple who really dig each other making love when they are not married. Instead, it seems to be more tied
to times and places where rape and prostitution and very common. As you can figure out if you think
* about it for a minute, rape and prostitution are usually: most common during times of wars and invasions,
where a lot of men from one country are taken away from wives and girl friends and sent to another
country which they are trying to defeat or conquer. Just plain male chauvinism comes out in the atti-
tudes of the guys toward the women of the other country, and they don’t have to worry about the laws
and social pressure they would feel back home. Also a lot of times racism enters into this situation.

If the women are just “niggers” or “‘gooks’”’, it’s considered even more okay to fuck them over. Out-
right rape becomes a common occurrence, and prostitution also begins to grow.

Vietnam today is a good example of this situation. The Vietnamese report that rape - and often
gang-bangs - of village women and girls are such a frequent thing now in South Vietnam, that they al-
most consider it as part of the “‘fighting task”’ of the American Gls.

Prostitution is also very common in those parts of Vietnam which are occupied by the US troops.
The normal life and work of South Vietnam is almost destroyed. Huge numbers of women are widows
with children and no means of support. Most of the jobs that people can get in those parts of Vietnam
are like maids to Gls or selling stuff on the black market. Everything revolves around the war and the
American army, and there are no decent jobs left. So a lot of women are forced to become prostitutes
in order to survive. And the corrupt Saigon government encourages them in this. The government itself
has actually built and maintained ‘official’? whorehouses at every US base in South Vietnam.

North Vietnam and those parts of the south controlled by the NLF are very different from this.
There women are respected, and prostitution has been abolished. Recently in the Boston Globe there
was an article comparing Hanoi and Saigon. Here are some of the things it said:

Hanoi is quiet. . . You can safely leave several hundred dollars worth of local currency in your hotel room. The girls
are plainly and modestly dressed in long pants and blouses. . . Even Communist diplomats complain they have to go
to Laos to find “feminine companionship”

Saigon is sodden with corruption. . . Bar girls, night clubs, and strip joints give a honky tonk air. . . There is a fancy
‘“thouse”’ for high officials and generals to meet their girls.

What all this means about VD is that in the North they have venereal disease now more or less under con-
trol. But in the South, it is really terrible. Many many women are suffering from this disease either be-
cause they have been raped or have been forced into prostitution. And the Gls themselves, frustrated
and lonely, disrespectful of Vietnamese women, also suffer from this disease and spread it to others. In
fact, there is a new, penicillin-resistent strain of gonorrhea which has grown up because of the war, which
doctors in this country have begun calling ““Vietnam Rose!”’ because it originated in Vietnam. Maybe

a better name for it would be “‘American Invader’’.

Anyhow, this is just one modern example of how male chauvinism and racism and national expansion
can help the spread of VD, because they encourage such sick sexual relations and the sexual exploitation
of women by large numbers of men. Syphilis was first taken to China by white “‘explorers’”’ from Europe.
The first big epidemic in Europe was spread from Italy where the French and Italian soldiers were fight-
ing a long drawn-out war and messing over the local women. Why doesn’t Dr. Fiumara mention some of
these problems and this history instead of blaming it on the pill?

Until our government and big business stop sending American boys overseas and until they stop pay-
ing them to kill and rape the people of other countries, the people of our own country are going to be
sick in many ways — a continuing epidemic of venereal disease is only one of them.

In the meantime, we should all do everything we can to protect ourselves and our friends. So turn to
the next page to remind yourself of the possible symptoms of syphilis and gonorrhea, and how they can
be cured in an individual. The social cure is going to be harder.

Syphilis
POSSIBLE SYMPTOMS
Primary state (9-90 days after infection): chancre Latent stage (10-20 years): no outward symptoms at all
Secondary state (few weeks-6 months later): Late stage: heart disease — crippling — deafness — blindness -
rash (all over, or on hands and feet) — sores in paralysis — insanity — death

mouth — sore throat — mild fever — swollen

joints — headache — patchy balding
DIAGNOSIS — Physical examination by doctor

In early primary stage: examination of pus from chancre
After that: blood test

TREATMENT ~— One or more shots of penicillin or some closely related drug
SLANG NAMES — Pox — Lues — Bad Blood — Siff — Hair-cut — Old Joe

Gonorrhea

POSSIBLE SYMPTOMS

In Women In Men
maybe slight vaginal discharge discharge from penis
maybe some pain when urinating pain during urination
(later) severe abdominal pains sore, swollen testicles
infected bladder infected bladder
infected rectum infected tubes (seminal vasicules or epidedemis)
infected tubes sterility
sterility arthritis
arthritis blindness
blindness death
death

DIAGNOSIS — Look at discharge under microscope (usually only works for men)
Examination of “cultures” of germs from the discharge (where the germs have been allowed to grow for
several days)
TREATMENT — One or more penicillin shots, or some related drug

SLANG NAMES — Clap — Strain — Gleet — Morning drop — A dose — The Whites

Important Information About Penicillin Treatment

Whenever you get a penicillin treatment for any disease, don’t drink any alcoholic beverages for 48 hours. Alcohol
deactivates the white blood cells, which are the agents that actually kill the disease. Even though the penicillin will still
work to stop the growth of new germs in that time, the treatment will be ineffective if the white blood cells are not active.

Boston Venereal Disease Clinics

These are the names of clinics and hospitals in the Boston area where you can be tested and treated for VD. Most of
them have special VD clinics arranged for certain hours during the week. The telephone number listed for each hospital
is the number to call to find out exactly when their hours for VD are. The Cambridgeport Clinic is probably the one that

is the most sympathetic and helpful to kids, but everybody already knows that so you'll probably have to stand in line a
pretty long time. (It’s up to you.)

Cambridgeport Free Clinic, 10 Mt. Auburn St., Cambridge — 876-0284
Cambridge City Hospital — 354-2020

Beth Israel Hospital — 734-4400, ext. 187

Boston City Hospital — 424-4082

Boston Dispensary — 542-5600, ext. 326

Massachusetts General Hospital — 726-2748

Peter Bent Brigham Hospital — 734-5000, ext. 2362

University Hospital — 262-4200, ext. 5356

if Birth Control

I. Making a Responsible Choice of Birth Control Method—Some Obstacles

All of us ought to have the right to make our own decisions about having children: if we will have
/ children, when we will have children and how many children we will have. The spread of contraception
I | has given some of us more choices in these matters, but we have not yet reached the time when all wo-
mt - men can make these decisions with freedom. Religion and economic factors play a large part in keeping
| women from knowing about and/or using contraception. In this society, the right of a woman to know
| about and/or use contraception is still controlled by the state, not by the individual. Check both the laws
i and hospital practice in your state to see how available birth control care is to every woman.

We women have a more personal interest in birth control than men do, for we bear the children, and

in large measure we are responsible for raising them. Numerous and frequently spaced pregnancies can
have serious ill effects on both mother and children. Until men take an unwanted pregnancy as seriously
as women do, they will consider contraception a female problem. However, we women must try to shape
a society where men will make this their interest too. Clearly there is no ideal contraceptive today. The
rhythm method has a high failure rate, the pills have undesirable side effects, etc. As we move into

| more sophisticated research in contraception, it is important that women insist. on male contraceptive

i research being given equal consideration.

The Senate hearings on the pill have made it all too clear that it is imperative that we women know
more about our own bodies and how they function. We have known for a long time that certain inter-
ests are making money off of our ignorance. The birth control pill is no different from any other drug
in that the main interest of the drug companies is first and foremost to make a profit. The prescription
task force of HEW estimated that in 1968 the drug companies spent $4500 per physician per year on

lh advertising and promotion of all drugs.! In 1968 women took $100 million worth of birth control pills.
In 1969 the sale of oral contraceptives amounted to $120 million.?

With such a lucrative product, it is easy to see why the drug companies might want to cover up “un-
iH - fortunate results” stemming from the pill. As early as the Senate hearings of 1963, it was learned that
fe the entire basis for the FDA’s safety decision on Enovid, one of the pills, was data collected on 132 wo-
men who had taken the pill for only one to three years. It has been estimated that 132 is fewer than the
number of women who will die in 1970 from the blood clotting caused by the pill.

| Another area tied in with the drug companies’ cover-up is their failure to solicit doctors’ reports of
a complications arising from the pill. On the contrary, the drug companies actually supported those doc-
a. tors who were ready to publish reports favorable to the pill. In 1966, Dr. Robert Wilson wrote a book,
| Forever Feminine, in which he advanced the theory that the pill could prevent menopause and make a
woman feel young and “‘sexy”’ no matter what her age. In 1964, the Wilson Foundation had received
$17,000 from the Searle Foundation (G. D. Searle is a major drug company, the makers of Enovid and
Ovulen 21). Searle has also given grants to Dr. U. E. Ayre who has done studies to show that Enovid

could not cause and might even inhibit cancer of the cervix.*

| _ The “population experts” have been the second major ally of the pill, pushing it because of its high

effectiveness and not looking so hard at its side effects and hazards. For years Dr. Alan Guttmacher
supported the “‘fertility rebound” theory - that when a woman went off the pill she would experience
an increase in fertility - until a 1966 report indicated that the pill had caused sterility, temporary and
permanent, in about 10% of the women studied.

The drug companies’ cover-up of the hazards of the pill was evident in the patient pamphlets which

distorted or denied known risks. Now, after the pill has been in use for ten years in this country, the

FDA is finally urging doctors that they disclose to their patients the warnings, adverse reactions and

counterindications. But the obstacles to our learning enough to make reasonable decisions do not end

with the drug companies’ cover-up and the population experts’ down-play of side effects and hazards

of various methods of birth control. Our doctors themselves don’t learn all they should, particularly
bees about the pill, a hormone-affecting medication that their patients will be taking for years at a time. And
ee what the doctors do know, they usually don’t pass on. The doctor, trained to treat us as patients, not

es |

people, has given us reassurance rather than the information we need. We can have no confidence in |
such individuals who do not inform us of the possible dangers of a drug they are administering to us.
Some doctors can only be interested in maintaining a kind of MD-priesthood mystique. Dr. Robert
Kistner of Harvard Medical School (one of the most ardent defenders of the pill at the congressional
hearings) was one of the main witnesses at the pill hearings for G. D. Searle, the major birth control pill
manufacturer. When counsel for the plaintiff asked him why he didn’t tell his patients of the potential
risks involved in oral contraceptive use, Dr. Kistner replied: ‘Well, if you tell them they might get head-
aches, they will get headaches.» We can’t take the place of doctors, but we have to demand to know what
is pertinent to our health and safety; instead of relying solely on doctors we must rely on ourselves, our
research, our feelings, our experiences and those of other women. And we must learn about every avail-
able method of contraception so that we are not at the mercy of the typical doctor who says, ““You got
headaches? You got cancer? Okay, here’s a prescription for the pill”; or, “‘I don’t like the pill; here,

take this I.U.D.

No matter what kind of birth control we choose (except condoms), how do we deal with our feelings
of legitimate resentment against the burden of total responsibility for birth control? This is paii.ful, be-
cause it brings home very sharply our vulnerability; we are the ones who get pregnant. From the male
point of view, “the chick got herself knocked up”. This kind of attitude fills us with such rage that we
often take it out on men. We have to cegin to be open with each other and with men about this problem.

If we are going to have sex, we must use contraception. According to United States mortality statis- ‘ |
tics, 100,000 pregnancies would result in about 25 maternal deahts—eight times the death rate associated — |

with the pill from blood clotting. Of those women who terminate their pregnancies through illegal if
abortions, about | in 100 will die. So if we choose to stop using the pill because we are concerned for a)
our health and safety, we’d better be sure that we are protecting ourselves from the higher health risks _ |

of pregnancy and abortions.

The only more or less effective methods of birth control, apart from the pill, are the diaphragm with
cream or jelly, the condom, foam and condom, or the }.U.D. Other methods can: significantly reduce fer- |
tility, but are not effective control methods. The fact that there is no effective, safe, and esthetically pleas- it
ing birth control method serves to maintain the dependent-submissive relationship women have vis-a-vis
men. A women is the one who risks impregnation and if a man doesn’t stand by her and support her,
she has to face the social indignation and psychological turmoil alone. She almost has to feel dependent
on him, to feel that he will not “let her down”. And how humiliating if he does! When a relationship |

|
|
|

which is supposed to be based on mutual respect and/or love is in actuality based on this kind of fear |
and dependence, we can understand the source of much female anxiety in sexuality. Is it this depen- |
dence which is one of the sources of our feeling compelled to “sell”? ourselves to a man, pleasing him i
through consuming a billion dollars worth of cosmetics a year, changing the fashion of our dress every ql
three months, playing the jolly industrious housewife? ib cs

We women demand birth control, not so that we can be used by men in demeaning or inhumane’rela-
tionships; a liberated woman does not mean a “free fuck”. Even as these imperfect methods of birth
control become more and more available, men have put pressure on women to fuck, and many of us feel - |
ourselves under an external pressure to do so, but with those terrible feelings of guilt, anxiety:and dis--
gust. In a submissive, dependent relationship, where women are afraid to make sexual demands, afraid,
to demand that men touch us where it feels good; in a culture where women have been so conditioned Ai
that we have been afraid ‘to experiment with and explore our bodies so we don’t always know what ~~ il
would feel good; in a world-historical situation where women have been inferior and powerless — what’

will it take for us to have pleasurable, fulfilling, guilt-free sexual relations? Far more than just good
birth control methods. But that, at least. is a start.

Il. Conception—The Process to be Interrupted (see pp. 4-8 as well) Hes wth od i

tei 4
The ovaries (Latin ‘‘ova’’=eggs), shown in the diagram on the next page, manufacture eggs and:female i j
sex hormones; the oviducts (‘‘egg ducts’’), each wide as a telephone cord and also called Fallopian tubes il
(after Fallopio, a 16th century physician who discovered them), extending from ovaries to uterus'(from — H
Latin “womb” or “‘belly’’), and the uterus itself. some four inches long. ‘Also: evident is.the cervix (from
Latin “‘neck’’=neck of uterus), protruding into the upper wall of the vagina (Latin for ‘‘sheath’’). One
end of each oviduct extends towards each ovary, and the other end enters the uterus. When a woman:

is standing, the uterus is nearly horizontal so that the small end of it (the cervix) points towards the tip
of the spine while the bulbous end projects forward. The cervical os (Latin ‘‘os’”’=mouth. opening) is
tiny; no tampax, finger or penis can possibly enter.

The ovaries, located four to five inches below the waist and halfway between sacrum and groin, con-
tain some 3000-4000 follicles, hollow balls composed of many layers of cells. However, only about 300
of these will mature egg cells in their centers and release them in the process of ovulation. The other
follicles degenerate before completing development. Each month one follicle begins growing, matures
an egg cell in its center, and moves closer to the ovarian surface. At some point in the cycle, it breaks
through the surface, ruptures, and expels an egg in the general direction of the oviduct. This is ovula-
tion. The egg, trapped by the funneled end of the oviduct, is helped towards the uterus by peristaltic
contractions of the tube (similar to esophageal peristalsis). The journey to the uterus takes about 6%
days, and the egg then has about 12 hours to implant on the uterine wall. If it is not fertilized, it won’t
implant, and the ruptured follicle (which all this time has been secreting progesterone in preparation
for a pregnancy) degenerates; the egg is expelled from the uterus. A scar is left on the surface of the
ovary from the degenerated follicle; in a pre-pubescent girl the ovary’s surface is smooth.

Fertilization is the process of union of egg and sperm. The sperm are ejaculated into the vagina in
seminal fluid. They can move an inch in 8 minutes, so that a sperm may reach an egg (in the outer third
of the tube) in 1’2 hours. The sperms make their way up the cervix into the uterus, and into the tubes,
where they are helped towards the ovary by waving cilia. Cilia are hairs protruding from the cells lining
the oviducts, and as the tubal cilia always sweep in the same direction they create a current that helps
the sperm up towards the egg. Fertilization takes place in the outer third of the tube, not in the uterus.
The cervical mucus is thinnest at ovulation, and thus least hinders the entrance of sperm into the uterus
at that time. (See Ib)

Ill. Hormones of the Menstrual Cycle

The next part of this chapter will concern hormone effects on uterus, ovaries and cervix. This is ne-
cessary for an understanding of how birth control pills work.

The main glands involved in the normal menstrual cycle (Latin “‘mensis” =month) are the ovaries and
the pituitary. The ovaries produce eggs (usually one per month), female sex hormones (estrogen and
progesterone) and small amounts of male hormones (androgens). The pituitary is called the master gland
of the body because its hormones affect almost all other glands and organs in the body. Its interaction
with other glands is controlled by various mechanisms. For instance, by secreting Y, it may stimulate
another gland to produce X. However, if X inhibits Y, as the level of X rises, the level of Y will fall.
Thus, eventually less X will be secreted. This type of control is called ‘‘negative feedback mechanism”
and is important for our discussion. (See Ia)

The cycle starts with FSH (follicle-stimulating hormone), a pituitary hormone which stimulates an
ovarian follicle to grow. FSH is secreted in greatest amounts during menstruation, is lowest at ovula-
tion, and then rises again. This is logical because FSH must be present in greatest amounts to start each
follicle’s development; a follicle begins developing during menstruation. Then at the time of ovulation,
FSH is needed least; the follicle is doing what it was ““meant”’ to do. Then it must rise again, to a level
where another resting immature follicle is stimulated to grow. In a diagram, FSH levels would look like

the diagram on page 44,

What makes the FSH level rise and fall? A rising level of FSH causes rising amounts of estrogen to be
secreted by the cells in one layer of the follicle. Because of the negative feedback mechanism, however,
increasing estrogen causes a decrease in FSH. A word here about atretic follicles. We have mentioned
that most of the follicles in the ovary degenerate before completing development. This is normal, called
atresia, but before the follicles die, they are secreting small amounts of estrogen. As follicles are con-
stantly degenerating, there is a low constant level of estrogen being secreted. This keeps the FSH level
manageable: only one follicle generally grows each month.

Getting back to the cycle, as the estrogen level rises, not only does it inhibit FSH but it eventually
stimulates the pituitary to release two other hormones, LH and LTH. LH, or luteinizing hormone, is a

Nr,

F
Overt an
Hormone 5

Endometrium

Saat |
implantation

‘dom oh um

TN ae ae SE

Causative factor in ovulation and in form
(“luteum” means yellow, and ‘
trophic hormone (again, “luteum’’. or yellow, and ‘‘trophic”
another layer of the follicle to produce progesteron
cells in the yellow body or corpus luteum.

28-day cycle, but if no pregnancy occurs, it

ation of the corpus luteum, the outer layer of the egg cell

‘luteinizing” is thus associated with the yellow body). LTH, or luteo-
, or growth), is necessary for the cells in
e. In other words, it causes growth of one layer ¢
The corpus luteum wouid last from day 14 to day 22 in:
degenerates. It does so because of another negative feec

Le ow.

GROWTH OF AN OVARIAN FOLLICLE

% DEVELOPMENT OF A CORPU DEGENERATION
SLUTEUMX oF THE CORPUS LUTEUM

CHANGES IN OVARY

ESTROGEN SECRETION

OVARIAN HORMONE LEVELS

3
zY
= Was
Elf jen ( :
Ya a? at's o ae wee
¢ MENSTRUAL PHASE i PROLIFERATORY PHASE SECRETORY PHASE os
Peer hit Pitt tt thee tt
° 3-5 4 28
DAYS OF MENSTRMAL CYCLE ORTHO

back mechanism. In this one, the rising progesterone level inhibits pituitary secretion of LH and LTH.
In other words, the corpus luteum’s own secretions are self-hindering. As the corpus luteum degener-

ates, and as estrogen and progesterone levels decline, FSH production is stimulated and the cycle starts
again.

Summary: FSH leads to follicle growth and estrogen secretion. Estrogen leads to FSH decline and
LH, LTH rise. LH, LTH lead to ovulation and progesterone secretion. Progesterone leads to LH, LTH
decline. LH, LTH decline leads to corpus luteum degeneration and estrogen and progesterone decline.

Estrogen decline leads to FSH rise; new cycle begins. Estrogen and progesterone drops cause menstrua-
tion.

This has been the ovarian cycle — from follicle growth to ovulation to follicle degeneration. There is

also a uterine cycle and a cervical cycle, both simpler to explain and both essential for an understanding
of birth control pills.

Uterine cycle: Estrogen causes the uterine lining to proliferate (to grow, thicken, form glands which
will secrete embryo-nourishing substances) and maintains this lining. Progesterone is what makes the
uterine glands start secreting the nourishing substances, and it also increases the uterine blood supply.
(Estrogen also aids secretion but to a very small extent.) An egg can only implant in a secretory lining,
not in a proliferative one. The lining is proliferative, under the influence of estrogen, until the egg is
ovulated. At that point, the corpus luteum starts secreting progesterone, which changes the character

of the lining to secretory. The egg,which takes normally about 62 days to get to the uterus, thus finds
a well-developed lining.

Cervical cycle: The cervical mucus, under the influence of estrogen, becomes thinner and wetter.
Under the influence of progesterone, after ovulation, it becomes thicker and dryer. In addition, the two

sex hormones. estrogen and progesterone. affect the content of the cervical mucus. There is a sharp peak
in calcium (Ca) and sodium (Na) concentrations at the time of ovulation. and this is apparently very
beneficial to the sperm. (About 24 hours before ovulation. there is a sharp drop in CA. and this is the
basis of a new test for telling when a woman ovulates.) The thinness and wetness of the mucus at ovu-
lation aid the sperm’s entrance into the uterus at that time. (See diagram)

Finally. a note on menstruation. Menstruation is no more than the shedding of the uterine lining as
a result of hormone withdrawal. As the estrogen and progesterone levels drop. the lining cannot be
maintained. and it is shed. About 4-6 tablespoonfuls (2-3 0z.) of blood may be discharged. Why does
menstruation only last a week or less? Because the FSH level starts rising after ovulation and a new
follicle starts growing — and starts secreting estrogen. Estrogen, causing growth of the uterine lining.
inhibits further shedding. The timing is such that the whole old lining (except for the bottom layer of
cells, which will form a new lining) is shed before a new one grows. Menstrual cramps are uterine con-
tractions caused by the uterus trying to discharge ‘foreign’ material which won't support a baby.

An interesting sidelight on the importance of hormones might be mentioned here. At the time of
menopause, when a woman runs out of follicles, she gets an estrogen deficiency. Since there is no more
~ inhidition of FSH, the FSH level goes wild, rising from normal (10-80 units) to us high as 350-500 units.
Women who want children but who can’t ovulate regularly if at all suffer from too low an FSH level.
They are treated by injections of a substance called Pergonal — which is actually FSH from “old lady
urine” (from women who have menopausal symptoms and lots of FSH!).

Medical researchers were able to study the hormone levels because these hormones (FSH. LH. LTH)
maintain their structural integrity (their identity), are bound to albumins under the influence of estro-
gen, and are then excreted in the urine. Estrogen and progesterone are metabolized by the liver to vari-
ous compounds also excreted in the urine, and can be detected by anyone with the proper equipment.
For instance, estradiol-17B is the basic estrogen made by the placenta, ovary, testis and adrenal. It is
excreted in urine as estriol in pregnant women, and as estrone in non-pregnant women. The conversion
of estradiol-17B to estriol or estrone occurs in the liver.

IV. Birth Control Pills

How They Work. Currently used birth control pills prevent pregnancy primarily by inhibiting the de-
velopment of the egg. On the fifth day of your cycle, when low estrogen level usually triggers the output
of FSH, the pill gives you just enough synthetic estrogen to inhibit the FSH. So in a month when you
are on the pill your ovaries remain inactive, and there is no egg to be fertilized. This is the same proced-
ure by which a woman’s body avoids unnecessary menstrual cycles when she is pregnant: the fetus puts
estrogen into her blood, thereby inhibiting FSH. So ina way, using much lower levels of estrogen, the
pill simulates pregnancy, and some of the pill’s side effects are like those of early pregnancy. If ovula-

tion occurs, it is because you have been given too low a dose of estrogen in your pill to inhibit your own
FSH level.

Synthetic progesterone is used differently by the two major kinds of pill. With the sequential pill, you
take pure estrogen for 15-16 days, then a combination of estrogen and progesterone for 5 days. This
schedule is more like that of your regular menstrual hormones, but is less effective in preventing preg-
nancy because all it does is inhibit ovulation. The combination pill combines estrogen and progesterone
for the whole 20 or 21 days. The addition of progesterone every day provides two back-up effects:
increased thickness of cervical mucous makes a barrier to sperm, and improper development of the
uterine lining makes implantation impossible should ovulation occur.

For purposes of birth control, then, combination pills are best. Combination pills are better also as
regards safety and side effects: they generally need to use less estrogen, and the estrogen they do use is

consistently counterbalanced by progesterone. (Estrogen has been linked to most of the major and many
of the minor side effects of the pill.)

Combination Pills

Description. Small pills which are taken for 20 or 21 days each month. Synthetic estrogen and proges-
terone are combined in each pill. You take one pill each day. During the days that you are not taking
pills, your period usually comes. The twenty-eighth day pill is a combination pill for women who have
trouble remembering an on-and-off pill regimen, and would do better taking a pill each day. 21 pills
contain hormones, 7 are placebos. (e.g. Norinyl | FE has seven iron pills. There is some question as to
whether iron is good to use, since the placebos have insufficient iron for women who need it, and women
who don’t need iron shouldn’t be getting it.)

Effectiveness. The combined agent pills have a 0.5% pregnancy rate. Pregnancy can occur if you forget
to take your pill for two or more days, if you try to juggle your pill schedule (a couple of days left off
at the end of cycle is okay, but no more), if you don’t use a back-up method of birth control for the
first ten days of your first packet of pills, and occasionally when you switch brands of pill (if you switch
to avoid side effects, use another method for ten days to be safe).

Simplicity. You must see a doctor to get the

pills. Then you have to follow the 20, 21, or 28
day regimen, taking one pill each day. You should
see a doctor every six months when you are on the
pill.

Application. Unrelated to sexual act. Take one
pill cach day, at approximately the same time
of day, with a meal or after a snack at bedtime
to minimize the possible side effects of nausea.
With most pills you start on the fifth day of
your period (the day you start your period is
day one of your menstrual cycle). If you for-
get a pill, take two pills the next day. If you
forget two pills, take two the next day and two
the next, then keep taking your pills but use
another method of contraception for that cy-
cle. If you forget three pills or more, with-
drawal bleeding will probably begin, so act as
though you are at the end of a cycle. Start a
new cycle according to your pill’s regimen, us-
ing another method of birth control as well,
from the day you realized you forgot the pills
through ten days of the next cycle.

Contraceptive
Pils

Reversibility. If you want to become preg-
nant, stop the pill, after the cycle is complet-
ed. If you ovulated regularly before taking
the pill, you will probably resume ovulation
and become pregnant two to five months after
stopping. In some women, the pill’s progester-
one oversuppresses the pituitary’s production
of L.H., and you won’t ovulate. Ovulation
can be made to start, if there are no addition-

al problems, by use of Clomid. If that doesn’ t
work, you may be given pergonal.

Safety. The FDA first approved the pill in 1960.
The longest time the pill has been taken by U.S.

women has been 12 years (in other countries, notably third world countries, the women have used it long-
er). Some doctors have women take it for 3-4 years at a time, with a stop of 3-4 months and another kind
of contraception is used during that time. Other women take the pill for nine months or the length of an

a
-

actual pregnancy. and then stop for several months while using another kind of contraception. As related
in the first part of the chapter. the Senate Hearings (January 1970) connected the pill with certain alleged
health hazards: so tar blood clotting is the only well-established hazard. Unfortunately, a few weeks after
these disclosures. it was possible to predict that up to 100.000 women would be afflicted with unwanted
pregnancies in the few months after the hearings. According to U.S. mortality statistics. 100.000 pregnan-
cies would result in about 25 maternal deaths. whereas only about 3 women per 100.000 pill users would
die of blood clotting. The issue of safety is clearly related to that of personal mental comfort. If you
stop taking the pill. will you be absolutely faithful about using another form of birth control every time
you have intercourse? Once women have had the freedom of the pill. it may become psychologically
difficult for women to use chemical or mechanical methods. The failure rate is high with chemical and
mechanical devices if they are not used regularly.

Infant sexual abnormalities do not seem to be pill-related, but not enough long-term studies have been
done.

Advantages of the Pill.

1. Just about complete protection against unwanted pregnancy.

2. Regularity of menstrual cycle.

3. Lighter flow during periods (combination pill). This effect pleases most women, bothers some.

4. Fewer menstrual cramps or none at all.

5. Pill often brings a sense of well-being and a new enjoyment of sex because the fear of pregnancy is
gone.

6. Relief of premenstrual tension.

Side Effects. In 1963, one out of five women had side effects. By now, the rate is probably lower be-
cause the hormone dosages have been reduced. If you get a bad side effect on one brand of pill, change
to a different one.

1. Gastrointestinal disturbances: nausea, bloated feeling; usually goes away after two months: is less
if pill is taken with a meal or just before bed; use antacid tablets to relieve.

2. Weight gain: androgenic or progestogen-dominant pills like Ortho Novum or Nove Lestrion can
cause appetite increase and permanent weight gain due to build-up of protein in muscular tissue: if you
want to gain weight, this is helpful. Estrogenic pills (Enovid, sequentials, Ovulen) can cause fluid reten-
tion due to increased sodium. This effect is temporary or cyclic. Watch your salt intake, ask the doctor
for a diuretic drug to help stimulate urine production, or change your brand of pill.

3. Headaches and tension from fluid retention. Some women develop bad migraines and have to
change or even stop pills.

4. Breakthrough bleeding or vaginal staining between periods: What happens here is that there isn’t
enough hormone (whether progesterone or estrogen) supporting the lining at a given point in the cycle,
and a little of the lining sloughs off. This may also occur if you miss a pill, as a result of the hormone
withdrawal. It usually happens a week or so after you start the first month of pills. Often it clears up
by the second or third cycle. Some women stop breakthrough bleeding by taking two pills for several
days and then returning to the regular dosage for the rest of the month. This works because the initial
hormone level was lower than what you were used to and the uterine lining couldn’t be supported on
it. So you increase the hormone level and it stops. If it doesn’t stop after a few months, you may need
to switch pills to find ones that more closely correspond to your own hormone levels.

5. Breast changes: tenderness, enlargement and secretion. Breast soreness should last only a couple
of cycles.

6. Rise in blood pressure in susceptible individuals.
7. Sexual desire may be affected, or you may begin to feel depressed.

8. Fatigue: May be due to calcium loss related to muscular activity. The effect of progesterone is to
retain sodium and potassium and lose calcium. As estrogen magnifies the effects of progesterone, both
hormones are responsible. Fatigue, as in early pregnancy, usually lasts only two or three months. —

9. Vaginitis: Can occur with any brand of pills. Vaginitis is defined as a vaginal infection, and may
be yeast, fungus or bacteria. The pills increase the sugar and water content in the vagina, so that all at-
mospheric yeasts or bacteria (or fungi) find the vagina excellent to grow in. It does not always occur,

but the point is that any of the pills could make the vagina more susceptible, particularly to monoliasis.
The combination pills do this the most. If you get recurrent vaginitis, you may have to go off the pill.

Possible Serious Adverse Reactions. Call doctor immediately if you suspect one of these warning signs:
leg pains, blurring vision.

1. Thrombophlebitis and pulmonary embolism, i.e. blood clotting.

2. Neuro-ocular lesions.

Contraindications (conditions which prohibit use of the pill). This is for pills in general, rather than for
combination vs. sequentials. These contraindications make it absolutely necessary for you to see a doc-
tor for a careful examination, pap smear, and taking of your medical history before you go on the pill.

Note: There are some 50 gynecological endocrinologists in the country, and over 25 of them are in
New York or Boston. These are the few people studying the side effects and contraindications of the
pill. More people are needed!

1. DiaSetes: Some doctors feel that none of the pills can be given to people with diabetes or a history
of diabetes in the family such that they might be incipient diabetics. This is because the progesterone in
the pills tends to bind the body’s insulin and keep it out of circulation, just what the diabetic doesn’t
need. Other doctors reason that since a pregnancy can be fatal to a diabetic, the risk of birth control

pills is worth it. These doctors will give pills to a diabetic, and then keep close watch on her blood sugar
count.

2. Cystic fibrosis: Definitely no pills.

3. Hepatitis or other liver diseases: These diseases indicate that the liver isn’t functioning properly.
As the liver metabolizes the sex steroids (progesterones and estrogens), a sick liver should be pill-less.

4. Migraines and epilepsy: Both are aggravated by sodium storage in the cells of the brain. Sodium
storage leads to water retention. This effect occurs especially with the estrogenic pills, which are respon-
sible for more water and salt retention than the androgenic ones.

5. Any disease associated with poor circulation, blood clotting, and heart disease or heart defect, such
as bad varicose veins in you or members of your immediate family. The estrogen in the pill, like the es-
trogen in the body during pregnancy, is suspected of causing blood clots (thromboembolism) and bad
varicose veins in women with a tendency to poor circulation. Sequential pills, with often a higher estro-
gen level and always several days of pure estrogen unopposed by a progestogen, seem to aggravate cir-
culation difficulties more than combination pills do.

6. Undiagnosed abnormal genital bleeding.

7. History of cancer: This and blood clotting problems have been most highlighted in material writ-
ten about the pills. Not enough long-term studies have been done on cancer and the pill. The estrogen
component may help existing cancer to grow, but does not appear to induce new cancer. As no one is
sure of what is going on, a family history of ovarian or breast cancer is contraindicative. Under the
microscope, the cells of a woman on pills have lesions (breaks) resembling cancerous cells, but the same
happens in pregnancy and then returns to normal. This is to say that it is something to think about
seriously. It is also a major reason for seeing a doctor every six months when you are on pills.

8. When nursing: You should not take the pill when nursing. Your milk will probably dry up if the
pill is administered right after giving birth. The reason for this is that pills inhibit LTH, the pituitary
hormone responsible for progesterone secretion, and a nursing mother needs a certain level of proges-
terone in order to produce milk. N.B.: Check on this. Two major source books on the pill say the new
low dosage pills won’t affect a mother’s milk if she starts pills six weeks after delivery. (Kistner’s The
Pill; Peel and Potts’ Textbook of Contraceptive Practice)

Cost. Visit to the doctor, plus $1.50 to $2.50 for a month’s supply of pills. About $16-33 plus MD’s
visits per year. One thing to remember is that you pay for the prettier package that is marked with days
on which to take pills. If you don’t have trouble remembering, get the cheaper brand. Until there is a
medical revolution, there won’t be clearly marked, cheap drugs. This is something we must fight for.
There are over 52 different kinds of pills, but only some 40 different compounds. 80% of these com-
pounds are made by the Syntex Corp. (Maidenhead, England and Palo Alto, California).

Sequential Pills

Description. Same as combination pills: small, must be taken at a certain time each day for 20 or 2]
days each month. The sequential pills do not have a threefold effect. They only stop ovulation without
providing any backup effects. The ovulation process is inhibited by the high estrogen content which in-
hibits FSH. Since the progesterone is given later in the cycle, the cervical mucus stays thin and the uter-
ine lining is suitable for implantation at the time ovulation would normally occur. If the level of estrogen
is too low to inhibit ovulation (remember that the estrogen and progesterone levels vary among women),
there is no protection against an unwanted pregnancy. Therefore, one must be especially careful not to
miss a pill on the sequential regime. Sequentials are, in summary, good for hormone deficiency (estrogen
therapy), but not for birth control. Estrogen and progesterone are given in sequence: estrogen for 15-16
days and progesterone and estrogen combined for five days.

Effectiveness. Sequentials have a pregnancy rate of 1.5% if no pills are missed. If you are on sequentials,
ask the doctor why, and see if you can switch.

Simplicity. Same as combination pills.

Application time. Same as combination pills, except that there is not as much leeway for missing pills
- or even taking them at different times of the day.

Reversibility. Same as combination pills, but remember that there is even more estrogen in the sequen-
tials than in the combination pills. (See discussion of effect of estrogen on FSH.)

Safety. More cases of thromoembolism have been reported by women on sequentials. (See discussion
under contraindications for combination pills.)

Side Effects. See discussion under combination pills. Sequentials emphasize estrogenic effects like nau-
sea, bloating, breast tenderness, hypertension, headaches, heavy periods.

Contraindications. See discussion under combination pills.

Cost. See discussion under combination pills.

Brands of Pills (General)

If you choose to take the birth control pill, how do you determine which pill to take? We should be
aware that different pills have different kinds, quantities and strengths of estrogen and progesterone in
them. (See Kistner’s The Pill for full discussion.) Certain progestogens like Norethindrone produce an-
drogenic (male) effects like hairiness, acne, scanty periods, permanent weight gain. Pills with a less anti-
estrogenic progesterone, and pills with more estrogen, have been reported to increase ‘‘female” charac-
teristics like bloating, breast swelling, heavier periods. Insist that your doctor discuss with you the com-
position of the particular brand he is prescribing. Also, see the following partial rundown on the various
brands, their contents, dosages, and the specific side effects. The British Committee on Safety of Drugs
now advises that only products containing 0.05 mg. or less of estrogen (like Ortho Novum *50) be pre-
scribed because reports of suspected adverse reactions indicate that there is a higher incidence of throm-
boembolic disorder (blood clotting) with products containing 0.075 mg. Or more estrogen than with pro-
ducts containing a smaller dose.

(Brands of Combination Pills (partial listing)

Enovid, Enovid-E. Both contain excessive amounts of progesterone and estrogen. Neither should be used

Norinyl, Ortho-Novum. These pills are the same. They contain one mg. norethindrone and .05 mg. mes-
tranol. As they are extremely anti-estrogenic, they should not be given to women with much body hair,
unless those women like more hair. They produce lighter periods because they favor a thin endometrium,
not very suitable for an egg to implant upon.

Norlestrin. Norlestrin | contains one mg. norethindrone acetate and 0.05 mg. ethinyl estradiol. Made by
Parke Davis & Co., Detroit. The pregnancy rate is about 0.5%. Norlestrin is androgenic.

Provest. Provest contains 10 mg. medroxy-progesterone acetate and 0.5 mg. ethinyl estradiol. It is made

by Upjohn Co.. Kalamazoo. Mich.. has a pregnancy rate of 0.57. and is estrogenic in effect, rather than
androgenic. Derived from 19-nor testosterone.

if Ovulen. Ovulen contains one mg. ethynodre! diacetate and 0.1 mg. mestranol. and is made by G. E. Searle
& Co.. Chicago. It has a pregnancy rate of 0.5% and is estrogenic in effect. Derived from progesterone.

Demulen. Produced by Searle. Demulen | contains one mg. ethynodrel diacetate and 0.05 mg. ethinyl
estradiol. Demulen .5 contains 0.5 mg. ethynodrel diacetate and 0.05 mg. ethinyl estradiol. Demulen
has not been sufficiently studied.

Ovral. Contains 0.5 mg. norgestrel-D and 0.05 ethiny] estradiol. Best for people with low glucose tol-
erance. May find excessive breast growth.

Brands of Sequential Pills
i) : wie
| Except for estrogen deficiency therapy. you should not be using these pills.

C-Quens. Eli Lilly has stopped producing them. If you have a prescription for them. get it changed.

Oracon. Made by Mead Johnson, Evansville, Ill.; the first 16 tablets contain no progestogen, but 0.1 mg.

| ethinyl estradiol (an estrogen) each. The last five contain 25 mg. (very high hormone level) dimethisterone
(a progestogen) each, and 0.1 mg. ethinyl estradiol. The effect of Oracon is midway between an estrogenic
and androgenic pill. and it has a 5% pregnancy rate. Higher breakthrough bleeding is found on these than
on other pills, and there are problems of fluid storage and depression (emotional).

Ortho-Novum SQ. Made by Ortho Pharmaceutical Corp., Raritan, N.J. This sequential regimen is andro-
genic rather than estrogenic, and so the pregnancy rate is less than 5%.

Notes on Pills

The progesterone from which some of the pills are derived comes from Mexican yams (interesting side-
light). Most important, the key to the pills is their biological activity (the compounds they contain), not
the dosage of each one.

List of Suggested Pills

For women with low glucose tolerance and women in general: Ovral, Norlestrin 1, Demulen 1, Norles-
trin 2.5, Demulen .5. For women in general: The ones above and Norinyl 1 and Ortho-Novrim 1.50.

‘V. IUD or Intrauterine Device (“‘coil’’, “‘loop’’)

Description. Gold, stainless steel or, most commonly, radiopaque memory plastic devices in different
shapes and sizes. They are placed semi-permanently inside the uterus. One or two strings extend into
the upper vagina so you can check weekly that the device is still in place. Once the IUD is inserted by a
doctor, nothing needs to be done other than weekly checking, unless there are problems or you want to
get pregnant.

How It Works. The IUD is a mechanical foreign body inside the uterus which acts as an irritant to it.
Doctors think (rather than know) that irritation of the uterus causes tubal hyperperistalsis (very rapid
peristalsis of the oviducts), so that an egg reaches the uterus before maturing, or before a proper secre-
tory lining is ready for it. Another possibility is that the IUD might change the nature of the uterine
lining so that it cannot support an egg. But a recent study was not able to prove that such changes in
the uterine lining could prevent conception.® Other studies are being done to determine if the presence
of the IUD causes hormonal changes which cause the suppression of ovulation.’ Ina fairly recent theory
- the uterine wall responds to the foreign body by sending out macrophages, huge white blood cells which
4 try to get rid of the IUD and, failing that, instead devour egg or sperm or both. Some people find it a lit
tle unsettling that no one knows exactly how the JUD works. Others, uneasy with the pill’s more genera
ized effects and the pregnancy rates of other methods, don’t mind the IUD. At least the effects of the
IUD are local—if something goes wrong, your uterus hurts and you seek medical help.

Effectiveness. Second only to the pill. With Safe-T-Coil, Lippes Loop, Dalkon Shield, Mazlin Spring, 3
pregnancy rate is about 2%. (Drug company representatives tend to give lower failure rate for their de- 3

e 4 most
aa ists used
{U0's @
spring 16 made)
nickel The

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Insertion of Lippes
Loop into Uterus

vice.) With Hall Inhiband, an older design, rate is 3-5% (get yours changed). Some women use foam
with the IUD, all the time if they feel particularly fertile, or for 7-10 days at mid-cycle (see Rhythm).

Application. Needs to be inserted by a competent doctor. Perforation of the uterus, occurring in 1 out
of 2000 women, has been found by the AMA to be primarily the result of faulty insertion by the doctor.
The process can be somewhat painful because the uterus is stretched a bit by the device. You may have
cramps during insertion and for the rest of the day. Take aspirin, a Darvon or Miltown beforehand, or
try shallow panting to keep your mind off it. Does not take long, anyhow—just about five minutes. The
doctor does a “‘souding” of the uterus to check the size and shape. The IUD can be put in a tipped uter-
us. If the uterus is small, as it is if you have had no pregnancies, you'll get a small IUD. (If it is too small
you won't be able to have one at all.) Just before insertion, the Safe-T-Coil and Lippes Loop are straight-
ened out in a plastic tube like a straw; remember, the diameter of the cervical opening is the size of a
thin straw. The doctor gently (we hope) puts the tube into the vagina and up into the uterus through
the cervix. When in place, the IUD is released (except that it’s your uterus [not your vagina], it is simi-
lar to putting a tampon in place; there’s a plunger) and it springs into shape within the uterus. The Dal-
kon Shield comes at the end of an applicator. No plunger is used: the applicator is twisted and pulled
out, the shield remaining in place.

Application Time. After childbirth or during menstruation. Insertion during menstruation is preferred
because (1) it is a little easier at that time; (2) insertion can make you bleed: and (3) most important,
doctors and clinics want to be sure you aren’t pregnant, as an IUD insertion can cause a miscarriage.
IUD can remain in place for years, although it should be checked every six months by a doctor.

Reversibility. A doctor must remove it. Chances of becoming pregnant are the same as before using the
coil.

Safety. Doctors maintain sterile technique when inserting the IUD so that danger of infection is kept at
a minimum. For your safety, be absolutely sure that you do not have V.D. or (have not recently had)
pelvic inflammatory disease when you get an JUD. If you are so infected, you will probably become one
of the 2-4% of IUD-using women who suffer from P.I.D.

Side Effects.

1. The major drawback is the 8-12% expulsion rate. The Lippes Loop and Safe-T-Coil are expelled
much more often by women who have never been pregnant than by women who have had one or more
pregnancies. The Mazlin Spring and Dalkon Shield, which are expelled less frequently, have been devel-
oped particularly for women who have not been pregnant. If you expel the coil, however, it can be put
in again and your chances of expulsion do not increase. The reason for checking the coil each week is.
pertinent here. When it begins to be expelled, it straightens out and cannot always be felt as it passes
through the cervix. Hence, if you feel a bit of plastic at the tip of the cervix, in addition to the two
strings, call your doctor!

2. Heavier and more irregular periods and more menstrual cramps, usually for the first 3-6 months of
using the IUD. This varies among women. Heavier periods are the result of a thicker uterine lining,

cramping occurs as the uterus works to shed the thicker lining and, until it grows accustomed to it, the
IUD.

3. Breakthrough bleeding. This is from irritation of the uterus. It should not continue more than a
few months. If it persists, it can often be corrected by use of a different shape of IUD.

4. Back pain is an occasional side effect. If it persists it can often be corrected by the use of a differ-
ent shape of IUD.

_ Contraindications. Endometriosis. Venereal Disease. Any vaginal or uterine infection. Pelvic inflam-

matory disease. Prohibitively small uterus. Excessively heavy menstrual flow and/or cramping.

Advantages. For many people, psychologically very freeing. You needn’t even remember to take a pill.
Also good for those who object to chemical substances in their contraceptives. Finally, if an unwanted
pregnancy should ensue, the removal of the IUD will result in a miscarriage in two out of three times if
done in the first eight weeks of pregnancy. If you want the pregnancy, you can carry the baby to term
safely and at the time of birth, expelling both baby and IUD normally. Occasionally (after the first
eight weeks), a doctor can remove the IUD without damaging the foetus. You can use tampax with the
IUD. Man’s penis.cannot feel IUD or properly trimmed string.

Responsibility. Woman or man must check strings of IUD once a week, feeling tip of cervix to make
sure there’s no plastic protruding. Be careful not to pull the strings.

Cost. Expensive initially, but nothing afterwards except a doctor visit once every six months. Initially,
$35-50 in Boston, $50-100 in New York. Some private doctors in Boston are cheaper than $35. Many
clinics are as low as $10, some places free.

VI. Diaphragm

Description. A diaphragm is made of soft rubber in the shape of a shallow cup, with a flexible metal
spring forming a circular outer edge. It comes in a variety of sizes measured in millimeters (mm); the
range is from 50 to 105 mm. or 2-4 inches. Approximately one teaspoon (*%4 inches of cream as it comes
out of the tube) or one plunger full of cream or jelly (gel) is put in the shallow cup, around the rim and
on the outside as well. Then the cup is pressed together and inserted into the upper third of the vagina
over the cervix so that it fits snugly behind the pubic symphysis. For extra protection, insert a little ex-
tra cream or jelly after the diaphragm is in place. When it fits properly, you should not be able to feel
it, nor should your partner in intercourse, except occasionally. The diaphragm is a mechanical device,
although the only protection is the chemical one from the cream or jelly. The diaphragm holds the
cream in place and against the cervix.

Effectiveness. From 95-98% effective depending on (1)-effectiveness of cream or jelly (some are much
stronger spermicidal agents than others) and (2) proper fit and proper care. The diaphragm can move -
somewhat during intercourse, as the vagina expands. Do not use vasoline on it. This corrodes the rub-
ber. Check it for holes. Wash it carefully after use, blot dry and dust with tale. Do not boil.

Insertion

Removal

—_

Simplicity. You need a medical exam to be fitted and a prescription to buy it. It isn’t hard to learn
how to use it and one should be positive about handling oneself. It should be put in place one to three
hours before intercourse, as one’s own body chemicals can destroy the spermicidal effect of the birth
control jellies and creams. (The shorter the time, the safer you are.) It should not be removed until
at least six hours after intercourse, and can be left in for 24 hours or more. You need to add another
teaspoonful of cream with an applicator for each additional intercourse. Application can be made by
the man as well as by the woman, or by both of you. Integrate it into your lovemaking.

Advantages. A good method if you have infrequent intercourse. And no side effects! Very effective
if you use it right.

Disadvantages. Closely related to sexual act. You must remember to use it every time, be sure not to
run out of spermicidal cream or jelly, be sure to have it with you when you need it.

Reversibility. Don’t use it if you want to become pregnant.

Comfort. Diaphragm is helpful if you want to have intercourse during your period. It can hold at
least 12 hours of menstrual discharge. Discharge of cream or jelly can be a nuisance; try different
brands. There is less leakage with foam. Can use a tampon or pad for leakage after intercourse.

Responsibility. Woman is responsible. Even if the man puts it in place, the woman must go to the
doctor, be sure it fits right, etc. A woman who always does the whole thing herself (off in the bath-
room) can end up resneting the burden and/or pregnant (doesn’t bother to put it in).

Cost. Diaphragm costs about $4.50. Medical exam is about $15 at a private office, less at the clinics.
Jelly, cream, foam vary in price. 2% oz. tube has about 12 doses. Total is about $56 yearly.

Life of Product. It should be examined every year for size fitting. It may last a couple of years with
proper care; check regularly for holes, tears, etc. (Hold up to bright light or fill with water.) You will

need a new size after a pregnancy, or after gaining or losing 15 pounds.

Popularity. In Guttmacher’s book, it is stated that just under 25% of all married couples of childbear-
ing age use it. No statistics about unmarried couples, nor breakdown according to class. race. ete.

Brand Names of Jellies and Creams. In choosing one brand over another, you have to consider factors
of: (1) effectiveness of the brand as a spermicidal agent: (2) smell and taste of product (oral-genital
play); (3) any allergic reactions on part of man or woman. If you don’t like what you are using.
change. Feel free to try different creams, jellies, etc., as long as you remember the various pregnancy
rates. Preceptin and Koromex are good to use. Other names can be gotten from the Consumer

Union Report (available in paperback ).

VII. Cervical Caps (no longer made)

This product hasn’t been used much since 1950, when diaphragms were generally substituted. It is
like a diaphragm only smaller, made to fit securely over your cervix, where it mechanically blocks
sperm. It is convenient because it can be left on for days or weeks. must be removed only during men-
struation. Spermicidal foam, cream or jelly can be inserted at time of intercourse for additional pro-
tection. Unless the woman puts it in every time she has intercourse, there is no chemical protection
on the inside of the cap, as spermicides are good for three hours at most. For this reason, and because
the cap is harder to put on than a diaphragm, and because it can slip off during intercourse, the cervical
cap is not as effective as the diaphragm.

VIII. Condom (rubber or prophylactic or safe)

Description. Thin, strong rubber (or lamb intestinal) membrane shaped like the finger of a glove.
Open end (1 3/8 in. diameter) is rubber ring; closed end is plain, or may have a pocket nipple of teat
(less likely to burst upon ejaculation). Length is about 7% in. The lamb membrane condoms are
called “‘skin’’? condoms — more expensive, but cut down less on sensation.

How to Use. Put on erect penis just before intercourse, not just before ejaculation — the first few
drops of the male discharge just prior to ejaculation often contain enough sperm for pregnancy to
occur. Remove after intercourse.

Effectiveness. As a mechanical barrier: 5-6% preg-
nancy rate. Combined with chemical if woman uses
foam or cream or jelly: less than 5% pregnancy
rate. Foam and condoms are the best method for
people before they get to a doctor, if pills are for-
gotten, if IUD comes out, etc.

Cautions.

1. Yin. of space left between penis and condom
on plain-ended condoms to collect ejaculate and
prevent bursting;

2. Use lubricant to prevent tearing (spermicidal
foam, cream or jelly, saliva, of K-Y Jelly);

3. Man must hold rin when he withdraws so
condom won't slip off and sperm won’t enter va-
gina.

4. If accident, cream or jelly should be used as

quickly as possible. The 1958 FDA findings show

that | in 350 condoms is defective. Get brand name
condoms, not bargain-types. Brand name condoms Vv The Condom ; Lower lefr

are checked by the government. Watch out for in Store peckage . Lower’ n Iright-
pre-lubricated condoms—lubrication can get on the rolled tnd fee BAY er, for” uses

inside and they can slip off. top - Unroved afprer Use .

Simplicity. Very simple to use; purchase over

McGill Hand book

counter: no M.D. exam.

Disadvantages. Has to be put in place just before intercourse: may be interference. though can be inte-
grated into sex play and put on man by woman. Can irritate woman. especially during entrance of penis
into vagina. if not sufficiently lubricated (either with woman’s vaginal juices, or saliva. K-Y Jelly. or,
best of all, contraceptive foam. cream or jelly). Many men find that condoms cut down on their sensa-
tion.

Reversibility. No problem: don’t use if you want to get pregnant.

VD. Only contraceptive that helps prevent VD spread from penis to vagina contact. Also protects
partners from infecting and reinfecting each other with an infection like trichomonas.

Responsibility. Man. Male contraceptive. so doesn’t interfere with woman's body processes. Man
must be willing to use it. If on long-term relationship with man, may alternate this method with others
that woman is responsible for.

Cost. Three for $1.00 just as effective as more expensive ones: difference is that the latter ones are
thinner and allow for greater sensitivity. $18-60 yearly ($0.35-S1.25 each).

Life of Product. Shelf life of two years. Some can be re-used five to six times if properly cared for (put
in bedside tumbler of water. wash. powder and reroll).

Popularity. Used by one out of four couples who practice birth control. Statistics on unmarried
couples not available.

IX. Effective Spermicidal Agents
A. Aerosol vaginal foam (the most effective)

Description. Comes in aerosol can with plunger-type applicator. Be sure to get the applicator kit the
first time. Foam mechanically blocks entrance to cervix, and chemically kills sperm.

Application. No more than fifteen minutes before intercourse. Shake the can very well (twenty-five
times). Put applicator on top. When applicator is tilted (Delfen) or pushed down (Emko), the pressure
triggers the release valve and a column of white aerated cream is forced into syringe, forcing plunger
out. Insert applicator 3-4 inches into your vagina and push plunger in. Do this lying down, if possible.
Use two applicators full.

Effectiveness. Less effective than creams and jellies when they are used with diaphragm; when used
alone, it is more effective than the creams or jellies used alone. The reason is the different physical
properties. Creams and jellies have a tendency to remain as a lump of material after insertion and are
distributed by penis during intercourse. Foam disperses evenly throughout the vagina even before inter-
course. Thus, the cervix is more consistently blocked by chemical substances with foam than with
creams of jellies alone.

Comfort. More comfortable than creams or jellies because no (or less) leakage; disappears within a
few hours after intercourse with no residue. Use tampax if you feel drippy. There is a problem if you
get to the end of a bottle and are without additional supply of foam; there is no indication that you're
at the end, unless you see the gas without the foam! Keep an extra can on hand. Delfer slows up.
Emko-—a spring on the cap tells you.

Responsibility. Woman.

Cost. 1 oz. bottle (25 applications) is about $3.00; also comes in 2 and 4 oz. sizes which are cheaper
per ounce. It is less expensive than creams or jellies (compare number of applications).

Popularity. Growing.

Brands. Emko Foam, which is more widely known, is reputed to have a 20% pregnancy rate and is
therefore not an effective contraceptive. Delfen Foam — no accurate effectiveness rate, but is con-
sidered to be around 90% effective.

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cervix, which hinders the sperm from entering.

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C. Jellies and Creams for Use with Diaphragm

B. Jellies and Creams for Use Alone (without a diaphragm)

Description. Tube which comes with transparent plastic applicator (plunger). Applicator, for which ;
you must pay more, is easily washed with soap and water. Fill applicator (usually screws onto tube)
with 2 doses within an hour before, but preferably closer to, intercourse and insert it 3-4 inches into
vagina and release plunger; put in another dose for additional intercourse. Action is chemical; spermi-
cidal agents immobilize the sperm cells and also, when in the vagina, form a film or coating over the

Effectiveness. Less effective alone than when used in combination with diaphragm, because the me-
chanical effect of the diaphragm is to keep the cream where it belongs—over the cervix, rather than
spread throughout the vagina. If you must use cream or jelly alone, get your partner to use a con-

Simplicity. No medical exam involved and sold over the counter in drugstores and, in some states, in

Application Time. Needs to be put in place just prior to each and every intercourse. Can be a drag
if you do it alone, can be fun if you do it together.

Reversibility. Just don’t use it if you want to get pregnant.

Responsibility. As seems to be mostly the case, the woman! Get your partner to help put it in.

Comfort. Problems of leakage, allergy or reaction to smell or taste of product. If your vagina is sen-
sitive to one brand, try another. Jelly is gooier than cream. Use tampax if you feel drippy. |

Cost. 2% oz. tube (12 applications) costs about $3.00.

List of Brands. See Consumers Union Report. Preceptin, Koromex A are good.

Contraceptive action of foam

Description. Everything more or less the same as under part B; also, see description of how to use

diaphragm. These tend to be less effective than the ones to be used alone.

X. Birth Control Methods that Don’t Work Very Well

A. Rhythm Method (safe period)

This is the only birth control method approved by the Catholic Church. We mention it in such de-
tail because some Catholic couples are trying to use rhythm without the assistance of a doctor or clinic,
and because too many teenagers and college students, unable to get good contraceptive advice and care,
try to avoid pregnancy by timing their intercourse according to some vague idea that there is a “‘dan-
gerous” time around mid-cycle. You can get pregnant at any time during your cycle, because in any
cycle you might ovulate early or late.

Description. No product involved. Method based on fact that woman usually releases only one egg each
menstrual cycle. Egg has active life of 12 hours;
sperm about 4-5 days. Therefore, 5-6 days each

month that intercourse could lead to pregnancy:
4-5 days before ovulation (egg release) and half day va THE RHYTHM METHOD
after. Normal woman ovulates 12-16 days before eT ee ee
next menstrual period. Formula as follows: ps Or el ieaasiete LENGTHOF | LAST UNSAFE
* SHORTEST DAY AFTER START LONGEST

1. Keep written record of your menstrual cycle — ath aa rencoo _iji oer

for 12 consecutive months. Count Ist day of men- DAYS ane oat 35 DAYS worn oAy
" 9 $s DAY DAYS TH DAY
struation as day | of cycle, and day before next gaa magia Speeeg aye eee
period as last day of cycle. At end of 12 months, "24 bays SAiear SA cave 13H Day
figure number of days in shortest and longest cycles. 25 pays 7TH DAY 25 pays 14TH Day
; : 26 pays 8TH Day 26 pays 151TH DAY

2. Subtract 18 from shortest cycle’s number and aviuave 1 -Oradae 27 Days 161u pay

this determines first fertile or unsafe day. 28 pays 10TH Day 28 pays 17TH DAY
a ; 29 pays 11TH DAY 29 pays 18TH DAY

3. Subtract 11 from number of days of longest SO nays tranny 30 pave 1S1H DAY
cycle; determines last fertile day or day on which 31 pays 13TH DAY 31 pays 20TH DAY

afe period ends. _32 bays 14TH DAY 32 pays 21st DAY
CoP 33 pays 151TH Day 33 pays 22ND DAY

4. Each month, bring list of 12 cycles up to date 34 pays 16TH DAY 34 pays 23R0 DAY
by adding cycle just counted to bottom of list and ae BAYS 7TH OAY 35 oavs__| 24TH DAY

; : ve age 36 bars 18TH DAY 36 pays 25TH DAY
CTOSSINE off oldest cycle on top. vi 37 bays 19TH DAY 37 pays 26TH DAY
! e 38 pays 20TH DaY 38 pays 27TH DAY
A daily record of basal body temperature (mea-
Time-Life

sured on a special thermometer, which only regis-
ters a few degrees, from 96-100° in 1/10 degree
gradations which are wide apart and easily read) is used in combination with the chart of cycles. The
basis of this is that whatever a woman’s so-called normal temperature may be, there are characteristic
(though slight) daily variations within each month caused by ovulation. The cycle runs like this: After
each menstrual period, temperature on awakening low. It may be still lower on the day associated with
ovulation, which is assumed to occur just before or just after lowest morning temperature reading. Af-
ter ovulation, because of action of newly formed hormones, progesterones, termperature rises several
tenths of a degree and remains up until a day or two before menstruation begins. If pregnancy occurs,
temperature remains consistently high for several months since progesterone continues to be formed.
Suspect pregnancy if BBT (basal body temperature) is high for more than 18 days.

Effectiveness. Depends on regularity of menstrual cycles. If variance of more than 10 days between
longest and shortest cycles, not effective because safe period is too brief (true for about 15% of women
Requires a lot of self-control and cooperation between partners. About a 20% pregnancy rate; lower if
diligently use thermometer and calendar and always abstain if chance of ovulation. Not good after preg
nancy; need several months to recalculate safe period.

Simplicity. Complicated to keep chart of menstrual cycles if irregular and to always interpret slight
variations in BBT with accuracy (fever-producing illness or tension leads to rise in temperature, as well
as Onset of ovulation).

Application Time. No devices, but have to have figures for menstrual cycle for one year prior to be
protected at time of intercourse.

oS eae

TE Basal Body Temperature during the menstrual cycle

DAY OF CYCLE |1 2 3 4 S 6 7 8 9 1011 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35)

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4 -
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99.0
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Reversibility. Calculations help tell you period of ovulation, and guide for days for intercourse if you
want to get pregnant.

Comfort. Psychological comfort is lousy; calculating safe period cuts down on spontaneity and prob-
lem increases, since guilt may be felt if one partner wants to have intercourse during safe period.

Responsibility. Need cooperation from both if to work most effectively. Problems: if relationship is
not long-term; if couple are not “‘practicing’’ Catholics.

Cost. $0.03 per chart; BBT $2.50-$4.00; M.D. visits if there is variation in cycles and one needs advice.

B. Douche

Some women try to flush out their vagina with water or other special solution immediately after inter-
course—an effort to remove semen before it enters the uterus. If douche works, it keeps sperm level be-
low number needed to assure fertilization. (Remember only one sperm is needed, but the trip is com-
plicated so many sperm are needed to support odds.)

But douching does not often work: sperm swim fast, and some will reach your uterus before you’ve
reached the bathroom; and the douche, which is liquid squirted into your vagina under pressure, will
push some sperm up into your uterus even as it is washing others away.

Douching is the least effective of all methods, and puts exclusive burden on the woman, who must
hop up to the bathroom immediately. Don’t use it!

C. Vaginal Tablets

Description. Tablets are 2-3 times the weight of aspirin. They are round or arrowhead in shape and
come packaged in tinfoil or in wax-sealed glass vials. One tablet is inserted as far as possible into the
vagina before each intercourse. The tablet needs time to dissolve — 15 minutes to one hour. It may
need to be moistened with saliva or a drop of water before insertion if the vagina is dry. While the
spermicide is incorporated into a cream or jelly base with foams or jellies. in the tablet it dissolves on
contact with moisture and delivers spermicide into upper vagina. The foaming kind of tablet also forms
film over cervix. Although they are one of the less effective methods. some physicians think that they
are One of the most widely used because they advertise. The ads are usually placed in publications which
are more frequently bought by the poor and promise a solution to “‘your most intimate marital prob-
lems.” The women who read these ads can be sure of two things: that the product is to be inserted into
the vagina and that it will take care of ““some problem.”’ The product is not sold with the information
that these suppositories are to be inserted before coitus or even that they are a contraceptive device.
Since pregnancy is one of the biggest “intimate problems” some of these readers have. they buy the sup-
pository and take a chance. The very same suppositories can be bought with a prescription and are a
much more effective birth control method because instructions are included which say to insert one be-
fore each intercourse to prevent pregnancy. Birth control laws in some states do not allow advertising
contraceptive devices. Thus a large segment of the population which could more effectively use this
product is kept in the dark as to how to use it most effectively.

Effectiveness. Less protective than creams or jellies and far less than foams because less sure that it will
dissolve rapidly and be distributed evenly. It is not a reliable method.

Simplicity. Probably the simplest of all current medical contraceptives. No exam or equipment is
needed. But you can also get pregnant pretty easily using them.

D. Vaginal suppositories

Description. Instead of being packaged as a tablet, spermicide is incorporated into a base of glycero-
gelatin, cocoa butter or soap. In this base, they melt ata little below body termperature. All the rest
of the information is just the same as for the tablets. It is interesting that suppositories have been
advertised as “‘feminine hygiene” preparations. Norforms or other “‘hygienic” preparations do not
serve as efficient contraceptives. ;

E. Withdrawal (coitus interruptus or “taking care’’)

This folk method is practiced without medical initiative and passed on from one generation to another.

Description. Withdrawal of penis far away from vagina just before ejaculation, so that semen is de-
posited outside vagina and away from lips of vagina as well. No equipment or preparation needed.

Effectiveness. Not highly effective, because fluid released before ejaculation may contain sperm as
well. But withdrawal is better than nothing!

Simplicity, Application, Comfort. Simple in theory, but hard to apply because of need for discipline
by man and split-second withdrawal. Therefore affects psychological aspects of sex—can’t relax and

lose consciousness. When used over long period, can lead to premature ejaculation by male. Can be

hard on woman, also, if she doesn’t reach orgasm before the man withdraws.

Reversibility. Don’t withdraw to achieve pregnancy!

Responsibility. Man is responsible for withdrawal. He has to feel sure enough of himself so he doesn’t
feel threatened if sperm lands outside woman. Woman must trust man.

Popularity. World-wide, most used of all methods. 5% of couples in America. Used by a lot of U.S.
couples who don't have access to good contraceptive care (teenagers, many college students, poor
people).

XI. Post-coital Medication — “The Morning-After Pill”

Some college health services (Yale, for one) and some doctors will give you a series of high-dosage
estrogen pills if you come in less than three days after unprotected intercourse in the middle of your
menstrual cycle. A lot of estrogen at that point in your cycle will usually affect the uterine lining so
as to make it impossible for a fertilized egg to implant. Check the birth control pills section for the
side effects of estrogen, and you will see why this is not a method to be used often. The dosage used
at Yale is 50 mg. of diethylstilbesterol (two 25 mg. tablets) to be taken together once a day for five
days. You might want to get anti-nausea pills at the same time.

XII. When You Are All Done — Sterilization

Sterilization is a 100% effective, absolutely final form of birth control, available for men and for wo-
men. It is legal in all states, although many hospitals are conservative about it and require that the

_ person be a certain age, with a certain number of children, etc., and that the person have the spouse’s
signed consent. (Other hospitals, notably in ghetto areas, tend to do too many and not entirely volun-
tary sterilizations. Black women in the south are all too familiar with the “Mississippi Appendectomy ”
in which their fallopian tubes were tied or their uterus removed without their knowing it.)

In the traditional sterilization operation for a woman, a fairly large abdominal incision is made, a
piece of each fallopian tube is cut out and the two ends are tied off. A more recent development is tlfe
laparoscope technique, in which a tube with mirrors and lights is inserted through a small incision, the
tubes visually located, and the tubes cauterized (burned) by a small instrument inserted through another
insertion. The traditional tubal ligation is major surgery, unless entrance can be made through the va-
gina. It requires a 4-5 day hospital stay and is accordingly very expensive. The laparoscopic steriliza-

tion requires only a one day hospital stay and is being done on an out-patient basis (much cheaper.
and less convalescing time). Sterilization does not affect hormone secretions. ovaries, uterus or vagina.

Sterilization for the man, called a vasectomy, can be done in a doctor’s office. The doctor applies
a local anaesthetic, locates the two vas deferns (tubes that carry sperm from testis to penis), removes a
piece of each and ties the ends off. The man’s genital system is basically unchanged: sperm are made,
his sexual hormones stay operative, there is no noticeable difference in his ejaculate because sperm
make up only a tiny part of the semen.

XIII. Future Methods of Birth Control

Male contraceptive research. At first a birth control pill was developed for men, but it drained-a

man’s ability to have an erection as well as acting as an antidote to the potency of the sperm-

producing cells. Now researchers are working on a sperm capacitation pill in Sweden and California.
This will stop the sperm’s ability to penetrate the egg. It may be available in two to three years. As yet,
no compound has reached serious clinical trial because of, as the British Medical Bulletin states it, “ap-

prehension regarding the risks involved from tampering chemically with the male germ cells.’”8 (our em-
phasis)

Female contraceptive research involves some of the following: (1) Trying to put progesterone on
IUDs. This would change cervical mucus and the uterine lining, thus making conception even less likely.
(2) Work on a pure crystalloid which will let a small amount of its contents out into the body each day.
The body will absorb an amount directly proportional to the surface area of the crystal (crystalloid),
which is a long oval and is inserted under the skin. This will be available in about two years, and will be
pure chlormadinone acetate (like the minipill).. Now it must be replaced once every six to eight months.
Hopefully the time can be reduced to once a year by the time it is released. The crystalloid would release
0.35 mgm. per day continuously into the circulation. You could check on the contraceptive protection
from time to time by feeling for a little bump under the skin of your arm or thigh. The problem of the
body reacting to the crystalloid as a foreign body may be solved by use of silastic, a silicone. (3) There
is an injection almost ready for release. This is pure cma: latex crystals with cma attached. The latex
isn’t well handled by the body, so problems still exist. (4) Doctors can now tell when a woman will
ovulate 12 hours before she does. This is done by measuring the sodium and calcium levels of the
cervical mucus, using flame photometry and spectrophotometric radiometry.” (5) There is research

going on in the use of prostaglandins, chemicals which are known to cause uterine contractions. Pros-
taglandins might be worked into a pill that could be taken once a month to bring on a period whether
the woman is pregnant or not.

Some of this research is frightening and confusing. We don’t want contraceptives to become one
more area in which we are intimidated and frightened into doing things we’re not sure of or don’t
want to do. Each of us has the right to choose a method that is best for us and to understand that z
method in terms of application, effectiveness, safety, etc. For we alone best know what our needs
are.

FOOTNOTES

‘1. Health-Pac Bulletin, March 1970, p.12. 2. Ibid. 3. Ibid. 4. Ibid. 5. Ibid., p. 11.

6. W.A. Kelley, Journal of Reproduction and Fertility, vol. 19, 1969, p. 338.
7. A. Pakraski and G. G. Ray, Journal of Reproduction and Fertility, vol. 19, 1969
8. British Medical Bulletin, vol. 26, 1970. 9. Conversation with Dr. Kosasky, 1969.

SUGGESTED BOOKS TO READ ABOUT BIRTH CONTROL

(All are paperbacks except Demarest and Sciarra.)

Demarest and Sciarra, Conception, Birth and Contraception, McGraw-Hill, Inc. (New York: 1969), $8.95
Kistner, Robert W., M.D., The Pill, Dell Publishing Co., Inc. (New York: 1969).

The McGill University Student Society Birth Control Handbook (available from New England Free Press or from
McGill Student Society)

Neubardt, Selig, Contraception, Pocket Books (New York: 1968).
Peel and Potts, Textbook of Contraceptive Practice, Cambridge University Press (Cambridge: 1969).

Yale University Student Committee on Human Sexuality, The Student Guide to Sex on Campus, New American
Library (New York: 1971).

Abortion

INTRODUCTION

Abortion is our right — our right as women to
control] our own bodies. The existence of any
abortion laws (however “‘liberal’’) denies this
right to all women. The abortion laws symbol-
ize the oppression of women in America and the
lies that support it: sex is beautiful; motherhood
is the ultimate fulfillment of women; children
are a full-time joy; and poor black, brown, white
women have the same opportunities as rich white
women.

We often become pregnant because we are
forced to believe that we are only acceptable as
sex objects and mothers. We are taught that sex
is not quite right (even though we are taught to
be sexy and flirt) so we’re scared to ask those
who may know where to get birth control and
which birth control methods are most effective
for help. For if we ask/get birth control, then
we are admitting we are doing that bad thing —
having sex. Or even when we do ask, we can’t
get birth control, especially the most effective
means, legally if we are unmarried and certainly
not as teenagers (in Massachusetts).* And even
if we can get the most effective method as far
as pregnancy prevention, it may not be the best
method for individual ones of us (for example,
we may have a family history of cancer and per-
haps should not take the pill). Birth control is
better than nothing, but there is no such thing
as an ideal method (i.e. one which is safe, sim-
ple, cheap and effective) yet. Birth control does
fail because the methods are imperfect, not be-
cause we are stupid. Nevertheless the blame
falls on us.

The risks are indeed great. Although the risk
of death for an abortion done under proper med-
ical supervision during the first 12 weeks is less
than for a full-term pregnancy, only 1% of Amer-
ican women can get legal abortions; some 1000-
5000 die each year of illegal abortions — the
most common cause of maternal death in this

* There is an exception to this, which was placed
in Roxbury (the implications being none too
subtle). At the Boston City Hospital Family
Planning Clinic in the Ob/Gyn outpatient depart-
ment, women can get many methods of birth
- control, including pills, free, regardless of age and
marital status. This program is financed by the
federal government, but the people working
there are fairly nice.

country. Sterility is another frequent result. The
risks to our mental health are enormous too. Either
we have to deal with the fear and trauma of getting
a “‘criminal” abortion (even though we know in our
heads that we should have the right to control our
bodies, we live in a schizophrenic system that sepa-
rates our minds from our bodies and tells us we
shouldn’t have that control) or the fear and trauma
of having an unwanted child which we may have to
raise by ourselves. We’re freed from the rat race of
the work world to face the ‘‘calm”’ of the home (40%
of women have full time jobs as well as full respon-
sibility for children).

If you’re white and middle class you’re still op-
pressed as a woman. Our poor white sisters are op-
pressed by class and sex and our black and brown
sisters by race, class and sex. Some of us suffer more
than others. 75% of women who die from abortions
are non-white (most of those abortions are done il-
legally). 90% of all legal abortions are given to white,
private patients. All of us want the choice only
available to the rich now.

Most important, we want those abortions to be
voluntary as well as free and safe; genocide of poor
and black peoples to keep the most oppressed popu-
lations in check is a real fear when abortion laws are
repealed. We don’t know from our own experiences -
since we’re white and middle class - whether other
women are forcibly made to abort or be sterilized.
Whether or not it is true, it is a fear that should be
faced. For this reason it’s crucial that whenever we
talk about abortion, we talk about the implications
for all women. One woman cannot be liberated with-
out the liberation of all women.

We must fight against those who keep us down:
(1) the legislators who use their power to prevent re-
peal of all abortion laws (don’t be fooled by “‘re-
forms’ — there have been just as many illegal abor-
tions in Colorado after the law as before); (2) the
medical profession that uses the laws to maintain its
power by defining the legality of each case and by
making profits off the legal abortions they choose to
do ($350 to $1000); and (3) the racketeers who pro-
fit from abortions ($150 to $1000) as they do from
prostitution (again women), drugs, etc. We are de-
manding free, safe and voluntary abortions, for all
women who want them, to be carried out in proper-
ly equipped hospitals or clinics by humane and quali-’
fied personnel.

HISTORY

One of the myths that anti-abortionists use to in-

fluence legislators and to harass and scare the wo-
man with an unwanted pregnancy is that abortion
violates some age-old and god-given ‘“‘natural law’’.
One look at history shows that they are lying or
terribly misled. Until one hundred years ago al-
most no one - not even the Catholic Church - pun-
ished abortion in the early stages of pregnancy.
Lawrence Lader says that “the Greek city states
and ancient Rome, the foundations of Western
civilization, made abortion the basis of a well-
ordered population policy.” (Abortion, p. 76)
Christianity infused the fetus with a soul, but dur-
ing eighteen centuries of debate the Church went
by the conveniently loose view that the fetus be-
came “‘animated”’ by the rational soul and abor-
tion was therefore a serious crime only at forty
days after conception for a boy and eighty days
for a girl. (No methods of sex determination were
specified.) English common law by the thirteenth
century settled into a fairly tolerant acceptance of
abortion up until “‘quickening’’, the unspecific
moment usually in the fifth month when the wo-
man feels the fetus move. In the United States for
a long time the common law inherited from Eng-
land protected the right of abortion of early
pregnancy.

Suddenly in the nineteenth century things
tightened up. In 1869 Pope Pius eliminated the
distinction between an animated and non-animat-
ed fetus, and since then the Catholic Church has
called all abortion murder and punished it severe-
ly. Anti-abortion laws were first passed in England
in 1803 and became stricter through the century.
Connecticut in 1821 punished abortion of a fetus
by poison after it had quickened, but as in other
states a succession of laws followed which cul-
minated around 1860 in outlawing all abortions
except those “necessary to save the life of the
woman.”

There were three main reasons why abortion
suddenly became a “‘crime’’. The first was quite
decent: abortion until recently was a dangerous
operation, methods crude, antiseptics scarce, even
hospitals dirty. It was in part the mid-nineteenth
century wave of humanitarianism which pressed
for abortion laws to protect women. The second
motive of the anti-abortionists was less laudable.
As biologists in the nineteenth century began to
understand conception, women began to practice
more effective contraception. Catholic countries
like France began “‘losing”’ the population race,

, and the Church wanted to keep its mothers run-

ning. So the Church itself turned to biology and
used the idea that “‘life’’ and therefore soul-infused
human life begins at fertilization. This reasoning
also spread to England and the U.S. It so hap-
pened that English and American industries needed

Ti aihep e See ee ahr

workers, the huge farmable territories of the new
world needed farmers, and the Civil War had de-
pleted America’s labor crop. Abortion laws saw
to it that woman took her place beside the other
machines of a developing economy.

The third reason for the sudden emergence of
anti-abortion laws is the most dangerous: it is the
idea that sex for pleasure is bad, that pregnancy is
a punishment for pleasure, and that fear of preg-
nancy will reinforce ‘“‘degenerating”’ modern mo-
rals. These ideas had long fought for supremacy
in the Catholic Church, and showed in 1869 that
they had won. The English and American puritan-
ism which still perverts our minds flourished in the
nineteenth century; it is significant that the 1873
U.S. federal law which banned from the mails any
literature, medicine or article to do with contra-
ception or abortion, was engineered and executed
by Anthony Comstock, fanatical secretary of the
New York Society for the Prevention of Vice. To-
day the idea that sex is bad is worked with cruel
sadism on the victim of an unwanted pregnancy
by her community and, worse, by her doctors,
many of whom underneath it all feel that a little

_ humiliation and a little pain might teach a girl a

lesson. It is partly this thinking which slows down
development of quick and painless methods of
abortion. And in a majority of states, including
Massachusetts, puritanism still works to keep abor-
tion laws and practices rigid. The legislators of
morality, undaunted by Prohibition, cannot stop
sex but do send one million American women a
year underground for dangerous and often fatal
(3000 a year) criminal abortions.

ABORTION PRACTICES IN SOME
OTHER COUNTRIES

Not all countries have stayed with the nine-
teenth century’s obsolete and cruel abortion reg-
ulations. Law and practice opened up abortion to
both rich and poor in Scandinavia beginning with
Iceland in 1934. We should notice that pressure
for abortion reform in Scandinavia, as in England,
came from not only the general public but also na-
tional medical associations and distinguished doc-
tors, whereas in the U.S. the medical profession
has been a major obstacle to change. Abortion in
Scandinavia is not given on demand, however:
there are strictly defined categories of legal abor-
tion, mostly medical categories, but also humani-
tarian (e.g. victims of rape), ““eugenic’”’ (e.g. for
cases of predictable fetal deformity), and in Nor-
way and somewhat in Sweden, social (e.g. where
poverty, too many children already, alcoholism,
etc., would make the birth of the child a misfor-
tune). A Scandinavian woman has to go through
a lengthy bureaucratic procedure to “qualify”

under one of these categories; as a result, few for-
eigners come to Scandinavia for abortions, many
Scandinavian women go to Poland instead of wait-
ing around at home, and the women who do get
legal abortions are often past the time limit for a
simple operation and must undergo more serious
surgery and therefore more risk.

In Russia and the Communist Eastern European
countries ideology values a woman’s independent
contribution to society and counts her an equal
with the right to control her own reproduction,
and the economic conditions have made workers
desirable and housing scarce. So despite the Cath-
olic Church, Russia off and on since the 1920s and
since the 50s Hungary, Poland and the rest of the
Eastern Bloc, have legalized abortion on demand
and perform in some cases more abortions than
live births. (Abortion rates will go down as con-
traception spreads.) The results of Eastern Euro-
pean abortion policies have been striking: Hun-
gary’s one-child family proves that abortion works
as population control; fatality rates are miniscule,
far lower than for childbirth or for simple tonsi-
lectomy in the U.S.; and criminal abortion, unlike
criminal abortions in Scandinavia, have been great-
ly reduced. Contraception, however, is spreading
at varying speeds and with different amounts of
government support in these countries, with, as of
1965 (Lader) the USSR being the most ambivalent
and Poland requiring contraceptive classes of all
women who have abortions.

Japan, where there are no religious or moral ob-
stacles to abortion, actually arrived at abortion on
demand as a matter of national survival. Countless
troops were returning home after World War II to
a devastated economy and a baby boom resulting
from war-time nationalism. The Eugenic Protec-
tion Law of 1948 and two later amendments, along
with low abortion costs, instituted abortion as the
national method of population control. It worked
fantastically, cutting the Japanese birthrate to less
than half in fifteen years. Japanese experience
with abortion demonstrates again that legal abor-
tion is safe, that legal abortion kills criminal abor-
tion, that a woman’s body does not suffer from
having repeated abortions, and that the psycho-
logical consequences of abortion in a society where
abortion is legitimate are only good.

Two side issues are worth noticing. First, Japan
has had a lot of trouble popularizing contraception
because abortion is so effective and so cheap. Se-
cond, the 13 February 1970 issue of Science maga-
zine reports that Japanese Prime Minister Sato has
reversed his position on population growth be-
cause the shifting age of the Japanese population
(older) means there are fewer workers for the fac-

Birmingham, where conservative doctors are exer-

tories making cars and cameras for America; he

urges Japan to strive to bring the birthrate up to

the “‘average”’ level. This attitude is ominous: pro-

fit, short-term economic development, and assidu-

ous exploitation of all available resources are clear-

ly the motives at work. Woman in Japan is still the

tool of economics and nationalism, which come

also before any consideration of world population

growth. |

England legalized abortion in 1967. Although
there is a statutory list of indications, and the doc- |
tors have held on to the final word, in effect abor- |
tion in England is on demand. Abortion is given
in the cases of threat to the woman’s life or physi-
cal or (widely interpreted) mental health, in the -
case of fetal deformity, and in the broadly inter-
preted social case of a threat to the physical or
mental health of existing children in the family.

The English were conscious at the time of the pass-
ing of the law that their facilities for abortion
would need quick and substantial expansion. But
the pressure on abortion facilities has turned out
to be quite uneven, with London bearing the brunt
of demand from out-of-towners from places like

cising their right within the present law to refuse
to perform abortions. London doctors also enjoy
a lively private trade from foreigners, especially
American women, who try to keep their numbers
secret so the door won’t shut.

U.S.A.: ABORTION REFORM OR
REPEAL, AND MEDICAL
CONSERVATIVISM

Since England, Japan, Eastern Europe are out
of the question for all but the richest of American
women, we have to move from these topics to face
our own abortion situation, which is improving in
some states but still does not look good. So far,
inertia, the strong Catholic minority, puritanism,
an extremely conservative medical profession,
sexist legislatures and the American woman’s am-
bivalence towards sex and towards her rights re-
garding her body, all have kept our abortion rigidi-
ties Operating, even in the few “enlightened”
states where reform along Scandinavian lines has
been achieved. As this paper is being written, it
looks like a number of states are moving towards
either legislative or judicial repeal of their abortion
laws. We are including the following discussion of |
the shortcomings of abortion reform not only for
historical interest, but also because we suspect that
many of the factors which give women in reform
states such a hard time won’t be changed merely
by repeal of restrictive laws. |

By mid-1969 five states (California, Colorado,

Georgia, Maryland, North Carolina) had modified
their abortion laws according to the American Law
Institute guidelines wherein abortion is permitted
for five reasons: if the pregnancy is the result of
rape or incest, if the mother has rubella (german
measles) or is under fifteen years of age, or if her
health is seriously endangered by the pregnancy.
The important word there is “health”? which can
be interpreted as mental health, allowing for-abor-
tion on psychiatric grounds. The abortion permit-
ted under these laws is called a “‘therapeutic abor-
tion’’, as though none other than a hospital abor-
tion can be considered therapeutic. By the end of
1969, five additional states had reformed their
laws (Arkansas, Delaware, Kansas, New Mexico,
Oregon), with Kansas and Oregon adding to the
ALI statutory list a provision for risk to existing
children and environment. A number of states
have reform actions under way.

But reformed abortion laws in the hands of the
American medical profession are just as bad as the
old laws, and often worse. The whole notion that
a certain woman “deserves” an abortion is an _ in-
sult, and opens the woman up to the degrading
procedure by which doctors and hospitals judge
whether she falls into some category of qualifica-
tion. And the medical profession hides behind the
list of qualifications, using it more to turn women
down than to accept them. According to Larry
Plagenz (Modern Hospital, July 1969), the number
of abortions in some California hospitals has in-
creased six-fold since the law changed, while some
have stopped altogether, and meanwhile the state-
wide rate of 100,000 yearly illegal abortions con-
tinues unabated. Dr. George Cunningham, Chief
of the Bureau of !Aaternal and Child Health, stated
in the same article that “hospitals that want to can
make the procedure for obtaining an abortion com-
plicated, time-consuming and expensive. One me-
thod is to require two psychiatrists’ statements
when the law requires only one.” The “‘abortion
committee’’, rarely required by law, is the shield
used by hospitals in many states. After a case has
been approved by two or more specialists, it must
be passed by a committee of three or more rotat-
ing senior staff members, and a unanimous vote is
often reguired. As it is not uncommon even in
non-Catholic hospitals for there to be a Catholic
or a conservative doctor on the board, most cases
are turned down. (We object not to a doctor’s re-
fusing on personal grounds to perform abortions,
but to his being able to stop other doctors from
performing them.)

Even if a case seems “‘deserving’’, the hospital has
often already filled its weekly, monthly or yearly

* quota of abortions, set in accordance with the
Ob/Gyn profession’s unofficial ratio of abortions

to live births for a given year. Another obstacle to
the approval of this “‘case’’ (remember this is a wo-
man) is the availability of a hospital bed. Medical
people piously assert that they can’t make full use
of the existing law for fear of being flooded with
abortion requests, which would fill up the beds.
But they are likely to see each woman one way or
another, either for delivery or for emergency

treatment after a botched illegal abortion; and in

these cases she’ll be taking up a bed for five or
more days. Abortions do not have to be so bed-
consuming: it is our doctors themselves who say
that an abortion patient must be hospitalized for
two nights, whereas in England women leave the
clinic six hours after-the operation and in Rumania
they leave after two hours (not to mention the
speedy departure some of our same doctors urge
on their illegal abortion patients). A further obsta-
cle to moving abortion out of the hospitals into
out-patient settings is current medical insurance
policy, which does not cover out-patient health
care.

The case might also be rejected because the hos-
pital is a teaching hospital, and although teaching
hospital staffs tend to be more liberal than most,
they want to do only so many abortions because
abortions are “‘dull”’ and “‘uninstructive’”’. Clearly
the doctors are resisting the notion of themselves
as public servants. They resist also the idea that as
public servants they might perform on demand —
for they are steeped in a professional tradition in
which the doctor knows all and the patient nothing.
Whereas this might be true with appendectomy, it
is not true with abortion. Dr. Lonnie Myers of the
National Association for the Repeal of Abortion
Laws quotes a poll of all doctors’ views on abor-
tion, in which the only group which came out con-
sistently for abortion on demand was the plastic
surgeons. Plastic surgeons, the only doctors whose
patients decide what is to be done, do not consider
operating on demand a threat to their professional
sanctity. Women must see to it that Ob/Gyns, who
came out on the opposite end of the poll, start to
feel this way not only about abortion, but about
the whole range of their services to women. (By
the way, this is not a plug for plastic surgeons;
we abhor both their cosmetic type of work and
the fantastic rates they charge.)

Doctors show also by the fees they charge that
they do not consider themselves public servants.
Women, always the major health consumers, really
bear the brunt of abortion costs. Fora purely
medically indicated D& C,.a doctor charges about
$200, while he gets $300 and up for the same tech-
nique when it happens to be a therapeutic abor-
tion. If he is doing it illegally; he gets upwards of
$1000 for the risk he is taking. The cost of a

therapeutic abortion in Washington, D.C. in March
1970 was about $600, half for doctor’s fee and
half for hospital charges. Medical insurance does
not always cover the cost of a T.A., especially em-
ployee insurance, university health plans, and al-
most all plans for the single woman (who can some-
times get the hospital to list her operation as a
simple D&C). There has been a suspicion voiced
that doctors play down abortion because delivery
is more remunerative, but actually there is a lot

of money in the abortion business, as some Lon-
don Ob/Gyns are discovering, and as the under-
world has known for a long time.

Medical conservatism will hold out for a long
time against both abortion on demand and abor-
tion for low fees. The individual doctor does not
break out of the system because he has been forced
to work hard for sub-standard pay for many years,
and just as he starts to make the money that he has
come to think is his due, he doesn’t dare risk his _
job by performing abortions or by urging his hos-
pital to allow more of them. Medical conserva-
tism feeds on itself.

So even in reform states a legal therapeutic abor-
tion is almost impossible to get. The clinic patient
without a private doctor and psychiatrist and mon-
ey to help her over the obstacles gets little benefit
from reformed abortion laws. About 80% of hos-
pital abortions last year went to middle and upper
middle class white women, while 75% of the deaths
from illegal abortions hit poor non-white women.
And even for the more wealthy woman, the pro-
cedure is lengthy and degrading: as in divorce pro-
ceedings where infidelity must be proved or faked,
so in obtaining an abortion on the usual psychiat-
tic grounds a woman must feign mental illness and
often finds herself labeled psychotic.

Clearly the only just alternative is the repeal of
all restrictions on doctor-performed abortions (un-
til methods are developed which can be applied by
non-doctors). In early 1970 Hawaii removed all
restrictions except that abortions be performed
by physicians in hospitals on residents of 90 days
or more. California courts have struck down the
1967 “reformed” law. Vermont abortion repeal
advocates have defeated a strict reform law. The
federal court for Washington, D.C. declared the
abortion law unconstitutional because it was too
vague, going on to say that no doctor should have
to bear the burden of proof that the law invaded
a woman’s liberty and the right of privacy which
“extends to family, marriage and sex matters and
may well include the right to remove an unwanted
child at least in the early stages of pregnancy.”

But the doctors remain in control. Current abor-
tion law repeal sentiment, as voiced by the active

National Association for the Repeal of Abortion
Laws, tends as in the D.C. court and the Hawaiian
legislature to lean towards leaving abortion up to
“the woman and her doctor.”’ This seems to be a
bad idea. The Washington, D.C. situation in March
1970 shows that even total absence of law does not
convince or liberate the medical profession. At
this writing Senator Robert Packwood of Oregon
has had to introduce a bill authorizing D.C. hospi-
tals and doctors to perform abortions because they
have been so slow to respond to the court’s verdict.
(Senator Packwood did, however, slip in one un-
fortunate clause requiring the husband’s approval.)
The same recalcitrance that doctors have shown in
reform states will operate to hold down abortions
in repeal states until women get together and press
for abortion clinics, shorter or no hospitalization,
low fees, and, most important, for abortion on de-
mand. As long as abortion is up to the doctor, it
will be hard to get.

THE ABORTION SITUATION IN
MASSACHUSETTS — MARCH 1970

(Courses given elsewhere can substitute
local information. )

Although Massachusetts is a Catholic state with
the most backward birth control laws in the coun-
try, the Mass. law on abortion is vague and there-
fore quite liberal. It states merely that unlawful
abortion is illegal, implying that there is such a
thing as “‘lawful’’ abortion. Physicians in the state,
especially in Boston, have long considered thera-
peutic abortion lawful under certain circumstances.
This interpretation of the law has been approved
by the Mass. Supreme Judicial Court in the 1961
case of the Commonwealth vs. Brunelle. In later
cases (Commonwealth vs. Wheeler, vs. Nason, vs.
Corbett), the court allowed the physician to pro-
cure an abortion for a patient in case of a threat
to her life or to her mental health. Although the
inclusion of mental health as grounds for abortion
seems liberal, the problem in Massachusetts rests
in_the final clause: “‘... if his judgment corres-
ponds with the general opinion of competent prac-
titioners in the community in which he practices.”
The “general opinion” of Massachusetts doctors
has been most conservative, and they have not
made full use of the court’s interpretation of the —
law. (See the section on medical conservatism. )

As aresult of the doctors’ hesitation, only about
2000 hospital abortions were performed last year
in Massachusetts, almost all of them in six major
Boston hospitals. (The rumor that many private
doctors admit patients for a ““D & C” which is
really an abortion is perhaps truer of out-lying
areas than of Boston, where most hospitals are

teaching hospitals with pathology labs which ana-
lyze every bit of tissue removed.) At least 90% of
the therapeutic abortions are done under the men-
tal health provision of the court. The protocol for
establishing eligibility varies from hospital to hos-
pital, the Beth Israel being the least restrictive. In
general most require the consent of the woman’s
gynecologist, two psychiatrists, the chief of gyne-
cology and/or the abortion committee of the hos-
pital. In the middle of August 1969, the Boston
Hospital for Women, Lying-In Division, one of
the most conservative hospitals, tightened up its
abortion policy. BLI now requires that the candi-
date for an abortion have been diagnosed as
schizophrenic prior to becoming pregnant, or that
she be undergoing treatment simultaneously with
her pregnancy, and strongly advises that she con-
tinue with counseling for several months after the
abortion. Even in the more liberal hospitals the
qualification procedure is long, insulting, expen-
sive, and often leaves a woman two or three weeks
more pregnant with the hospital door shut in her
face.

The Boston abortion is expensive, about $600
by the time the doctor’s and hospital bills are
paid, even more if a number of psychiatrists were
seen. Blue Cross/Blue Shield will pay for a thera-
peutic abortion for a married woman only. Wel-
fare usually covers its recipients. The Boston City
Hospital takes five “‘charity”’ cases a week for con-
sideration, which sounds magnanimous until you
_ realize they don’t take all the cases they consider,
and even if they did it would be only 260 a year.

Groups Counseling Women with Unwanted
Pregnancies

The Massachusetts resident or student with an
unwanted pregnancy has a few places to turn be-
fore she starts on the lonely road underground.
She can, of course, first try her doctor, who might
surprise her.

A. The Pregnancy Counseling Service, 3 Joy
St., Boston. 523-1633

To examine her legal alternatives the woman
with an unwanted pregnancy can go to the PCS,
where a counselor will help her figure out what
she might do if she chooses to continue the preg-
nancy, or, should she choose to stop the pregnan-
cy, the counselor will help her determine if she
can (and is willing to) qualify for a T.A. at a Bos-
ton hospital, or if she can qualify in a more liberal
state. The PCS will help the woman with which-
ever alternative she chooses, and will also give her
the names of doctors who will give her means of
contraception. The PCS will also describe for her
the safe and unsafe methods of abortion, in case

she has to turn underground. The PCS is working
to establish an independent medical facility for
abortions, which involves persuading doctors to
take advantage of the current vague law. The PCS
is, of course, broke and welcomes volunteers and
contributions. They have a good fifteen hour
training program for counselors.

B. The Clergy Consultation Service. 527-7188

The clergy helps a woman consider all her op-
tions, and if she is forced underground they try to
help her avoid a bad illegal abortion. The woman
calls the central number and is informed by a taped
message which clergymen are on duty that week.
She then calls and makes an appointment with the
one she chooses (various faiths are represented),
to whom she brings a doctor’s statement of how
far along she is in pregnancy. The CCS always has
a few weeks’ waiting list and so can help only wo-
men who are under ten or even nine weeks preg:
nant. To protect themselves the Clergy sends wo-
men out of state, most often out of the country.
They try to adjust the fees to the client’s ability
to pay. Despite some crackdowns and arrests,
Clergy Consultation Services operate in many cities
and states.

C. The Parents Aid Society, 1575 Common-
wealth Ave., Boston. 783-0060

This advisory service is run by Bill Baird, and
we do not know exactly what kind of referrals he
makes.

THE NEW YORK ABORTION —
MARCH 1971

Women in the Boston area who come to Preg-
nancy Counseling Service (3 Joy St., Boston; 523-
1633) are usually directed to clinics or hospitals
in the New York City area (unless they qualify for
and want a legal Massachusetts hospital abortion,
which PCS can advise on too). There is presently
no New York residency requirement, though this
may change, and New York City costs are lower
now than elsewhere in the state. Out-patient clin-
ics take women up to 12 weeks after their last
menstrual period (LMP). Besides sound medical
care, clinics avoid hassles and extra expense of
hospitals, and some also give good, supportive
counseling. The whole clinic procedure, includ-
ing pap smear, blood tests, counseling, abortion,
and recovery time, can take as little as 3-4 hours.
Women 4-6 months pregnant are directed to hos-
pitals where the saline or hysterotomy procedures
are done. (Doctors don’t do abortions by any
method between 12 and 16 weeks LMP, except
very rarely a late D&C.) The saline takes three
hospital days, the hysterotomy up to six days.
Most hospitals also provide counseling.

Whatever the method, and whether or not coun-
seling is available, it is a good idea to go to New
York with one or two friends. Women friends can
be particularly supportive at a time like this.

Typical costs: D&C or Suction (up to 12 weeks
LMP) — $150-$200. Saline (16-20 weeks LMP) —
M.D., $150-$250, plus hospital, $300-$400. Hys-
terotomy (20-24 weeks LMP) — total cost approxi-
mately $700-$900.

PCS can arrange free or low-cost abortions for
woman with little or no money who are under 12
weeks pregnant. This is harder after 12 weeks:
hospital costs are inflexible, though doctors some-
times waive their fees. PCS also tries to arrange
rides to New York where needed.

Since the New York abortion law went into ef-
fect on July 1, 1970, many exploitative agencies
for counseling and referral have cropped up: AIA,
Med-Ref, 5th Ave Women’s Pavillion, Prestige
Placement are a few. They make profits of $25-
$150 per woman. Some are now subpoenaed but
not yet shut down. Such useless, profiteering
agencies aren’t just in New York City but in Bos-
ton, Philadelphia, Washington, etc., with ads in
local papers everywhere.

But there are trustworthy, non-profit services in
many areas. In New York City, call Women’s
Abortion Project (a Women’s Liberation group).
Outside Boston, check Information for a local
Clergy Consultation Service, Planned Parenthood,
or Women’s Liberation group. Don’t rely on ads,
however good and reassuring they sound. If you
don’t know anyone who knows an agency or
clinic first-hand, it makes sense to call PCS in
Boston.

ABORTION METHODS

When legal resources fail her, the woman with
an unwanted pregnancy starts asking friends of
friends, nurses, taxi drivers, in a frightened and
hysterical nosing around which ends her up on a
doctor’s table if she is lucky and rich, in the hands
of a nurse, or worse, of some semi-medical quack
if she is less lucky and less rich, at the mercy of
her own mutilating hands if she is desperate, and
in the emergency ward of a hospital if the “‘opera-
tion” turns bad.

It is important for a woman to know the whole
range of abortion methods, both so she will know
what she is talking about with her doctor, and,
more important, so she can judge the methods of
an illegal abortionist and find the courage to walk
out if her life is in danger. (Don’t pay in advance
if you can help it.)

I. Timing

When the embryo is one month old it is a tiny
mass Of tissue, with no resemblance to a human
being. At the end of the first month the em-
bryo is about the size of a small pea. By the end
of the second month, the growing embryo, by
this time called a fetus, is a very fragile one inch
long mass of differentiated tissue acting as a
parasite within the mother’s body. When the fe-
tus is three months old, it has attained a length
of about five inches. (Birth Control Handbook,
Montreal)

The earlier the abortion is done, the safer it is
for the woman and the easier it is on the doctor.
Even doctors-who will perform abortions willingly
have some cut-off point, ranging from when the
fetus takes clear human shape (“‘pulling out an
arm and then a leg”’ is deeply disturbing to one lo-
cal Ob/Gyn), through the time near twenty weeks
when the fetus moves (making abortion far more
dangerous for the woman), to the time of “‘viabili-
ty” around 28 weeks when the fetus could survive
if born. Hospital abortions in Boston are almost
never done after the fourth month, illegal ones
rarely after the third.

II. Medical Techniques for Abortion

A. Up to three days: post-coital medication

Some doctors in the country are experimenting
with high dosages of estrogen which will abort a
less than three day old fertilized egg. If you have
had unprotected intercourse in the middle of your
menstrual cycle, get their names from Planned
Parenthood or the Pregnancy Counseling Service
and offer yourself as part of the experiment. There
have been no reported failures from the medica-
tion, but since it must be used within three days of
intercourse, no one knows how many of the wo-
men were actually pregnant.

B. Up to 12 weeks: 1. dilation and curettage

The D &C is the standard method of hospital
abortion up to three months in the U.S. The .
procedure, which is done on women for various
reasons including infertility, involves the dilation
of the cervix and the scraping of the womb with
a curette. The cervix is dilated by means of gradu-
ated dilators starting at 2 mm. and proceeding up
to about 12 mm. at ten weeks pregnancy and to
14 mm. at twelve weeks. The doctor uses the
curette, a metal loop on the end of a long thin
handle, to scrape gently the internal uterine wall,
removing the fetal tissue with forceps. The pa-
tient is totally anaesthetized, and requires from
six hours to two days of recuperation, during
which time there might be some bleeding.

UTERINE
Lining

“30 07

B. Up to 12 weeks: 2. Vacuum aspiration

In China, Japan, Russia, England, Eastern Europe,

i i , ;
Operat ng unit for vacuum curettage up to twelve weeks the fetus is aborted by means

eennecto of a sterile metal, glass or plastic tube with a lateral
patti! re us wa opening near the tip, which is inserted through the
Shea hee ONA dilated cervix into the uterus and moved about to

im ay collection hose

dislodge the fetal tissue from the uterine wall; the
i va sy fragments are then drawn out by means of a vacuum
bottles eek SEE WE Vig goes pump connected to the tube. Although it still re-

; ght ee quires a highly trained person to pass the tube -
through the cervix into the uterus without punc-
ture, the vacuum suction method is easier, quicker
and less traumatic (physically) than the D&C, and
allows abortion to become an inexpensive out-
patient procedure. American doctors are resisting
the vacuum suction technique; a few Boston hos-
pitals have the equipment, but none use it often.

C. 12-16 weeks.

In England during this period, doctors use a
combination of the vacuum aspiration and D&C
with forceps methods; the operation is over a hun-
dred dollars more expensive. In the U.S., doctors
often make a woman wait until she is 16 weeks
pregnant and can have a saline injection (see be-
low). There seems to be a touch of sadism in mak-
: ing a woman, especially a young girl, wait until a
Berkeley Tonometer Co. more painful and traumatic method must be used.

Power switch

handle tissue bag

Storage spare

Safety-trap
(underneath)

Collection
hose

Swivel handie
assembly ‘
with vacurettes ;

pump
compartment

D. After 16 weeks: 1. hysterotomy

In a hysterotomy the fetus is removed through
a small abdominal incision, usually below the pubic
hair line. This is major surgery, requires several

; \

days’ hospitalization and convalescence, is there-
fore more expensive (at least $1000 here), and in
the U.S. often condemns a woman to caesarian
births thereafter. Although as major surgery the
hysterotomy involves more risk, it does not affect
a woman’s reproductive system at all (unlike the
hysterectomy, or removal of the uterus, with
which it is often confused).

D. After 16 weeks: 2. saline injection

With this method, a long needle passed through
the locally anaesthetized abdomen withdraws some
of the amniotic fluid and replaces it with an equal
amount of concentrated salt solution. This solu-
tion kills the fetus and induces labor and miscar-
riage in twenty to twenty-five hours. This method
is useful only at 16 weeks because the amniotic sac
must be big enough to find. -The saline injection
method is more painful and emotionally harrowing
than a hysterotomy, but it is not major surgery,
takes less time, and is cheaper. While this proced-
ure may be necessary for some women, if it is not
done with extreme caution and precision, it is very
dangerous and could be fatal.

Ill. The Doctor-performed Illegal Abortion

Many illegal abortions up to 12 weeks are per-
formed by doctors who give D & Cs or vacuum as-
piration abortions in hidden offices. Many do it
for profit but some do it because they believe
abortions should be done but are scared to court
atrest by doing them in the open. The cost ranges
from an occasional humane hundred or so, to the
usual $600-$1000. Except for a more hasty de-
parture afterwards and the use of a local instead
of a total anaesthetic, the abortion performed by
a skilled and conscientious illegal abortionist who
keeps his tools clean is just about as safe and com-
fortable as a hospital abortion. While on the whole
the rural woman has a harder time than the city
woman in finding an illegal abortion, Lawrence
Lader describes the abortion practice.of some
small town doctors who have some kind of under-
standing with the local police. Lader also tells of
the woman whose unsympathetic gynecologist
told her to go elsewhere and then at the end of
her long and panicked search turned out behind
. face mask and gown to be her illegal abortionist.

IV. Methods of the Unskilled Abortionist

The dirty D&C. The D&C in the hands of hur-
ried incompetents with no anaesthetics, no anti-

septics and dirty tools is frightening and dangerous.

The catheter method. Catheters are narrow tubes
sold at drug stores for drawing off urine. The
catheter is inserted into the uterus through the
cervix, a dangerous procedure when attempted by

an amateur. Germs introduced into the uterus by
the catheter cause an infection which the uterus
contracts to expel, thereby “spontaneously”’ abort-
ing the fetus.

The high douche. Forced douche or injection un-
der pressure of over-the-counter chemical agents
like soap, turpentine, Lysol, vinegar, lye, will pro-
duce an abortion if the solution reaches the fetus
or sufficiently irritates the uterus.

Both the catheter method and the high douche
work on the theory that an infection or danger-
ous substance will kill the fetus before it kills the
woman. They can result in permanent disability
or death.

Air pumped into the uterus. This method causes
air embolism (air into the bloodstream) and sud-
den and violent death.

V. Self-induced Abortion

The most unskilled abortionist of all is the wo-
man herself.

External means. Woman try extremely hot baths,
severe or prolonged exercise, violence to the lower
abdomen, and various long sharp tools of self-
mutilation. Except for the occasional knitting
needle abortion we hear about, which may be
myth, none of these methods work.

Drug store abortifacients. The woman can also

get from her “friendly” druggist a number of abor-
tifacients which, all expensive, endanger her life

to varying degrees and almost never work.

1. Soap-base pastes and douche solutions are
among the most dangerous. Soap goes directly to
the uterine veins to cause blood vessel blockage,
shock and death.

2. Desperate women douche with almost any
liquid they can think of, running the risk of severe
burning of tissues, hemorrhage, shock, death.

3. Tablets of potassium permanganate, a caustic
tissue-destroying agent which damages the vagina
walls and can cause massive hemorrhaging, ulcers,
and infection, are sold despite a FDA prohibition.

4. Among the useless folk remedies sold are
quinine pills and Humphrey’s Eleven pills, which
women take in massive expensive doses (literally
hundreds of pills) because once a woman who
thought she was pregnant took some around the
time when her period was due, and lo and behold
her period came.

5. Women also take quantities of birth control
pills, which actually support the pregnancy if any-
thing, and are suspected of causing genital deform-
ity in the fetus.

6. Castor oil and other strong purgatives are.
used to no abortive effect.

Of the million women in the U.S. who yearly
get illegal abortions, between two and five thou-
sand actually die. Thousands more spend time in
the hospital with sceptic abortions, peritonitis,
gangrene, air embolism and other acute repercus-
sions. Unknown numbers of them find themselves
infertile later on when they want to plan a preg-
nancy. (At an Abortion Conference in Boston
sponsored by the Unitarian Universalist Women’s
Federation, it was disclosed that 10% to 20% of a
local infertility clinic’s patients have had previous
sceptic abortions.) And many thousands of wo-
men escape from the frightening experience physi-
cally whole but with a new cynicism and very rare-
ly any better contraceptive techniques than they
were using when they got pregnant.

FUTURE PROSPECTS

“Even when abortions are easily available, mid-
dle class women who go to private doctors for their
abortions will be made to feel uncomfortable and
patronized. When poor and black and brown wo-
men go to the hospital OPDs, they will feel despised
and degraded. Black and brown women are already
afraid that their tubes may be tied without their
permission or that an IUD may be inserted after
childbirth or during a gynecological exam without
their knowledge. (Whether these stories are true
or false, they are believed.) With the acceptability
of abortion, there may well be pressure put on poor
black women, on unmarried high school and col-
lege students, to abort rather than to bear the child.

“The first problem is to get the abortion laws
repealed. But many women are already looking
ahead to the problem they will face even after the
laws are repealed. Medical and nursing students,
nurses and other health workers are beginning to
ask that more abortions be performed immediately
and that institutions make plans for dealing with
the increased demand after the laws are repealed.
Women’s liberation groups who already have abor-
tion referral services, are now urging women to go
to hospitals for their abortions, to show the insti-
tutions that the demand is there and that they must
face it. Some women’s groups are looking ahead
to the obstacles raised by doctors’ and hospitals’
attitudes towards abortions. ‘Abortion law repeal
will be meaningless,’ said one spokesman for the
repeal movement, “unless women seeking abortions
are treated with dignity and respect by doctors and
hospitals. No one should think that with legal abor-
tion on demand, or even with free legal abortion,
that the women in this country will consider them-

selves liberated.’ ”’
— Rachel Fructer, A Matter of Choice: Women Demand Abortion
Rights, in Health-Pac Bulletin, March 1970

TWO PERSONAL EXPERIENCES

Probably the most insidious mistruth about
abortion is that of the so-called post-abortion
guilt feelings on the part of the woman. In fact,
many women have been taught to expect. and in
some perverse way, may welcome, the “cleansing
effect” that anticipated post-abortion guilt offers
them, as though they have to atone for their
crime. For as long as this society fails to recog-
nize and refuses to sanction the right of a woman
to have an abortion whenever she chooses to do
so, the fear of post-abortion self-recriminations
represses her as surely and as effectively as any
prohibitive law is capable of doing. The problem
then is, how to get women to face the reality of
post-abortion feelings while shaking off the
shackles of superimposed guilt feelings. Ironically,
guilt, the psychologists tell us, grows out of an-
ger — anger at ourselves for feeling inadequate and
unwomanly, but also anger at a society which re-
veres us as mothers and child-raisers, but despises
our rights to make the decision not to
child. Perhaps then sharing my personal experi-
ence might in some way show my sisters that
guilt and its attendant emotions need not follow
an abortion.

have @

“I’m sorry,” the voice said to me over the
phone; “‘the test was positive.” From that mo-
ment on, I was a changed woman. I was going
to become a mother. But was | really, in the
true sense of the word? Any woman who has
ever conceived understands the mixed emotions
I was feeling. Understand, then, the thrill I felt
in knowing that life was beginning. My body is
constructed to bear children, and it was fulfilling
that purpose. But then, I was forced to ask my-
self, is that my purpose as a rational, as well asa
biological human being, and was | not reacting to
a societal stimulus as well as a biological one in
feeling good about being pregnant?

For me, the answers to these questions result-
ed in my decision to abort my pregnancy. For I
realized that these vague biological stirrings inside
of me could never justify giving birth to a child
I did not want, and was not prepared to raise.
Neither was I willing to subject myself to the or-
deal of pregnancy and waiting only to relinquish
the child at the end of it all. It’s all crystal clear
to me now, the re-telling of it. At the time, my
decision was not so well thought out, but rather
grew out of the conviction that I could not, un-
der my circumstances, continue with an unwanted
pregnancy. For me the fetus represented an un-
desirable growth that had to be expelled and with
it also any guilt feelings about what | intended to
do. Not once then did I ever think of the fetus

asa human being, but rather as an entity that con-
tained some of the properties and carried the po-
tential for human life, in much the same way that
a fertilized egg contains the properties and poten-
tial forlife. If then, the destruction of a fertilized
egg is within our power, why not a fetus?

Finding an illegal abortionist was not easy. The
few legal avenues that are open did not even occur
to me (I had my abortion over two years ago), al-
though I’m sure I would not have qualified for a
so-called therapeutic abortion. As millions of des-
perate women before me, I went underground.

My search led to a registered nurse (I was told)
who did illegal abortions. My contact was a wo-
man who had recently undergone an abortion by
the R.N. and who seemingly had suffered no phy-
sical ill effects from it. The negotiating was done
entirely through my intermediary and after settl-
ing on the price ($400), the date was fixed. All
the while I was not able to pry out of my contact
many details about the procedure, which really
panicked me. There was no one else to ask, so I
went into the thing “‘cold turkey” and all of my
dreaded fears about the physical pain were real-
ized. The woman came to my apartment, spread
me out on the kitchen table and inserted a
cathether tube up my vagina into my uterus.

This, I was told, would in time start the contrac-
tions in the uterus which would lead to the expul-
sion of the fetus. When I questioned the abortion-
ist further, she put me off as though I were unde-
serving of anything more than what she had just
done for me for $400. I had to be content with
her vague instructions about what to do when the
bleeding began while trying to stifle my anxiety
about complications. The entire procedure took
about 15 minutes and her attitude was one of do
the abortion and run. It was apparent that with
the exception of my two friends (who were as ig-
norant of the process as I was) I was strictly on my
own. And so began a 48 hour ordeal of pain and
anguished waiting for it to be over. At that point
I had little regard for myself as a worthwhile hu-
man being, I was someone to be scorned and avoid-
ed — I was a walking, bleeding catheter tube. On
Sunday the contractions began, and by the middle
of the afternoon it was over. The force of the
uterine contractions had dislodged the catheter
tube and it slipped out easily and along with it the
fetus. Looking at the fetus was an experience I
will never forget. I had been approximately two
months pregnant and at that stage the fetus had
acquired some of the characteristics of a human be-
ing as we know it. It was about an inch long and I
am unable to remember its color. I do remember
staring at it in a curious, somewhat detached way;
it looked so strange, and indeed it was. Its appear-

ance did not shock or repel me, partially due to

the fact that by that time I had shut myself down
emotionally and was feeling only relief that it was
over. It was only much later that I was able to
internalize how I felt and continue to feel, and then
to verbalize, as I have tried to do here. Even now,
my total emotional reaction to it escapes me, except
in one vitally important way. At no time, even in
the shadow of societal taboos, did I believe that I
was doing something “wrong” or committing some
“offense against nature’. When, in fact, it is my
nature and my right to determine my destiny as a
woman. Since that time my confidence in the right-
ness about my decision has grown and along with it
a sense of dignity and self-determination about my-
self as a woman. |

RAK KK K KK K€

I had my second child in March, stopped nursing
him in October and became pregnant in December.
Right after making love - too lazy to put in the dia-
phragm - I realized that I had miscounted and was
possibly ovulating. In a panic I remembered from
a long time before I filled the sink with water and *
washed myself out. Around the time my period
was due IJ began to feel the sensuality I know means
for me either pregnancy or some kind of minor
cyst (which stimulates pregnancy hormones). My
doctor gave me an intensive dose of progesterone
to induce bleeding if I wasn’t pregnant. I didn’t
bleed and went back to him; he confirmed the
pregnancy. I told him I didn’t want to be pregnant
and asked him his position on therapeutic abor-
tions. He outlined the procedure — hospital board *
approval and recommendation of two hospital psy-
chiatrists (my own wouldn’t do). He implied that
I would pass the board because he was on it and
said he’d contact the psychiatrists he felt would be
most sympathetic to me. He added that I would
have to pay $700 in advance to Peter Bent Brigham. *
He also suggested that I consider having a tubal li-
gation, after all I was 32, had two children, etc., and
it would make the doctors more sympathetic to
giving me an abortion. I told him that for me a tu-
bal ligation was a major decision, whereas having a
D&C seemed relatively minor. His reply: froma
medical point of view a tubal ligation was a minor
operation, whereas the D&C was something
equivalent to major.

So I set my mind toward a therapeutic abortion.
Emotionally and intellectually I was for it: (1) I
didn’t want to bring up a third child, there was too
much I wanted to do; (2) I had been writing a pa-
per about women choosing whether or not they
wanted to have children and how many they want-
ed to have, and here I was faced with the necessity
of living out these beliefs we have that women

should have the power to choose their own lives;
(3) So important, the whole idea of abortion was
made easier because I knew from much talking with

women and my reading how many women go
through abortions; and that knowledge would defi-

nitely have sustained me through whatever I was go-

ing to have to experience, whether it be therapeutic
if I could get one, a trip to England, to Montreal,
even an illegal abortion if that became necessary.

In spite of this generalized feeling of support, I
realized that though some of my close friends had
had abortions, I had never really asked them the *
specifics and knew very little about what had hap-
pened to them; and I| began to ask them to talk
about their experiences. I also felt for the first time
what it meant to be really fertile, and learned that
even with birth control methods, there’s a fairly
high incidence of pregnancy. It seems so obvious
that we should have back-up abortions.

Meanwhile I was incredibly depressed. At the
same time that I knew in my gut I didn’t want to

_have another child, I felt terrible that I didn’t want *

this pregnancy. I am used to welcoming and look-
ing forward to pregnancy, and it was unnatural in
the deepest way not to want to be pregnant (I had
been infertile, gone through three years of trying to
get pregnant, had an operation for ovarian cyst re-
moval and became pregnant in three months, had a
first beautiful pregnancy, and a few years later a
good second one). I found it impossible to stop
being depressed.

The day I was supposed to call my doctor to find
out if he had made appointments with the two psy-
chiatrists, | began to spot. The world turned over.
A miscarriage? I called the doctor, he said “Run
around the block a few times” and come see him
the next day. I jumped up and down often, happy
as the spotting increased, feeling crazy to be hop-
ing so for a miscarriage.

The next day the doctor said: “‘You’re miscarry-
ing. I could try to give you some hormones, but
there’s a 90% chance you’re going to lose it, and un-
der the circumstances, go into the hospital tonight *
and I’ll give youa D&C.” A little later I said to

him again, ‘‘It’s all crazy”’ and he answered “It some-

times happens like this. I had a girl once who was
getting on a plane to go to England (—-—) when she

started to bleed. I had her in the hospital in no time.

I went into the hospital at five, and at eight was
taken up to the operating room (same floor as de-
liveries). For 45 minutes, 1, and anesthetist and the
nurses waited for my doctor. I asked one of the
nurses what the doctors’ attitudes were toward
D&Cs. She answered that doctors didn’t seem to
mind doing them because they were medically ne-

cessary, but that she had seen doctors’ eyes as they* |

were doing therapeutic abortions (D & Cs) and she
felt their distaste. Some nurses refuse to work dur-
ing therapeutics. It’s clearly written on the chart
whether it’s a therapeutic or a D & C (same thing).
She said one doctor came into the operating room *
where a woman was waiting to have a therapeutic,
took one look on her chart and walked out, not
performing the operation.

Since I had eaten lunch and couldn’t be com-
pletly anesthetized, and since anyway I wanted to
be aware during the D & C, I had my first spinal
which was clumsily done. Finally I became totally
numb from my waist down. Earlier in the hospital
room I had felt nauseous at the idea of being scrap-
ed out. Here in the operating room I felt nothing
physical, but had a lot of other feelings: my doc- |
tor seemed cold and distant, I joked trying to make
some connection with him but couldn’t. I cried be-
cause I had miscarried and had to be scraped out
and I was very tired. I felt guilty too because I was
glad of the miscarriage and felt I was playing the
part of someone who was sorry.

I spent three hours in the recovery room, a dull
neutral time it felt like, but now, thinking about it,
I was probably recovering in all kinds of ways. I
had been in that same room after the births of my
two babies when I had felt high, joyful and totally
relaxed; now was so different, no experience of
birth before, a nothingness of feeling.

It took a day or two to recover physically from
the D&C. And it was only after talking to many
people and thinking very hard about all my ambiva-
lent feelings — the guilt, the anger at my husband
that it was I who had to go through all these has-
sles, the contradictory feelings about the abortion-
miscarriage - that my two-month depression dis-
appeared, convincing me even more that though it
can be a hellish bitter struggle to get into reasons
for depressions, once the reasons are found and
talked over, the depression begins to disappear.
And women have to look into themselves and talk
together to an enormous extent to untangle our
feelings which are so wrapped up in body processes
that we confuse physical with psychological. We
have to talk together too because we are socialized
not to feel and express deeply negative things con-
cerning our bodies and wills. The wish to do away -
with a pregnancy was hard for me to cope with
and confused me for a long time. After this ex-
perience my mind is clearer.

* I have put stars next to many of the things that happened which
I found objectionable, appalling, which should be discussed on a
lot of levels.

INTRODUCTION

We, as women, grow up in a society that subtly
leads us to believe that we will find our ultimate
fulfillment by living out our reproductive function
and at the same time discourages us from trying to
express ourselves in the world of work (often by
pointing to our reproductive roles as a reason for
doubting our seriousness). Because our opportuni-
ties, hence our motivations, are limited we ourselves
often begin to believe that in motherhood we will
find greater satisfaction than as student, worker,
artist, political activist, etc. Often we look for-
ward to pregnancy and motherhood as a time when
we can put our identity crises on the shelf and
relax, secure in the legitimacy of our maternal
roles. Both we and our children fare better when
conception is chosen freely out of a desire for a
child to love and care for and not as a means to ful-
fill other important needs for identity, security
and social approval.

Instead, more or less haphazardly, we get preg-
nant, and it’s during the pregnancy that we become
involved in the struggle to come to terms with who
we are. Because often we are not aware there is a
struggle; because we don’t know what it’s about
and/or have no language to express it or we'may
understand our ambivalence and feel guilty, we
experience serious depression during pregnancy or
after childbirth.

Consequently, when we live through these de-
pressions, nightmares and fantasies, we think we

Pregnancy

are the only one to have them. As soon as we are
able to talk to other women about them we find
we’re not alone! (At a meeting where a group of
us met to discuss our feelings during and after
pregnancy four out of five of us there told of fan-
tasies about taking up knives or about people en-
tering our houses to kill our children. We all dis-
cussed the various forms of depression we had felt,
usually subtler than suicidal wishes and less easily
identified as depression.) In our isolation we feel
guilty for our ““unmotherly unnatural” feelings.
When we meet and talk together we discover as a
common experience that we have strong negative
feelings about having children. Most important of
what we are learning is that our feelings are shared,
are legitimate. We all have them to some extent,
we shouldn’t shrink from them (they don’t go
away), and we must accept them as legitimate as
a first step in dealing with them. Having the cour-
age to recognize, express and share these feelings
is the beginning of the struggle to understand why
we have them.

Often we are not free of our own psychological
needs even in “‘choosing”’ to stop the pills or what-
ever and become pregnant. Societal pressures on
men as well as women persuade us that we must
demonstrate our fertility and immortalize our
man’s seed by having children. We produce the
children, and we see them as extensions of our-
selves, as our possessions, not people. Further, our
limited opportunities and lack of legitimacy in oth-
er areas make the traditional role of mother the

course of least resistance for many of us. For some
of us and most of our third world sisters, very real
economic pressures make pregnancy and mother-
hood a nightmarish rat-race for survival. The men-
tally “‘healthy”’ pregnant woman must be secure in
knowing that all material needs (adequate hous-
ing, food, clothing, toys, etc.) will be provided, ei-
ther by herself, her family or the society.

We should not have to make the choice that
many of us are forced to make today — one of
commitment to motherhood or to serious work.

If we want to be with children, we should first

try out caring for friends’ children or helping in a
playgroup or preschool. We should have some
space to examine our feelings about being with
children, including feelings of possessiveness that °
all of us who grow up in this society are taught.
Maybe we’ll decide that we don’t want the full time
responsibility of rearing or adopting children, but
decide to be part-time parents. We should talk with
friends who have borne children and those who
have adopted; both are alternatives which we should
examine. In addition, there should be guaranteed
income for all individuals in our society, so that
women who want to have children alone are not
forced to be financially dependent on a man; there
should be childcare at the job or in the community

that lasts for 24 hours and is community controlled;

there should be communes with all members shar-
ing childcare equally; and there should be mater-
nity and paternity leaves until we have our strength
back and the baby is sleeping through the night.
Further, we believe that half-time jobs should be-
come the norm so both parents can lead fully hu-
man lives and participate in the raising of their chil-
dren and the life of their community.

PREGNANCY

Why become pregnant? Why have a child? We
as women are talking about having versus not hav-
ing children. Some of us feel strongly that there
are no good reasons for having children. Some feel
it’s self-indulgent for us to have our own children
but all right to adopt children who need homes.
And some believe that giving birth to and rearing
our own children can be a creative, even revolution-
ary act. These are vital questions to ask and try to
answer before discussing pregnancy. But I wrote
this paper at a different level of consciousness: it
gets at the negative reasons we have for wanting
children. It talks about how it feels to be pregnant
and describes what is happening to and within our
bodies. Basically it assumes: (1) that a wanted
pregnancy is good, and (2) that it’s necessary and
exciting to have some control over the process both
by learning as much as possible about ourselves and

by changing attitudes and institutions to be more
responsive to our needs when we decide to have
children.

It’s essential to realize that we as women can be
whole human beings without having children. It’s
possible for us to be complete both physically and
emotionally, just as men are. We should be free to
decide whether or not we want to have children,
and if we do, how many we want to have. And
we should be able to decide how much time we
want to spend rearing children. For the first
choice to take place, we must become aware of
the many factors that hinder our freedom to
choose. For the second decision to be possible,
we must work together to change many kinds of
attitudes and institutions, making them more flex-
ible and responsive to our needs; and we must de-
velop day care centers and new kinds of communi-
ties to free us from our traditional roles. Only
these kinds of societal support will enable us to
live out our choices with confidence and freedom.

As things stand now, a woman as mother is not
free, for the bearing and raising of children de-
mands much time and emotional energy. In order
for us to fully come to terms with pregnancy, we
should thoroughly consider what having a child
means to us personally. Once we become aware of
societal and religious pressures and expectations
weighing on us, and realize to what extent our
thoughts and emotions have been grossly and subtly |
directed, then we can begin to extricate ourselves
from binds we don’t want and positively choose
our own attitudes towards having - or not having -
a child.

Some biological pressures: Women are physical-
ly different from men in that they are able to bear
children. A particular biological process is begun
and completed when we become pregnant and give
birth. The biological process quickly acquires so-
cial significance; it becomes difficult to separate
the two. And though we are human beings capable
of choice, in many societies women still breed like
animals. We are trapped and defined in advance
by the biological efficiency of the reproductive pro-
cess: it is so easy to get pregnant. It is biologically
preferable that strong healthy young women in
their teens and early twenties be the bearers of
children. And when people are young, sexual feel-
ings are surprising and newly intense. Asa result,
we become pregnant, married and unmarried, be-
fore we have a chance to develop fully as autono-
mous human beings.

As for societal pressures, in this society we are
persuaded on many levels that we have no choice,
we don’t need to have a choice, we don’t want to

have a choice. This society has a vested interest in
keeping us non-autonomous, and many mechanisms
develop which come to determine how we should
feel and act. The Catholic Church tells Catholic
women they should have as many children as possi-
ble. Consumerism and advertising convince all of
us from our birth that we must be pretty to attract
men so we can get married and have a home and
children. Then there are attitudes such as: all wo-
men are good for is to bring up children (and be
sexual objects on the side), and the ensuing glori-
fication (by men) of Motherhood. Mixed in with
these attitudes and best expressed by the Victorian
and Puritan traditions, of which we are still vic-
tims, is the gut feeling that our physical functions
in general are base and unclean. We are not free to
be sexual beings, men think, but we must justify
our sexuality by becoming pregnant. Women, who
menstruate, carry their children in their wombs
like animals, give birth with obvious effort and dis-
comfort, are thought to be close to ‘‘nature”’; but
men are threatened by this physicality, and create
myths about women which we partially come to
believe, though our experience tells us these myths
are false. Women are not predestined to be mo-
thers.

More specifically, here are some common phrases
expressing these “cover-up” attitudes: “Earth
mother... You’re not a whole woman until you’ve
had a child . .. The most intense exciting experi-
ence of a woman’s life is to give birth . . . The ful-
fillment of having children.”” And from a very mid-
dle class booklet handed out by a Boston area doc-
tor and written by a man: “A woman is likely to
glow and look more beautiful during this period
while her body is fulfilling its ultimate physical
function. For each woman pregnancy has its own
unique mystery, emotional response and content-
ment. Yet, while every mother-to-be differs in
these respects, there are innumerable experiences
which are common to all. They bind every woman
into that exclusive sorority called Motherhood.”
And later: “Doctors who devote their practice to
the care of pregnant women report again and again
how amazing it is to observe a girl become a woman
physically and emotionally in nine months. For
many, the prospect of motherhood makes them
mature. They become poised, proud, confident,
and beautiful. Nature, in her own mysterious man-
ner, seems to have devised an intricate balance that
prepares the body for a baby and the mind for ac-
ceptance of motherhood. A conscientious woman
responds to these responsibilities. She uses them
to become a better person and a contributor to
the growth of society.”

These words are loaded in many ways. We find
vague emotional words, such as “ultimate”’, “‘beau-
tiful”, “mystery”, and they are used by amanina
biased way. Does our fifth pregnancy have its own

ef)

‘unique mystery’? Is it ‘nature’ which prepares our

minds for acceptance of continual motherhood?
Are we “poised and proud” when bearing an un-
wanted third child? Most important, the definition
of us is biased in traditional ways. To be a woman
equals motherhood which equals fulfillment of des-
tiny as preordained by Nature. These are the defi-
nitions most ingrained into us and they provide us
with socially-backed positive attitudes toward child-
bearing that are a far cry from more individual
thought-out attitudes.

These traditional definitions are often used by
us aS an excuse not to go out and tackle a world
we have been ill-prepared to face up to. Excuses
are not autonomous choices. We get pregnant for
so many unconscious reasons: to hold onto or pos-
sess Our man, to keep a marriage together, to prove
we are not sterile (a sin), to please our family (and
so often because the man insists on having his own
children), to produce something of our own, to ex-
tend our own ego, to compete (women as products,
as tools for producing babies, babies as products).
Then there are other reasons which in practice can
turn out to be constructive or destructive: we want
to relive our own childhood as a parent; to prove
to our parents or ourselves that we can do better;
we are curious. Often what happens is that we end
up exerting our own limited power over our kids,
taking out our frustrations and disappointments
on our children, expecting and even demanding
that our children live out our lives where we feel
we have failed. This is especially true of our pa-
rents’ generation.

Some women, to escape jobs that are unreward-
ing or difficult, take refuge in repeated pregnancies.
Someone suggested that babies provide the only
opportunity for tenderness in some people’s lives.
So we find that under the guise of being ‘‘a con-
tributor to the growth of society” we “‘intention-
ally’’ become pregnant because for so many there
is little else we feel we can do well (because being
out of the house is made dull or difficult for us by
the system).

Then too there is the matter of guilt. If you
have made your choice, you must constantly keep
defending it. If you decide not to have children,
you must keep making that decision and fight for
it, justifying your choice to yourself and others,
convincing yourself that you are not physically and
emotionally sterile, a non-woman. If your intellec-
tual, political arguments against having children are
well thought out, your emotions (and society’s
judgments as society stands now) will confuse you
especially as you get older, and remain at least par-
tially unfulfilled in your chosen work, as you have
been persuaded from birth that you will.

Next, the question of childrearing. What choices
do we have today as to how and by whom we want
_our child to be brought up? What facilities do we
provide for women in all categories who need free
time and time to work as children are growing up?
It does not have to be true that the woman who
bears and gives birth to the child has to bring her
up too; that only she, because she is a Woman, is
emotionally equipped to care for children. From
our births we are socialized into tender nurturant
home roles, and men are encouraged to be tough,
to go out into the world. These roles should be
changed. Also our society has limited itself to the
family as a viable child-rearing unit, a family in
which the man is the breadwinner and the woman -
super-cheap home labor - raises the next bread-
winning breeding generation. It is very important
that we question a set up so limited and limiting.
Keep in mind too that 15-20% of the babies born
at Boston City Hospital and Boston Lying-In have
unmarried mothers. What provisions other than
debilitating welfare have been made for these mo-
thers and children? What provision do we make for
us who autonomously decide to have children and
rear them without men?

Finally, we should ask the question: What are
the positive reasons for having children? The an-
swer of each of us depends on her goals, principles
and history. Each of us must make the choice to
conceive a child with a sense of deep responsibility.
Having children raises important questions such as:
In what ways do we as people become more con-
servative in order to protect our families? What
are the mental effects of being parents (for instance
we are often forced to be more authoritarian than
we would like to be)? In what ways does the nu-
clear family put pressures on both parents and
children which inhibit our mutual growth, which
destroy meaningful communication over a long
period of time?

Once these and similar thoughts have been
broached, we will begin to think in a clearer way
about the necessity of escaping from our roles. We
can be partially freed by our knowledge, then by
our efforts to change all kinds of institutions. Be-
cause pregnancy has enslaved us in the past, that
does not mean it must continue to do so. A preg-
nancy positively chosen can be a deeply joyful ex-
perience.

Pregnancy and childbirth have been shrouded by
both men and women in mystery and fear. We
- have been forced into thinking that most physical
discomfort and pain resulting from pregnancy is our
“lot”. So we submit to the experience and don’t
feel altogether legitimate in expressing questions,
hesitations or fears. Or perhaps we never learned

how. Society has emphasized the joys and been
condescending, unsympathetic, or ignorant about
the trials. Surely there are happy simple pregnan-
cies, but even then our bodies change so greatly
that we are bound to have questions. During preg-
nancy the normal functioning of the body as we
experience it is called into question as it is during
an illness. How irrelevant that doctors tell us it is
normal for a woman to be pregnant. What do they
mean by normal?

Basically three main things are happening dur-
ing pregnancy. (1) Something is growing in the
body. (2) Our bodies change physically both to
make this growing possible and as a result of this
growth. (3) We go through all kinds of psycholog-
ical and emotional changes during this time. We
owe it to ourselves to know as precisely as possible
all that is happening to us, so that we know what
questions to ask, how to pursue demands we might
make on doctors and friends in order to lessen any
discomforts we might be feeling and to insure that
we get humane treatment. There are many things
we don’t know about this crucial event, and it’s
difficult to get information as a result of our long-
standing inertness, and of doctors’ attitudes toward
us as we climb on the medical conveyer belt of
pregnancy.

In this part of the chapter, pregnancy will be
discussed as follows: (1) signs; (2) procedure for
detecting pregnancy: tests and the pelvic examina- -
tion; (3) some thoughts on what it feels like to be
pregnant, both physically and emotionally; (4)
some common changes taking place in the body
and possible complications to be aware of; (5) pos-
sible doctors’ attitudes and future examination
schedule; (6) demands. In an appendix there will
be a discussion of (1) the growth of the fetus from
week to week, (2) infertility, possible reasons and
what to do, and (3) miscarriages, possible reasons
and ways of coping.

Most important: Though your pregnancy will
have many things in common with other women’s
experiences, it will also be unique. Experience
your own pregnancy. Talk to other women who
have been pregnant and who are pregnant at the
same time as you, but remember there’s no “‘right”’
way to be pregnant. Try to learn about everything
that happens, everything you don’t understand.
Remember that when we talk about experiencing
signs and emotions, there are many exceptions and
many combinations. Each pregnancy will probably
be different and the first will be unique, for ev ty-
thing that happens is new.

Signs. You might have none, some, or many of the
following early signs of pregnancy: if you have —

had regular periods you will miss a period (amen-
orrhea). You might have nausea or more rarely
vomiting, but they will disappear much before or
by the 10th or 12th week. Breasts enlarge, tingle,
and may hurt. The nipples may darken, and the
area around them might become larger and darker.
You may feel constantly exhausted. You will prob-
ably feel you have to urinate more often (frequen-
cy). If you feel this need, either alone or with the
signs mentioned above, demand that a urine speci-
men be taken to be studied, for (1) if you feel the
need to urinate more often it’s either a sign of preg-
nancy or you might just have a urinary tract infec-
tion, or (2) if you are pregnant you become more
susceptible to urinary tract infections. You should
specifically demand that you doctor check your
urine sometime during the first three months of
pregnancy.

If you have irregular periods, you might not rea-
lize for 3-4 months that you are pregnant if you
have none of these signs. You might or might not
gain weight, but generally by the fourth month
clothes don’t fit too well around the waist. Dur-
ing the fourth or fifth month you can feel the
first movements of the fetus, like a fluttering inside.

Procedures for detecting pregnancy: Tests and
Pelvic Exam. You will see the doctor when you
recognize some of the signs as pregnancy; or you
might find you are pregnant while being checked
for some other thing.

There are two main kinds of pregnancy tests,
biologic and immunologic. Both use a hormone
(HCG—human chorionic gonadotropin) secreted
by the developing embryo and found in the urine
of pregnant women. It can be detected as early
as three weeks after conception. Both kinds of tests
use urine. In the biologic tests when the urine con-
taining this hormone is injected into laboratory ani-
mals - rats, mice, rabbits, frogs - it causes them to
ovulate. This process takes a few days, whereas
the fastest immunologic test takes only:a few se-
conds. When a drop of urine is mixed on a slide
with a drop of serum hostile to it and two drops of
another substance, the mixture won’t coagulate if
the hormone HCG is in it. These tests are 95-98%
accurate, but can be false if they are performed
too early before there’s enough hormone in the
urine, if there are technical errors in handling or
storing the urine, or if the test animal doesn’t re-
spond as it should. Usually the diagnosis of preg-
nancy can be made without these tests, but they
are really useful if your periods have been irregu-
lar and you specifically want to know soon. The
tests become unreliable after the 16th week of
pregnancy because then the amount of HCG goes
down as it is not needed any more by the growing
fetus.

Then there’s the pelvic examination: if you are
pregnant, (1) the doctor can feel that the tip of the
cervix has become softened, (2) he can see that the
cervix has changed from a pale pink to a bluish hue,
(3) the uterus feels softer, and (4) the shape of the
uterus changes: where the embryo attaches itself
to the inside of the uterus it makes a bulge which
can sometimes be felt on the outside of the uterus.
The doctor will most likely put one gloved lubri-
cated finger into the vagina as you lie on your back
on an examining table. If there is pain, say so.
During a pelvic, it’s most important to be relaxed
for tension increases your own discomfort. Relaxa-
tion involves trust and that is sometimes difficult
to have.

From the 16th to the 18th week the doctor can
feel the fetus in the uterus. Its heart tones can be

heard around the 1 8th-20th week, at approximately

twice the rate of the mother’s.

What pregnancy feels like. What does it feel like

to be pregnant? Some pregnancies are comfortable,

others are not. Up until the fourth month, except
for some possible signs, you don’t feel the changes
going on within, for the placental system is devel-
oping within the uterus as well as the complicated
system of the fetus. Then, as the fetus begins its
bulkier growth, your waist becomes thicker, your
stomach starts to swell below the waist, and occa-
sionally you can feel the slight movements of the
fetus from within (4th-5th month: called “‘quicken-
ing’). Very very gradually the bulge becomes larg-
er. It feels hard to the touch, for the uterus is a
strong muscular container and is completely filled.
Toward the sixth or seventh month you can feel
the movements of the fetus both from the inside
and the outside as it changes position, turns som-
ersaults, sometimes putting pressure on the blad-
der, sometimes on the obturator nerves at the top
of your legs. You can put your hand on it and feel
bumps — the knees, hands, elbows and feet — mov-
ing around, like a pillowcase seen from the outside
with a cat moving inside. Each baby will lie in a
certain position. Occasionally it hiccups, some-
times regularly for a few minutes. All of these
movements get stronger and stronger; toward the
very end of pregnancy they lessen and stop as the
head settles into the pelvis. -

As your body gets heavier, you tend to walk dif-
ferently for balance, often leaning back to
counteract the heavy front. Some women become
very large, others barely show even at the end of
pregnancy (fairly rare); some women really broad-
en, Others remain narrow. Your breasts will be-
come larger, you’ll probably have to wear a bra if
you don’t already, or get a bigger one, for it’s a
good idea to support the breasts in order that they

go more quickly back into shape after you’ve had
the baby, or later on have stopped breast-feeding.
If you plan to breast-feed, massage your nipples to

toughen them.
* KK KK

It seems presumptuous to tell how you will feel
individually, but we as woman do have many feel-
ings in common. Feelings during pregnancy are so
dependent on how we usually feel about ourselves,
how much we want to be pregnant, to have a child,

how we feel about the man. Some positive feelings:

sometimes at the beginning of pregnancy there’s an
increased sensuality, a kind of sexual opening out
toward the world, and heightened perceptions.
Expectation. Great excitement, especially when
you find out you are pregnant and then feelings of
power and elation, when you feel the quickening,
the first signs of life you are able to feel, though
the fetus has been moving around for several
months. And there are many questions: what is
going to happen? How will the experience change
me? What willl learn? Will I be able to cope well?
And throughout the pregnancy there will be nega-
tive feelings and thoughts, during general depres-
sion and especially if a woman feels threatened, an-
gered, and upset by it. The depressions are perhaps
related to all the underground anxieties we have in
relation to our own mothers and our childhoods.
Anger about the takeover of our bodies by some-

ae thing tiny, invisible. This anger can be most in-

tense at the beginning if there is nausea, and toward —
the end when it seems to have gone on too long we ‘
and we want to be free and light and empty again.
Anger that a cycle has begun over which we have ~ 7
no control. Resentment that some part of our free- 4
dom might be curtailed, has been curtailed. And ~
there are many fears: with a first baby there’s very
simply fear of the unknown. No matter how much
one knows about the physiological changes and ~
events in the body, there’s something incompre-
hensible about the beginning of life. There are fears
that the child will be deformed, that one will

die, that the child will die, that the whole thing

for some reason won’t happen at all. The fears
might express themselves in nightmares, or in wak-
ing violent fantasies. One woman felt that though
she had convinced the world she was beautiful, she
had been deceiving everyone, and the child by being
deformed would reveal to the world how ugly she
really was. And then we feel guilty that we have
these fears, for don’t they in some way suggest that
as mothers we will be inadequate? We can’t allow
ourselves these depressions because we are supposed
to be strong, maternal, natural, accepting, etc. It is
vital that we realize that our fears and depressions
are legitimate, and we can and should feel free and
right in expressing them. Talking together and shar-
ing these experiences is vital in breaking down our
societal isolation as well as the isolation that our
fears impose upon us.

You might feel surprised after the first five
months that there are still so many more to go,
and very impatient. Or maybe glad that the preg-
nancy is going on so long, so that motherhood and
the responsibilities it entails be postponed. If the ©
pregnancy is good there’s a completeness in the
symbiotic relationship: the mother is glad to carry
the child, and the child is protected from the world.
And then there’s a possible numbness, a kind of
self-protectiveness against something happening.
Some women don’t think of the baby as a person,
but as a fruit or vegetable, so that they won’t have
to begin to think of anything serious happening to
something like themselves. Pregnancy makes some
women feel dependent on other people.

It’s important to know that these fears and
doubts can occur during a good pregnancy too,
for in a very real sense, your body has been taken
over by a thing and a process which is not within
your control, and you must come to terms with
that, not passively, but actively, by knowing what
the fetus looks like as it grows, what is happening
to your body, and what your specific fears are.
Talk to friends and try to sort out the inevitable
old wives tales from the realities.

Some women want to know how they will look,

how they will feel about their changing changed
bodies, how a man will feel about them. An im-
portant reason for this question is that we are
taught that women must be sexually attractive:

in this society we must be slim, firm, well-groomed.
We are also taught that we are to become mothers:
a pregnant woman is fulfilling her expected role,
doing her duty though she might not be a creature
of traditional sexual beauty in the process. Thus
as our bellies become larger, we must make a tran-
sition from one role to another, and sometimes
our images clash. Again, the way in which the
woman feels about herself is important here. She
might feel ripe, fertile. filled, beautiful. Or she
might think of her body as swollen, distended, de-
formed, and really hate it. These feelings seem to
depend on how much she feels she is in control
about what happens to her body and how much
she accepts its changes. How the man feels de-
pends partly on the relationship between them:

if either has negative feelings it’s best if they can
talk about them and realize they are legitimate and
changeable. Talk can also lead to some deep good
questioning about the conventional ideas of beauty
that we’re all brainwashed with on some level.
Some men are turned on by pregnant women.
Some men even participate in women’s pregnan-
cies by experiencing nausea and other symptoms.
Other men are repelled, disgusted, threatened for
a lot of reasons, and hostile. Two people will have
to work these complex feelings out individually.

What about making love during pregnancy? Tra-
ditionally, doctors have asked that women abstain

from intercourse four to six weeks before giving
birth and up till six weeks after; altogether women
had to abstain for three months. According to a
recent Siecus Study Guide (No. 6: Sexual Relations
During Pregnancy and the Post Delivery Period),
this abstention was based on four unproven beliefs:
(1) the thrusts of the penis against the cervix in-
duces labor, (2) the uterine contractions of orgasm
will induce labor, (3) membranes may rupture,
leading to infection and (4) the sex act is physi-
cally uncomfortable. Masters and Johnson have
some evidence that the contractions of orgasm
could set off labor, but the women in their study
were close to term anyway. The Siecus pamphlet
concludes that intercourse toward the end of preg-
nancy is not inevitably dangerous! But you should-
n’t make love if you have any vaginal or abdominal
pain, if there is any uterine bleeding, if the mem-
branes have already ruptured (then there is danger
of infection), or if you have been warned that mis-
carriage might occur. In the latter case you should
not masturbate either, as your orgasm might bring
on the miscarriage. Also sometimes oral-genital
contact isn’t good as air blown into the cervix
might endanger the baby.

During pregnancy, some women want to make
love more often, some less. Masters and Johnson
report an increase in sexual desire during the se-
cond trimester, and a decrease during the third.
Many booklets and manuals mention that new
and groovy positions can be tried. When you are
pregnant, it is not usually comfortable (sometimes
not even possible) to have the man above you; it
might be better for you to be on top, for him to
be behind you. It’s possible that the woman or
man might feel that the presence of the fetus is a
hindrance and that the act is no longer as private
or free as they want it to be. Or maybe you will
want to use pregnancy as a time to be free from
making love. On the other hand, especially at the
beginning of the pregnancy, both women and men
might feel freer for there is no worrying about con-
ception, and making love can become more fluid
and more natural.

To sum up, when we think of the complex feel-
ings we have during pregnancy, we learn most by
accepting and working with them. Then we come
to know ourselves. A lot of our negative feelings,
fears, and anxieties during pregnancy can be di-
rectly linked to specific forms of repression that
society has inflicted upon us and our mothers be-
fore us. If our mothers were afraid because of ig-
norance, we will probably have absorbed much of
their fear. We must become articulate, and learn
together who we are so that we can choose to be
the best that is in us, so that we can change tradi-
tional attitudes toward motherhood which deny

80
us knowledge and control over ourselves.

Changes and Precautions. As the pregnancy ad-
vances, our bodies change in many ways. The skin
over the abdomen can become stretched and lines |
of stress will appear. By mid-pregnancy the breasts,
stimulated by hormones, are functionally complete
for nursing purposes. After about the 19th week

a substance called colostrum may come out of our
nipples, but because of high hormone (estrogen-
progesterone) levels, there is no milk. Our breasts
are larger and heavier.

There are changes in our circulatory system.
Total blood volume increases 30-50% as the bone
marrow produces more blood corpuscles and you
drink more liquid. Because of the increase in blood
production, our bodies need more iron; many doc-
tors prescribe iron pills at this time. The heart
changes position and increases slightly in size. Its
peak load happens about the 30th week, then blood
pressure tends to go down. Any of us who have a
history of heart trouble should be aware of this.

The flow of urine is reduced because of hormon-
al changes, but both early and late in the pregnan-
cy, partly as a result of pressure from the enlarged
uterus, and because you drink more liquids, there’s
a frequent need to urinate. Again, urinary tract
infections are more common, as the flow of urine
can be slowed down and the functioning of the
kidneys changed.

Movements of the bowels and the entire diges-
tive system can be slowed down because of pres-
sure from the uterus, so indigestion and constipa-
tion occur sometimes. Also as a result of pressure,
the veins in the rectum (hemorrhoidal veins) be-
come dilated. Varicose veins in the legs are com-
mon.

Sometimes we salivate more - it is not known
why - and our gums tend to bleed more easily than
usual. It is a good idea to have teeth checked, if
possible, in the early months of pregnancy.

The joints between the pelvic bones widen and
are made moveable about the 10th or 1 1th week,
stimulated by a hormone called relaxin. Posture
changes because we must lean back. Occasionally
the separating bones come together and pinch the
sciatic nerve which runs from the buttocks down
through the legs. Backaches are common: there’s
more pressure on the spine.

Some of us get cramps in our legs (calves, feet
and thighs). Sometimes in the morning you wake
up and have sudden cramps which quickly wear off.

Many of us tend to put on weight greater than
_ the weight of the fetus, uterus, enlarged breasts,

amniotic fluid. The body tissues retain more water
(edema) arid feet, hands, toes and ankles can swell
up. This weight gain can strain the heart if it is
excessive.

When we go to the doctor for each examination, —
we are weighed, our blood pressure is taken, and
our urine checked. These are preventative mea-
sures which guard against a disease of pregnant
women called eclampsia. Those of us who tend to
retain fluid are most susceptible, but there’s no
way of determining who will become toxic; that
is, Some interference occurs within the uterine cir-
culation, causing a decrease of oxygen in the pla-
cental area. This may cause toxic substances to
appear in the maternal circulation, substances
which haven’t yet been isolated. Eclampsia is di-
vided into roughly three stages, called toxemia,
pre-eclampsia, and eclampsia. Signs of toxemia
are a weight gain of five pounds or more in four
weeks, suddenly rising blood pressure, albumin in
the urine, and swelling ankles. As soon as these
are caught, they can be treated by proper salt-free
diet and diuretics to get rid of the extra fluids in
our kidneys.

Finally, the uterus changes greatly. Its size in-
creases five to six times, its weight increases twenty
times, and its capacity increases 1000 times. In the
beginning it grows because it is stimulated by hor-
mones. After eight weeks, the growth of the
embryo-fetus determines its size. The greater part
of the uterine weight is gained before the 20th
week. During pregnancy it contracts painlessly
(Braxton-Hicks contractions). It’s possible for you
to feel the hardening caused by the contractions,
which last only moments but are repeated often.

This is by no means an exhaustive detailed list
of body changes. But it does indicate that drastic
processes are going On in our bodies and keeping
in mind that we are in some ways adapted to bear-
ing children, we must realize that we’ve got to be
aware of possible difficulties.

Pregnancy examination procedure and possible
doctors’ attitudes. It’s a good idea to see a doctor
when you either think or know you are pregnant.
During the initial visit he will examine you after
(hopefully) taking a careful medical history. Be
sure he knows your blood type. After the first
visit, you will see him once a month until the 28th
week. Then twice a month until the 36th week,
and from then till the birth, once every week. Dur-
ing these exams you will have your blood pressure
taken, your urine and weight checked. The doc-
tor will measure the growth of the fetus both in-
ternally and externally. After the heartbeat be-
comes audible to him, he will listen to it each time.

_ During pregnancy we can become emotionally
vulnerable and, as a result of all we’re experienc-
ing and the often impersonal efficiency of the ex-
amination, we may be rendered almost speechless.
Often both private and clinic doctors treat us as
children who know very little and are capable of
learning less. It’s a good idea to prepare lists of
questions and persist in asking them until the an-
swers are clear and satisfactory. It’s much easier
to do this and to establish some kind of reasonably
good relationship with a private doctor than with
clinic doctors who rotate so that we don’t see the
same doctor twice during a pregnancy. In either
case we should demand to be treated as the intelli-
gent and capable human beings that we are. This
involves a lot of fighting and persistence, for we’ll
come up against stereotypical situations (pater-
nalistic, punitive, condescending attitudes) and
find ourselves forced into taking roles and playing
games we don’t want to play.

iter

on,

Demands. When we are pregnant we should be able
to meet with other pregnant women to discuss our
common anxieties and apprehensions. Doctors and
clinics should make addresses and phone numbers
of pregnant women available to each other. In
each office or clinic we should demand information
y | about pregnancy classes for couples and women
e | alone. We cannot depend on hospital one-time
) classes or even prepared childbirth classes as they
exist today to meet all our needs for information,
support and encouragement. We must help each
other as much as possible and as women we must
demand that society provide us with the rooms,
printed materials and group leaders of our choice
to make our pregnancies times of learning and
growth, and not full of fears.

APPENDIX

Growth of the embryo-fetus from week to week

_ The word embryo comes from the Greeks and
means to swell or to teem within. Fetus comes
from. Latin and means young one or offspring.

Fertilization and growth of the embryo: The
female ovum can be fertilized 12 to 24 hours after
leaving the ovary, and the male sperm is effective
for about 48 hours. A few dozen reach the vicinity
of the egg. There are approximately 400 million
sperm to 3.9 cc. of an ejaculation. (Another esti-
mate: 20 to 500 million sperm to an ejaculation.)
While many sperm manage to detach the outer
layer of the ovum (zona pellucida), only one sperm
can fertilize the egg. It must reach the egg’s nucle-
us. The sperm loses its tail: its head - a nucleus
containing chromosomes - swells. The 23 chromo-
somes of one cell meet the 23 of the other to form

a single cell. At that precise moment the sex is de-
termined, as well as certain dominant characteris-
tics of the (from the) parents. About 10 hours af-
ter the first cells unite, there are four cells. Within
the next 30 or so hours, it becomes multicelled,
called the morula or mulberry, and is the size of a
pinpoint. At about the end of the fourth to fifth
day, it has reached the uterus, propelled forward
by the movements and the cilia (hairs) of the fallo-
pian tubes. It is now about 150 cells with a kind
of hollow space inside (blastocyst). Implantation
(attachment to the uterus wall) occurs between 514
to 7 days. This process is called nesting or nidation.
Tiny blood vessels in the wall of the uterus are bro-
ken and the growing cells absorb the nutrients from
them, grow roots called villi, gather nourishment
and the blastocyst implants itself in the uterus.

During the second week, the embryo is plate-
shaped, with hundreds of cells, some of which
form the embryo itself, the embryonic shield which
contains preliminary tissues for a whole body; some
form the umbilical cord, the placenta and the am-
nion (a membrane, a cluster of cells into which
fluid flows).

By the third week, the embryo is one-tenth of
an inch long, its neural tube formed, a swelling
which runs from head to tail; from this tube grows
the spinal column, nervous tissue and brain. By the
18th day, the eyes and ears begin to develop. The
placenta takes up one-fifth of the uterine surface.
By this time the first period will have been missed.

Fourth week: The embryo is % inch long. The
heart, looking like a U-shaped tube, starts beating
on the 25th day. Proportionate to the fetus it is
nine times as large as the human heart. There’s a
beginning circulatory system. There are simple
kidneys, liver and digestive tract. The tongue has
begun to form. On the 26th day, limb buds appear.
(By now you can be given a birth day about 238
days in the future.) ‘Relative size increase is never
again so great as in this first month. The embryo
is now 10,000 times larger than the egg. Also the
extent of physical change is never again to be
equaled.” (Smith, p. 142) By now the embryo has
a closed system of circulation independ ent of the
mother’s.

Fifth week: The heart is pumping frequently,
65 times a minute. External ears are starting to
take shape. About the 31st day, arm buds become
hands and shoulders, and a few days later, finger
outlines appear. The nose, upper jaw and stomach
start to form. The embryo is % inch long. On the

33rd day, the eyes are dark for the first time; black |

pigment has just formed in the retina. The brain
is % larger than three days earlier.

During this time the fetus is unnoticed but vul-
nerable. The mother’s diseases can be communi-
cated to the embryo; the part growing most rapidly
is most susceptible.

Sixth week: About the 37th day the tip of the
nose is visible and eyelids begin to form. Five sepa-
rate fingers and toe outlines begin to appear. The
skeleton is complete and growing, but it is still
cartilage rather than bone. Stomach, intestines,
reproductive organs, kidneys, bladder, liver, lungs,
brain, nerves and circulatory system are develop-
ing rapidly. The embryo is % inch long.

Seventh week: Embryo one inch long, weighs
1/30 of an ounce. The stomach produces diges-
tive juices, the liver makes blood cells, and the kid-

neys have started to extract uric acid from the blood.

The ears develop in unison, timing, and form, as
do the arms and legs. The upper and lower jaws
are clear, the mouth has lips, a sort of tongue and
first teeth (buds). The arms are as long as printed
exclamation marks!! The thumb is different from

the fingers. The first true bone cells develop; there’s

a working brain and a working circulatory system.
There are active muscular reflexes. The body is
- padded with muscles and covered with thin skin.

Eighth week: Neck visible, head very large.
Uterus four inches long. Placental area 1/3 of the
uterus.

Embryologists can tell precisely how old an em-
bryo is by seeing the stage of formation of its body

during the first 48 days. After the eighth week, the

embryo changes mainly in dimension and in refine-
ment of the working parts (perfection of funcion
follows perfection of structure).

Ninth week: Its sex can be seen externally. Its
footprints and palmprints are indelibly engraved
for life. Spontaneous movements occur, eyelids
and palms are sensitive to touch (reflex squinting
and gripping). Nails begin to grow. Eyelids close
for the first time. Amount of HCG reaches maxi-
mum level. (The 8th and 9th weeks considered
the best time for abortions.)

Tenth week: The quarter stage reached at 66th
day, but the fetus will have to multiply its weight
over 600 times in the remaining three quarters.
The uterus weighs about seven ounces, contains
one to three ounces of amniotic fluid. A common
time for miscarriages.

Eleventh to fourteenth weeks: Fetus can frown,
move thumb to fingers, swallow. Vocal cords com-
pleted. Urination begun and urine is removed with
renewal of amniotic fluid. Can digest swallowed
fluid. Sperm or egg cells exist. The mother’s uter-
us moves up out of the pelvis and can be felt from

the outside if the woman is thin. By the 12th week
the fetus is about 2% inches crown to rump or 2%
inches crown to heel and weighs *4 ounce.

This is roughly the end of the development peri-
od. The fetus and placenta are about equal in size.
The fetus’s movements are fluid and graceful. :
Every baby by now shows distinct individuality in
his or her behavior.. The amnion tissue surround-
ing the fetus is transparent, paper-thin, tough,
slightly elastic, shimmering; it’s an enclosing water-
tight protective bubble growing with the baby. The
fluid within is never stagnant; one-third of its vol-
ume is removed and replaced every hour. The
baby’s lungs and kidneys are thought to be one
source of the fluid; and so is the amnion itself.

The fetus fills the uterus. Its heart pumps fifty
pints a day. The uterus is halfway between the
pubic bone and the navel. The placenta produces
the hormone progesterone in sufficient amount to
maintain pregnancy (formerly done by the de-
funct corpus luteum).

In its second stage of growth, during the 15th--
18th weeks, hair starts to grow on its head. Eye-
lashes and eyebrows begin, nipples appear, nails
become hard. At birth they will be so long they
will need to be cut. The heartbeat can be heard
externally and you can feel its movements as it
moves and hiccups. The skeleton hardens, it
sleeps and wakes like a newborn, buds for perma-
nent teeth come in.

19th-22nd weeks: Premature life is possible. It
can grip firmly with hands. A hairy growth called
' lanugo appears on arms, legs, and back. Now ap-
proximately 12 inches crown to heel. Uterus is
up to navel.

23rd-26th weeks: Many prematures at this age
are able to live. Amniotic fluid perhaps 1% pints,
but after 30th-36th week may not increase or
might even decrease to allow fetal growth. Head
hair grows long, lanugo disappears. F etus can and
does suck thumb. Umbilical cord reaches maxi-
mum length. Uterus a few inches above the navel,
fetus about 14 inches long.

The third stage: 27th-30th weeks: by about
the 28th week the fetus is “‘legally viable’; that
is, it has organs sufficiently formed to enable it to
live if born early. It settles into a head down po-
sition, is fatter, with smoother skin. About 16
inches long.

31st-34th weeks: Still growing, about 17 inches
long. Premature babies look more like babies as
they have more fat on them, and less like little old
people.

35th-38th weeks: The fetus’s heart pumps 600

ORTHO

pints a day. Growth stops shortly before birth.
One cell has become 200 million cells. The weight
of the original fertilized egg has been increased five
billion times. The uterus is 14 inches long, maxi-
mum size, and it weighs 2% pounds. The placenta
weighs 142 pounds at term and is seven to nine
inches in diameter. The baby is ready to be born.

From the mother’s blood, from the placenta
and perhaps from the amniotic fluid the baby has
been receiving substances which make him immune
to a large variety of diseases. It receives disease-
combating proteins called antibodies which have
been built up from the diseases she has had. These
immunities will gradually wear off after the first
six months of life. In the last month before birth,
the baby will have a level of antibodies and gamma
globulin equal to that of its mother.

Infertility

Many woman have difficulty becoming pregnant.

Usually if a man and a woman have been trying to
conceive over a long period of time, many tensions
are built up. Trying to conceive on the mathemati-
cally right day, during ovulation, can become a
self-conscious mechanical process, eventually des-
troying good sex. Both the man and the woman

might begin to resent each other, to hold unfound-

ed grudges and suspicions, and above all, to feel
inadequate.

How long should a woman or a couple wait be-
fore seeing a doctor? If you can’t conceive a child
after trying for two years, or for one year if you
can’t wait or if you are past thirty (your fertility
declines with increasing age), then you should see
a doctor interested in infertility who has had ob-
stetric and gynecologic experience, and knows |
about the physiology of reproduction. He should
also definitely know about semen analysis. If he
is a good doctor he will be aware of your tensions
and hang-ups and he will try to deal with the emo-
tional and psychological conflicts you might have
toward each other and maybe towards having a
child. A doctor who runs through a series of tests

without talking with you will be helping you less
than he could.

Often you, the woman, will feel more guilty and
responsible for not being able to have children than
the man will. Studies show that 10-15% of the
couples in the U.S. are infertile, and in more than
40% of these cases the man is responsible. It’s
possible that some men will resist (1) the idea
there’s something amiss with them and (2) going

aaa

ao Rese SS ay

to the doctor with you. It’s threatening for him
as well as you to think himself on some level im-
potent, and even more upsetting to find out defi-
nitely that his sperm are not “powerful” or num-
erous enough. But if he’s really interested in hav-
ing a child, he’ll consent to be examined first. It’s
usual to examine a man first because it’s a much
simpler process. But now it’s possible within the
span of two menstrual cycles for a woman to get
a series of diagnostic studies done if the sequence
is treated logically; or she can, in two days in the
hospital, have many tests done. Of course these
tests cost money, and we should demand that they
be made available to all women who need to have
them, who want to have a child.

If you decide to see a doctor systematically,
then prepare for a first meeting by trying to go
over your medical histories. The doctor should
take your histories in detail. He’ll probably ask
you as a woman if you are married. He’ll ask
about your gynecological history: when did men-
struation begin, regularity of periods, discharges,
periodic bleeding, spotting, former infections,
abortions, possible rape. It’s hard to speak factu-
ally about difficult events like abortions and rape;
but they are facts, possibly medically important,
and it can be part of our strength that we speak of
them clearly. The doctor will review your circula-
tory, digestive and excretory systems to find out if
you have been or still are ill, and to find out how
you have been treated for these illnesses in the past.
He’ll probably ask about your sexual relations.

The next step for a man will be a physical exam
and a sperm analysis, and for the woman a physi-
cal exam and a pelvic exam. It might be that just
going to see a doctor will relax you enough to con-
ceive, if nothing else is wrong. It might be that the
man’s sperm might be defective in some way, and
you can work with the doctor from that evidence
to try and conceive.

Before going into the specific kinds of things the
doctor will be looking for, it makes sense to men-
tion the conditions on which fertility in women de-
pends: (1) good general health, (2) desire to give
birth to and rear a child, (3) no infection or inflam-
mation in the reproductive tract, (4) good function-
ing of the reproductive tract — vagina, cervix, uter-
us, fallopian tubes, ovaries, the anterior pituitary
gland and parts of the hypothalmus and cerebral
cortex.

For an egg to be fertilized there are roughly
twelve conditions: (1) At a time properly related
to the developmental stage of the endometrium
(lining of the uterus), an egg must be discharged
from the ovary. That presupposes that at least one
ovary be intact, that it have “responsive”’ follicles,

that its activities be governed by a functioning hor-
monal-endrocrine apparatus. (2) Near the exact.
time of ovulation, the hairs (fimbriae) of the fallo-
pian tube must surround the lower half of the ovary
and catch the ovum. (3) In the tube the egg must
progress at a rate of no more, no less than 5-6 days;
otherwise, the fertilized egg will not implant suc-
cessfully. (4) Healthy sperm must be deposited in
a healthy intact vagina. (S) Once in the vagina a
sufficient number of sperm must go into the endo-
cervical canal as a result of their efforts or because
of “‘in-sucking”’ organic contractions of the uterus.
(6) Once in the canal there must be a good bio-
chemical environment. The cervix must be in all
ways intact. Its secretions must interact well (non-
toxically) with the sperm. (7) From the canal the
sperm must climb to the uterus. (8) Then into the
fallopian tubes. (9) They must be able to swim
against the push of the hairs to the farther third of
the tube and there meet the egg during its time of
viability. This depends on the vigor of the sperm,
maybe on the chemical secretion of the tubal se-
cretions. (10) Large numbers of sperm must affect
the shell of the egg so that it can be penetrated.
(11) As it is swept along the tube toward the uter-
us the fertilized egg must undergo a series of ma-
turational changes that make it into a blastocyst

as it arrives in the uterus. It must be genetically
and embryologically normal. (12) The endometri-
um must be ready to receive it, the secretory
changes of the menstrual cycle must be adequately
advanced.

Thus, if any of these things are prevented from
coming about, the end result can be infertility.

During the second step of the exam, the doctor
will then give you a pelvic. He’ll look at the dis-
tributions of pubic hair, the development of the
labia, he’Il look for evidence of infection. Next
the entrance to the vagina is inspected. Sometimes
it’s found that the hymen isn’t sufficiently open.
Two glands (Bartholin’s and Skene’s) are examined
to see if they’re closed up, infected or tender.
There might be some obstruction in the vagina.
The amount, color and odor of vaginal secretions
are noted. The doctor inserts a speculum to hold
open the vaginal walls, and observes the position,
size and shape of the cervix. Then he’ll palpate
the cervix and uterus with one finger inside and
one hand outside to determine the size of the
uterus in relation to the cervix, its position, con-
sistency and freedom to be moved. In the same
way he’ll also check the position, size and consis-
tency of the ovaries.

If he hasn’t found anything wrong anatomically,
and if the man’s semen is normal, then you return >
for the third step of the investigation, which con-

i sists f complete blood tests to check your oritial
endocrine functioning and basic body health. You
will have a complete blood count to check the

| number of red and white cells that you have; a

hematocrit, a count of the percentage of red cells

in a specimen of blood to determine anemia; a test
to determine by checking white blood cell count if
there’s any infection and a differential: a check of
the kinds of cells involved in the white blood cell
count. Your blood will be typed, for it’s possible
that incompatible blood types may be reflected in
the sperm and in the egg. And as abnormal thyroid
function affects fertility, you’ll have two or three
tests to determine how efficiently the thyroid is
working. You should have a two-hour post-prandial
blood glucose test to determine that there’s proper
functioning of glucose control mechanisms, a test
for diabetes. And finally you will have a urine anal-
ysis to determine kidney function, hormones in the
urine, infections.

If everything described above gives no clues to
what is wrong, the doctor will do a systematic in-
vestigation of the bodily systems of reproduction.

First he’ll want to find out whether your ovaries
produce graafian follicles which upon ripening emit
eggs. Two days before menstruation he’ll do an
endometrial biopsy which consists of taking a small
sample of the uterine wall tissue to give informa-
tion about whether ovulation takes place and how
the endometrium develops. He will do a fern test
twice, once during mid-cycle, once at the end of
the cycle: when estrogen is present and highly con-
centrated, during ovulation (mid-cycle), the cervi-
cal mucus under the microscope shows fern-like
designs. At the end of the cycle the fern pattern
will no longer be there, for the progesterone of a
normally ovulating woman inhibits fern formation.
Another way of determining ovulation is to record
your basal body temperature rectally on a special
thermometer. Your temperature is supposed to
rise 1° F at ovulation and stay high during the life
span of the corpus luteum. If there’s no significant
rise, progesterone isn’t being provided in effective
amounts. The basal body temperature is of great-
est value with women who have regular menstrual
cycles. All these tests of egg formation shouldn’t
be counted as conclusive. It might be that they’ ll
have to be done a few times, for you might have
an atypical cycle the first time. Any diagnosis of
ovulation to be fairly complete should cover at
least three cycles.

There are several kinds of menstrual disorders
which indicate that something has gone wrong éei-
ther with ovulation, hormonal levels or some other
facet of the menstrual cycle. There are different
kinds of bleeding: disfunctional uterine bleeding,

possibly caused by persistent corpus luteum cysts,
pelvic inflammations or infections, anemia; dys-
menorrhea (abnormal menstruation); amenorrhea
(no menstruation); anovulatory bleeding (bleed-
ing without ovulation). The doctor needs to fol-
low here a logical sequence of studies. A common
cause of lack of menstruation is the Stein-Leven-
thal syndrome: enlarged ovaries or ovaries with
cysts. The cysts can be removed by a simple oper-
ation.

If he has to continue the search, the doctor will
check the transportation of the cells, by looking
for tubal disorders. The fallopian tubes might be
blocked, so that he will blow CO, through them
(the Rubin test, CO insufflation test). This test
in itself might correct the blockage.

A hysterosappingram may be taken of the uter-
us and tubes. A water-soluble opaque medium is
injected into the uterine cavity and outlines the
uterus so that any obstruction or malformation
shows up clearly in an X-ray.

Tubal disorders may be grouped under two cate-
gories: (1) mechanical obstruction by organic le-
sions, caused by pelvic inflammatory disease, rup-
tured appendix, peritonitis, abdominal or pelvic
operations:or (2) disturbances of the physiologic
function of the tubes — failure of the ovum pick-up
mechanism, delayed or too rapid ovum transport;
endocrine disturbances and/or psychic stimuli; that
is, if you are psychically disturbed, what goes on
in your brain might inhibit certain necessary hor-
mones from being released.

If nothing yet has been found to be wrong, the
doctor will then look into how sperm are placed
on or near the cervix and how they pass through
the cervical canal. The most well-known test is the
Sims-Huhner or Postcoital test. Often it is the
first test to find out how the sperm enters the wo-
man. It should be done six hours after a couple
has had intercourse, though there’s disagreement
about that timing. When cervical mucus is taken
from the woman and looked at under the micro-
scope, the number of actively moving sperm is
counted. There’s also the semen penetration (Mill-
er-Kurzrock) test in which a specimen of the man’s
semen is placed near a sample of cervical mucus.

If the sperm can penetrate the mucus and live,
then they are viable, they interact well. Sometimes
the semen and cervical mucus are simply hostile,
the male immune in some way to the female, or
vice versa.

Position of a couple during intercourse becomes
important, another kind of test.

Finally there’s something called psychogenic

infertility. This means simply that because of con-
scious Or unconscious anxieties or fears a woman
will try in all kinds of ways not to have a baby.
There’s infertility due to no identifiable cause,

the cause has not been found. And there is abso-
lute sterility, for instance where both tubes have
been seriously damaged.

The whole process of finding causes for infertili-
ty can be incredibly wearing and depressing. It
takes a lot of strength for a woman to go through
some or all of the above tests. But it’s helpful to
know some of the causes, some of the tests; it’s
essential to demand of the doctor that he tell you
what the procedures he uses consist of, that he des-
cribe the tools he will be using if you want him to,
that he give you some idea of how the different
processes will feel and be responsive to your reac-
tions.

Miscarriage (natural abortion)

Miscarriage is always an emotional event. There
are different kinds of miscarriages at different times
during pregnancy. If it happens early and the fetus
is barely formed, you might be less affected than if
it happens after the fourth or fifth month, after
you have felt the fetus move within you and felt
it to be real to you. But if you want a baby, even
if it happens early and especially if it has occurred
once or several times before, it can be occasion for
increased anguish and despair and add to the ten-
sion involved in trying to conceive again. Many
fears are increased, and you become more and
more vulnerable and must work on building up
defenses. If a miscarriage occurs in the fifth month
or later, some women feel incredibly incomplete,
and find themselves waiting for something to hap-
pen — their time sense gets shaken up. This can
happen even earlier. All of this is not to alarm but
to make women aware that miscarriage is a possi-
bility during pregnancy (one in ten women mis-
carry) and can be very difficult to cope with. But
anxieties can be lessened by your persistence in
both learning reasons for your miscarriage and by
being as much as possible aware and constantly in
touch with your feelings and fears. It is also vitally
helpful that you talk out these feelings, and
very important that your friends not gloss over the
event, feeling so uncomfortable with it - and it can
be hard to deal with - that you are frustrated when
you try to communicate your feelings. Often
through talking both to the man involved and em-
pathetic friends you can sort out your own strong
feelings and begin to know your anxieties.

If a woman is not fertile, the reasons for her in-
fertility might be the reasons for miscarriage. (The
man is less responsible for miscarriage than for in-

fertility.) So many of the tests performed for in- ee
fertility are useful in determining why a woman
will habitually abort.

There are four general classes of causes of mis-
carriage: (1) defective egg or sperm, (2) faulty pro-
duction of estrogen or progesterone, (3) anatomi-
cal illness or functional abnormalities, or general
illness or infection, (4) psychological. 30% of wo-
men abort and around 50% of the fetuses are found
to be abnormal. Some more percentages: after a
first miscarriage it’s 85-90% sure that the next preg-
nancy will be all right. After a second, there’s a
50% chance, and after a third, a 25% chance. A
woman who has miscarried three times or more is
called a habitual aborter. She should definitely
have preventative (preconceptual) therapy and
treatment.

-Miscarriages are classified into stages or types.
One abortion can pass through many stages.

Threatened abortion. There’s a difference between
bleeding and abortion bleeding. Some women when
pregnant about the time they are supposed to have
their periods bleed slightly for a few months. Some-
times as the blastocyst implants into the uterine
lining there’s slight bleeding. Sometimes the bleed-
ing might be bright red — if it continues for several
days, go to the doctor; he’ll examine you for le-
sions. Early bleeding has no effect on fetal devel-
opment. If bleeding does begin (slight brown stain-
ing with little or no abdominal cramps), there is
always uncertainty. The pregnancy might or might
not continue. You will be advised to go to bed un-
til the bleeding has turned brown and then stopped
for 24 hours. Afterwards you should not douche,
be too active or make love until the 14th week of
the pregnancy. Many women find the fact that
there is no treatment hard to accept; and find it so
hard to accept the fact that if the bleeding contin-
ues for several days, it means almost definite mis-
carriage.

Inevitable. Severe cramps, cervical effacement and
dilation occur with strong bleeding and clots. No
way to stop it.

Complete. The uterus empties itself completely of
the fetus, membranes and the decidual lining of
the uterus. During the first three weeks, spontane-
ous abortion is almost always complete. Some-
times then and even later it might feel like a really
heavy period; sometimes you might not notice it
at all as it takes place around the time you expect
your period. If the pregnancy is more advanced
than three weeks, the doctor would very likely
give you a D&C to be sure that every bit of mem-
brane is out of the uterus, for unless it is complete-
ly emptied, the uterine muscles won’t contract to _

compress the bleeding vessels and control the
hemorrage. 3

Incomplete. Varying amounts of tissue remain in
the uterus, either attached or free. Mild to severe
cramps, perhaps pain in a specific place. Must get
aD&C.

Missed. When the fetus has died but remains in
the uterus. Symptoms of pregnancy disappear,
breasts get smaller, the uterus stops growing and
gets smaller. Spontaneous abortion almost always
occurs, There’s a brown spotting. Doctors usually
wait until it begins by itself, and then give a D&C.

For the record there’s something called a septic
abortion. What that means is that a woman has
tried to abort herself and has caused either infec-
tion or an incomplete abortion. If abortions were
free and legal and easily available this “‘medical”’
category would completely disappear.

Sometimes a woman’s cervix has been injured
and can’t hold in the fetus. A simple operation

can be performed to prevent her from losing her
baby.

In general, if you have a history of miscarriage,
you should get fully examined along the lines of
the infertility investigation. If you have miscar-
ried only once, that usually means that the egg or
sperm is defective, and it’s paradoxically a healthy
thing for your body to get rid of an embryo or fe-
tus which isn’t growing well.

- BIBLIOGRAPHY

Obstetrics in General Practise — articles from the British
Medical Journal. British Medical Association, Tavistock
Square, London, WC 1. 1966.

Controversy in Obstetrics and Gynecology. Reid and Bar-
ton. W.B. Saunders Co. 1969.

Obstetrics and Gynecology, 3rd edition. Willson, Beecham
and Carrington. C.V. Mosby Co., St. Louis. 1966.

Obstetrics. J.M. Brudenell. Staples Press, London, 1964.

Management of the Infertile Couple. Maxwell Roland.
Charles C. Thomas. Springfield, Ill. 1968.

Clinical Obstetrics. Tenney and Little. W.B. Saunders and
Co. Philadelphia. 1961.

Siecus Study Guide No. 6. Israel and Rubin. Siecus Pub-
lications Office, 1855 Broadway, New York, N.Y. 1967

The Body. Anthony Smith. Avon Books, N.Y.C. 1969.

Human Embryology, 2nd edition. Bradley M. Patton.
McGraw Hill. 1963.

Pregnancy and Birth. Guttmacher. Signet. 1962.

The First Nine Months of Life. Geraldine Lux F lanagan.
Simon and Schuster. 1962.

A Child is Born. Sundberg-Wilsen, Dell. 1969.

An Analysis of Human Sexual Response. Ed. by Ruth and
Edward Brecher. Signet. 1966.

eT,

As we examine the history of childbirth prac-
tices (see Awake and Aware by Dr. Irvin Chabon),
we realize that when anesthesia began to be used
and children began to be born in hospitals, less of
us died in childbirth. However, we paid a price.
As we moved from home to the hospital, we be-

came “patients” (“‘objects’’, “victims’’), were seen

as “‘sick’’, and thus lost control over the experience.

Now that we are taking control of our bodies and
evaluating the use of drugs (not only during child-
birth!), we are also questioning the hospital as the
only place to have a baby. We are going forward,
not backward. We are not saying no drugs, no hos-

pital. We are learning the reasons for both and feel

that they are an advance for some of us; but for
others of us they are not necessary. It comes down
to us understanding our own bodies, the risks we
take, and demanding the right to shape our experi-
ences, whether in the hospital or at home.

Preparation then takes on a new meaning beyond
that envisioned by Lamaze and his followers. It is
a process of exploring our own feelings and trying
to figure out what we need and want during the
short period of childbirth (and how that relates to
the larger period of preparation for children); of
learning what happens during labor and delivery
and acquiring skills for coping with our bodies: of
understanding the medical situation in America
(particularly the hospital and the doctor) and final-
ly of integrating the parts of the process for each
of us in a way that enables us to: approach child-
birth with confidence in our ability to handle all
parts of the experience so the experience as a whole
is positive and one of growth for us.

HOW YOU GET PREPARED: CLASSES
FOR PREPARATION, DETAILS AND
DIFFERENCES IN APPROACH

There are two different groups that offer pre-
paration classes in the Boston area. One is a group
of trained nurses (RNs) who teach the Lamaze me-
thod (they have some LPNs too). The group is
called The Lamaze Childbirth Education, Inc. AI-
though not affiliated currently with ASPO, they
are known as the official Lamaze group in the area.
The other classes are sponsored by the Boston As-
sociation for Childbirth Education (BACE). You
don’t have to be a trained nurse to teach (often the
teacher is a nurse and her assistant is not); BACE
has its own training course and apprenticeship pro-
gram for its instructors. The method they teach is
eclectic, combining techniques of Dick-Read, La-
maze and Shiela Kitzinger (see bibliography).

The biggest difference between the two groups
is their general organization. The Lamaze group is
a medical, professional organization, and the BACE

group has,a parent, para-professional organization.
As I mentioned above, this means that only trained
nurses teach the Lamaze classes, while parents may
teach the BACE classes. The Lamaze group has
talked of non-nurses teaching, but has not changed
since they feel it’s important that the teachers also
be monitrices (monitor or coach) during labor and
delivery (to be a monitrice your credentials have
to be approved by the hospitals). I don’t know
whether BACE has a system of monitrices, but
parents do teach courses.

The orientation of the Lamaze classes is on
childbirth and that of the BACE classes on parent-
hood. Both groups give similar physical training
for the actual period of childbirth. BACE goes be-
yond the birth of the child and talks about breast
feeding, child development and other topics of rele-
vance to new parents. BACE also talks about fami-
ly centered maternity care in the beginning, a con-
cept which is a challenge to all medical facilities
in the Boston area. The BACE classes will more
likely teach you to be properly critical of hospital
procedure and the medical profession than the La-
maze classes. The Lamaze classes teach the women
(couple) how to cope with the doctors and hospi-
tal (responsibility is on the woman), while the
BACE classes teach the woman (couple) that she
will not be well received and will need a lot of sup-
port from her man (hospital’s problem which cou-
ple has to be aware of). Even though the BACE
group is not about to break with the medical pro-
fession, the governing body of the BACE organi-
zation is a parent board which shapes the classes
and changes as the parents change.

From a woman’s liberation point of view, both
sets of classes fall short. Nevertheless, it is essen-
tial to have some kind of training and coaching in
exercises and breathing, and they are the only ones
doing it now. Both Lamaze and BACE are excel-
lent in physical preparation of a woman for that
short period of time called childbirth. BACE goes
a little further in recognizing the emotional changes
and social changes of becoming parents. However,
neither group has adequate preparation for chil-
dren. The classes do not begin early enough; they
should start before conception. People should
have an opportunity to talk through a decision to
conceive a child before the child is actually con-
ceived (e.g. if you want a child to care for, why
not adopt?). From the period of conception to
the start of classes in the seventh or eighth month
is a long one; unless you happen to have other
pregnant friends you are not likely to have a chance
to talk out the many feelings and fears you have
about having a child. (Even then there is pressure
not to talk about negative feelings.) In other coun-
tries where midwifery is practiced, women have

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The purpose of this chapter is to explain to wo-
men the experience of childbirth and the ideas and
techniques of prepared childbirth from a women’s
liberation viewpoint. It is important that prepared
childbirth be discussed in the context of a course
on women and their bodies that includes sections
on sexuality, anatomy, medical institutions, etc.
My larger aim is to re-unite women’s minds and
bodies, not just for the brief period of childbirth,
but in an overall program of Overcoming our men-
tal and physical Oppression as woman.

There are two basic assumptions which I think
are important to state clearly at the beginning:
(1) Every baby born should be wanted (there should
be free, legal and safe abortions to any woman upon
her request alone). (2) Every woman (married or
unmarried, rich or poor, black, brown, yellow, red
or white) has the right to childbirth preparation.

Childbirth preparation does not begin or end
with childbirth; a more accurate description is pre-
paration for children, which begins with the deci-
sion to have a child (hopefully not a casual one),
goes through the defined stages of pregnancy, labor,
delivery and birth of a child, a short postpartum
period (length varied) and a longer (endless?) peri-
od of childcare. I will focus on labor, delivery and
the birth of the child and will call that preparation
for childbirth. This discrete period (average of 14
hours from beginning of true labor to birth of the
child for a primipara or first-time woman) com-
pared to the time it may have taken to conceive.
the nine months of pregnancy and the 21 years
of legal responsibility (years of emotional respon-
sibility are unnumbered) is short and intense.
Childbirth is a period of crisis for all women, a
time of great physical, emotional and social
changes. Childbirth preparation must help the
pregnant woman and those close to her under-
stand the changes and her feelings about them;
it must identify the range of physical, emotional
and social changes, their inter-connections and
ramifications and offer support, experience, ex-
planations, partial solutions. This sharing may
start at conception of a child but it does not stop
at childbirth.

My primary focus is on us as women, on us as
people and we neither begin nor end with the birth
of a child. The child is a new dimension and can
be an exciting dimension as long as it isn’t the
only dimension. With this introduction we can fo-
cus on preparation for childbirth.

Prepared Childbirth

_ a woman’s body is biologically equipped to bear

WHAT'S IN A NAME: SOME
COMMENTS ABOUT HISTORY

Prepared childbirth is often misnamed ‘“‘natural
childbirth”. The only thing that is natural is that

and give birth to a child. (We have been taught to
want children and to expect to raise them our-
selves.) Although considered normal by most wo-
men (reared on the usual myths), it is not natural
for us to have our babies in helpless, degrading, ig-
norant pain and fear. Dr. Grantley Dick-Read, an
English obstetrician, believed fear caused tension
that inhibited the process of childbirth. If women
were educated to understand what was happening
to their bodies, he felt pain would be minimized.
He certainly was a pioneer (book published in
1942) in preparing women for childbirth; however,
his method appealed to religious conviction and
mystical beliefs about a woman’s role in society.

A French obstetrician, Fernand Lamaze, visited
the Soviet Union and saw Pavlovian reflex theories
applied to childbirth. All kinds of women gave
birth in joy rather than in pain. Excited by what
he observed, he returned to France and in 1951
introduced a method called the psycho-prophylactic
technique in clinics for working women (psycho-
prophylaxis of pain in labor means prevention by
psychic means).

“Although the goal was the same - childbirth
with minimal discomfort and with medication, en-
abling the mother to see her child coming into the
world - the Lamaze method differed from the Read
method chiefly in advocating that the mother be
very active during a contraction instead of concen-
trating on relaxing.

‘The Lamaze method was introduced to the
United States in 1959 with the publication of
Thank You, Dr. Lamaze, a book written by Mar-
jorie Karmel, an American whose first child had
been delivered by the French physician in Paris.

“The following year, Mrs. Karmel and Elisabeth
Bing, a Berlin-born physical therapist, founded the
American Society for Psychoprophylaxis in Ob-
stetrics [ASPO], a nonprofit teaching organization
of doctors, teachers and parents.

“*We don’t call it natural childbirth but educated
childbirth,’ says Mrs. Bing. . . ‘Read says it’s a nor-
mal physiological process, which shouldn’t hurt if
you think right. He’s very mystical. We say labor
is a situation of stress and we try to cope with that
situation.’ ” !

contact with the midwife who will deliver her baby
from very early in her pregnancy. The midwife is
a woman with whom you can share feelings; she is
also a source of contacts with other pregnant wo-
men (often in the neighborhood since the midwife
is assigned to one or two neighborhoods). Clearly
one of our demands must be to make the practice
of midwifery legal and popular.

The classes never discuss the nuclear family as an
institution of oppression (for both children and
parents) and means of childcare (playgroups, day
care, communal child care, etc.). This could be a
time for women and men to split and talk alone
and then come back together as a group.

The classes are too large (15 to 20 couples) to
have the kind of discussion I’m talking about, too
expensive ($30 a couple) and too exclusive (they
attract primarily middle class, married couples,
highly educated intellectual types). BACE has
started one class in a local community center for
low income women. But all women must have
preparation — in their neighborhoods, in clinics,
in churches; in schools.

PREPARATION BEFORE LABOR:
LEARNING ABOUT YOUR BODY AND
HOW TO USE IT — MUSCLES, EXER-
CISES AND NEUROMUSCULAR
CONTROL

The work of labor centers on the pelvis and
uterus. In order to approach labor, we have to un-
derstand the construction and functions of these
parts of our body. Then through physical exercise
we will prepare our bodies for the hard work of la-
bor.

Pelvis. The pelvic girdle is formed by the hip bones
which create a shape something like a lobster-pot
sloping downwards and forwards, through which
the baby passes when it is being born. The pelvic
outlet is limited by the sub-pubic area in front, the
ischial tuberosities at the sides, and the sacrum be-
hind. The coccyx, the little bone at the bottom
of the spine, although curved forward, is attached
to the sacrum bya joint which moves back when
the baby is being born, so that it does not get in
the way..

Uterus. The internal reproductive organs of a wo-
man are composed of a hollow, thick-walled mus-

ft cular uterus or womb, shaped like a pear with the

| stalk end pointing downwards and usually slightly

| backwards. In front and behind are the bladder
and the rectum. and the mouth of the uterus, or
cervix. connects up with the vagina from below.

“By the end of pregnancy, the uterus has moved
up and out of the pelvis into the abdomen, is nar-.
row-shaped and about 12 inches long. Its fundus
(top) reaches nearly as high as the diaphragm,
which is the sheet of muscle which separates the
abdomen from the thorax (chest). The baby is
protected within the walls of the uterus which are
about half an inch thick, and is also inside a bag of
membranes, where |she] floats in (amniotic fluid,
or bag of waters), attached by the

“Bie | ? 91
during labor.

“Exercise 1. Sit on the floor ‘tailor fashion’. If
it feels hard sit on a cushion; but don’t lean against
anything. Make your back muscles support your
body in an upright position. The exercise you are
about to learn will help increase the suppleness of
the muscles of the pelvic floor. . .

‘Put the soles of your feet together with heels
as close to your body as possible without losing |
your balance. Grasp your feet together with one
hand and put the other hand under one Knee.
Now push your hand toward the floor with your
leg; then bring the leg back to its previous position
with your hand. Notice that the muscles on the

umbilical cord to [her] placenta
es ‘ oS)
through which [she] is nourished.

The open space created by the
bony pelvis and which supports
the growing muscular uterus is
called the pelvic basin. Across the
bottom of this basin stretch the
pelvic floor muscles. [n their nor-
mally firm state, these muscles
keep the intestines and other soft
organs from falling through the
lower Opening o: the pelvis. Dur-
ing delivery these muscles should
be relaxed to permit the baby to
pass through.

Here are three exercises from
Erna Wright that will get your pel-
vic muscles in shape for labor. As

HP BONE

you do them, you will understand
your body better and take control
of parts of it so it works for you

Cross-sectio , Pelvic B25 ,No-
| Pregnant Waman,(Weignt pi).
Ee

External View, Female Peluic Floor,
Wright ep. 32

—4

ie 2

outer side of the thigh are pulling against the mus-
cles on the inner side, called the adductors. Repeat,
pushing toward the floor in one smooth movement,
and bring the knee back once more. After six re-
peats, change hands and do the exercise six times
with the other leg. Then keep your feet together
without holding them, and use both hands under
both knees simultaneously. Again repeat six times.
Don’t jerk your knees downward — just push as
smoothly as possible each time.

“After a few weeks of doing this whole pattern
once daily, you will find that you can bring your
heels closer to the body without losing balance —
proof that your adductor muscles have lengthened
(postnatal exercises will reverse this again).

“Exercise 2: This has become a boon to many
expectant mothers who suffer from backache. The
exercise is intended to make the muscles covering
the back of the pelvis more supple.

‘““Kneel on the floor, sitting back on your heels.
Rest your hands on the floor in front of you, with
the elbows turned outward and slightly bent. Put
your head down and hump your back. Now, using
your thigh muscles like pistons, push your buttocks
out backward — like a duck lifting its tail. Feel
your thigh muscles doing the work. Then make
them pull your buttocks back again, as though you
were trying to hide them. Repeat six times. Alter-
natively you can do this exercise sitting on a hard
chair about halfway along the seat. Plant your feet
firmly on the floor in front of you. In this posi-
tion hold your thighs with your hands to feel the
muscles at work. :

“If you ever find that you back suddenly goes
into a spasm, especially after bending down, don’t
stay in a bent position. Sink onto your knees in-
stead, and do this exercise. After a few minutes
the cramplike sensation in your back will ease.
This exercise is also often beneficial in early la-
bor if backache is experienced.

“Exercise 3: Kneel on the floor with your knees
slightly apart. Put your hands flat on the floor
with your arms held straight. Your back should be
arched slightly upward so that your body forms a
square between knees and hands.

“Do the exercise as follows: Contract the mus-
cles surrounding the back passage [anus]. Decon-
tract. Repeat with muscles surrounding the front —
passage [urethra, vagina] and then the whole pel-
vic floor. Repeat the whole pattern three times,
once a day.

‘““A word of comfort: It is almost impossible to
do this the first few times. Just get the idea, and
then persevere. After a few weeks you will achieve
control over the different parts of the pelvic
floor.”’>

You will want to do some exercises to strengthen
the upper and lower muscles of your abdomen. =
These muscles are used during delivery when you
help push the baby out. It’s important that you
begin to get these muscles in shape because the bet-
ter each push is, the fewer pushes will be needed,
and the baby will stay in the birth canal fora
shorter period of time.

These exercises are very simple. Lie down flat
on your back on the floor. With arms at your sides,
relax (i.e. decontract) all muscles. Try to think that
if the floor was not supporting you, you would
float free in space.

Upper abdominal muscles: Slowly lift just your
head from the floor (shoulders should come up as"
little as possible) until your chin touches your
chest. Do this to the count of three and lower to
count of three with pause in between raising and
lowering. Do this three times the first time and
work up to ten within a few weeks. Do this exer-
cise once a day.

Lower abdominal muscles: Now lift your feet
off the floor, keeping the rest of your body still.
You should raise them just high enough so you feel
a pulling sensation in your lower abdomen. Do this
in the same pattern as for the exercise above.

You may also want to do exercises to strengthen
the muscles under your growing breasts. Both of
these exercises should be done sitting up straight.
For the first, grasp both wrists with the opposite
hands and push hard towards the elbows. Hold
three counts. Relax. Repeat four times. For the
second, place both palms at temples, fingers point-
ing upwards. Push palms against head while slowly
raising elbows as high as possible. Repeat four
times. These can be done after the baby is born
too.

Not only these specific exercises, but exercise in
general is important throughout pregnancy. The
better physical shape you are in, the easier it will
be for you to cope with the physical demands of
labor. That doesn’t mean you should start to do
physically heavy work if you’ve never done it be-
fore. It’s more that you should keep working and
living as you had before. Dancing and sex included!
(See section in Brecher summary of Masters and
Johnson for sex during pregnancy.) For psycho-
logical reasons as well it’s important that you re-
main active and not let the pregnancy dominate
your life for nine months. Certainly think and talk
about fears and feelings, about changes in your
body, your head and your life. They are all real
and legitimate and essential to talk out with wo-
men, with your man. But keep thinking about
yourself and who you are/ want to be in addition

to the reality of being a pregnant woman. You
neither begin nor end with that baby; you area
person apart from the child and need continually

to think on that — for your sake and for the child’s.

Be as sensible about resting as about exercising.
Rest when you need to. It’s most important dur- .
ing the last month so you will be ready for the hard
work of labor. It’s also hardest then; you feel most
heavy and it’s difficult to find a comfortable po-
sition. Relaxation exercises, which I'll get to in a
moment, can help.

To make the transition from those exercises
which get our bodies in good shape before labor to
those breathing exercises we need to learn to man-
age our labor, we need to talk about the functions
of oxygen and of neuromuscular control.

“Before doing exercises, we must know how to
do them properly. Whenever we make our body
do any work that is more than the usual amount -
and this is what exercise really means - the muscles
use more body fuel, stored from our food. To do
this efficiently, they need more oxygen. Oxygen
is a gas present in the air, more so in fresh than in
stale air, so always do your exercises in a room
with an open window. The amount of oxygen we
take in by ordinary automatic breathing is not
quite sufficient for doing extra work, and under
such circumstances we feel our body demanding
more. Think back to the last time you ran after
a bus. You will recall that when you reached it
and collapsed into the nearest seat you were prob-
ably puffing a bit — the body’s way of saying,
‘More oxygen, and faster please.’

“This is not the best way of doing it. It is far
better to recognize the need in advance and pro-
vide the extra oxygen by adapting one’s breathing

to the work the body is doing. We do this by using

consciously controlled breathing.

“During [childbirth] the group of muscles called
the uterus works very hard over several hours to de-
liver the baby from the mother’s body into the out-
side world ... The muscles are working far more
than usual. And as we cannot tell the uterus to
rest when we choose to, we must prepare for con-
stant work. This is why it is important for all oth-
er physical activity to be reduced as much as poOssi-
ble. If other muscles go into action when the uter-
us does, they are wasting energy and oxygen that
should be in reserve for the uterus. Then the body
will tire quickly and prevent the uterus from func-
tioning as efficiently as it should.’4

We must learn certain skills so we can help the
uterus work hard and constantly during labor with
minimum diversion of energy to other muscles. If
you have the image that you will lie and passively

Telax during labor you are wrong. Rather you will
be very active, you will be working very hard; but
with your uterus, not against it! Now how'do we
do that? First we learn how to breath in a con-
scious and controlled way. Today you may be un-
aware that you are breathing. During labor you
will be aware of each and every breath. ‘In a simi-
lar way you may be unaware when you move mus-
cles to lift an arm or extend a leg today; but during
labor you must become aware that each contraction
of a muscle other than that of the uterus may bea
waste of energy which must be conserved for the
constant work of the uterus. In other words, you
want to use other muscles efficiently, as you want
to breath appropriately and efficiently.

Since we have learned to use muscles not singu-
larly, but in combination with one another (we use
many more muscles than those in our legs to walk,
for instance), we have to learn to dissociate the
muscles from one another if we are going to be able
to allow the activity of the uterus to be as un-
hampered as possible.

“When any muscles work, they do so because of
a message sent by your brain and prompted by
your will. The brain sends the message to the
muscles concerned via the nerves; this is called
neuromuscular skill. The simple ability to reach
out and grab something, which you acquire at
about five months, is a complex neuromuscular
skill.

“There is no harm in the fact that these skills
become mechanical. It is perfectly all right for or-
dinary purposes. But it does mean the brain ac-
quires habits in the way it works... We therefore
have muscles with a strong habit of working togeth-
er, regardless of whether or not they are needed
for a particular activity.

“But in labor the situation is very different. In
labor you have one group of muscles contracting
as it wants to, to a particular pattern of its own.
And when these muscles begin to contract strongly,
then other muscles, quite unconnected with this —
function, do so too: the muscles of the arms, legs,
back, and even face, all try to join in. And this is
the typical picture painted so luridly by Victorian
fiction writers when they described women in
childbirth. ‘A terrible groan escaped from her pale
lips. Then her hands clutched the bedpost as her
whole body was contorted by unendurable agony.’
—something like that. But all they are really des-
cribing is neuromuscular association. Even so, it is
rather an uncomfortable endeavor because it con-
sumes so much energy and oxygen. And it’s hardly
a picture of relaxation, is it?

“Instead we will teach your brain a new neuro-
muscular skill — the skill of deliberately keeping

94
apart muscular activity. This is called neuromus-
cular disassociation.”

LABOR AND DELIVERY

When I talk about labor and delivery, I am as-
suming a normal, uncomplicated one. It’s all im-
portant to remember your experience will be simi-
lar but also unique.

You’ve gone through a lot from the time you de-
cided to have a. baby until now. You are well pre-
pared, both physically and emotionally, and pretty
psyched up to have the kid. And then you freak
as the prospect of labor gets more real as you get
closer to your “due date”. You begin to feel scared
and lose the confidence that has been building up
over the months; you’ll never be able to manage.
You must have been crazy to want a kid in the
first place; you worry about loss of your own in-
dependence, the dependence of another person
on you... And will you be able to tell a true
labor contraction from a false one? And what
does a contraction feel like anyway??

A contraction during labor feels something like
menstrual cramps. You may feel it in the lower
abdomen, groin, back depending on your own body
construction and on the baby’s position. Unlike
uterine cramping during menstruation, uterine
contractions during labor are not a.constant level
sensation, but a sensation that rises to a peak and
then falls. As seen in the sketch at the top of the
page, the uterus is composed of opposing sets of
muscles. ‘“The opposing sets of muscles interlace
down its upper two-thirds and more circularly
around the bottom third. In pregnancy, the lower
set keeps the baby from falling out, but during la-
bor they must relax progressively against the pull

Full-term baby before labor begins; mother on her back with head
out of picture, left. (1) placenta and cord. (2) uterus. (3) moth-
er’s navel. (4) bag of waters (amniotic fluid) surrounding baby.
(5) pubic bone. (6) birth canal, (7) cervix, thick and closed with
mucus plug. (8) bony structure of spine, tailbone, and back of
pelvis.

- Se e's
Uterus, showing (1) right-hand round ligament which moors it
at the vulva and (2) right-hand uterosacral ligament which at-
taches it to the back of the pelvis. There are also left round

and left uterosacral ligaments on the far side not shown in the
picture. (from Lester Hazell, Commonsense Childbirth, p. 85)

of the upper ones to allow the cervix to open up.”
So as you feel a contraction beginning you may
sort out a pushing sensation at the highest point of
your bulge and a pulling sensation in your groin.

“During the three weeks or so prior to the onset
of labor, certain changes take place which are useful
for determining the approach of labor. These are
(1) lightening (engagement of the baby’s head);

(2) frequency of urination; (3) beginning efface-
ment (thinning) of the cervix; and (4) false labor.

“Lightening is the lowering of the uterus which
takes place in first-time mothers (primiparae) sev-
eral weeks before their due dates. This locks the
baby’s head down tight in the pelvis so that he can’t
do much gross moving around. Because the top of
the uterus no longer crowds the lungs, breathing is
easier, the heart and stomach function more smooth-
ly, and the relief of pressure is the reason for calling
this process lightening; though she doesn’t look it,
the woman feels lighter. In women who have had
more than one baby (multiparae), the lightening
often does not occur until early in labor itself,
perhaps because the abdominal muscles may not
be as firm, and the uterus tends to bulge out rather
than being pushed down by them. After lightening
has occurred, walking becomes more difficult from
increased pressure on the hip joints. Frequency of
urination may be due to the pressure of the baby’s
head on the bladder, limiting its capacity and re-
quiring it to be emptied more often.

“Beginning effacement of the cervix and false
labor should be discussed together because they
will blend from precursors of labor into labor itself.
Although there may have been false labor (Braxton
Hicks contractions) since the beginning of pregnan-
cy, it may make itself felt more and more in the
last weeks before birth. False labor contractions
are erratic and irregular; the uterus contracts and

Cervical dilation in centimeters, shown actual size: 2 centimeters in very early labor;

95
to haif an hour.

- So when are you going to be in
true labor? Enough with the prelimi-
naries, you say! There are three signs
that the first stage is beginning: (1)
bloody show is visible; (2) premature
rupture of membranes(from trickle to

~ one cup); and (3) regular uterine con-
tractions. The show is blood-tinged
mucous (pinkish, thick vaginal dis-
charge rather than bloody red) that
has up until now been a plug in the
cervix (like a cork on a bottle) which
has served to protect the growing
baby from germs that might enter
through the vagina. The “‘cork”’ fall-
ing out shows that the cervix is be-
ginning to open up.

For most women the bag of waters
doesn’t break until the beginning of
the second stage of labor, though it
can break before or any time during
the first stage. The membranes can
also be ruptured by piercing them with

6 centimeters at beginning of transition; and 10 centimeters full dilation at end of first a needle (doesn’t hurt; sensation like

stage. (from Hazell, op. cit., p. 224)

relaxes, whereas in true labor it contracts and re-
tracts. (By retract we mean that each muscle fiber
instead of contracting and relaxing, as is true of
most other forms of exercise, contracts and then
remains in a shortened state while it rests, thus push-
ing the baby farther down within the abdominal
cavity and closer to [her] birth.) Early effacement
of the cervix is probably the result of some of these
false labor contractions which do more and more
retracting as the due date approaches. . .”””

I want to mention the three stages of labor and
include pictures before I go on to woman in actual
labor. Stage one (which is further divided into
three parts) is concerned with completing the ef-
facement (thinning out of cervix or neck of uterus,
measured in percentage from 0% to 100%) and
dilation (opening of cervix measured in centimeters
or fingers from 0 cm to 10 cm or 1 finger to 5 gin-
gers; 1 finger equals 2 centimeters) of the cervix
so it is wide enough for the baby’s head to move
into the birth canal. It begins with the onset of
regular contractions and ends with the crowning
of the baby’s head (whole of top of baby’s head is
visible when lips of vagina are opened). Average —
time is 12 hours. Stage two begins with crowning
and ends with delivery of the baby through the
birth canal and out of the mother’s body. Average
time from one-half to two hours. Stage three is the
separation and delivery of the placenta and attached
membranes. Average time is from a few minutes

a balloon filled with water bursting).

““The intact bag of water has an im-
portant function in labor that makes a superb dila-
tor of the cervix by maintaining equal pressure
according to the laws of hydrodynamics. If you
apply force upon an enclosed liquid, this force will
be transmitted equally everywhere throughout the
liquid. In the case of the bag of water the part of
it known as the forewaters protrudes down through
the dilating cervix. As the uterus contracts, the
total force of the contraction is transmitted right
into that little finger of forewaters, causing it to
spread and act as an opening wedge through the cer-
vix. Hence the intact bag of waters makes a better
dilator than the contours of the baby’s head...

“The membranes often rupture when enough of
the cervix is dilated so it no longer supports the
membranes.””®

If your bag of waters is leaking or has broken,
call the doctor immediately and get to the hospital
or settle in one place at home. The reason is that
once the waters are gone, there is a chance that the
cord can get wrapped around the baby’s head, es-
pecially if the head is still high up in the uterus,
but more important, there is a real possibility that
the baby’s head will press against the cord and cut
off his own blood supply. If the contractions of
your uterus stay regular, get longer, stronger and
closer together, you know you are in true labor.

If you have questions about whether you're really
in labor or not, change position or activity. For

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ample, if you are lying down, get up and walk
| around; if you’re standing, sit down; or take a

_ | shower. I was told that when contractions were
| five minutes apart with my first baby (ten with my |

| second — time depends on distance from the hos-
7 pital and what’s happening inside your particular
body), 1 was to leave for the hospital. In the read-
_ ing ’ve done since then, [ discovered it wasn’t the
time intervals between contractions that were im-
| portant, but the length and strength of the con- .
-_tractions, for they, rather than the time between,
indicate how well your uterus is working (which
| made me think that doctors don’t tell us that pos-
| sibly because they don’t think we can understand_/
| judge that but assume we can tell time!).

Anyway, you're in labor and off to the hospital!

_ In addition to your suitcase with stuff for the
} hospital stay, take the following for labor (don’t
} laugh; I'll explain uses as I go along): stop watch
| or watch; lollypops; small brown paper bag; tennis
} balls; powder or cornstarch; hot tea with sugar in
| thermos; playing cards; books; favorite pictures;
} posters; camera; tape recorder; candy bars; sand-
} Wiches (for your man, coach — they can eat while
} you labor even though you can’t); and anything
| else that will make you happy in the foreign en-
} vironment of the hospital.

|} Toeat or not to eat... Ill present both view-

| points and you choose. You’ll have to take into -

| account when you last ate and when you expect

todeliver. Not to eat: If you’ve just finished a big

| meal, too much oxygen will have to go to the di-

| gestive muscles and less to the uterus, which needs

} al the oxygen for contractions. You can take lolly-
pops and sips of tea between contractions to give

| you quick energy. Some doctors say no to even

| that but I don’t know any good reason why not. .-

| Even if you do feel nauseous during transition

} (end of first stage of labor), these foods won’t

} temain in your system that long. To eat: “You

} tust stock up on food before the digestive pro-

} “esses are cut down. Otherwise you will go into

} kbor, the available sugar in your blood will ex-

} ‘aust itself, and you will get very tired, needlessly. —

| ln fact you will be starving. But you won’t feel
} ‘ungry, simply weak. So this meal is therapeutic.’

| As your contractions are about to begin, you

| Want to think about the shape of them — there is
| beginning, a middle and an end. They gradually
| "se to a peak and then descend. It’s fascinating to
| observe the rise and fall of your own contractions,
| see the pattern of your body emerge. Also, it
__ | keeps your mind active and prepared to respond

'} With appropriate breathing techniques which also
_ | eve a beginning, a middle and an end. Otherwise,

you might be laboring all the time and not relaxing

at all. The ability to relax becomes more important
as labor gets harder.

_ The first regular contractions you may have are
about 30 seconds long and 15 minutes apart. These
feel like premenstrual cramping only at regular in-

‘tervals. Usually they are not uncomfortable and

don’t interfere with whatever you are doing at the
time (these gentle contractions are sometimes

called effacement contractions since that is their
function). By the time the contractions are 45
seconds long and five minutes apart, you’ll prob-
ably need to begin breathing consciously (you may
have started sooner). What you need is a gentle

and relaxed kind of breathing, thus you do Can-

die Blowing (see Appendix, Chart A for instructions).
(Also, this kind of breathing because it is so relax-
ing is helpful in getting to sleep during the last

month of pregnancy and also may be useful toward
the end of the first stage of labor if the more active
breathing tires you out. With all kinds of breathing
you can switch back and forth; the only guideline

-is your comfort.)

Three centimeters is an important guidepost:
you are about one-third of the way through labor
and also your contractions are at their strongest.
They will get longer and closer together, but not
stronger. This is very encouraging because you are
totally on top of the situation at that point and it
makes you feel that you really might be able to
manage your labor! (I can’t document this. The
nurse who taught the Lamaze class I went to before
the birth of my first child told us this. I can’t re-
member if during either of my two labors I felt
this to be true since the contractions of 9 centimet-
ers are clearer in my memory than those of three
centimeters. I do remember that it was a morale
booster, especially at first birth. Whether you take
it as fact or fancy, it’s a good thing to remember.)
At this point, when you’re feeling very confident,
I want to stress the importance of taking one con-
traction at a time — repeat — one contraction at a
time. Just think about what you need to do for
the one contraction that is upon you, not how
many more there will be. I stress this because if
you have a difficult contraction and start feeling
tense and out of control, you tend to think about
the endless numbers of contractions to come (they
are finite) and assume that they will be as bad or
worse than the one you just went through. Re-
member you got through it. A success! One ata
time. Count each success, don’t anticipate failure.

If you are not already in the hospital, you have
called your doctor and are on your way by 3 cen-
timeters dilation. You can lie down in the car if

-you’re more comfortable that way. At the hospital,

OB ces

if they are sure you’re in labor you will probably
be taken toa labor room; if they are not sure, to
an examination room. If you are sure and they are
not sure (nurse says, “you are so young, how could
you know you're in labor’; or, grabbing you by
the arm, says, “‘listen, girl, you think having a baby
is fun; well, it’s the worst pain you’ll have known!”’
—help like this we can do without!), you and your
man/coach can make demands to be taken directly
to the labor room. You may still have to deal with
a bitchy nurse or an inhuman resident who makes
you feel dumb and worthless. It’s lousy, but re-
member it’s their problem, not yours. Insist long
and hard enough. Don’t forget you are paying a
lot of money, whether you are a clinic or a private
patient.

A note about hospital labor rooms: your social
class is revealed by whether you’re assigned to a
private labor room or not. White, middle class pa-
tients go to private rooms, black, poor patients
to ward rooms. For example, Boston Hospital for
Women, Lying-In Division (BLI) will only give
private labor rooms to private patients. Even if
there are free single labor rooms, clinic patients
go to the wards. When I questioned this policy,
the woman who was taking us on the hospital
tour told me “‘you get what you pay for’. Other
hospitals which have only a few private labor
rooms follow the same class based policy only it’s
described in different terms. At Mt. Auburn Hospi-
tal in Cambridge, Lamaze patients get the private
rooms, because they are too “‘noisy”’ and disturb
the other women (a friend was told this by her
doctor who is head of obstetrics there). I wanted
to be alone with my husband when I had my two
children. I can see a time, though, when all wo-
men have preparation for childbirth, that we might
want to be together with our sisters during labor.
But then group labor rooms would be our wishes
and not hospital rules.

When you get to the labor room, you are what
they call “‘preped””. + you’re put in a hospital gown
and have your pubic hair shaved. There is a real
question about the necessity of this shaving pro-
cedure; there are so many antiseptic solutions
poured, wiped, etc. over your pubic area that it cer-
tainly is not for the sake of cleanliness. Rather, it’s
custom that: most doctors subscribe to. Of course,
they’re men and don’t have to deal with itchiness
as pubic hair grows back. If you can avoid being
shaved, you should. “The only valid reason for
removing the hair that I can see is that it might be-
cloud the doctor’s view of the perineum in case he
needs to make an incision. No hair grows where
the incision should be. Some doctors have solved
the problem by having the hair clipped with scis-
sors right around the outlet of the birth canal.

While this may be unnecessary, still it avoids the

problem of shaving, not the least of which is itch-~. ae

ing and soreness as the hair grows back.”’!9. If yous):
are shaved, you can ask the nurse to stop during. «
contractions if the shaving bothers you. Remem- ~:
ber about making demands. Think positive, as-
sume success.

Next you will probably get a vaginal exam (may-
be rectal too since the rectum is close to the cervix.
and therefore you can feel the amount of dilation
from that point too — refer to pictures of anatomy
earlier in this chapter) by a resident. (Doctor may
not appear until middle to end of first stage of la-
bor.) Ask any questions you have of anyone: You
have to let people know you are a human being
and not a piece of meat. The resident or nurse
may listen to fetal heart tones (you can ask to hear
it too) and check vital signs — temperature, blood-
pressure, pulse.

Another preparation is the enema. A bag’s
worth of soapy water is put into your rectum and
within minutes you start eliminating everything —
water and fecal matter. “‘As for the enema, it is
supposed to insure that no fecal matter will be ex- _
pelled with the second-stage contractions and con-_
taminate the doctor’s sterile field. But does this —
work? Sometimes, but so frequently does the last.
of the enema arrive along with the pushing of se-
cond stage that a friend of mine who is an obstet-
rical nurse remarks, ‘I don’t really believe the baby .
is coming until I smell feces.’ [Does the American
idea that childbirth is dirty come from this?]

“The other theoretical purpose of the enema is
to make sure that there is no hard fecal matter in
the rectum which would compress the adjacent
birth canal, making the passage smaller for the
baby. Left to her own devices, nature usually takes
care of this. The same hormones that start up the
contractions of the uterus in early labor often cause
the intestines. Many women have a sort of painless
diarrhea that persists until first stage is well ad-..
vanced and the intestines are clear. The laxative ,

action of labor may be lost, however, in the inhibit- «.),

ing atmosphere of the hospital. I have never seen
a home delivery that was contaminated by involun-
tary bowel movements; many hospital labors are.””!!

If you can get to the toilet, it’s more comfort- ~
able there than on a bedpan. Again, ask to wait
until your contraction is over. You will have to do
breathing for contractions while you are on the
toilet. Contractions will get stronger right after
the enema (because of it) and may persist at the
strength for several contractions. The enema as
well as the breakage of the bag of waters will speed +
up several contractions. Expect it; don’t settle
back into a pattern or rhythm which you will:be

able to anticipate. But by this point you are ready
for another kind of breathing. It is a slow, shallow
panting where you close the pant by saying either
hut or out (whichever you prefer). You can also
do just a regular shallow pant (only your. chest
should move and ever so slightly), but the closing
off of the pant with a sound seems to give you an
added crispness and something more on which to
concentrate. (See Appendix, Chart B for instruc-
tions.)

You know to start this kind of breathing because
the candle blowing is no longer working, i.e. it no
longer is enough to keep you comfortable. You
feel a stronger pulling sensation at this point, pres-
sure and tension building up during a contraction.
You are dilated about 4-5 centimeters (2 to 2% fin-
gers); contractions are lasting about one minute
and are four minutes apart. You may still be able
to read, sing, play cards, talk to people around you:
if that is relaxing to you between contractions.
Medical people need to check dilation, vital signs,
fetal heart tones, but if they are just standing
around and bothersome ask them to leave. You
are having the baby and have the right to shape
the kind of experience you have. If someone is an-
noying you and you lose control in the middle of
a contraction, do the following: (1) relax, (2) pant
rapidly (let your man/coach know and they should
know how to command you to relax and should
pant with you), (3) use rest time to relax complete-
ly. This is something you can do at any time dur-
ing your labor. Remember, if you feel tired try
candle blowing for a contraction or two. If you
feel sleepy, change positions; if you’ve been lying
down, sit up (prop pillows under legs and behind
your back to make you comfortable). You need
to be alert at all times. Whatever position - whether
sitting, on your knees as for pelvic rock exercise,
lying - is comfortable for you is the one you should
use; disregard comments of nurse, etc. Sometimes
a change in position is very helpful. Your coach
might suggest it from time to time since you are
so busy with breathing and relaxing. Coach should
also be aware, because of what you’re going
through, that you may resent the suggestion (that
resentment is normal too). Again, it’s you that is
having the baby. The Lamaze chart at the end lists
feelings for this part of labor under mid-phase,
first stage. Some comments on what you can do:
if you start feeling tired, suck a lollypop; if you
are thirsty - panting does that to you - ask for ice
chips to suck or take little sips of water, not big
gulps (you will still feel like taking big gulps).

Sucking a cold, wet washcloth is also very satisfying.

This mid-phase (from 3 or 4 centimeters to 7 or
9 centimeters) can be a low point of labor. You’ve
gotten over the initial excitement of realizing that

you are really in labor and are really going to have
a baby; you’ve been able to handle each contraction
easily; you’ve gotten into a pattern. Then the pat-

tern changes. Maybe the bag of waters breaks or

is punctured by the doctor and the contractions

are longer and closer together (remember they don’t
get stronger) and you have to concentrate harder.
In addition, after working very hard for an hour,
two hours or more, the doctor comes and examines
you and says you haven’t dilated any more. Dis-
couragement sets in, you feel restless and your back
begins to hurt since the baby’s head has changed po-
sition and is pushing against the sacral vertebrae.
Erna Wright lists several rules for handling backache
labor: (1) all pressure must be taken off the back;
(2) the uterus must be tipped forward during con-
tractions; (3) the uterus must be supported during
contractions; (4) back massage of back effleurage
can be applied during contractions; (5) position
should be changed every half hour to keep up the
morale; and (6) between contractions a cold com-
press over the sacrum is a wonderful boon.!? Don’t
let yourself be weepy. Remember you’ve man-
aged each and every contraction so far and here
comes another. You take a deep cleansing breath,
let it out and start shallow panting in rhythm with
your contraction. After the contraction is over is
the time for some changes. Change your position
and adjust your pillows. Have a lollypop and some
water. While you are relaxing let your man/ coach
give you a gentle back rub which can be continued
with greater force during the next contraction.
While someone else is putting pressure on your
back, you can give yourself an effleurage, the light
caressing stroking of your abdomen, a very pleasant
sensation after the hard work of the uterus (the
powder of cornstarch is used when your abdomen
gets hot and sweaty). The effleurage can be a cir-
cular motion with the fingertips of one or both
hands which is slow and gentle; it can be a fairly
rapid and heavier back and forth motion with the
fingertips or with one hand; you can do it or some-
one else can do it if you are busy concentrating on
your breathing (at one point during my second la-
bor, I was breathing, my husband was putting pres-
sure on my thighs and my monatrice was giving me
an effleurage fast, furiously, but lightly). If the
back or leg pressure is getting you down after a few
contractions (even with all the changes), you can
ask for an analgesic, a mild medication which re-
laxes your muscles. Doctors tend to have favorites.
You should talk with him during your pregnancy
about what kinds he uses and why; you should get
the names because you may know that one of the
several he uses really makes you dopey and you can
request another (remember you want to relax, not
go to sleep; you have to keep on top of your con-
tractions, not be driven under by them).

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100

“There are several categories of drugs used in la-
bor. First are the tranquilizers, which have the:
well-known effect plus that of increasing the effects
of other drugs given with them. I feel that tranquil-
izers have their greatest use in the hospital after the’
baby is born to ease the impact of a strange environ-
ment upon a mother who needs rest, and that they
are still too new to be evaluated for side effects
they may have while the baby is in utero:

“Next there are the sleep-producing drugs, of
which seconal and nembutal are the classic exam- —
ples. These have the effect of reducing the amount

of oxygen available to the baby and are rarely used

any more during labor if the baby is expected to be
born during the time when the drug is having its
effect and could interfere with the beginning of
breathing. .

“Next come the analgesics, the pain killers.
Demerol is the one most often used in labor. It i is.
like morphine in many ways-and can also have a
depressant effect on the baby’s respiratory center
if it is given within a few hours before the. baby’s
birth. You can never be sure how soon the baby
will be born. As with other drugs, different women
respond in different ways to Demerol. A common
side effect is vomiting and some women find that .
it is not particularly helpful for relieving discom-
fort. Doctors who regularly conduct minimum
drug labors have found that if Demerol is going to
be effective, the smallest dose, recommended by
drug companies, 50 milligrams intramuscularly, will
usually work just as well as the higher dosages with
probably less risk to the baby. (It is an interesting
aside that an 8-pound baby needing Demerol after
he/she is born would be given 5 milligrams.)

‘Probably the safest analgesic if used correctly
is Trilene. This is a volatile liquid that is placed in
a special inhaler. The mother holds the inhaler her-
self and breathes in the vapors as she needs to. If
she gets enough of the vapor to make her drowsy
her hand falls away; and she will soon have her head
clear from breathing fresh air. Trilene used in this
manner is an analgesic rather than a general anes-
thetic. The only problem comes in the mother’s
learning to time her breathing of the Trilene so that
its maximum effect coincides with the height of
the contraction. In most women it takes about
thirty seconds for the Trilene to take effect.. There-
fore in order for it to work, they must labor breathe
the Trilene from the first inkling of the contrac-
tion’s coming. Trilene has the definite advantage °
to the baby that its effects are apparently not re-
sidual as they are with any substance that is in-
jected into the mother.” ? ;

You are working hard and long and your spirits
are rising as you handle each new contraction. .Doc-
tor comes in and says he has to examine you during

a contraction to find out most accurately the ex-
tent of the dilation. You pant for all you are worth,
but it hurts. Doctor says you’ve made progress;
you've gone from 3 or 4 to 7 or 8 centimeters.
Wow, you feel great! But no time, a new contrac-
tion, ‘and you haye to start the more rapid panting,
third kind of breathing (see Appendix, Chart C).
You’ve moved very quickly into the third and final
phase and hardest phase of the first stage of labor.
It’s called transition. It goes from 7 or 8 centi-
meters to 10 centimeters and complete dilation. _
Contractions are 60 seconds (sometimes as much

as 90 seconds) and 3 to 1% minutes apart. Basically

contractions are long and very close together. Be

encouraged, baby is almost out! If the labor has
been normal up to now and the baby’s head is in
the normal posterior position (head down, face
toward backbone), it should last for only one hour
and about 20 contractions if it is a first baby. If
you can, try to remember time is short, the end is
in sight. You’ll havea hard time concentrating
and need someone to be very directive and to do

the panting with you. Because you are panting so

fast, you may get hyperventilated. This means that
you are taking in too much oxygen and not giving
off enough carbon dioxide. As a result you may

' feel tingling in hands and feet and feel dizzy. Coun-
teract this by breathing into the brown bag you’ve

‘ brought (or into your hands if you forgot the bag).

- At this point the doctor may become very con-

cerned about fetal heart tones. If your oxygen-
carbon dioxide balance is off, so will be the baby’s.
The doctor has to watch that the baby’s breathing
rate stays above a certain point; if it goes below
that point, the doctor knows he has a definite time
period in which the baby must be born and if he

doesn’t think the baby will naturally be born in

that time span he’ll have to speed up the delivery
himself.

You may have to cope with feelings of nausea
(remember you have nothing in your stomach to

' throw up). You may feel very hot (you don’t have

time for ice chips but a wet washcloth over your
face is great and you ¢an suck it too). You may
feel irritable and’ then will need direction and en-
couragement, strong and clear, loud and repetitive.
You are almost there! You may have to deal with
the urge to push. You will feel this urge because
of the position of the baby’s head. The urge may
be weak or so very strong that you’re sure you’re
just about ready to shit the baby out! It feels like
you have'to have the biggest bowel movement
you've ever had‘and you can’t hold it in one second
more. But you can’t push because you are not
completely dilated and will tear yourself and hurt
baby’s head if you do. So there are three breath-
ing techniques you can use to control the urge to
on: until you’re completely dilated and the doc-

tor gives you the signal:

Whoo-Ha. A rapid, shallow pant done saying the
words Whoo-Ha and moving your head side to side
(another thing to keep your mind active) at the
same time. This can be used earlier in labor during
difficult contractions or just for variety. With any
of these techniques where words and motions are
incorporated into the breathing, they should be
done clearly and loudly. It takes lots of concentra-
tion and your mind off your uterus which is work-
ing for all it’s worth at this point.

Pant-Pant-Blow. A couple of shallow rapid pants
followed by a huge, loud blowing out of air. You
can’t blow out and push at the same time, which
is true of the other techniques too. You need to
pant as well as blow or you'll get hyperventilated
(even practicing the technique when not in labor
makes you feel a little dizzy).

Slump and rapid shallow panting technique accom-
panied by saying ‘“‘one-two-one-two” as you slap
your leg and expel air. Sound complicated? It
does in fact take a lot of practice to do it on com-
mand, but you avoid the problem of hyperventila-
tion if you can do it well. However, you can’t use
this technique if you are lying down (impossible
to slump in that position) and have to use one of
the others. Whoo-Ha will work if your urge to
push is not too strong. But if it’s strong you’ll
need to use the Pant-Pant-Blow and keep a brown
bag handy in case of hyperventilation.

Now we can think about medication. Only now,
when the baby’s head is crowning and the hardest
work of the uterus is done, can we be given anes-
thesia (as opposed to analgesia, tranquilizers).
Why not until this point? Medication which dead-
ens the nerves so you don’t feel the contractions
also slows down the uterus and until this point it’s
essential that the uterus be working at full force
to get the baby’s head into place to be delivered
and to get the cervix dilated. Remember you are
not a failure if you take medication. If you’ve han-
dled each contraction up to this point and the
baby’s head is in a position so the delivery will be
normal and you are not so tired that you can’t go
on (fatigue slows down labor), then don’t worry
about medication now and refuse the caudal that
the doctor offers. The caudal must be started no
later than 7 centimeters because it takes a while
to work (don’t expect immediate relief; the aim is
to get it working best during delivery when you
may Or may not need it), in contrast to the spinal
or saddle block, which is given later and takes ef-
fect immediately.

“Conduction anesthetics is a very popular cate-
gory today. This consists of saddle blocks, caudals,
epidurals and other local anesthetic agents injected

101

somewhere into the back, depending on where the
doctor wishes the anesthesia to extend. The caudal
and saddle block are the most popular for obstet-
rics. In a caudal, a large-gauge needle is put up into
the low back where the tailbone connects. Through
the needle is run a catheter tube which remains in
place throughout labor and through which the local
anesthetic agent can be injected from time to

time. Doctors who use this method usually start

at about 4 centimeters dilation and keep injecting
the agent as necessary to maintain numbness. The
effect is to numb and paralyze everything from
that level down. This is a tricky procedure from
the standpoint of getting the anesthetic agent in
the caudal canal where it belongs, and there are
dangers which require a very experienced doctor

to handle. For this reason caudal is not the choice
of most doctors unless they work in a large well-
equipped medical center. There is some dnager of
inadvertently putting the needle into the baby’s
head, but more likely is a misplacing of some of
the anesthetic agent with a subsequent drop in
blood pressure to the mother and less oxygen to
the baby. When the mother’s blood pressure drops,
so of course does the blood pressute in the placen-
tal bed. By far the worst disadvantage to caudal is
that the bearing-down reflex is obliterated, and the
baby usually must be tugged out by forceps on his
head instead of pushed from behind by the gentle
force of the contractions.

“Saddle block is a low spinal anesthetic which
is a one shot affair. It gets the name from the fact
that it blocks the area of the mother that would
touch.a saddle if she were riding a horse. The ef-
fects last about an hour and a half, and it has the
blood pressure and forceps disadvantages of the
caudal. In addition, about 20% of mothers receiv-
ing a saddle block have a spinal headache afterward
for days that is far worse than the pain of labor it
was supposed to obliterate. Since there are more
local, less dangerous ways of blocking nerves, and
since the saddle block is given after transition,
which is the hardest part of labor, it seems to me
to be the poor choice of too much too late.

“Local anesthetics, pudental blocks, and para-
cervical infiltrations are injections made from be-
low directly into the nerves of the perineum or
around the birth canal or the cervix. They don’t
carry the general risks of caudals and spinals, nor
do they stop a mother from bearing down. The
main reason locals and pudentals are given is to
numb the perineum when an episiotomy will be
made and must be repaired. However, the descend-
ing head of the baby creates its own anesthesia of
the perineum, which lasts about ten or fifteen
minutes after the baby is born. I can testify from
personal experience and observation that when an

2 ee see eer

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LL LTTE

I NT ATE

tt i I ee ——

102

episiotomy is made at a time when the perineum
is bulging and the baby’s head is clearly visible,
there is no pain from it. The sensation is rather
like having the sleeve of your coat cut: you are
aware that someone is using scissors near you, but
there is no pain. However, the episiotomy must
be repaired right away or this natural anesthesia
wears off. If the doctor is by himself and must see
to the baby immediately, often he cannot put the
stitches in before the numbness is gone. If he has
a helper, he can do the necessary needlework be-
fore the placenta comes out and can leave threads
loose to allow him extra room to deliver the pla-
centa.

_ “Paracervical infiltration can be done repeatedly
(it wears off in about an hour and a half) from
about 3 or 4 centimeters of dilation. It numbs the
area around the cervix and is a help in relieving
backache. However, in a certain number of cases
it causes the babies’ heart rates to slow temporari-
ly. Although these babies seem all right at birth,
the possible long-term effects have not been evai-
uated.

‘**Another class of drugs. . . is the type used to
stimulate the uterus to contract. These drugs are
called oxytocics. Posterior pituitary extract (Pito-
cin) is a common one, and it is sometimes used in
induced labors to start the contractions as well as
in slow labors to speed things along. It is usually
given along with intravenous fluids in an arm vein.
It can be lifesaving but must be used with care.
Because of the unpredictability of the amounts of
labor hormones secreted by the mother, Pitocin
carries the danger of a possible violent labor with
ruptured uterus, or oxygen deprivation in the baby
from having the uterus contracted long enough and
hard enough to cut placental circulation. Asa
hangover from the days when mothers were so
drugged that their uteri were completely flaccid
after birth, a similar drug is given routinely on the
delivery table after the baby is born. Sometimes
with an awake mother who is producing her own
abundant supply of posterior pituitary hormones,
this causes the placenta to be trapped, which is an
annoyance requiring either patience until the ef-
fects of the drug wear off or a strong sedative or
general anesthetic to relax the uterus. Oxytocics
also duplicate the natural hormones which are se-
creted and contract the uterus as soon as the baby
is put to the breast. The result usually is painful
uterine cramps. Also for the purpose of contract-
ing the uterus, Ergotrate, another oxytocic, is often
given in pill form for a day or so after the baby is
born. I suspect this is necessary for women who
don’t breast-feed, but for those who do, it may
give rise to painful ‘‘after pains’.””4

You want to take as little anesthesia as neces-

sary. Remember, it’s given according to your body
weight, which is a large dose for the average 7-
pound baby. Unless there are problems involving —
the life of your baby, I see no good reason for a ©
general anesthesia which knocks you out complete-
ly (and even in the case of deformity or death it
may be more difficult to deal with the pain in-
volved if we’re put out and awake to discover the _
horror). In any case, we should be involved in the oF
decision about whether or not we get general anes-
thesia.

After that low note let’s go on to a high one. It’s
absolutely fantastic to watch your baby be born
and important in your feelings about yourself and
your baby in the hours and days that follow the ©
birth. So on to delivery!

The second stage of labor is the delivery. You
have been wheeled from the labor room (where »:
you’ve been for approximately 12 hours if it’s been»
a typical first delivery, shorter time for subsequent .
deliveries). You are moved to a new table (it’s un-
comfortable in the middle of a contraction, so ask
nurse, etc., to wait). Your legs are put in stirrups;
they are like the ones on the examining tables in
the doctor’s office though wider apart. (There is
question whether stirrups are necessary - home de-
liveries are done without them - or for the doctor’s
convenience. There is a special chair designed for
childbirth that supports our bodies in a sitting,
slightly reclined position which certainly seems a
more “‘natural”’ position for birth (body is in line
with the forces of gravity and thus facilitates the
delivery) than lying down on a bed. Of course,
these chairs are not in use in American hospitals,
as I know!) Then they may try to strap your hands
down. Don’t let them — they have no right and
you need to use your hands for pushing. Someone
(the anesthetist) may try to give you a spinal. Be
sure there is a reason for it. In some hospitals it’s
so routine they don’t stop to ask the doctor, let
alone you (this happened to me last year at Cam-
bridge City Hospital). (Like the doctor, the anes-
thetist is concerned about getting his money for
his time and he may be required to be on duty whe-
ther or not his skills are needed.) Next you'll have
sterile solutions poured all over your crotch and.
your legs and body draped with sterile cloths. If
you're lucky, there will be a mirror so you can see
what it looks like from below as your baby is born.
Mirror or not, be sure your man/coach supports
you under your shoulders so you can get as close
to the action and see as much as possible. If your
membranes haven’t ruptured naturally or been bro-
ken by the'doctor, he will do it now. It’s been a
long day of probably the most concentrated physi-
cal exertion for you, but you’re almost at tke end; se
the prize is almost in view! ‘agi

Lamaze and his followers have falsely given wo-
men “the idea of birth as an athletic achievement. .
Under this system the obstetrician may keep up a
running commentary on the progress of a woman’s
labor and although some women like this constant
encouragement, some are distressed by the contin-
ual flow of words, the reiterated ‘Alors! Madame,
attention! Poussez! Poussez...Poussez... Pous-
sez... Encore. Encore! Continuez! Continuez!
Tres bien. Tres bien. Reposez-vous. Respirez
bien.’ etc. .. .The better the coordination of ute-
rine contractions, voluntary muscular activity and
breathing rhythm, the less effort is required from
the woman and a relaxed and natural second stage
results.’’}5

Contractions are one minute long, 4-5 minutes
apart, and of decreasing intensity after transition.
This part usually takes about an hour. Now if you
get the urge to push, you can push (you may have
been pushing in the labor room or on the way to
the delivery room). It feels great, you feel exhiler-
ated! It’s also a hard time since very probably
you're tired and you may feél uncomfortable as
the baby’s head is pushing on the perineum, caus-
ing a burning sensation. Keep your perineum re-
laxed by pushing it out and the burning will be
less. The tiredness and burning continue but in
contrast to what many male doctors think, this
stage is not as painful as transition might have
been. They may gauge pain by the effort you are
exerting as you push and the redness of your face,
but you may feel tremendous excitement at that
time as you know that the baby’s coming within
minutes! A contraction is about to begin and the
doctor signals you to push. You'll use the follow-
ing technique: Take a cleansing breath and let it
out. Then take a deep breath to fill your lungs as
completely as you can with air and hold it. As you
are taking the breath, get into position to push by
putting your hands on the stirrups and by lifting
your shoulders and tucking your head on your
chest. (The exercises for the various muscles of
your abdomen prepared you for this.) And now
you push hard with all the muscles of the abdo-
men against your vagina (in contrast to against
your rectum as for a bowel movement). When you
run out of air, drop your head back quickly, take
another breath and push again. You may need two
or three new breaths or three pushes for each con-
traction. You only push during contractions. In
between them you should rest. Probably after a
few pushes the doctor will give you a local anes-
thesia (if you haven’t had anesthesia already) into
the perineal area (the perineum is the skin that
stretches from anus to vagina which you have
strengthened by exercise and learned to relax for
labor and which you will learn to tighten after de-

; 103

livery so that internal organs won’t fall out in later

; years). Next comes the episiotomy, or cut into

the perineum. I question the need for an episioto-
my for all women. They are now done routinely
but should be done on an individual basis. Some
babies need more room to get out (for instance
those in breech position with bottom rather than
head first), and then it makes sense for the doctor
to make a cut than for the woman to be torn. If
it’s done so that the woman’s pelvic floor doesn’t
get stretched excessively, that has to be weighed
against how long it will take stitches to heal and
problems in sexual intercourse from too tight
stitching or from stitches not dissolving as they are
supposed to. Remember the doctor is a man and
has his own and other men’s interest in mind more
than that of woman. To illustrate with a comment
from my doctor at my six week checkup after the
birth of my last child: Full of male pride he tells
me - while doing a pelvic exam - “I did a beautiful
job sewing you up. You're tight like a virgin. Your
husband should thank me.” These same lines were
repeated to other women friends who use the same
chauvinistic doctor! We must share in making the
decision about whether or not we get an episiotomy.

The doctor may need to use certain instruments
at this time. “Instruments used in labor include
forceps and the newer vacuum extractor. Basically
forceps are tongs with two blades that can be sepa-
tated. The doctor inserts each blade individually
before joining them at the hinge and pulling the
baby out. Forceps can be lifesaving to the mother
and baby, but their use is often abused. While
many of the babies who would have been delivered
by dangerous ‘high’ forceps (used before the baby’s
head is engaged) are delivered by Cesarean section,
it is still routine in many parts of the United States
to give knock-out amounts of gas or paralyzing
conduction anesthetics and deliver babies by ‘low’
forceps (when the head is visible during conttac-
tions). The newest tool, which is still being evalu-
ated, is the vacuum extractor. It is a suction cup
which is placed on the baby’s head and pulls him
out of the birth canal. The method seems to be
less damaging to both mother and baby than for-
ceps, but more experience is needed before the
best use can be made of this tool.”’!6

At delivery the baby needs to tuck her head onto
her chest to decrease its diameter to get under moth-
er’s pubic bone. The doctor will then turn or rotate
the baby internally to get her head through. Rota-
tion usually takes place at the first contraction and
pressure is then decreased on sacral vertebrae (this
is the cause of low back pain). When the baby’s
head is coming out, pant, don’t push; you don’t
want to hurt her head. Contractions are pushing
the baby’s head out with help of your pushing;

104

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106

there is a rocking back and forth motion; a little
more progress with each contraction and then your
baby’s head is born! (Each time I’ve typed this
sentence I’ve remembered just how excited I felt
when my daughter’s head was born!) You can’t be-
lieve it! The baby may begin to cry when only her
head is visible and the rest of her body is still in-
side you. It feels amazing! She is bluish and pur-
ple; if she cries before completely born she will
look fairly pink by the time her body is out. She
is wet looking, her head is shaped or molded from
the birth canal, openings full of mucous, very little
blood. You may want very much to grab her and
deliver her from your body yourself. But you'll
be stopped; your hands are not sterile, and of
course, it’s the doctor’s job, his achievement to
deliver the baby (while in actuality you’ve done all
the hard work). Lousy but true. I’ve seen marvel-
ous pictures of women taking their own babies
from their bodies (some books on bibliography in-
clude such “dirty” pictures), but it will never hap-
pen in American hospitals! Your baby will cry
now if she hasn’t already; rarely are babies spanked
or need help in starting to breathe when the mo-
ther has not had medication (doctor himself or a
machine can force oxygen into the baby’s lungs if
there are problems in getting the baby to breathe
on her own and avoid danger or retardation which
comes from a lack of oxygen to the baby’s brain).
“If the cord is long enough, the mother can hold
and nurse [her] even before it is cut. As soon as
the blood is emptied from the cord, the doctor
will clamp it a few inches from the baby’s navel
and cut it. After several days the remnant of the
cord will drop off, and the baby’s navel will look
like any other navel. Contrary to some misinfor-
mation, the contours of the baby’s navel are de-
termined by heredity and not by the doctor’s skill
in cutting the cord.””!7

The cord struck me as exceedingly strong and
beautiful — translucent, blue and in the shape of
a telephone cord but thicker. The doctor gave my
baby to the nurse to suck out more mucous, wipe
and wrap and only then did I get her. I was shaky,
chilly, exhausted and happy. I wanted to hold
and nurse my baby but had no energy left. So my
husband held her close to me. I felt so close to
him at that moment and also to the woman who
was my monatrice. She had been great, especially
during the pushes, and very supportive. I realized
later it was very important for me to have a woman
there who had been through the same experience
as I. I only wish now it had been at home and with
my Other child and friends around. (See Lester
Hazell and Shiela Kitzinger for details about home
delivery.)

The placenta is delivered during the third stage.

Watch for it. I was amazed at how it looked — ©
beef hearts on one side and an intricate series of
veins and arteries on the other. Part of the trans-
parent bag was attached. It was so amazing be-
cause it was this placenta that kept my baby living
in utero for nine months! Several contractions
expel the placenta and it slides out; the doctor can
push on your abdomen (ouch) and reach in and
grab it. If he does, pant to keep comfortable. You
can do pushes as you did to help the baby come

~ out for the placenta. When the placenta is taken

off the wall of the uterus, the circular muscles close
off the blood vessels so massive internal bleeding
does not occur. You may be given a drug (shot or
drip into your arm) to keep the uterus contracted.
Take pain relieving medication (like Darvon) for
constant crampiness. Learn to feel if your uterus
is hard; if it softens, massage it briskly. Better for
you to do the massage than nurse.

After the placenta is out and examined, the doc-
tor will sew you up. That was the only thing that
hurt me. (It could have been less painful if he had
put in the stitches loosely before the numbness of
the area wore off and therefore before the placenta
was taken out.) It was a sensation of pin pricks. It
was bothersome because by that time I did not
want anyone to touch my body. “You will notice
that first of all you get a series of small injections
around the area to be repaired. Those will numb
the area, although they will not take all the sensa-
tion out. You should breathe [do what kind makes
you comfortable] and decontract the pelvic floor.
In fact the trick is to push the pelvic floor forward
a little [as you did when the baby’s head was born],
so that there is no tendency to tighten the muscles.
Keep the pelvic floor forward, and don’t contract
your stomach muscles. . .”!® (By the way, the
stitches don’t have to be taken out. They will
dissolve by themselves.)

In addition to the possible afterpains or crampi-

" ness you'll have a blood loss like a heavy menstrual.

period that will last for several weeks. It’s called
lochia. Lochia reminds me about sexual relations,
because the most liberal of the “‘experts” say you
should wait until lochia ends (discharge of lochia
goes from bright red to brown to a yellowish dis-
charge) to have intercourse. Doctors say wait un-
til the six week checkup. Masters and Johnson
say six weeks may not be necessary. I say let your
mind and body decide for you — see how you feel
emotionally and physically.

YOUR FEELINGS RIGHT AFTER
CHILDBIRTH

You are wheeled from the delivery room into a

room which is your room in the hospital. (You

may be with another, with one, two or many other
women. The more privacy, the more you pay. The
first time I really enjoyed being with another wo-
man. It was her third child and she was very help-
ful to me. The second time, since I couldn’t be
with close friends, I wanted to be alone.) You'll
be starved, tired, exhausted to the bone, but prob-
ably not ready to sleep (if you haven’t been
drugged, that is). You’ll be happy with yourself
and your man/coach, but also feel strange and not
at home in the hospital. You’ll want to share your
excitement with family and friends, but you’ll be

limited to telephone. (If you don’t have a telephone

_ in your room then that is not even a choice right
- after birth.) You may feel some loss when you
look down at your abdomen and also realize they -
have taken your baby - whom you have just bare-
ly seen - to the nursery for a minimum of 12 hours.
You may feel sad about that and also guilty that
you haven’t felt some “‘gush’”’ of motherhood.
Don’t feel guilty; it doesn’t happen like that! It
takes time for you and for the beautiful little
-creature that has just emerged from your body -
amazing, you feel, as you recall what’s just hap-
pened! - to get to know each other. You may also
just want to be alone for a while. You may feel
very scared; you may get depressed when you think
_ Of what responsibility for another person means.
You may need to talk with your man, your coach
or someone else. You may have other feelings that ©
~Thaven’t mentioned. Remember those feelings are
yours and you have the right to feel whatever you
do; don’t let anyone tell you otherwise. You also
~have the right to make demands for your needs
to be met. I’ll make no promises about what re-
Sponse you'll get, but you never know until you’ve
tried. If you are feeling miserable and being treat-
ed like a non-person, make demands to get out of
the hospital as soon as you can. (They usually
make you stay five days, but I have known women
‘who have left the hospital as little as one day after
» the birth of their child.)

»- 1m thinking two sets of thoughts as I’m writing:
/ (1) negative ones about the hospital and (2) posi-
tive ones about the experience of childbirth.

More and more | feel that if we want our babies
to be born at home it should be possible for every
woman — unless there are strong medical or per-
sonal reasons against it. We should know all the
facts and be the ones that make the final decision.
(What if our homes are crawling with rats and
roaches and are not fit to live in, let alone give
birth in? That means we must demand that every
woman have a home where she can.give birth and
can then actually make the choice of home or hos-
pital. That means our struggle for ourselves must
bea struggle for all women (all people) which

107

won't end until we have power over all aspects of
our lives, until we take power from those who keep
the system running for ourselves. It means a revo-
lution, sister!)

At this time our demands should include: (1)
availability of life supporting mobile units to all

homes; (2) doctors deliver babies at home until

(3) there are enough trained midwives to take the
place of doctors. We women want to have our ba-
bies in safety and in comfort. And we will not be
satisfied until this is a right of all women. ~

The experience of childbirth is an important
one — and should be a positive one as well — for
those of us who decide to have children. For some
of us it is the first time in our lives we are in touch
with all parts of our body. And when we are pre-
pared, it is an experience which demands that our
minds and bodies work together and therefore an
experience that helps us break out of the mind-body
separation that keeps women “‘in their place’. Also
the whole range of feelings of giving birth to anoth-
er being - especially as you see with your own eyes
that being emerge from your own body - is so very
powerful (thrilling) and other women talk of feel-
ing much more able to allow themselves to experi-
ence sexual pleasure (and to demand it once they
have felt it) after going through the physical up-
heaval of labor and childbirth. ‘Nothing more mas-
sive could happen to my body,” one women said to
a group of women, “‘so I could let myself get into
and enjoy sex more.”’

And you have a child, a child who will change
your life and whose life you will help to shape.
With the help of your man, your friends and good
childcare arrangements (which you'll have to strug-
gle to get; it seems to me that deciding to have a
child today is also a decision to get into that strug-
gle, a struggle of survival for women and for their
children), the activity of raising a child, like that
of giving birth, is rewarding, unalienated work!

I tried to write this paper so that other women who have not
had children and not thought about childbirth could learn enough
about childbirth preparation to teach it to others. However,
everything can’t be included in a paper of this length, nor could
I, as one person, even think of all the information and feelings
that are relevant. So I caution all who use the paper to talk to
other women about their feelings and experiences and ideas and
to refer to books on the booklist. Finally, there are several
movies of actual births that might be helpful (refer to organiza-
tions mentioned on booklist).

Childbirth preparation for all!
Power to women!

tt NONE AG

108
APPENDIX

Breathing Techniques — Practice Outline

The instructions that follow are from two different Lamaze classes I took.

Practice for brief periods, frequently during the day, Make use of Braxton-Hicks contractions, for they will give you
some sense of what early labor contractions feel like.

During practice, stop if you get dizzy. You do not need the extra oxygen now, as you will in labor. Also, don’t get
discouraged if it seems hard to master these breathing techniques at first; they are easier to do during actual labor than

during practice sessions.

Candle Blowing Breathing

Inhale

“ Hoey aber

Candle blowing is used most in the early part of the Gradually increase to 30-45 seconds, perhaps five se-
first stage of labor (it may be used in the last months of conds a day until you reach 45.
pecans Peo help you relax and also later in labor ot Ve Add neuromuscular release technique when the breath-
ad for a contraction or two). Use this technique as long ing has been mastered. When you can relax (decontract all
as it keeps you comfortable. It usually stops being helpful muscles) and do the candle blowing, add the effleurage
about three centimeters dilation, but trust your own feel- ete ae dee ied din che bod hate "eit: BE
ings and don’t worry about numbers. (Both are described in the body of this chapter.)

At the start of a contraction take a deep cleansing
breath and let it out, making a sound like “whew” loudly COACH OR SELF WHAT YOU DO
and clearly and crisply. It’s important that you be clear §==COMMANDS m
and noisy and definite in this and all breathing — both in

ractice and during labor; the patterned nature of the
eceiuis is as crucial for a comfortable labor as is the

“Contraction begins” Cleansing breath in through nose,
out through mouth with “whew”

technique of breathing itself. “Inhale” ‘ Inhale through nose at normal depth
Inhale a normal amount of air and breathe out evenly “One-two-three-four” Exhale steadily through pursed lips
through pursed lips, counting 1, 2, 3, 4 to yourself as you to the count of four
| —— You should ray _ — is a lit candle a Repeat count of four Continue through pretend 'contrac-
| foot from your mouth and with each count you are ex- as you time the pre- _ tions (rate of 8-12 a minute)
i haling to bend the flame of the candle evenly and con- void contrantins

stantly without blowing it out. You can practice with an
actual candle or with just a match at first to get the feel
of it. The breathing should be very smooth and the tran-
sition from one to the next breath should feel easy. This
kind of breathing should make you feel relaxed. (Keep “Rest” Resume normal respiration, stop
your eyes open; you don’t want to go to sleep!) conscious control

“Contraction is over” Deep breath in through nose, out
through mouth with “whew”. End
contraction just-as you began it.

Begin practicing with 10 second pretend contractions.

Slow, shallow panting, closed off by “Hut” or “Out” (chart next page)

This “hut” or “out” panting is used when the candle blowing no longer keeps you comfortable.

Start with a deep breath in and out. Then begin slow shallow breathing with most of the air exchanged in the upper
chest, just below the throat. Use either nose or mouth, not both. Mouth is easier for most people. Abdomen and shoul-
ders should remain as motionless as possible. Say the words either ‘hut’ or “out” to close off each breath with a sound.
Keep the depth regular and even. Think light and bouncy. Keep your tongue behind upper teeth to minimize drying of

109

Fepiration |
Contrtetiow
Ads

Rest between contractions.

COACH OR SELF COMMANDS

“Contraction begins”

WHAT YOU DO

Coach_paces contraction by calling out
when 15, 30 and.45 seconds have
elapsed.

“Contraction is over’’

Rapid Shallow Panting, accelerated and decelerated with shape of contraction

This kind of breathing feels much like the previous kind,
only it must be quicker to respond to contractions which
are longer, closer together and feel stronger. The more ac-
tive the uterus, the more active must be the breathing to
keep our attention on the breathing, to keep us from tens. °
ing muscles and thus interfering with the work of the uterus.
The panting is so rapid that we don’t have time to close off
- each pant with a sound as before. We must be sure to ex-
hale as much as we inhale or else get hyperventilated from
an imbalance of oxygen-carbon dioxide.

Start with a deep cleansing breath and then begin shal-

)Ssec

your mouth (ice chips or sips of water help between contractions). Finish contraction with a deep breath in and out.

Take a deep breath through nose, exhale through mouth, “whew”. |

Inhale through mouth, less than normal amount, at faster rate. Close off each
through moy | !

pant with either “hut” or “out”. Exhale through mouth. Continue:through

pretend contraction (rate of 60 a minute).

Deep breath in and out, “whew”. Rest, resume normal respirations.

_ during labor you will need to.concentrate fully to make:

_acouple of times a day. Don’t start this kind until you |
._ have mastered the other two kinds of breathing. So you , if
. will build up to what is suggested above slowly, at your

heaerete
(Brate |
sewer)

| :
low enting with acceleration of speed as the contraction
builds up; fast superficial breathing at the crest of con-

traction; deceleration of speed as contraction subsides.
Finish with deep cleansing breath. Both in practice and

the change in rhythm very smooth, and keep the breath-
ing even within each rhythm.

_ Practice for 2-3 contractions each of 60 second duration

= SERRE me “ -

110°

own pace. It’s important not to become discouraged during practice because you think there is some pre-set endurance
test you have to meet. Make your own schedule. Just be sure you do practice regularly according to that schedule.

When you practice, use a watch with a second hand. 15 seconds to go.up to the wave of the contraction with the
breathing gradually getting quicker; 30 seconds of rapid-shallow breathing at peak (rate may be as high as 140-160 a min-
ute at peak; don’t try to practice that amount, for you’ll get too dizzy — remember it’s much easier to do this breathing
during labor than in practice); and 15 seconds for the gradual return of normal breathing as the contraction ends, Vary
length of practice contraction occasionally. Add neuromuscular release technique and effleurage when breathing is mas-
tered. It helps if your coach calls out passage of time (i.e. 10 seconds, 15, 20, etc.); gives you a sense that there is move-
ment and the hard work will end and there will be a brief rest period before you start again.

This breathing is used when the slow “hut” or “out” panting no longer works for you. We may use it before then,
when there is a change in the pattern of our contractions and we need more active breathing to cope, after enema or
breakage of bag of waters.

COACH OR SELF COMMANDS

“Contraction begins”

WHAT TO DO

Cleansing breath in through nose, out through mouth with “whew”

Coach paces contraction by calling out Inhale through mouth, less than normal amount, at fast pace which gets faster
passage of seconds and by signalling as contraction peaks and becomes slower with decrease in intensity of contrac-
when to accelerate, decelerate breathing tion. Exhale through mouth. Continue through pretend contraction.

‘Contraction is over” Deep breath in and out, “whew”. Rest, resume normal respiration.

LABOR SUMMARY (Lamaze)
WHAT YOU CAN DO

PHASE OF
LABOR WHAT YOU MIGHT FEEL

Stage One

Early Phase Backache Nofood

Q-2 fingers Diarrhea or constipation Time contractions

0-4 cm. Abdominal cramps Call nurse and doctor

Show Pelvic rock for backache
Ruptured membranes Candle-blowing breathing
Excitement, anticipation Get accustomed to contractions
Regular contractions Conscious relaxation

Mid-Phase Stronger, more frequent
2-4 fingers contractions Effleurage

4-8 cm. More serious concentration Ice chips, water sips
Dependent on companionship Relax

Discouragement, doubts Vary position bed/pillows

Slow “hut” or “out” panting or rapid panting

Restlessness Mild medication (analgesic)
Back and/or leg pain Back rub
Weepy Concentrate on one contraction at a time

Encouragement from man/coach

Rapid panting mostly but vary with other kinds
Techniques for resisting urge to push

Transition Leg cramps and shaking
4-5 fingers Nausea and vomiting
8-10 cm. Heavy show Remember time is short

Hot and perspiring Wet cloth on face, suck

“Sleeping”’ between contractions Man/coach tell woman to concentrate

Stage Two
Expulsion
of Baby

Stage Three

Placenta

Nursing
(Hazell, p.
232)

2. Kitzinger, pp. 29-31.
8. Ibid., p. 95.
14. Ibid., pp. 134-36.

Total involvement, detachment
Apprehension

Inability to concentrate
Increased pressure

Desire to push

Dizziness

Contractions may slow down

Urge to push

Pressure to rectum, perineum

Total involvement

May feel exhausted and have
difficulty concentrating

Excitement with actual birth
of head, shoulders,.etc.

Expulsion of May feel slight contraction

Suckling at the breast helps con- The baby is offered both breasts right after birth and whenever [she] is hungry.
tract the womb to prevent bleed-

ing and satisfies the baby

FOOTNOTES
1. “We Don’t Call It Natural Childbirth, but Educated Childbirth”, Marilyn Bender, New York Times, 16 May 1967, p. 380.
4. Ibid, pp. 33-34, 85. 5. Ibid., pp. 81, 82, 83-84. 6. Hazell, p. 92.

9. Wright, p.109. 10. Hazell, p.9. 11. Ibid., pp. 9-10. 12. Wright, p.162. 13. Hazell, pp. 132-33.
16. Hazell, p. 136. 17. Ibid.,p.98. 18. Wright, p. 142. (See booklist for references.)

3. Wright, pp. 53-56.
15. Kitzinger, p. 143-44.

Specific commands

Lots of encouragement

Use brown bag, hand over mouth for tingling from hyperventilation
Don’t panic!

Specific instructions for each contraction

Relax, push out perineal muscles

Three pushes/contraction (don’t be afraid to push hard)
Be ready to stop pushing and pant

Man/coach support shoulders, give encouragement

Relax, pant, push out perineal muscles. May ask to stitch loosely before removes placenta.

7. Ibid, p. 84,91.

~ BOOKLIST

Childbirth Without Fear. Dr. Grantley Dick-Read (1942).
Written by English doctor who was one originator of prepared
childbirth. Method more mystical than Lamaze method, with
‘more stress on relaxation and less on activity.

Thank You, Dr. Lamaze. Marjorie Karmel (1959), pb.

Lively, personal account of two experiences with prepared child-
birth. First child delivered in France by Dr. Lamaze, second in
America. (Comparisons of practices in two countries’) Fun to
read. Little outdated.

Childbirth Without Pain. Dr. Pierre Velley (1961).

Series of lectures, exercises by associate of Lamaze. Good, thorough

in Lamaze method though hard to read. Shouldn’t be the first
book you read. Be sure to look at the pictures of a delivery —
very exciting! Velley is practicing in France.

Awake and Aware. Dr. Irvin Chabon (1967), pb.

Book written by American doctor. Good history of childbirth
practices (part I liked best was explanation of change from home
to. hospital deliveries), Lamaze method, short birth records of
women, exercises and good pictures. Current, easy to read,
recommended.

The New Childbirth. Erna Wright (1966), pb.

Manual to prepare woman for childbirth written by midwife. Ex-
cellent preparation in Lamaze method. Written by woman who
has children. Pictures! Less critical of medical profession than
book by Hazell. Could do all physical preparation necessary with
this handbook alone.

The Experience of Childbirth. Shiela Kitzinger (1962).

English woman. Method described combines Read and Lamaze.
Strong psychological orientation (I felt it made woman look too
much in on herself and not look enough beyond herself, at the
society, for origin of some problems). Has chapter on home de-
livery which is more specific than the one in Hazell.

Commonsense Childbirth. Lester Hazell (1969).
Written by woman. Best overall book for many reasons: good to
tead, complete and sensible approach to childbirth. She has had
kids of her own and conveys what it feels like to give birth. Even
more important, she has an understanding of the source of lots of
women’s problems during childbirth — the medical profession (and
is very critical of it). (This is more important since no other books
I've seen on the subject of childbirth preparation seem to have that
understanding.) Information in book fits right into women’s lib-
eration. Excellent section on why to have a baby at home; also
ey one on breast feeding. If you buy one hardback book, get
one.

A Practical Training Course for the Psychoprophylactic Method

Yea Elisabeth Bing, Marjorie Karmel, Alfred Tanz, M.D.
).

Lamaze techniques. Manual officially approved by A.S.P.O.

Pregnancy and Birth. Dr. Allan Guttmacher (1965), pb.
Guttmacher is head of International Planned Parenthood; he prac-
ticed obstetrics and gynecology for many years in New York. He
has written many books for the general public. This book is okay
when you don’t expect to understand topics in too great depth.

The First Nine Months of Life. Geraldine Lux Flanagan (1962), pb.
Story of conception and week by week progress of baby in utero.
Exciting to follow when pregnant. Terrific pictures, for example
of baby sucking thumb in utero!

Life Before Birth. Ashley Montagu (1964), pb.
I haven’t read this book. Title covers the content though I can’t
make any comments on author’s point of view.

Husband-Coached Childbirth. Dr. Robert A. Bradley.

I haven’t read the book. It’s often referred to in childbirth pre-
paration courses, I guess because it’s directed toward the man.
However, I’m skeptical about a man writing about how men can
help women in childbirth; without having read the book, Fd be
happier if the author were a woman.

A Child Is Born, Lennart Nilsson and Axel Ingelman-Sundberg and
Claes Wirsen (1965), pb.
Beautiful color photographs.

Conception, Pregnancy and Contraception. (1969).

New book with excellent drawings and photographs. I was espec-
ially impressed with drawings of female anatomy which gavea
sense of the relation of one part of our bodies to another (which
is rare in most books I’ve seen).

‘111

The Womanly Art of Breastfeeding. La Leche League (1963), pb.
Some helpful information if you can get past the sickening stuff
about a woman’s role is to bear and raise kids. Little outdated in
comparisons between breast and bottle milk! Does give woman
lots of support for breast feeding.

Nursing Your Baby. Karen Pryor.
I haven’t read it completely, but I felt it had the same information
as The Womanly Art... and was less objectionable to read.

Baby and Child Care, Dr. Benjamin Spock (1946; rev. 1968), pb.
Well, what does one say about Spock, anyway? He was reassuring
to me at times, but mostly was too general to be of real help (have
to always call your own doctor), Revised edition not much differ-
ent than original, He may be good about Vietnam war, but he’s
terrible on women (don’t expect father to play with the child af-
ter a long hard day at the office, let him read his paper, bring

him his slippers), sex, and religion. He has a new book out called
Decent and Indecent, which is more chauvinistic and more rigid
than the first. Spock is on his way out as far as I’m concerned.
We’ll have to write our own book to replace his “‘classic’’.

Textbook of Pediatrics. Nelson.

This was recommended by a woman medical student friend. I
haven’t gotten it since it’s expensive ($20.). Several of us have
talked about buying it collectively. It’s the book pediatricians
use to check on illnesses. With a medical dictionary to decipher

’ the jargon, we should be able to check before we call the doctor

and have some check on his diagnosis.

Prenatal Care, Infant and Child Care, Your Child from 6 to 17,
Adolescence. U.S. Department of Health, Education and Welfare,
Children’s Bureau Pamphlets.

Have about the same information as Spock, but are free from

the government.

The Magic Years. Selma Fraiberg, pb. ;
Covers years from birth to six. Freudian but not too offensive.

- ([haven’t read it thoroughly since women’s liberation and now

might find it worse.) Helpful hints and some good stories if you
don’t take everything too literally.

Gessell Institute’s Child Behavior. Ilg and Ames (1956), pb.

Can give some information of what to expect from a child of a
given age: Don’t take age norms too seriously. Remember it’s a
statement about what children have done in this society over ten
years ago. Things are changing and need to be pushed more. (For
instance, children can begin to relate to each other from the time
they are only weeks old. Yet this and other books say not until
three, an assumption that the child is in the nuclear family until
that age and then goes to nursery school as a first encounter with
the outside.) R

Love Is Not Enough. Bruno Bettelheim, pb.

Written about children in his special Orthogenic School in Chicago.
Although the book is not about “normal” children and Bettelheim
is a very authoritarian man, he has some important things to say
about all kids. I especially liked his chapter on food, on in-between
times and space.

Infants and Mothers and Their Development. Dr. T. Berry Brazel-
ton (1969).

The book is a study of three different children. I haven’t.read the
book but he is the pediatrician I use. He has done work with Je-
rome Bruner and the book reflects these studies on learning, I’m
sure. It probably has some good observations:about effect of
children on their environment (as well as the environment on them).
Beware of his chauvinism (I understand it has a terrible part on
working mothers) and tendency to Freudian interpretations.

Analysis of Human Sexual Response, Ruth and Edward Brecher.
Excellent summary of revolutionary (!) studies of sex by Masters
and Johnson. Talks about sex during pregnancy and after child-
birth and that’s why it’s on this list. :

I did not do a survey of literature to make up this booklist; the
list is based on the books I like and was familiar with. I’m sure
there are things I have left out. Please feel free to add others (and
pass the word on to me).

If you can’t get the books from the library or from the book-
stores, check with (1) Boston Association for Childbirth Educa-
tion, (2) Lamaze Education, Inc., (3) La Leche League.

Outside the Boston area, you can check with these groups:
International Childbirth Education. Association, Box 5852, Mil-
waukee, Wis. 53220; American Society for Psychoprophylaxis in
Obstetrics, 36 W. 96 St., New York, N.Y. 10025; La Leche
io arama, 9616 Minneapolis Ave., Franklin Park,

ll. 601

ese

——

INTRODUCTION

Postpartum emotional disturbances, like most
(possibly all) mental disorders, are defined by the
social context in which they occur. (Marcuse
writes, ““‘Health is a state defined by an elite.’’)
For example, on an Israeli kibbutz the mother who
feels that she cannot leave her newborn between
nursing times to contribute to the community
work is regarded as in need of special counseling
for anxiety. In the U.S., the woman who returns
promptly to work after childbirth is regarded as
cold, neurotic and unresponsive to the needs of
her baby.

In fact, a baby’s need for stable responsible

Post Partum

adults can be met by a group or community of
people. We believe it is a myth that the mother
must be omnipresent to prevent psychological dam-
age to the infant. The myth is perpetrated to keep
us isolated and privatized in keeping with the com-
petitive capitalist ethic.

What little research has been done on postpartum
is heavy with male bias and conventional attitudes
about motherhood. It shows that over half of all
women who bear children have some emotional up-
sets following childbirth. If we look at the minori-
ty of women who cope well during this difficult
time, we may find the seeds of the social conditions
needed to make both motherhood and childhood a
time of satisfaction and growth. Some of these

are: (1) complete choice in becoming pregnant
(physically, psychologically, and socially); (2) eco-
nomic security; (3) child care that can meet the
needs of infants and toddlers so that we need not
give up our work in order to be mothers.

The psychological postpartum period, the
months following childbirth (for some the feeling
of helpless lethargy lingers on for years), is for
many of us a time of emotional changes. Some
of us are high, some mellow, some lethargic and
depressed, some have mood swings. We are con-
fused and a little scared because our moods do not
resemble the way we are accustomed to feel; we
never expected this overwhelming need to sleep,
even in the early morning, the inability to con-
centrate on a book or other activity, the suicidal
fantasies (anger turned inward) or the fantasies of
leaving the baby and its father (anger turned out-
ward). We are frightened by anger at the baby who
is so terribly vulnerable and dependent on us. If
you never have had the experience of being respon-
sible for another’s care - if you have never cared
for small children - it is an awesome responsibility
to find yourself totally responsible for the life of
another human being. The newborn human infant
cannot meet its own needs except by crying to sig-
nal discomfort. It depends on us for nourish-
ment, removal of fecal matter, clean clothes
and occasionally even a change of position
(let alone affection).

For us as first time mothers it begins to
seem as though life henceforth will be mere-
ly a struggle to meet the personal needs of
the baby and ourselves (in that order), with
little or no time left for anything meaning-
ful or fun.

It is very important to remember that the
time the baby needs so much care is short.
In the first year, babies learn to hold their
own bottles or cups, sit up, crawl, stand,
sometimes walk and begin to say words.
Every few months brings a new stage of de-
velopment (don’t worry if your baby is a bit
slower than your friends’) and some lighten-
ing of your load (more messes at first, though).

Example: At a recent meeting a woman speaks
suddenly about herself: “I have one child and I’m
prensat again. Immediately after the birth of my
irst baby, I felt high and exhilerated. But that night
I got sad. I cried all night long. During the next few
days I lay in my bed thinking of how I would kill
myself. I looked at how the windows opened and I
concentrated on figuring out times when no nurses
were on duty. I couldn’t sleep at all. I tried to tell
them I was depressed, and all they gave me were
sleeping pills. I felt like I’d never feel anything again
but this incredible despair, that it would never end.

I had nightmares. The one I remember best is where

113

I would be feeding the baby. I would fall asleep and the
baby would fall off the bed and be killed. I don’t know
why I had these dreams and impulses. I have had a happy
marriage and it was a wanted pregnancy.”’ She talked about
meeting another woman and finding that she had gone
through the same kind of experience, including a dream
that she had slit her new baby’s throat with a knife.

The postpartum period, the first few months af-
ter childbirth, is treated by most doctors from a
purely physiological point of view. They dismiss
most of the psychological and emotional feelings
as ‘natural’. Postpartum depression in its mild
forms is considered so common as to be unworthy
of mention, so little research has gone on in this
field. However, some 10% of the psychosis in wo-
men develops from the reproductive experience
(Piker, 38). Women are offered verbal bromicides
rather than realistic treatment. After all, society
tells us, women should find Motherhood totally
fulfilling and should instinctively know how to re-
spond to and care for their babies. Because of the
societal pressures surrounding Motherhood - the
mystique of the maternal instinct, joys of child
care, fulfillment through others - many women are
unable to pinpoint their feelings of confusion and
inadequacy or are unable to feel legitimate in ver-
balizing their hesitations and problems. This

———

114

chapter will cover the emotional, social, and physi-
cal stresses on the postpartum woman, and put
forth some proposals for action by women so that
pregnancy, birth and the initial phase of mother-
hood can be a positive experience, perhaps even a
time of real psychological growth.

The problems that develop in this period are
accentuated by the fact that the obstetrician is of-
ten the only supportive professional the woman
sees during pregnancy. And he is very rarely sup-
portive of her emotional needs. When a woman be-
comes pregnant, she is put on an assembly line,
whether she goes to a clinic or sees a private doc-
tor. She goes to the doctor and finds that her
body is regarded as a machine to be serviced peri-
odically. Pregnant women are always referred to
as the patients (the same category as sick people).
She is shunted through at predetermined inter-
vals during pregnancy, and then not until six weeks
after delivery. If she sees a private doctor, she
should object to paying a fee for the cursory treat-
ment she is given. If she goes to a clinic she will
see a number of doctors and possibly even be de-
livered by one she has never met.

Nowhere are the woman’s many fears touched
upon: her difficulty in coping with her self image
and the changes it must undergo when she becomes

w” a Pg

nnntt ce

a mother. The doctor does not usually make a

real attempt to deal with her feelings. Even fears
of childbirth are rarely dealt with. Concerns about
parenthood are almost certain to be dismissed with
bland assurances that women simply know these
things when they need to. The myths about the
unbounding joys of pregnancy, delivery, birth, and
motherhood felt by “normal”? women are only en-
hanced. Even most childbirth preparation classes
are oriented toward physical control during the
birth process and do nothing to prepare the mother
for motherhood and babycare. Furthermore, in
this society the positive self-esteem gained by moth-
erhood is undercut by the difficulty in continuing
one’s career because of the extra domestic activi-
ties she now has. Although the occupation of mo-
therhood is highly touted, that of housewife
(=drudge) is generally considered pretty undesir-
able. But for most people they are inseparable,
with motherhood held out as the reward for cheap
household labor.

Yet pregnancy, a life crisis with tremendous
growth possibilities, is treated merely as an initia-
tion period to be gotten through, with birth as a
climax, while the birth of a child can be a traumatic
experience for any couple, or person; and for us to
build an entirely new web of relationships. This
emphasis on the delivery is useful for the image of

the doctor as a specialist, and a performer; a
sop to his ego. He is the magician, the “‘de-
liverer’. Paid up until birth, he sees the wo-
man afterwards only in extreme cases except
for the perfunctory six week checkup at the
end of the puerperium (Latin; puer - a child,
parere — to bring forth). During this time the
generative tract usually returns to normal.

After the birth, if the woman should be up-
set and call her doctor he might refer to the
baby blues, a catchall term, used to describe
the common symptoms of irritability, crying,
and hypersensitivity. Her legitimate com-
plaints might be brushed aside as emotional-
ism. One woman here in Boston, soon after
childbirth complained that fecal matter was
coming out of her vagina. The doctor refused
to examine her and dismissed this as fantasy.
Was he unwilling to acknowledge the possi-
bility that his episiotomy was not done per-
fectly? In desperation, the woman went to
another doctor, who treated her successfully
for a ripped vagina. Thus the woman is left
mostly on her own. Specialization provides
her with one physician up to the birth, anoth-
er for her newborn child, and a psychiatrist
if needed for severe emotional problems. The
English midwife system (explained later)
eliminates this fragmentation.

Most women go home after a five day enforced
rest in the hospital, which is now about five days
for paying patients and two days for non-paying.
There they have no help and often have other chil-
dren to care for. For the next few months, they
are unable to get more than four hours of sleep at
a stretch. In casual conversation, many women
report such things as falling asleep in company, no
time to fix their hair or take care of their own per-
sonal needs, inability to cope with daily household
routines, or inability to maintain involvement in
outside interests. They often feel that they have
lost control of their lives, and a dread that life will
always be this way. They often feel guilty be-
cause they think their own inadequacies are the
cause of their unhappiness. They do not ask if
their roles are realizable. The casual observations
are confirmed by a survey of 137 obstetrical pa-
tients postpartum. They showed “subjective evi-
dence of anxiety and/or depressed and cognitive
dysfunction in 64%. Symptoms included inability
to sustain attention, distractibility, poor recent
memory and labile moods resembling clinical

signs seen in acute brain syndromes but much
milder in degree.”

Many household routines can be minimized or
streamlined during this period in the interests of
efficiency and getting rest but even those activi-
ties that are beneficial to the woman’s morale are
often too much of an effort after a day of crying
babies, feeding every three hours, and washing
clothes. In earlier times, women had fewer appli-
ances, but more peorle helped with housework,
especially when a new baby arrived. Even the visit-
ing nurse seems to have gone out of style as wo-
men become “‘better educated”. That our educa-
tion rarely touches on baby or child care is taken
into account by no existing public or private in-
stitution. Although there are many classes which
help us to deal better with the physical side of
pregnancy and childbirth, there is little readily
available instruction for childcare, which is also
a learned skill, not instinctual. A study of mater-
nal role-taking responses showed consistently
higher scores for multiparas (those who have been
mothers before) (Reva Rubin, Nursing Research).
Another study (Gordon and Gordon) shows that

women who attended child care classes during preg-

nancy had significantly fewer emotional upsets
postpartum. All the classes emphasized that the
responsibilities of mothers are learned, not inborn.
This confirms our belief that knowing what to do
with a newborn does not necessarily get into our
heads by ‘“‘maternal instinct’’.

the second and fourth days, corresponding to en-
gorgement and the beginning of lactation. It is not

really known why this connection exists. Some
people feel that the separation of the mother and
child in the hospital increases the depression. This
is true for nursing mothers as well since there is
usually an initial mandatory twelve hour separa-
tion. Mild postpartum depression is not an item
high on the research priority list although nearly
half the adult population in the United States

(i.e. most of the women) experience this syn-
drome (probably because mothers are not as im-
portant to the efficient functioning of the indus-
trial machine as other members of society). These
“blues” in themselves are not indicative of longer
term depression. During this time it is a good idea
to talk to someone about your feelings. If your
doctor has no time for you or is unsympathetic,
try to have someone close to you be there to talk
to.

Our attempt to research the professional jour-
nals produced only a handful of articles over the
last two years. Most of these deal with aspects of
the postpartum depression. Of course, everyone
should not expect to have a depression, but it is
common enough to suggest that contributing fac-
tors exist in most of our lives. One study done in
1968 by Rita Stein shows the lack of integrated
research of the emotional side of pregnancy and
postpartum period. (Her study contains a valuable
bibliography, showing the gap from Hippocrates
to 1928. It provides a good historical overview
with a sociological approach.)

The “traditional” and first serious theory (30

fs a

115

SSS

years old) was that women suffering from severe
postpartum depression had deep-seated mental ill-
ness and that the birth of the baby was merely the
trigger that brought the pre-existing psychic distur-
bance to the surface. Women suffering from psy-
chotic postpartum disturbances were diagnosed as
schizophrenic, manic depressive, or whatever clini-
cal syndrome their behavior was thought to resem-
ble. Often they were hospitalized for years; in
some cases, for life.

Today this attitude is being rejected in favor of
stress triggering theories. These can be broken
down into two streams of thought: (1) The depres-
sion is caused by physical stress, i.e. hormonal im-
balance and the bodily shock of labor. (2) The de-
pression is caused by social stress, including one’s
background and one’s current environment. A
study in 1962 found postpartum depression analo-
gous to combat fatigue (Hamilton). Women who
exhibited severe symptoms were sometimes found
to have thyroid difficulties and made dramatic re-
coveries when treated with thyroid compounds. It
is known that there is normally a change in the
amounts of 17-hydroxyclorticoids, steroids re-
lated to the sex hormones, in the blood level when-
ever there is a general emotional arousal. Perhaps
the hormonal imbalance caused by the end of preg-
nancy can help to trigger the depressed feelings so
often encountered. Those who favor the physical
stress theories emphasize hormonal treatments,
drugs, such as tranquilizers, anti-depressants, and
sometimes hospitalization in severe cases. A study
currently being done in Boston attempts to pre-
vent recurrences by controlling the hormonal bal-
ance, tapering the drug dosage off over a period
of two months. Other reports show that the social
factors including one’s background and one’s cur-
rent environment are larger contributors to depres-
sion for most people. This is borne out by reports
of depression in fathers (Lunenberg, 1967) and
adoptive mothers (Rheingold). Rita Stine’s study
lists four major role changes for the mother of a
newborn: (1) Becoming maternal yet not experi-

enced in coping with the demands of an infant.
This dichotomy between expectations and experi-
ence is definitely perpetuated by the nuclear fami-
ly, where there is usually no other adult to help
with child care during the day. (2) A change in
personal status in the occupational and social
scheme. She must choose between doing some-
thing and being a mother, since child care is not
available in many cases. (3) A change in ego-ideal.
The mother must put the child’s needs before her
own. A woman is taught to obliterate her person-
ality and live through her children and husband.
(4) A change in marriage and family patterns. Her
role becomes more rigid and confined. Rita Stein
recommends taking life histories emphasizing early

childhood and marital adjustment to determine
which women are likely to require special help in
changing into their new roles. She does not dis-
cuss the validity of the role. Anothtr recommen-
dation of the study is to use pre-natal groups to
discuss problems.

A questionnaire developed by Richard and
Katherine Gordon was successfully used to spot
potential problem areas and predict the statistical
likelihood of having postpartum difficulties. The
findings of this study showed that 78% of the wo-
men who showed 7-10 stress factors (explained be-
low) developed postpartum problems. Those with
the most stress factors were likely to have the most
severe and long-lasting illnesses. Of first-time mo-
thers interviewed, nearly one in three developed
difficulties! For one out of ten, the problem per-
sisted for at least six months.

Stress factors for this study are divided into
two main categories: (1) “Personal insecurity’’ or
background factors, such as loss of a parent in
early childhood, inexperience with babies, first
pregnancy, etc., and (2) Current environmental
factors, especially role conflict, but including such
things as isolation, financial problems, husband
working late, and upward social mobility. The
Gordons believe that though a woman’s history
plays some part in her ability to ‘‘adjust to moth-
erhood”’, it is the current factors of isolation, lack
of stimulation and role conflict that deepen the
problems and cause them to continue. In The
Wretched of the Earth, Franz Fanon similarly finds
that mental disorders of childbirth among Algerian
refugees were deepened by their living conditions
despite appropriate treatment. This has applica-
tion for all women who must bear their children

under traumatic conditions and raise them in pov-
erty.

In making use of information gathered by social
scientists we should be careful to distinguish be-
tween scientific findings and the underlying assum p-
tions, biases, of the researcher. We should beware
of such phrases as ‘“‘a good adjustment to mother-
hood”’ or “‘female-passive vs. male-aggressive role
conflict”. In the Gordon study, the stress factors
were separated into two categories, personal inse-
curity and role conflict. As we read the items
which make up the personal insecurity factors, we
find they refer to such things as early death of the
mother or lack of experience with babies. In other
words, these are factors of insufficient experience
and knowledge in the maternal role. If a man feels
insecure the first day of a new job, his masculinity
and whole self image are not called into question.
Unfortunately, our society encourages a woman
to fuse and confuse her role as a person with her
role as a mother. She is taught to believe only she

aie ee
ck, aes

ae ee eo ESE Ge

ey F

alternative child care.

can best mold her children. This is reinforced by
a society that does not provide her with adequate
Role conflict exists be-
cause the society makes it so difficult for a woman
to pursue other goals while providing good care
for her children.

PHYSICAL ASPECTS

The physical changes occurring in the post-
partum period are enormous. Although they are
considered “‘natural”’ they closely resemble the
pathological. Nicholson J. Eastman, M.D., who is
the author of a textbook for medical students on
obstetrics as well as a book for pregnant women
called Expectant Motherhood, says that ‘“‘under no
other circumstances does such marked and rapid
tissue catabolism (tissue break-down) take place
without a departure from a condition of health.”

A woman should be aware that such changes are
taking place and that they will probably affect

her physically as well as emotionally. It is impor-
tant to note here that feelings, particularly of de-
pression, are intensified and are of longer duration
if the woman permits herself to get run down phys-
ically. Some women have stubborn virus infections
which may lead to depressions, or substitute for
them (in women who cannot acknowledge depres-
sion).

As with pregnancy, some women will experi-
ence a number of discomforts while others will
have hardly any at all. Some discomforts of this
period are sweating, especially at night, loss of
appetite, thirst due to loss of fluids and constipa-
tion partly due to inactivity but principally due to
relaxation of the abdominal walls and their conse-
quent inability to aid in evacuating the intestinal
contents. Getting up and walking as soon as possi-
ble is thought to prevent severe constipation. A
woman may feel that her genitals are looser. As
far as sexual relations are concerned, the Masters
and Johnson study indicates that if a woman’s
vaginal area feels okay, there is no reason to avoid
intercourse if you desire it. However, proceed
slowly at first because if your episiotomy is still
tender and starts to hurt under pressure of the pe-
nis, the side position is probably best for inter-
course. The taboo varies from one country to
another, even in the Western world. Many women
in the U.S. begin in their third week postpartum.
Most women find that their vaginas do not lubri-
cate easily at this time and fear they’ve become
frigid. (If you have this trouble, just use a plain,
unscented lubricant, as K-Y Jelly.) Doctors make
the six week rule for their convenience so they do
not have to be bothered taking each case individu-
ally. This rule originated in the days before anti-
biotics: Remember, too, that if you sleep with

‘the woman is able to get up out of bed and move

appendix.

117:

someone regularly you probably already share the
same germs and have developed a tolerance for
them. (See appendix for more on postpartum sex.)

After a normal delivery the patient is out of bed :
24 to 72 hours postpartum. Those who get up

soon after delivery state that they feel better and
stronger sooner and have fewer bladder and bowel
difficulties. By getting patients up earlier it has
been possible to reduce the recommended hospi-
tal stay to four or five days as compared to the cus-
tomary ten days in the recent past. You might also
consider whether the high costs of hospital stays,
shortage of beds and the depersonalized treatment
the patient gets will affect how healthy you feel.

It would be better if women had the choice of de-
livering at home. (It’s safely done now in England.)

However, it should be emphasized that because

around does not mean she is ready to re-assume her
usual responsibilities at home. It is important to
get enough sleep and to set aside some time in the
afternoon to make up sleep lost due to night feed-
ings. For the entire six weeks, time should be set j
aside for exercise and rest. Paternity leave, time a |
father gets off from work when a child is born to

help care for it, or daycare for other children would
help with this immensely. Housework should be
shared by other family members or simply kept to
an absolute minimum. If there is no help, the first .
week home plan on take-outs, frozen dinners, paper |
plates, etc. No more stair climbing and other exer-
cise should be done than you can do comfortably.
You may feel you want to limit stair climbing to
once a day for even the first week. Be careful of \
heavy lifting, which should not be done before you |
are able. Try to tune in to signs your body gives i
to tell you it is tired; don’t ignore them.

Thanks to prepared childbirth, women feel bet-
ter after giving birth and are able to resume their
customary activities sooner. However, we feel that
the common discomforts of this period have been ii
so de-emphasized that “‘prepared” mothers are of-
ten quite distressed when they find themselves not
feeling as well or as strong as they had expected.
Do not get taken in by the modern equivalent of
dropping the baby in the fields — the cliche ending
of the natural childbirth films in which the mother |
hops off the delivery table with the baby at her
breast and walks off unsupported into the sunset.
You may feel great, you may have few or no dis-
comforts, you may have many; you will not know
until the time comes. But when you are aware of i
the range of possibilities you probably can handle i"
them better if they occur. For a more detailed i
physical account of the body changes and their if
effects on you during this time, please turn to the

ae TO Se

WHAT CAN BE DONE

We as a women’s liberation group can begin to
organize ourselves to fight those aspects of our
society which make childrearing a stressful rather
than a fulfilling experience. We should recognize
the fragmentation of education into subjects not
integrated with real experience so that most of us
learn nothing about babies until we have them.
We should be aware of the isolation of the nucle-
ar family. We need to be aware of the lack of
maternity and paternity leave, lack of good child-
care facilities forcing women to choose between
family and career. We must recognize the mys-
tique of the full-time mother that causes women
to feel that they are depriving their children if
they have careers or other pursuits and fight the
male supremacy which requires the women to
come home from a job and take care of the back-
log of home and child care.

1. As an immediate step, the Gordon ques-
tionnaire could be widely distributed to obs and
clinics with follow up provided for women who
showed six or more social stress factors. Since
it doesn’t look as though this is being done, a
women’s group could leaflet these questionnaires
at medical buildings, clinics, childbirth classes and
maternity shops inviting women to come to meet-
ings to talk about infant care, women and social
stress. Group counseling could be organized for
pregnant and postpartum women who are already
experiencing difficulties. Crash counseling can
help women deal with their problems effectively
(Kniebel).

2. Develop pregnant-couples groups to explore
feelings, fears, hopes about pregnancy, childbirth,
and parenthood. Use the crisis of pregnancy to
bring about individual psychological growth and
help move the marital relationships (where they
exist) to .a new stage of development.

3. Make more use of group processes in already
existing groups. Humanize childbirth classes so
that feelings are dealt with along with the physi-
cal facts of pregnancy. Psychologically trained
people should train lay people and nurses to deal
with feelings in these groups. Psychiatrists should
be available to consult with individuals or couples
who feel they need it.

4. Set up a pre- and post-natal telephone ser-
vice. Any woman with a problem could call.
Serious problems would be referred to qualified
people.

5. New organizations of visiting laywomen to
help with post-natal problems.

6. Work on developing, with sympathetic

medical people, a nurse-midwife approach like
that existing in England. The midwife sees the
woman during pregnancy, stays with her during
all of the delivery, and helps with child care for
the first few months of the child’s life. She can
handle all routine procedures competently and
can recognize complications. Then the obstetri-
cians could be on call for all difficult pregnancies
and births, pediatricians could care for all serious
infant illnesses, not just for those who could af-
ford to have them.

7. Develop mobile emergency units (again, as
in England) to enable women who want to de-
liver at home to do so as safely as in a hospital.
This would remove the implications of emergen-
cy, trauma, and disease associated with hospitals
from the birth process. With these unnecessary
stresses removed, the return to normal activities
could be speeded up.

8. Place realistic information in every clinic
and doctor’s office.’ (The doctors should pay a
little for the printing.)

9. Demand maternity leave for mothers and
fathers as provided in Sweden. Then both pa-
rents can cement the “‘love affair with the baby”
(Baher) and learn together to meet its needs.

10. Daycare should be provided by all places
of employment so both parents can return to
productive work with mothers able to nurse the
child on the job. This will have the added bene-
fit of breaking down puritanical prejudices
against breast feeding, a natural function of a
woman’s body. It should not have to be done
surreptitiously.

We must free ourselves from the equations
woman = passive, man = active, woman = child
rearer, man = provider. We are all human beings,
all one species. Our reproductive Organs deter-
mine complementary roles in reproduction. They
need not and should not determine our roles in
society.

APPENDIX

The appendix describes the physical aspects of
postpartum in more detail than the chapter.

After Labor

For at least one hour after the completion of
labor, the physician or midwife should remain in
attendance in case of complications. If at the end
of that period the uterus has satisfactorily con-
tracted, the woman may be left alone. If not,
contractions should be stimulated and progress
carefully watched until all danger of hemorrhage

has passed.

The genitals must be kept clean to prevent in-
fection. The cervix is large after pregnancy, ad-
mitting two fingers. It is very important not to
introduce anything into the vagina because of the
danger of infection: The cervix returns to nearly
normal condition in one week by proliferation of
new cells (unlike the uterus, which first auto-

digests part of itself and: then makes a new hning).

The genitals are washed with an antiseptic solu-
tion each time after elimination and the sterile
pad changed. Dr. H.J. Eastman, the author of
our medical text, states that the pad is useful not
only to absorb the lochia but because “‘it makes
it difficult for the patient to touch her génitalia,
a practice very common among the uneducated
classes. . .” The good doctor does not mention
whether he has ever tried telling these “uneducat-
ed” women about the dangers of infection.

An abdominal binder is not necessary, but
many women feel more comfortable wearing one
(usually a girdle that won’t roll up).

Afterpains caused by contractions of the uterus
are more common in women who have had more
than one child. They are often accentuated while
the baby is nursing. When they are severe, co-
deine or aspirin is prescribed.

The uterus, by a process called involution, be-
comes reduced to 1/20 to 1/25 of its size at de-
livery. Involution is effected by autolytic (self-
breakdown of cells) processes by which the pro-
tein material of the uterine wall is broken down,
absorbed and cast off through the urine. The
endometrium (lining of the uterus) is excreted as
lochia (a blood stained vaginal discharge). The

discharge is bright red for the first few days; after»
_ three or four days it becomes paler and usually

after ten days. there is merely a whitish or yellow-
ish discharge. . Unusually heave or long term

. bleeding suggests need for more rest.. Though the

lochia consists of waste material (not longer need-
ed in the body), it is clean and should not have

a bad odor. If it does, it may indicate imperfect
involution or retention of parts of the afterbirth.
By the end of the third week, the entire endo-
metrium has been cast off, including the placen-
tal site, so that women who bear many children
do not have scar tissue in the uterus.

There is usually a weight loss of about. five
pounds in addition to, the weight loss 'represent-
ing the baby and the contents of the uterus;
This represents water loss and other factors.

The vagina requires some time to recover from

__ the distention and rarely returns to its pre-preg-

119

nant size. If you have used a diaphragm, most
likely it. won’t fit now, so use another method
of birth control. If you are nursing and can’t
take the pill, use your old diaphragm with lots
of cream or jelly until you can be fitted with a
new size. It is not known if any of the com-

-monly prescribed exercises for the vagina are ef-

fective. .The vaginal outlet is markedly distended
and shows signs of laceration. The labia majora
and minora become flabby and atrophic as com-
pared with their condition before childbirth. You
can probably see some of the changes of your
genitals if you look at yourself with a mirror.

Masters and Johnson examined a limited num-
ber of postpartum women during intercourse and
found marked changes from the normal. The

_physiologic reactions of most parts of the geni-

tals were reduced in rapidity and intensity. The
vaginal walls were quite thin and failed to lubri-
cate as soon or as much as before. ‘‘Normal ru-
gal patterns (folds) were flattened or absent and
the. vagina was light pink in color [usually vivid]
and appeared almost senile to direct observation.
Particularly was this steroid-starvation true for

the three nursing mothers.” Orgasm was not as
strong or as intense. Interestingly enough, the

feelings. of sexual tension did not correspond to

the physical appearance, as they usually do.
“Sexual tensions frequently were described at
non-pregnant levels, particularly among the nurs-
ing mothers.’ This may be in part due to pelvic
congestion, which can be experienced as sexual
arousal. But even more important, the women
could not subjectively feel the difference between
orgasms during this time (3-4 weeks) and those
three months later when their orgasms looked
physiologically like those of a nonpregnant wo-
man.

The process. of involution of the peritoneum
(abdominal cavity) and the abdominal wall, re-
quires at least six. weeks.’ Except for the pre-
sence of silvery ‘striaie, they gradually return to
their original condition provided the abdominal
muscles have retained their tonicity. This is why

- it may be important to exercise during pregnancy

and to do the exercises prescribed for the post-

partunr period.

Between the second and fifth day there is a
condition called diureses or lots of urination. -
During pregnancy the body tends to retain water
and this diureses of the puerperium is simply *
reversal of the process and a return to norma’
the water metabolism. Urination may amour
to over a gallon a day. Occasionally sugar is
found in the urine. This is due to the pre*°”
of laetose or milk sugar and has no conr

eee ee a
= ee
\

—————

120 —

with diabetes. If the patient does not urinate with-
in six hours after delivery, she must be catheterized
because the bladder may become distended to the

point of bursting. Patients who have had analgesics
in labor may not be aware that their bladder is full.

Bowels. A mild cathartic may be given on the
second or third day to relieve constipation. It is
desirable to get the bowels moving during the hos-
pital stay but this is not always possible.

Most of the blood and metabolic alterations of
pregnancy disappear within the first two weeks of
the puerperium. In a study of 1000 deliveries, 20%
of patients had anemia on the fourth day post-
partum. In 15% it was mild, but in 5% it was se-
vere. If you feel unusually weak or tired during
the first two weeks, anemia may be the cause.

Diet. The postpartum woman may eat a normal
diet. La Leche League lists foods for nursing mo-
thers which may help to avoid colic. If she is nurs-
ing, her diet should be the same as during pregnan-
cy with the addition of a pint of milk, bringing
the milk total to a quart and a half a day.

Temperature. The temperature should be care-
fully watched during the first two weeks because
fever is usually the first sign of infection.

Care of the Nipples. Little attention is required
beyond simple cleanliness. If the nipples become
sore, a nipple shield may be used temporarily.

If your doctor is not helpful with nursing prob-
lems, call La Leche League. .

Menstruation usually returns in eight weeks in
women who do not nurse. In nursing mothers
there is ordinarily no menstruation as long as the
child is completely fed by nursing, but there is
great variation with menstruation occurring some-
times as early as two months but most commonly
at four months. Most women do not ovulate while
nursing, but a substantial number do, so it is wise

to employ reliable birth control precautions.

APPENDIX ON CHILDCARE

An entire paper should be devoted to childcare.
But that hasn’t been written and your child has
arrived and so we’re adding a few notes on chil-
dren, mothers, and childcare. |

The full impact of having a child often doesn’t
hit us until we’re home from the hospital and faced
with the responsibility for another human being.
Many feelings, thoughts, and fears come to mind:

I am supposed to be fulfilled because now Iam a
mother, but this seven pound being that just emer-
ged from my body is not a person — she just sleeps,
eats, and shits at first. But I still have to be around
most of the time to care for the baby and give up }
my other interests, my independence. And I feel
scared: what if I do something wrong — I’m afraid
to even bathe the baby for fear I might drop and
kill her.

All these things are common problems. Just be-
cause we’re women, we don’t instinctually know
how to care for children — experience is essential.
Also, once your child is born, she is a separate be-
ing, one that you have to get to know, and who has
to get to know you. We have learned from talking
with each other that a child has a very strong will
to live; there is not much we can do to hurt the
child physically. We have also learned that our

independence and emotional well being is as impor-
tant for our children as for ourselves: we must re-
main people in spite of the fact that we’re now mo-
thers! Therefore, in thinking about childcare we
have to talk about our own needs as well as the
needs of our child.

And we must talk about our own needs first,
because in no other place are they given the con-
sideration we know they warrant.

_. Even though we have physically borne the chil-
dren, we know that we cannot for ourselves and
must not for our children rear them alone. De-
pending upon our own living situations, we have

to find the easiest way to share the care of our chil-
dren from the very first day home. Sharing means
‘to us joint responsibility, not just a division of
tasks. We expect the other constant adults in our
children’s lives to know how to take care of the
child without having to turn to us as “‘the experts’’.
(“I didn’t know how to change a diaper any more
than my husband did. In fact, I may have been
more nervous about it, since as a woman | was ‘ex-
pected’ to know how. I learned to do it and so

caf he and others.’’) Our children need intimate,
consistent care from adults, and that care can

come from the father of the child, friends with
whom we may be living collectively, in childcare
centers, and from us as mothers. The important
thing to remember is that we must not forget about

ourselves as people just because we’re now mothers.

And if that means we want to be away for a day,
a week, or even a month, our children shouldn’t
suffer. If primary relationships exist between our
children and other aduits from the start, then
everyone will be happier. If, on the other hand,
we allow ourselves to think that we are the only
adults able to care for and love our children, then
we will almost always come to think of our chil-
dren as our possessions.

We don’t want to push women out of the home,
but we want to leave the door wide open - for both
ourselves and our children - to grow and develop
_ aS independent people.

Clearly we can’t cover all the things we’ve
learned about‘children.. We-have learned from
talking with the other adults who share the care
of our children and from our sisters who have been
mothers before us. We have learned that there are
no final rules to follow; our children are as differ-
ent from each other as we are from our friends.
The key thing is to try to relax and enjoy your
children - they can be great fun - as long as you
don’t have exclusive responsibility for them twen-
ty-four hours a day.

Here are some random pointers that come to
mind:

141

. No books are adequate (especially Dr. Spock,
even id atonne he can be reassuring at times). None
take into account the mother as a person. Talking
to friends is more helpful.

2. Time for ourselves alone is essential — awake
and asleep. You’d be surprised how much getting
enough sleep determines your ability ‘to cope.
When you’re away from you baby, enjoy being ©
yourself; motherhood ‘is only one part of you. ’

3. For details about the physical care of your-
self and your baby: :

— Check Lester Hazell’s Commonsense Child-
birth (not yet in paperback) and Sheila erie eee S
The Experience of Childbirth. 1

— If you’re planning to breast feed your baby,
read some good, supportive books about it first
(Commonsense Childbirth has an excellent section
on breastfeeding, as does the Kitzinger book, and
Karen Pryor’s). Don’t let people discourage you,
and remember that sleep and lots of liquids are”?
necessary.

— Don’t let up on your doctor/clinic until all.
your questions are answered. If you have a qués-
tion, it’s valid even though the doctor may not °—
think so! 4

+ Check with your friends — their experiences
will give you support as well as information. .

4. Finally, we’re including a list of some pro-

ducts we have found helpful (you may or may not).

_ ‘Disposable diapers (Pampers); diaper, service;
or if you do your own, use diaper antiseptic. in the
wash.

— Pacifiers (some babies won’t ever take them,
and probably don’t need them, but it’s useful to
introduce them during the first week to get haces
baby accustomed to them).

— Baby carriers, infant seats, portable beds, ne
—anything that increases your mobility., A.baby,, :
can sleep anywhere and under most circumstances
if you teach her early enough. Security shouldn’t.
come from a bed or a place but from adult re-
assurance, and your expectation that the child can
do it.

— Other equipment that gives the child mobility
and variety: jump seats, swings, jumpers, Mobiles,
etc.

aE food. grinder (which you can buy for about
$1.00) or a blender (a lot more expensive) will
allow you to grind all adult food into baby food.
It saves money on canned baby food , and it’s also
amost invariably: better for the baby.

We can’t emphasize enough that Maring fora
baby is a earned skill, and one that we are con-
tinually learning. Through experience - the every-
day variety of trial and error - you and your

122

housemates will come to know the baby’s needs and learn to meet them in the most direct and uncom-

plicated way.

BIBLIOGRAPHY

A.A. Baker, M.D., Psychiatric Disorders in Obstetrics, Blackwell
Scientific Publications, Oxford and Edinburgh, 1967.

Nicholson J. Eastman, M.D., William’s Obstetrics, Appleton Cen-
tury Crofts, New York, 1956.

Nicholson J. Eastman, Expectant Motherhood, Little Brown and
Company, Boston and Toronto.

Alan F. Guttmacher, M.D., Pregnancy and Birth, Signet Books,
New York, 1962.

Sheila Kitzinger, “An Approach to Antenatal Teaching”. Avail-
able from Boston Association for Childbirth Education, Box
29, Newtonville, Mass. 02160.

Masters and Johnson, Human Sexual Response, Little Brown and
Company, Boston.

Richardson and Guttmacher, Social and Psychological Aspects of
Childbearing, Williams and Wilkins, Baltimore.

Kane, Harmon, Keeler and Ewing, “Emotional and Cognitive Dis-
turbance in Early Puerperium”’, Brit. J. of Psychiatry, 1968.

Gordon & Gordon, ‘Social Factors in Prevention of Post-Partum

Emotional Problems”, Amer. J. of Orthopsychiatry, Jan. 1967.

Rita F. Stein, “Social Orientations to Mental Illness in Pregnancy

and Childbirth”, International J. of Social Psychiatry, 1967-
1968.

A.T. Beck, M.D., Depression, Hoeber Medical Division, Harper
and Row, New York, 1967.

Knobel Mauricio, ‘‘Previous Psychotherapy in Pregnancy”’,
Psychotherapy and Psychosomatics, 1967, 15(1)34.

In the previous sections to this course, we have
discussed the problems women face in their en-
counter with our medical system. We have been
given inadequate and often incorrect information
on how our bodies function. We can’t get birth
control, so thousands of us die each year from il-
legal abortions. Childbirth is often a terrifying and
inhumane experience. These problems are not mis-
takes, they are results of a system which is designed
to make profits, maintain a professional elite, and
treat certain sick people, rather than deal with the
problems of human beings and their illnesses. The
purpose of this paper is to show how our medical
institutions work so we can better understand how
to restructure them for our own use and health.

Doctors, clinics, hospitals, and medical schools
do not take responsibility for the health of the peo-
ple. Health care in America is not a unified system
dedicated to keeping people healthy, measuring the
results of treatment, or dealing with health prob-
lems in the society. It is a system designed to pro-
fit certain groups of individuals or corporations.

In one study it was revealed that 60% of therapy
reviewed was below acceptable standards (For-
tune, January 1970). There are practically no
preventitive public health programs in the country.
Most of the existing programs study epidemiology
and innoculate against communicable diseases.
When Federal money is allocated to “‘more impor-
tant’’ expenditures, such as the war in Vietnam, .
even these programs suffer. The Federal govern-
ment recently decreased funds for a mass innocu-
lation campaign against a German Measles epidem-
ic predicted for the year of 1970. In contrast, it
has reported that communicable diseases have
been practically eliminated in North Vietnam.

It is well known that German Measles can be
serious for children and devastating to the fetus in
early pregnancy. It can be very damaging even
when the mother has such a light case that she is
unaware of it and before she has discovered that
she is pregnant. If you are contemplating getting
pregnant, it takes two or three months in Massa-
chusetts to have a simple antibody titer test done
on your blood. If you don’t have antibodies and
want an immunization, you have to wait three
months after the shot to be safe, and then have
another blood test. You can go out of state and
pay $10 (in Massachusetts, it is a free state test
only) to have the results in a few days.

The factors in our society which produce a
great amount of sickness are not dealt with by

123

Medical Institutions

the medical establishment. In fact, bad housing,
poor nutrition, poor sanitation, pollution, and dan-
gerous working conditions are not dealt with by
any establishment. The diseases resulting from
these factors are obviously suffered mainly by poor
people who have no control over them. Unfortu-
nately for the poor, building low income housing,
as has been stated many times by builders, land-
lords, bankers, and city planners, is not profitable.
All of the previously-mentioned disease-producing
factors could be eradicated if the effort were made
and the money were allocated. Recently, the Mass.
Dept. of Health refused to set up stricter levels for
pollution in our air, although it was reported that
the yearly average of sulfur dioxide in Boston, for
example, was double the amount at which adverse
health effects have been noted. Boston Edison was
the voice they listened to when making their stan-
dards. The FDA is supposed to screen drugs before
their release, but in a recent study in 19 out of 27
drugs, dangerous contraindications were not report-
ed to or checked by the FDA. The FDA, a regula-
tory agency, is well regulated by the pharmaceuti-
cal (“ethical drugs’’) industry (see The Therapeutic
Nightmare). It commonly approves drugs known
by the drug companies, and often by the FDA it-
self, to be unnecessary and lethal.

Children put things in their mouths. In slum

124

apartments in every city in the country, they are
eating lead-based paint which is flaking off the
walls. Lead poisoning is also an industrial disease
where lead or compounds of lead are used.. The
human body has no way of eliminating lead. As
it accumulates, the initial signs are intestinal pain,
muscular weakness, and anemia; later signs, pro-
duced by relatively tiny concentrations, are men-
tal retardation and death. The lead lobby, people
who profit by the use of lead, are strong enough
to prevent other substances being substituted for
lead in certain products, such as gasoline.

In the rural South, hookworms live in the soil
and enter the body through bare feet. The multi-
ply, are very debilitating, and can cause death.
Hookworm infestation is more prevalent among
poor people because of the lack of shoes and be-
cause malnutrition increases the likelihood of being
sick with hookworm. Malnutrition makes the body
more susceptible to any infections and many. other
diseases. Dr. Jack Geiger of Tufts has said: “If I
could do just one thing to improve the health of

cause the coal companies have refused to installa —
$50 device which has cut the incidence of black
lung in European mines, some miners die and oth-
ers have to retire at forty with no compensation, .
so the companies won’t have to dig into their pro-
fits. Recently a compensation bill was passed,
with the money coming out of tax money instead
of company profits.

In Boston, workers who dig tunnels for our gas
mains, water mains, and transportation systems
suffer 20-30% casualties on every job because of
dangerous working conditions. In nearly every in-
dustrial shop, workers can tell you about unneces-
sary conditions that endanger life and limb. In
1968, 2,200,000 industrial injuries were reported,
900,000 leading to permanent disability and 14,500
leading to death (HRN 5-69). The only way for
these accidents to be decreased is for management
to be more concerned with the health of the work-
ers and less concerned with profit.

The U.S. spent $62 billion for medical care in

the people, I would double their per capita income.” 1969 —

In coal mines, the coal dust in the air causes
black lung disease (Reader’s Digest, from the Wash-
ingtonian, April 1969), which shortens life drastic-
ally. 125,000 Americans have black lung disease.
The coal companies have successfully blocked
black lung compensation bills in West Virginia. Be-

$35B to “proprietary” hospitals and nursing
homes

$12B to doctor’s services

$10B to supply companies

$ 6B to drug companies

$ 6B to commercial health insurance

$ 2B on medical research

$ 2B on construction costs for hospital building

America spends more money per person on health
than any other country in the world. It is estimat-
ed that by 1975, health care will be the nation’s
largest “industry” in terms of money spent and
people employed: our national health bill is ex-
pected to be $94 billion. In the last nine years it
has gone from $27 billion to $62 billion. This fig-
ure includes everything connected with health:
drugs, doctor’s bills, hospital bills, private health
insurance premiums and so on. Someone is mak-
ing money off sickness, the money is going to pro-
fit, not good medical care. Of the $62 billion spent
on health in 1969, at least $3 billion are profits,
$600 million going to drug companies, $400 mil-
lion to supply companies, and $1,400 million to
physicians and surgeons. In one supply company,
93% of its income comes from disposable items,
thus increasing unemployment (no laundering) and
pollution (burning the items).

Stock brokers are recommending the health in-
dustry for good investments. Some of the compa-
nies expanding into health issues are: Motorola,
IBM, Monsanto, Litton, Lockheed, and Philip Mor-
ris. In its second year, Healthcare Corp., a Boston-

based nursing home and medical supply company,

made a net profit of $1 million. (In its third year,

Healthcare Corp. has had an antitrust suit filed
against it.) The state of New York has banned for-
profit corporations from owning hospitals. Has
someone realized that profit making is not com-
patible with high health standards?

America has the most highly developed medical
technology, the most equipment, the most drugs,
and just about the worst health record of any in-
dustrialized country. We rank 18th in infant mor-
tality and 12th in maternal mortality in the world.
Of course, as Fortune magazine points out, if you
exclude the poor, the figures go up. The non-poor
Americans as a group rank 10th in infant mortali-
ty, indicating the poor quality of medical care
given even to people who pay for what they think
is the best care available. Millions of America’s
children are born disabled or become disabled
through medical and nutritional neglect during
their early years. We rank 22nd (World Health
Organization) in life expectancy for males. If we
figure the statistics separately for blacks and whites,
we find that black life expectancy is seven years
less than that of whites, and that black maternal
mortality rate is four times that of whites; a pathe-
tic example of the unequal distribution of medical
care. Harris polls show that over one-third of the
nation feels ill-cared for in its medical needs. One-
third of this nation also lives in poverty or severe
deprivation. For all our technology, we discover
hunger in 1968.

Medicine, like other fields, has traditionally dis-
criminated against women. Hysteria comes from
the Greek word for uterus and was thought to be
caused by the wandering of the uterus to various
parts of the body because of its longing for chil-
dren. Hippocrates recommended marriage as the
remedy. Dorland’s Medical Dictionary defines
hysteria as a psychoneurosis with certain symp-
toms and does not mention any sex incidence.
Medical students, however, learn from their teach-
ers (often by snide remarks) that hysteriacs are
bound to be women. It is obvious then that a man
presenting identical symptoms is defined different-
ly. The difference isn’t in behavior, but in the
‘word used.

Doctors’ attitudes toward patients are terribly
condescending, especially toward women. You
aren’t supposed to read the record of your own
body, and you are scolded like a child if you do.
Doctors withhold information that you are dying.
They withhold information that you might have a
difficult pregnancy or childbirth. In playing God,
their attitude is that you must have complete con-
fidence in them to make all of your decisions for
you. Why should they make your decisions?

Doctors see women as patients more frequently,

125

women average 25% more visits to the doctor per
year than men, not counting the many times they
accompany their children. A standard complaint
of doctors is that they are tired of neurotic women
with nothing wrong with them who come in because
they are lonely or dissatisfied with life. Psychia-
trists get more women patients. A study showed
recently that conceptions of behavior of normal
men and normal adults coincided, but behavior
stereotypically feminine was not thought by psy-
choanalysts to be normal adult behavior. No won-
der more women end up on the couch, where they
are supposed to learn to adjust.* It is also true

that many women have a more difficult time adapt-
ing to “‘their roles’’ in society.

The system fails to provide basic preventive
medicine for people. For example, cancer of the
cervix or the uterus can be totally cured by early
detection by the Pap smear and early treatment.
The Pap smear was developed about thirty years
ago, and yet today (1970) only 12% of American
women regularly get Pap smears. It would be sim-
ple (but boring) to have a mass screening campaign.
A great proportion of the 14,000 deaths per year
from uterine cancer could have been prevented. A
young internist recently remarked that he rarely
did pelvic examinations of his women patients be-
cause it embarrassed him. How many women die
because doctors have hang-ups about their genitals?

On the other hand, unnecessary and cruel sur-
gery is often performed. In a study at Columbia,
one-third of the hysterectomies reviewed were
judged as having been done without medical jus-
tification. The study covered 6,248 operations.
30% of the patients aged 20-29 who had hysterec-
tomies had no disease whatsoever. In individual
hospitals, the percentage of unnecessary hysterec-
tomies has been as high as 66%. (Carter, The Doc-
tor Business) In Appalachia, doctors have removed
healthy reproductive organs from 11 and 12 year
old girls to get the $250 fee. Unnecessary surgery
is common in America. We have twice as much —
surgery, per capita, as England. The unnecessary .
operations are called “remunerectomies” (done
for monetary remuneration). How many remun-
erative testectomies do you think are done?

The medical system is not responsle to the com-
munity. It is controlled by the doctors. Fortune
magazine says,

The doctors created the system.. They run it.
And they are the most formidable obstacle to

* “The country’s number one problem”, occupying half of the
hospital beds, has been designated to be abnormal behavior, peo-
ple who can’t adjust to life situations. Maybe the “‘sick”’ person
is the one who can adjust to life situations and the society
around him or her. It is often not us, but our society, which is
sick.

126

its improvement. It is the doctor who decides
which patients will be treated, where, under
what conditions, and for what fee; who will en-
ter the hospital, for what therapy, and for how
long; what drugs will be purchased and in what
quantities.

We also know they decide how we will have our
babies and whether anyone can be with us. A pri-
vate doctor is responsible only for the patients
who walk into his office. He (note sex assumption)
has no means of knowing what’s going on out there
in the community, whether the people are healthy,
what the medical problems are, what the causes
are. Not many doctors will refuse to see a patient
who can’t pay them, but most will make all possi-
ble efforts to direct people without money to cli-
nics. Few patients are willing to press the point
that they should get reduced rates or free care
from the doctor. It’s good to know that if you ask
for a reduction of fees, you can get it. Faced with
the reality of your income versus his, the doctor
does sometimes give in. Recently, however, Rob-
ert K. Funkhouse, M.D., of Cambridge, answered
a young couple whose income was $5500/year
before taxes and who requested to pay $10 instead
of $20 for a 20 minute examination:

Unfortunately it is completely impossible for
me to make a living wage at the rate you have
calculated. As itis, from a full-time medical
practice I am only able to earn something in
the neighborhood of $20,000 a year which is
not enough to enable me to put my children
through college.

While the system of financing medical care in
the United States may leave
much to be desired, it is the
one that existed at the time
you made an appointment to
come to see me, and I would
very much appreciate it if you}
would pay my fee.

The fee-for-service system sets
the tone of private medical care
in the country. The doctor sells
a commodity to those who want
to buy it and can afford it, and
he sells it on his terms. All
the private doctors in Charles-
town take Wednesday off. Pa-
tients complained, and they
asked the doctors to rotate days |
off so there would always be =
someone there. All the doctors
in Charlestown still take Wednes
day off. For obvious reasons,
most doctors prefer the fee-for-

service system. This is the system by which the
doctor bills the patient himself, the amount based
on what the service was and what he thinks the pa»
tient can pay. For example, a family without in-
surance was charged $150 for an appendectomy.
A few months later, another child in the family
had the same operation and the family was re-
lieved that in the meantime they had gotten in-
surance. This time the doctor charged $300,

$150 for the family to pay and $150 for the in-
surance. He argued if they paid it before, they

can pay it now. This attitude reflects the attitude.
that ‘if it doesn’t hurt, it isn’t doing any good’.
The doctors feel if it doesn’t hurt the pocketbook,
you won't appreciate the medical care; also; you
might lose respect of the doctor if he loses con-
trol of the billing process.

There are two alternate systems of remuneration:
one is prepaid group practice where the doctors are
salaried. The AMA state and local societies have
fought this system by using their power to deny
hospital admitting privileges to the physicians in
group practice. Group practices have difficulties
attracting doctors. One western group has been
trying to recruit an orthopedic surgeon at $40,000
per year in vain because they can make $80,000.
Another drawback in this system is that it may be
set up so that salaried doctors may be exploited by
senior partners (often doctors) in the business and.
keep the profits for themselves. The other system
is payment per patient treated (i.e. by the govern-
ment); this is called capitation.

The AMA (American Medical Association) has
been an extremely powerful force in insuring that

‘CLENCHED. FIST: SALUTE iis given by some of demonstrators leaving - Hotel.
~ Americana: ballroom after interrupting opening of American: -Medical. Assn.*
meeting. They protested AMA stand on health care measures. (AP)

medicine is practiced for the doctors, not the pa-
tients. Although it does not speak for every doc-
tor as an individual, it does write the rules that all
doctors must follow. Milford O. Rouse, M.D.,
last year’s AMA president, has asserted that there
is a threat to medicine in the concept of health
care as a right rather than a privilege. The AMA
has the richest lobby in Washington, spending
$1.1 million in 1965 (HRN, 8-69). In 1968,
AMPAC, the AMA’s front for political contribu-
tions, gave $680,000 to candidates for national
office who think our resources should be allocated
to death: wars and guns and ABMs and MIRVs,
rather than to clinics and more doctors. It is es-

. timated that five times this amount is spent at the _

_ local level.

The N.Y. State Journal of Medicine, the organ
of the state medical society, has an interesting def-
inition of illness, although it doesn’t look as if the
patient would benefit by it (Carter, The Doctor
Business).

.. What does illness mean? Cowardice, maling-
ering, laziness, maladaptation, cussedness, pure
worthlessness. .. It is time that someone - every-
one - should hoist Mr. Charles Darwin from his
grave and blow life into his ashes so that they
could proclaim again to the world his tough but
practical doctrine of the survival of the fittest. . .
The Declaration of Independence said that man
was entitled to the “pursuit of happiness’. Any
man who wishes to pursue happiness had better
be able to stand on his own two feet. He will
not be successful if he feels that he can afford

to be ill.

It has been stated that physicians have a low
opinion of humanity.

The AMA has opposed free innoculations against
diphtheria and polio, free vaccinations against
smallpox, the establishment of Red Cross blood-
banks, federal grants for medical school construc-
tion and medical student loans, national health in-
surance and Medicare. In 1938, federal public
health authorities made it known that they were
ready to spend millions on polio research. The
AMA opposed it: “Until we learn more about it,
any program which contemplates prevention of
infantile paralysis is a bogus campaign.” (Carter,
The Doctor Business) In 1955, after Salk devel-
oped his vaccine, the AMA House of Delegates
passed a resolution demanding “immediate termi-
nation” of free distribution of the vaccine. The
Federal Government’s program to innoculate peo-
ple was called “‘a violation of the principles of free
enterprise”. In New Jersey, the state medical so-
ciety forbade physicians to participate in the free
programs except when the patients were paupers.

127

Half of the vaccine purchased by the Federal Gov-
ernment went unused in the first year of the pro-
gram, due to doctors’ unwillingness to participate
in free programs. The doctors charged $5 a shot.
They get most vaccines free.

The AMA has fought any form of practice of
medicine that promotes preventive measures ra-
ther than curative treatment. The AMA’s positions
on pollution, smoking, car safety, and working con-
ditions all show that they put the freedom of the
corporations above the concern of keeping people
healthy. 45% (HRN 8-69) of the AMA’s operating
budget comes from the drug and medical supply
industries, so the AMA is interested in laws which
bolster the exorbitant profits of these industries.
An example of such a law is the ability of the drug
companies to obtain a patent on a new drug, thus
inhibiting competitive pricing. Dr. Milton Rouse
has stated the purpose of the AMA by saying that
the AMA should “‘concentrate [its] attention on
the single obligation to protect the American Way
of Life. That way can be described in one word:
capitalism.”

The ‘‘usual and customary” fee-for-service clause
in Medicare was inserted by the AMA, ensuring
that the traditional system of the doctors billing
the patients be preserved. Subsequently, in 1966,
doctors raised their fees 8%, costing the U.S. pub-
lic $500 million (HRN 8-69). The AMA has also
had a hand in setting up hospital practices.

Instead of having health teams to give continu-
ous care necessary for the protection of health,
the system in this country is that patients are
treated only after they become sick enough for
admission to a hospital. (When was the last time
a doctor came to your house?) Hospitals are cen-
ters for dealing with crisis medical problems. Yet
only a few hospitals can do this well. The others
do not have enough personnel, equipment, experi-
ence, or desire. There are several kinds of hospi-
tals. Proprietary hospitals are owned by private
investors, usually doctors, and make a profit for
their owners. Their annual reports are often con-
fidential.. There are mainly small ones in Boston.
Most of the big hospitals around here are volun-
tary hospitals, originally set up by charitable or-
ganizations and partially supported by private
contributions although now most of their financ-
ing comes from governmental and other quasi-
public funds. The other kind of hospital is pub-
lic and is supported by the city or other govern-
ment. The source of the financing of the public
and voluntary hospitals does not differ greatly
(eventually, tax money), but they are benefitting
different people. Most of the people who can’t
pay for their care and who don’t have insurance

128

are supposed to go to the publicly-financed public
hospitals while private patients go to the publicly-
financed “‘private’. hospitals. But there are many
more private and voluntary hospitals than public.
The city of Somerville has 88,000 people and no
public hospital, one proprietary and one voluntary.
Government grants and other monies go mainly to
the voluntary hospitals thus insuring that more
money is spent on “‘welfare”’ to rich and middle
class people, rather than poor people.

Most of the hospitals’ policies are set up by the
doctors who are involved in them. The doctors
are in an extremely hierarchical and autocratic
pecking order. This pecking order also extends
down through nurses, nurses’ aides, technicians,
orderlies, maintenance, and housekeeping. The
decisions are made by the chiefs of each medi-
cal department and passed down to each lower
person as in the military. This insures that the
high people won’t be bothered by the low people.
There was actually a conference titled ‘“‘Develop-
ing Subordinates” at the New England Hospital
Assembly, Spring 1970.

Fortune, January 1970, says that payroll rep-
resents 60-70% of hospital costs (which are reach-
ing $100 a day). Fortune cites Mass General sta-
tistics of salary increases for blue-collar workers,
nurses, interns, and residents which have gone
up to $84 and $150 a week, $7,000 and $11,000
a year respectively. These figures fail to mention
that senior physicians get around $40,000 in addi-
tion to their private patients, and hospital admin-
istrators get over $40,000, to one of $75,000 (New
York City). 35% of hospital employees are in
this upper category and here is where most of the
payroll money is going. If a hospital had 100 em-
ployees, 35 of them getting $40,000 and 65 aver-
aging $6,000 (which is probably high), then the
annual payroll would be $1,400,000 to the doctors

and administrators and $390,000 for everyone else.

And in their public statements, hospital adminis-
trators blame the wage increases of the workers
for the increase in cost.

A teaching hospital is any hospital which takes
medical students for teaching purposes. The teach-

ing hospitals are run mainly by the medical schools.

All of the major hospitals in Boston have relation-
ships with one or more of the three medical
schools. Here is one place to look for medical
empires. Although the trend is allegedly chang-
ing, the medical students practice mainly on ‘‘char-
ity” patients, that is, poor people who come in
without a private doctor. The hospital is depen-
dent upon the medical school for personnel to do
the routine scut work. Taking advantage of medi-
cal students and treating them roughly insures they

will continue the tradition when they have the — pe
power to do so. The medical schools could not re.

teach without patients to work with.

Hospitals are concerned with having the equip-
ment and supplies that allow doctors to practice
modern medicine. As it is, they are spending most
of their money on equipment and specialists that
can meet the most exciting type of medical dif- —
ficulty. Boston City Hospital recently announced
its first open heart surgery case. There are three
other places within a ten minute drive (assuming.
no traffic congestion) where the same operation
could have been performed. The hospitals are
competing among themselves for prestige. This
is why they build another open heart surgery
team which costs $500,000 a year to maintain, ra-
ther than spend the money on ambulances, com-
munity doctors, or local clinics. The Public Health
Service reports that in 1967, 776 hospitals had

open heart units, but 31% hadn’t been used for a‘

year. Not using the equipment and people’s skill
regularly is very dangerous for the patient. In the
Soviet Union, they have centers for such a spec-
ialized operation, and the government flies pa-
tients thousands of miles to them. Would the
community the hospital was supposed to be serv-
ing pick open heart surgery over something like
15,000 out-patient visits a year? Prestige is also
measured by the “‘quality”’ of interns and residents
the hospitals get, and they need fancy equipment
to get them. Harvard in particular has a number _
of superlaboratories at hospitals to train people

_who will be leaders in medical schools all over the

country. This helps to maintain Harvard’s elitist —
and highly academic, research-oriented influence
on the training of doctors all over the country.

The medical schools are becoming an increas-
ingly dominant force in the way medicine is com-
ing down to people. Doctors are doctor chauvin-

ists as well as male chauvinists. Most women d6c- ~

tors are no exception to this, having taken a role
of “honorary men”. Although 70% of hospital
employees are women, 7-10% of the doctors are
women. Two percent of doctors are black (Pa-
rade, 11-30-69). Medical schools teach their stu-
dents very carefully. You learn that you are being
trained to occupy an exalted position in the medi-
cal world (and society in general), but in the pro-
cess you must take a lot of shit. Dr. Lewis of
Harvard has said: “Doctors go through a greater
socializing process than even the priesthood.” .
For at least seven years they spend most of their
waking hours not only absorbing medical infor-
mation, but “learning how to act and think as
well’. Thus the order in which the doctors dump
all over anyone below them is established.

Mee PEON Se RT

Medical schools are maintained as elitist institu-
tions by their high tuition and the almost total
lack of federal aid for scholarships to medical
schools (unlike graduate schools). The students
are mainly from well-off families. The top 12%
of the socio-economic structure in this country
provides 50% of the medical students (HRN 8-69).
The AMA has fought hard to maintain this status
quo. The AMA has also contributed by blocking
federal funds to build medical schools, keeping the
number of doctors for an expanding population
criminally low. In 1900, before medicine was so
“advanced’’, there were 157 doctors per 100,000
population in the U.S. In 1959, there were 132.7.
In Massachusetts, the figures were 174, in Missis-
sippi, 69 (EAM, Harris). Somerville has 35 doc-
tors for 88,000 people and their average age is 60.

Medical schools are disease-oriented rather than
people-oriented. This leads to the dehumanizing
experience of a person being referred to us “‘a
pneumonia in room 222”. The medical schools
have recently been pushed, largely by students, to
reform. A committee of deans and faculty and a
few students try to decide what’s to be done with-
out asking the people in the community they are
supposed to be serving. The community does not
represent the same interests as the trustees do:
real estate, banking, construction, insurance, drugs,
and hospital supply companies. These reports are
usually shelved.

The purpose of clinics is to provide care for the
patient who can’t afford a private doctor. They
are run with this in mind. Most of the poor people
in Boston go to the clinics at Boston City Hospital,
where facilities are so understaffed and undersup-
plied that a doctor was heard complaining about
his inability to find a clean tongue depressor.

This concentration of patients is changing a little
with the other big hospitals expanding their clinic
facilities. BCH serves over 1000 people a day in
assembly line fashion. You may see as many as
six doctors in the course of your pregnancy. In
-no case is any effort made that you see the same
doctor for any longer than the duration of one
particular illness. Disease is regarded as a purely
technical matter, the malfunctioning of a machine
(the heart is a pump.. .). Work is arranged so that
the students, interns, and residents of the teaching
hospital can see the maximum number of “cases”
in a short period of time. They fail to take the
whole person into account, to see that he/she
follows as good a diet as possible, to recognize
his/her fears and anxieties which may be exagger-
ating his/her sickness, to see that her/his life is
making her/him sick.

In the out-patient department at Boston City,

129
most patients wait two or more hours to see a doc-
tor. Much of the human contact comes in the
form of “‘Alright, numbers one through ten line
up and get weighed’’. There are only two nurses
and two aides for sixty patients each morning in
the Ob-Gyn. clinic. Some new liberal administra-
tors at BCH are concerned that the service is in-
human. They think that the solution is an appoint-
ment system, which the Ob-Gyn clinic has had for
a long time. Only about half the patientskeep
their appointment, which messes up the system.
The liberal administrator interprets the unkept ap-.
pointment as a lack of the middle class value of
the importance of time, so they plan to give lec-
tures to the waiting patients on the value of keep-
ing their appointments. A few conversations with
patients would reveal that when you wake up in
the morning, two or three bus trips from the clin-
ic, a household to care for, children to find a baby-
sitter for or lug on the bus with you, not feeling
well, and anticipating the bureaucracy and cold-
ness of the clinic, you think twice about going. It
takes a lot of will power to go. The appointment
system doesn’t necessarily decrease the amount of
waiting anyway, because patients always come in
without appointments.

The Boston hospital system is dimly aware of
the fact that they are too far from where the pa-
tients live. It is reasonable to have to travel several
bus trips to get specialty treatment, involving
complicated machinery or specially trained per-
sonnel. But basic family services should be avail-
able around the corner. The city provides some
very fragmented services out in the communities.
Mayor Kevin White and hospital administrators

- give lip service to the need to establish compre-

hensive care units in neighborhoods. They have
vague plans to establish nine such centers in Bos-
ton. One has been built in Charlestown, but they
have put off any work on the rest of the centers
for two years and have given their planning grant
to an organization called Hospital Planning for
Greater Boston, now Health Planning for Greater
Boston. Instead, they announced the construction
of a new out-patient facility in an empty lot right
across the street from BCH. Again the city and
hospital administrators have decided against
neighborhood facilities. Perhaps this is because

in some places where neighborhood health centers ©
have been established, the community has begun
efforts to try to take over their administration

and make it serve their needs.

It may be that the city decided to locate the
outpatient facility where they did because of the
problem of staffing community clinics. Medical
personnal clearly prefer the centralized system
since it allows efficient concentration of teachers,

OE Se ait NEE Ty f

130

students, and teaching material (patients). Out of
1000 people who get sick, 100 go to the doctor,
ten go to a hospital, and one goes to a teaching
hospital. Our doctors are trained almost exclusive-
ly on that one case in 1000. When (and if) they
get out and set up a practice and find out that
nearly every patient has something minor and/or
is neurotic, they are bored. They were trained for
more complicated things. The big money is in
specialties. The big prestige is an appointment at
a teaching hospital.

The need for neighborhood clinics is still des-
perate. There are only 17 doctors practising in
Roxbury, for a community of 70,000 people. Rox-
bury used to have a hospital called the New Eng-
land Hospital, which was originally set up asa
hospital for women doctors to practice, since they
were not allowed into the other hospitals. After
the exodus of doctors from Roxbury, the hospital
wasn’t getting enough patients. A planning firm
studied the problem, and concluded that the prob-
lem must be an antiquated physical plant, and
that they should build a new one (a standard an-
swer). Then some experts from Harvard came
along and said the hospital should get federal funds
to support certain community services. The hos-
pital’s board of directors voted to include the Har-

vard men on the board. The new board shut down
the hospital. They are making plans to put ina
maternal and infant care program and a youth pro-
gram. These programs are extentions of the work
of community medicine departments at Harvard
teaching hospitals, thus contributing to the increas-
ing fragmentation of medical services and their
control by distant institutions who know very
little about, and have little concern for, the com-
munity.

The Columbia Point Health Center sounded good
on the drawing board. It was the first center fund-
ed by OEO, the organization consisting mainly of
public relations programs to demonstrate to Ameri-
cans that there really is a Great Society. The grant
proposal submitted by Tufts said that the purpose
of Columbia Point.Center was “‘to intervene... in
the cycle of extreme poverty, ill health, unemploy-
ment and illiteracy by providing comprehensive
health services, based on multi-disciplinary com-
munity health centers, oriented toward maximum
community participation.’ Nice language, but it
hasn’t worked out that way. At Columbia Point,
the community has gotten together to fight for its
interests and the clinic tries to hold on to its de-
cision-making power. The theory is that it is only
the professionals, with all their training, who know

how to run a health center. The reality is that the
professionals are isolated, by their backgrounds,

their training in elitist institutions, and their posi-

tions of authority over the people they treat.

So far, the existing medical institutions have
been unable to give proper medical care to all the
people. Because of this inability, small groups in
a few places have gotten together to form clinics
of their own. In the spirit of the idea that health
care is a human right, most of these clinics have
been free. Our society and the medical world do
not take kindly to these clinics, they are not the
American Way. The Black Panther Party of Bos-
ton has set up a free clinic in Roxbury on the pat-
tern of the Judson Mobile Health unit in New York
in which the patients are encouraged to ask ques-
tions, and are invited to look through microscopes
at their own blood samples, and participate in the
decision making. Watch out for harassment. The
Free Clinic in Berkeley was attacked by the Berke-
ley police with cannisters of CS gas during a fight
over People’s Park. One of the .cannisters was shot
through the window of the clinic during regular
clinic hours. CS is a dangerous substance, especial-
ly when used against already sick people. Many
medical and scientific personnel in this country
spend all their time on research, development, and
testing of chemical-bacteriological weapons, yet
the Hippocratic Oath says, “‘I will use treatment
to help the sick according to my ability and judg-
ment, but never with a view to injury and wrong-
doing.”

The drug companies and equipment manufac-
turers have a clearer position on health care. They
admit that they’re in the business for the money.
Drug companies made over 15% profits on their
sales in 1960, it is said to be up over 20% now.
This compares with around 9% for the average of
the top 500 corporations in the country (EAM).
The rise in stockholders’ investment in leading
drug companies has gone from $287 million in
1947 to $896 million in 1959 and has risen greatly
since. In this country there are over 7000 drugs
on the market; Sweden, which has a better health
record, has only 2000 drugs on the market. The
government there limits drugs to the ones it con-
siders useful and safe. Of every dollar we spend
on drugs, 6% goes to research and 25% goes to ad-
vertising; the cost of the materials was 32%. In
tetracycline, a drug known for price fixing, the
production cost of a certain amount was $5.03,
the sale to wholesalers $24.22, sales to druggists
$30.60, the sales to the consumer $51.00 (EAM).
Drug companies’ expenditures on trying to get doc-
tors to buy their products by means of pamphlets,
ads, engraved golf balls, and steak or lobster din-
ners (at Jimmy’s Harborside) amount to $4000 per

131
doctor per year (HRN 8-69). With over 300,000
doctors in the country, think what this money
could do if it were spent on medical care. Doctors
and hospital administrators also benefit from the
high profits of the drug and medical supply com-
panies; often they own stock in these companies
and sit on their boards of directors. They are in
an excellent position to have their company de-
velop and market what the hospital needs, and to
have the hospital buy from the company. The re-
sult is higher costs to the sick and a higher standard
living for the elite. The major catalog of drugs is
Physician’s Desk Reference, which is published by
drug company interests and distributed free. Need-
less to say, it lists no price for drugs, so the doctor
often has no idea of the costs of drugs (he gets his
free).

The medical institutions we have do just exactly
what they are intended to do. The drug and sup-
ply companies make money, the AMA protects
capitalism. The medical schools train a small num-
ber of people to fit into the system. The hospitals
treat some sick people. The clinics see some peo-
ple and offer study material to students. None of
them is responsible for the health of the people.

Blue Cross was set up during the depression by
the hospitals, to insure they would have their bills
paid. Blue Cross is non-profit, tax exempt and re-
ceives all its funds from its subscribers (and inter-
est from investments). Financial information of
Blue Cross is not available, although it accumu-
lates large reserves ($4-5 million in Connecticut
alone) which it invests. They have a policy called
“experience rating’ which evaluates group policies.
Those groups who have a higher rate of sickness
pay more. Since poorer groups of people are sick-
er, the poor again pay more. The Board of Trustees
of Blue Cross does not have the consumer interest
represented unless you count leading businessmen
from Con Ed, International Nickel, and Federated
Mortgage Investors. Ten out of 23 board members
are doctors, hospital administrators, trustees or
other medical establishment (HPB, 9-69): When
hospitals negotiate reimbursement contracts with
Blue Cross, they are often negotiating with them-
selves.

Medicare and Medicaid were supposed to allow
poor people the means to have a private doctor,
but the Mass. General still has the White building
for poor people, Baker for middle-class, and Phil-
lips for the rich. And the difference is phenominal.
The Reader’s Digest (8-69) alleges that “the Medi-
caid program is in deep trouble because a disgrace- ~
fully large minority of medical professionals have
been permitted to cheat both the government and
the needy.” It is estimated that double-billing,

132
kickbacks, and overcharging, by our respected
medical profession (doctors, nursing homes, drug-
gists and dentists) have amounted to half a billion
dollars in the last year alone. Is this what the AMA
means when it talks about the American Way of
Life? No significant changes can or will be made
until an entirely new system of medical care is in-
stalled. The present programs like Medicaid and
Medicare are designed to protest capitalism and
the fee-for-service system and to prevent the com-
ing of the bogeyman, Socialized Medicine. Social-
ized medicine merely means that medicine is prac-
ticed for the people rather than the profession.
Many people have advocated a national health in-
surance. There are three major plans on the draw-
ing boards now: the AMA plan, the Rockefeller
plan, and the Reuther plan (HPB, 1-70). These are
insurance plans, not socialized medicine. A few
people may benefit from them in terms of medical
care, but the major beneficiaries as usual will be
the doctors, drug companies, the usual. The Reu-
ther plan is the most liberal, but still shares the
shortcomings of the others:

— National health insurance (NHI) will reinforce
the fee-for-service system.

— NHI will make the health system dependent
on private insurance companies.

— NHI has no aggressive cost control mechanisms
built in.

— Most of the proposals for NHI are based on
regressive taxing methods.

— NHI makes no provision for consumer/com-
munity participation in program planning or bud-
geting.

The medical establishment is being challenged
on all sides. It is changing and being changed.
There is some federal money available for local
neighborhood clinics run by the community, al-
though the AMA and medical societies have tra-
ditionally opposed these clinics because they would
take some power out of doctors’ hands. Doctors
are losing some of their power but unfortunately
it is not to the people but to the corporations.
January 1970’s Fortune shows the trend clearly.

The first of four articles on American Medicine
is called “‘Better Care at Less Cost Without Mira-
cles”? and extolls the Kaiser Foundation program
of prepaid corporate medicine. The Kaiser plan
is an improvement at the moment to Blue Cross,
but it is still set up to profit the doctors and hos-
pitals. ““Any reduction in operating costs below
management’s projections swells a bonus fund that
is shared by doctors and hospitals.” In 1968, the
Kaiser doctors in Northern California each collect-
ed a bonus of $7,900, on top of their $20,000-
$53,000.

The third article is “The Medical Industrial Com-

plex”. Johnson and Johnson’s earnings went from
$15 million in 1959 to $59 million in 1968. Gen-
eral Electric ‘““dominates” the medical X-ray ma-
chine market. (Past anti-trust suits have shown
how GE “‘dominates’’). “According to Arthur D.
Little Inc., the total market for medical technolo-
gy, including electronic devices, probably exceeds
$450 million a year.” They are talking big busi-
ness. A headline to this article is ““Costly Machines
to Save Lives”. This is corporate propaganda: if
you are against a hospital’s purchase of a costly
machine, you are against saving human lives.
These articles clearly show the shift that is taking
place in medicine. Medicine is converting (or be-
ing converted) from entrepreneurial capitalism to
corporate capitalism. Before we cheer the loss of
power of the medical societies, we’d better take a
look at what is replacing them.

We will have a National Health Insurance. It |
will be run either by insurance companies who will
obviously run it in the interests of big business
(themselves) or it will be run by the Federal Gov-
ernment. In the latter case it will still be run in the
interests of big business, much like the Department
of Defense. We will have to spend millions in the
War against Death as we do in the War against Com-
munism. And it will be in the form of Costly Ma-
chines to Save Lives. The situation, like the De-
fense Department, will be that the suppliers will
create the need for goods, will be assured that the
goods will be bought for a long time, plan the ob-
solescence, and fix the prices. Fortune reports that
“a single X-ray unit can cost $100,000 and is sub-
ject to rapid obsolescence.”. Like defense, the gov-
ernment, universities, and medical schools have
collaborated to serve industry. Much more money
is given in National Institute of Health grants for
equipment than personnel.. The schools are com-
peting with each other and the measure of success
has become the amount of equipment possessed.

The construction industry is also benefitting
from the surge in medical spending. Their answer
has been to solve human problems by building new
buildings such as hospitals. This is known as the
““Ediface Complex”. Fortune’s last chapter in the
medical series is ““Hospitals Need Management
Even More than Money”. They advised that new
managerial approaches and scientific planning
methods which hospitals need, demand computers
and perhaps going into sideline business ventures
(such as hospital supply?) to boost their incomes.

We believe that health care is a human right and
that a society should provide free health care
for itself. Health care cannot be adequate as long
as it is conceived of as insurance, which is the

CL me ane oe ee ese ee

business of taking in $100 from 100 people to

_ guarantee them against loss by a contingent event

and then paying out $40 to the people the event
happened to and pocketing the rest. The profit
system guarantees that certain people will benefit
and the rest will be exploited. We will gain nothing
by pumping more money into our present system.
Health care for everyone is possible only outside

of the profit system. Elitist attitudes and patients
being regarded as ‘‘consumers”’ would not be sup-
ported if society and its institutions were run by
and for all of the people.

BIBLIOGRAPHY

Carter, Richard, The Doctor Business, Doubleday, 1958.
“How the money-mad medical profession values profit above you
and your personal health.”

Harris, Richard, A Sacred Trust. The New American Library, N.Y.,
1966.
History of AMA dealings.

Harris, Seymour, The Economics of American Medicine. Macmillan,
N.Y., 1964.

Statistics on costs, profits, etc., of our medical system.

Mintz, Morton, The Therapeutic Nightmare. Houghton Mifflin Co.,
Boston, 1965.

Report on how the drug industry controls the FDA, AMA; and
knowingly mazkets worthless, injurious and lethal drugs.

Sanders, Marion K., ed., The Crisis in American Medicine. Harper
and Bros., New York, 1960, 1961.

Description of some of the problems of American medicine. Beau-
tiful example of the attitudes (of the writers themselves) which
will prevent any good (i.e. radical) solution.

Fortune, January 1971.

Four articles on medicine as a fast-growing, very profitable big
business.

Health Pac Bulletin (HPB), 17 Murray St., New York, N.Y. 10007.
Monthly.

“The only radical publication on health statistics.”

Health Rights News (HRN), Medical Committee for Human Rights,
1520 Naudain St., Philadelphia, Pa. 19146. Monthly.

Informative news items and articles. Counter-AMA group of
medical professionals.

134.

Women, Medicine, and Capitalism

Marcuse says that “‘health is a state defined by
an elite.” A year ago, few of us understood that
statement. What does he mean? We believed that
all people want to be healthy and that some of us
are more fortunate than others because we have
more competent doctors. ““Now you should go to
Dr. A. Man. He’s my doctor and he’s just great!”

Today we understand the stark truth of Mar-
cuse’s statement. We have not only started to look
at health differently, but have found that health
is one more example of the many problems we as
people, especially as women, face in this society.
We have not had power to determine medical pri-
orities; they are determined by the corporate med-
ical industry (including drug companies, Blue Cross,
the AMA and other profit-making groups) and aca-
demic research. We have learned that we are not
to blame for choosing a bad doctor or not having
the money to even choose. Certainly, some doc-
tors have learned medical skills better than others,
but how good are technical skills if they are not
practiced in a human way?

We as women are redefining competence: a doc-
tor who behaves in a male chauvinist way is not
competent, even if he has medical skills. We have
decided that health can no longer be defined by
an elite group of white, upper middle class men.

It must be defined by us, the women who need

the most health care, in a way that meets the needs
of all our sisters and brothers — poor, black, brown,
red, yellow and pink. ’

THE IDEOLOGY OF CONTROL AND
SUBMISSION

Perhaps the most obvious indication of this
ideology is the way that doctors treat us as women
patients. We are considered stupid, mindless crea-
tures, unable to follow instructions (known as or-
ders). While men patients may also be treated this
way, we fare worse because women are thought to
be incapable of understanding or dealing with our
own situation. Health is not something which be-
longs to a person, but is rather a precious item
that the doctor doles out from his stores. Thus,
the doctor preserves his expertise and powers for
himself. He controls the knowledge and thereby
controls the patient. He maintains his status in a
number of ways: First, he and his colleagues make
it very difficult for more people to become doc-
tors. (For instance, for thirty years the AMA op-

posed the expansion of the existing medical schools,

primarily to protect their entrepreneurial economic

privilege.) Second, he sets himself off from other
people in a number of ways, including dressing in
whites. (In fact, in most hospitals there is a rigid
hierarchy which is demarcated according to dress:
doctors wear whites, nurses wear white with a cap
denoting what school they attended, nurses’ aides’
wear another color uniform, and housekeeping
women still another color. The implication being,
of course, that it is very important not to confuse
one group with another.) Another much more im-
portant way doctors set themselves off from other
people is through their language. Pseudoscientific
jargon is the immense wall around that body of in-
formation, experience, etc., which they consider
as medical knowledge. (epistaxis = nosebleed,
thrombosis = blood clot, scleral icterus = yellow

eyeballs, etc.)

Thirdly, doctors insulate themselves from the
rest of society by making the education process
(indoctrination) so long, tedious, and grueling that
the public has come to believe that one must be
superhuman to survive it. (Actually, it is like one
long fraternity “‘rush”’ after which you’ve made it
and can do what you like. Only members of the
club get to learn the secret, which is that doctors
don’t know much to begin with and are bluffing
a good deal of time.) Thus, a small medical elite
preserves its own position through mystification,
butressed by symbolic dress, language, and educa-
tion.

It is important for us to understand that mysti-

Bh A ON aN ala cell ll

fication is the primary process here. It is mystifi-
cation that makes us postpone going to the doctor

for “that little pain”, since he’s such a “busy man”’.

It is mystification that prevents us from demand-
ing a precise explanation of what is the matter and
| how exactly he is going to treat it. It is mystifica-
} tion that causes us to become passive objects who
submit to his control and supposed expertise.

OBJECTIFICATION

We know that we as women are objectified as
sex objects in our society. Any woman who has
walked alone at night knows the feeling of vulner-
ability and helplessness that accompanies our
awareness that we are being perceived as pure sex
objects. The medical setting further objectifies a
person. The patient is assumed to be an object on
which one can “‘objectively”’ and “scientifically”
perform certain operations. The patient is merely
the vehicle which brings the disease to the inter-
ventionist (instrumentalist). The outgrowth of
these assumptions is that the best place for a doc-
tor to act on a patient is in the hospital, i.e. when
the patient is horizontal, passive, most like an ob-
ject. Finally, that part of a person which is con-
sidered sick is further separated and removed.
(“The ulcer in 417.” or “We did a gall bladder
today.”) For us as women, the treatment of any
gynecological or obstetrical problem thereby re-
sults in the alienation of us from our own body,
from our own genitals.

ALIENATION

Naomi Weisstein, in her essay On women,

135

‘Psychology Constructs the Female’’, has out-" _
lined very well how the society has caused the
alienation of a woman from her body. Freud’s
impact cannot be overestimated; we have internal-
ized the notion that woman is incomplete, that
something is missing. This alienation leads to a
condition which is epitomized by the middle class
woman, who, whenever she feels ill, goes to see
her gynecologist. The implication: whatever is
the matter with her has to do with her sexuality.

Alienation is also what makes it hard for us to
talk about sex. Our sexual experience is so priva-
tized that we never find out that other women

have the same problems we do. We come to accept

not having orgasm as our natural condition. We

remain ignorant about our own sexuality and chalk

it up to our own inadequacies. And if we should
be so bold as to go to a doctor - and if we should

summon up the courage to ask him about our com-

mon problem - chances are he will know nothing
about it, although he will never or rarely admit
this and will probably laughingly dismiss our ques-
tions. Doctors in general are as ignorant about
sexuality as the rest of the men in society.

Doctors’ blatant ignorance about sex stands in
stark contradiction to the fact that they are con-

sidered the only legitimate person to consult about

any sexual problem. Thus, we bring all our awk-
wardness and ignorance about sex to a doctor who
cannot understand that his own ignorance and
arrogance are the epitome of male chauvinism.
(Add any man’s standard portion of male chau-
vinism to the whole mind set and life style of the
man who controls knowledge and thereby people

136

“for their benefit’’ and we come up with the doc-
tor of our society.)

Which brings us to preventative medicine. We
as women are made to feel uncomfortable about
going to a doctor in the first place. If we cannot
feel comfortable going to our doctors normally,
then to go for preventive reasons will be all the
more difficult. Thus, while the medical profession
has come out in favor of massive screening of wo-
men for cancer of the breast and cervix (the cervix
is the neck of the uterus, or womb), their practice,
their approach, their manner - that is to say, their
ideology - all works in the opposite direction.
First, our complaints aren’t important enough,
since we think that we aren’t important. (A man
.is made to feel uncomfortable in a different way;
he is made to feel that it isn’t masculine to admit
to a minor ailment, since he should be tough and
not feel it.) The net result is that both men and
women postpone seeing a doctor, whom they re-

- gard as too important to be bothered. And when
the visit involves a pelvic examination, it is even
less likely a woman will go through with it. Small
wonder that only 12% of the women in this coun-
try who ought to have “‘Pap”’ tests (short for Papi-
nicolaou, the guy who invented it) for cervical
cancer get them. This is one of the very concrete

ways that male chauvinist medicine means poorer
health care and health protection for us.

We cannot begin to write here about capitalist
forms of medicine per se; that is to say, the pro-
hibitive cost of medical care, the racist and inferior
treatment of poor people and black people, the
profit and prestige-making institutions of the
“health industry” (hospitals, medical schools, drug
companies, etc.), the total neglect of the public or
preventive protection, or the fee-for-service, pay-

_as-you-die economic base upon which most medical

practice is based. This is an important and exten-
sive issue which must be dealt with elsewhere. Suf-
fice it to say that capitalism is incapable of provid-
ing good health care, both curative and preventive,
for all the people. Cost-benefit analysis trades off
the benefit to the people of collective public health
in favor of the cost to the people of private, patch-
up medical care. The capitalist medical care sys-
tem can be no more dedicated to improving the
people’s health than can General Motors become
dedicated to improving the people’s public trans-
portation. Our difficulty in perceiving the simi-
larity between the health care system and any oth-
er corporate capitalist enterprise in the society re-
sults from our acceptance of the rhetoric that
medicine helps people.

a
—— ae

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Andrea Lurie Papers, 1913-1986, bulk 1967-1982

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