Hey, doctors: Big families are not on trial

The thing that finally relieved my anxiety about giving birth

Stop me if you’ve heard this one:



And that’s all they want to talk about from then on.



















Now, you tell me.











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49 thoughts on “Hey, doctors: Big families are not on trial”

  1. I don’t get it. Its as if most Drs have some bias towards “you have lots (over 3 in #) of children? Then any issue you are having (either all, or any that remotely could be but not always are related to having kids in general), even if you insist otherwise, ARE (always) related to having lots of kids. Problem. What if the issues the woman are experiencing is related to cancer, heart disease, MS, ALS, etc? No no….it just that you have a lot of kids….excuse me but LISTEN TO YOUR OATIRNT AND IGNORE YOUR BIASES!

  2. Great article, Simcha! I see that you grew up in the town I live in now (Claremont.) We have 11 kids. I knew your name sounded familiar, but not sure if we ever met. Anyway, had to give you props on this one as it has gone around and across my Facebook news-feed! 🙂

  3. Thank you, Simcha Fisher, for being you.

    I grew up in a Waspy-Wasp-Wasp family, in a Waspy-Wasp-Wasp neighborhood. There was one “nutty” Catholic family in the neighborhood. The dad taught English at my school, and they had six kids. Nutty because: they weren’t rich. There was another “big” family at that parish–five kids–but they were fabulously wealthy, so nobody cared. While I was in high school, the father of the nutty family died of cancer, and everybody tut-tutted about how they’d had all those kids, what a terrible situation the mom was now in, and oh, how terrible it was. I went to the funeral–I saw their faith. It was the first time I’d been inside a Catholic church. When a friend invited me back for Ash Wednesday Mass, I went. Two years later, I went through RCIA. I married a Catholic man and now we have … FIVE kids (That’s so many kids, right? Am I right?). I’m exhausted, overwhelmed, depressed, anxious, and deliriously happy. I attacked a light fixture with my son’s tennis racket the other day, in a fit of undirected rage. Is it a sin to look forward to making the priest laugh during Confession? Praise God from whom all blessings flow!

  4. A doctor’s perspective:

    Mrs. Fisher,

    I enjoy your blog. Your writing style and attitude remind me of some of the no-holds-barred women I respect and admire greatly, some of whom are also “grand multips”. I am so sorry that you were frustrated by your experience with your doctor. It is not my intent to in any way to undermine or demean the hurt or grief you felt during that experience, and if you feel that I am doing so please feel free to delete my comments without explanation; I won’t be offended. I don’t think you would care if I was offended, which is awesome; but I won’t be.

    I spend a lot of my time as a physician trying to make sure my patients are heard, and I hear a lot of stories of physician who didn’t listen or didn’t care. I know the other side of that coin, too; decreasing medicare and insurance payments, pressure from hospitals and clinics to do and see more in less amount of time, increasing documentation demands that have you taking care of charts instead of human beings, and a culture that bashes doctors like emotional scapegoats even though we aren’t, by and large, the cause of the failings of the healthcare industry (I’m looking at you, insurance company CEO’s and overpaid hospital administrators!). There are some doctors who don’t care; plenty of them. I’ve bumped into them in the hospital or in the clinic and they make my blood boil; really, the people around me have gotten sick to death of hearing me rant about them. But they are in the minority.

    Also, I love big families. We just had our 3rd child and aren’t done yet. Our best friends are a team of doctors (pediatrics, internal medicine) with 8 children; every one of them that was alive at the time was in our wedding. My mentor in medical school is a doctor and his wife is a lactation consultant; they took their 8 children and started a women’s and children’s hospital in East Africa. So I will admit that I am probably a little… atypical in my reaction to big families in my clinic. “Congratulations on your pregnancy! How many is this? Number 7? That’s awesome!” I’m an outlier, I get it.

    And, I COMPLETELY AGREE that big families experience prejudice, judgement and discrimination in our society, and medicine is no exception to this (makes me feel bad for the doctors I know with 6 or 8 kids; they are kind of getting it from both sides, huh?). You can’t spend one week on the OB wards without hearing the snide comments and even disgust directed at mothers coming in to deliver even their 5th or 6th kid. Every time I read an article or blog post or facebook meme railing against this, I hear the echo of my own voice, in the hallway of the OB ward after the patient’s door is shut, standing up for those women and the decisions they have made; “YES she knows what causes that.” “It is their decision, not mine or yours.” “YES, I do think she would mind if you ‘accidentally tied her tubes’ during the c-section. It’s not funny to even joke about” (to be fair, a LOT of the things doctors and nurses joke about really aren’t funny, but they are trying to stay sane. Dark humor is par in medicine, but my cut-off is when it undermines people’s dignity). Big families, I have intentionally created awkward and uncomfortable, even embarrassing, situations at work on your behalf, not because it was going to tangibly affect your care but because I was offended when your dignity and autonomy were attacked.

    So when I read the title of your blog post, shared on FB by a physician friend of mine, please believe that I was prepared to be incensed along with you and, just maybe, to uncover some way that I have myself been ignorant or insensitive to big families in my own practice. My attitude was, if I’m being frank, “let’s hear this story so I can be righteously angry for this woman for a few minutes, and let’s make sure I’m not guilty of whatever it is she’s talking about, too” (I really, REALLY enjoy being righteously indignant; it’s addictive, and this current political climate has me going from one high to the next). So I was surprised, and a little disappointed, to read your post and find out that your medical treatment was… Well, not just appropriate, but actually really good… I mean, pretty excellent medical care, from what I could piece together from the story that you told. And if you are still with me, I’ll explain.

    You said that you went to visit your doctor during the last week of your pregnancy, so can I assume you were term? 37-40 weeks? You had a lot of anxiety about delivery, and you’d been through it enough times that mere “reassurance” wasn’t going to help with that anxiety. You were having trouble sleeping, focusing on your kids, being present with your family… it sucked. You asked for something safe to help you sleep and sooth the anxiety… and here’s the first stop. I guess my question is, now that you have the benefit of retrospect, what could your doctor have prescribed for you at that moment that would have fit the bill? If you dive into evidence and opinion based treatment recommendations of any illness, there’s usually a section called “special populations.” This is because treatment of most illnesses is just not as straight forward (if there is such a thing) in the very old, the very young, the immunocompromised… or pregnant women. I cannot tell you how many times, as a resident, I looked on up-to-date or Essential Evidence or various medical society clinical guides only to find the phrase, “Treatment of _______ in pregnant women presents a difficult challenge for clinicians…” GAH! Thanks for NOTHING; I already knew it was a challenge, that’s why I was LOOKING IT UP in the first place! You left that first appointment “SO ANGRY” that your doctor didn’t give you a 3 day prescription of something to make you sleep. But the thing is, that doctor wasn’t holding out on you. There was no secret password you could have said or special club you could have been a part of that would have gotten you through to the backroom where us doctors keep the REAL medicine. I’ve dealt with anxiety and insomnia and fear of delivery pain in patients that really were drug seeking all the way to my own wife, and I’m here to tell you that there just isn’t anything that you can safely give to a 39 weeks pregnant woman to make her sleep that won’t also have a high chance of affecting the baby. Earlier in pregnancy, MAYBE there are some medicines I would try… but the week before the baby was due? My medical license and your child’s life aren’t meant for playing with that kind of fire.

    So your doctor referred you to the psychiatrist. Was this just because of their policy? If they really have a policy about anxiolytics and seeing a psychiatrist first, it exists to protect the patients and doctors and should only be ignored at great peril. My clinic didn’t have such a policy. I did my clinic work in a residency that also served as a sort of Psych safety net for our patients. Psychiatrists are in short supply and our patients were poor and under-served, and so I prescribed a lot of medications for anxiety, depression, bipolar, schizophrenia… because we wouldn’t be waiting 3 days for them to see a Psychiatrist, we’d be waiting forever. We DID have a policy about narcotics, and I broke it only on the rarest of occasions, even though it sometimes meant sending people out the door still in pain. These medicines- opoids, benzos, stimulants- they are dangerous. We doctors have done a lot of harm with them, and a lot of the time it’s because our compassion gets us, and our patients, into trouble; we are trying to do better.

    I wouldn’t have sent you to a psychiatrist. I know that there’s not really any medication that’s safe that we could try, and I wouldn’t want to give you false hope or waste your time or the Psychiatrist’s. I would have listened for a LONG time, because that’s the best way to diagnose anything, and then I would have asked a lot of questions about your pregnancies and the births of your children. Not, not, NOT because you had 9 kids at home already, but because you were a pregnant woman coming to me for anxiety about childbirth and that’s exactly the right thing to talk about during that visit. And then I would have explained the balance between your symptoms and your child’s safety (which you already knew) and why I couldn’t prescribe anything. And then, if you hadn’t decked me or walked out of the room, we would have spent time working on non-pharmacologic ways of dealing with the fear, and stress, and anxiety, and insomnia. Breathing techniques, exercises, sleep hygiene, diet. I would have been late for my next patient, and maybe the one after. That means my charting would back-up to the end of the day and I’d be late for dinner with my own wife and kids that night, or maybe have to stay up late or work some that weekend to catch up; but that’s fine, your problem is worth it, you are worth it as my patient. And I can say for certain that I would have done this because that’s exactly what I did do, over and over again, for the years that I worked in a clinic. And at the end of the visit I would have sent you away ’empty handed’ with no prescription exactly because I was trying to give you my best, and wasn’t willing to gamble with your child’s safety, but still wanted you to find some hope of relief for your symptoms. Would you still have been so angry? Would you have chalked it up to me judging you for your big family?

    But your doctor sent you to the Psychiatrist. You say you knew you were being treated badly. Maybe it was just the clinic’s policy, but my guess is there was at least a hint of two other factors that went into your doctor’s decision making: humility, that maybe there was a chance the Psychiatrist could figure out some treatment he or she hadn’t thought of that could really help your symptoms, and compassion, that if there was any chance at all they wanted you to have it. AND, they got you in in THREE DAYS! Oh my goodness what clinic do you go to where they can get you to a Psychiatrist in 3 days? I have patients who have been waiting 2 years. So you went to the stupid appointment, and the Psychiatrists spent 20 minutes asking you questions that probed into your experience during past deliveries (i.e. the source of your anxiety and the reason you were coming to the doctor in the first place) and your “long-term psychological state” (i.e. the part of your life that it’s their whole job to find out about). You say that this was for no other reason than the number of times you had given birth. What makes you think that? Was it something they said, the way they asked the questions? I’m not refuting the claim; I wasn’t there. But based on just what you wrote in the blog post, it seems like your Psychiatrist was actually doing a really good job. You kept repeating, “That is not relevant. This is situational anxiety.” But all those things aren’t just relevant, they are INCREDIBLY relevant. You weren’t anxious because your feet hurt or because of a job interview, you were anxious about delivering again. If a Psychiatry resident prescribed a 39 week pregnant woman anxiety medication for anxiety about childbirth, without asking about long-term psychiatric health AND about her past experiences with childbirth, the faculty would have them drawn and quartered.

    And just to quickly answer your questions, YES and YES. If I had a topless dancer visit me for anxiety or depression medicine for ANY reason, I am definitely going to spend the majority of that visit talking about lifestyle and digging for signs of regret, anxiety, abuse, human trafficking, drug addiction, sexual coercion, and everything else I can think of to ask. And if a trans man with AIDS visits about anxiety, we are darn sure going to talk about his AIDS and his sexual history and preferences and his experiences as a trans-gendered person. Anxiety doesn’t exist in a bubble, and throwing pills at a problem without trying to understand it first is not an indicator of the absence of prejudice or discrimination; it’s a sign of bad doctoring.

    The Psychiatrist prescribed you atarax (I assume), which didn’t help. I can’t know whether this happened in the context of a long discussion about the emotional and physical and psychological risk of not being able to rest for the next four days vs. the risk of your baby being affected by the medicine and requiring resuscitation or NICU care, or having nursing and latching problems later on, but I hope it did. I wouldn’t have felt comfortable prescribing it. And if that didn’t work, what stronger options are there? Ativan or Xanax? No, the risk of hypotonia/floppy baby syndrome in 3rd trimester is too great, and we are way, way too close to delivery at this point. We aren’t talking physician preference anymore; now we are talking about malpractice. Medical school is a bit of a blur, but I’m pretty sure we took an oath about not prescribing Xanax to pregnant women at 39 weeks. SSRI’s are another option, but those take time to work and 4 days prior to delivery they are going to be essentially useless. We could have talked about it earlier in pregnancy, but that would have been another long conversation about risks and benefits, and we would have to talk about trimester-specific risks of birth defects, even with an old medicine like Prozac. Also, we would have tapered off of it well before 39 weeks to prevent your baby from having withdrawal symptoms after delivery.

    I got a little snippy there for a minute, so I’m sorry about that. My point is, I think there are lots of stories, even some horrible stories, about doctors discriminating against or judging families for having more than the accepted 2.58 children. I’ve seen some myself. This… just doesn’t seem like one of them. I can’t guarantee that a woman with anxiety about childbirth with her first or second child would have experienced the same treatment that you outlined above; I can only hope that she would. I hope I might have cleared up some of the medical details. If, despite or aside from the appropriate treatment decisions (your psychiatrist and I can agree to disagree about the anti-histamine), you feel that you weren’t listened to by your doctors, than I am truly sorry. Because of your story, I’ll be trying especially hard this week to make sure my patients know that I hear them.


    -You friendly, neighborhood family physician.

    1. Thanks for your response. Based on the length of your comment, I believe you when you say you would have spent a long time talking to me, if I had been your patient.
      Here’s what would have been helpful to me: (a) If anyone had simply told me, at any point, “There is no drug that we consider safe at this stage of pregnancy; (b) If they had told me that right away, rather than making me wait an additional three days; (c) If they had taught me anything as simple as a breathing exercise so that I could feel like I had at least some tiny bit of recourse, rather than big fat nothing.

      I am not a stupid or a reckless woman. I would not have had any interest in harming my unborn baby. If anyone, at any point, had said, “Pregnant women at the end of their term are very hard to treat safely. The best we can do is make an appointment with a psychiatrist, and maybe she can help you work toward some safer kind of treatment,” then I would have been disappointed, but I would have understood. Maybe I would have gone to the appointment or maybe I wouldn’t, but at least it would have been my choice. They essentially tricked me into going by giving me the impression that she was the one who would be able to prescribe something effective for me.

      1. For what reason on earth did they not give you some Ambien? I took it for a few days at 17 weeks when I was in an anxiety/insomnia spiral I couldn’t get out of. No crap from my doctor whatsoever. Four days of no sleep was pure hell and I was truly suffering. Many friends of mine have had it for bed rest/itchiness/whatever close to the end of pregnancy.

      2. Mrs. Fisher,

        Thank you for your quick and gracious response. Yes you are right, if your PCP left you with the impression that there were definitely medicines that were safe and would be effective for your symptoms, but that you would have to wait 3 days to get them from the Psychiatrist, that would be incredibly frustrating and ultimately extremely disappointing when you found out that this wasn’t the case three days later. Maybe they really didn’t know if there were safe medicines at your point of pregnancy or not, maybe they just didn’t want to be the bearer of bad news, or maybe it was something different altogether… Either way, I’m very sorry for your experience.

    2. I am so grateful for your compassionate, reasoned response. It’s helpful to me to hear the other side of the story and (even more) to be reminded of those out there who strive so tirelessly to act in humane and benevolent ways. God bless you!

    3. Family doctor,
      Some of what you say makes sense, but I think you, too, are guilty finally of brushing a patient aside. I read your post and was, quite frankly, quickly angered as it seemed to me that under the veil of ‘doing whats best for the mother and child’ you were, in fact, NOT choosing to do the harder thing- namely, treat the mother for what could become a serious medical problem. Did you read when Simcha said that she hadn’t slept in, maybe, four days? How does that, as a doctor, not concern you enough to make you want to help her find a solution quicker than in 3 days?! It seems you are gambling with the mother and childs health at this point, its just a much more passive risk, than, say, prescribing her the atarax or something to start with. Now, I realize a lot of people will exaggerate, but the medical field is also incredibly adept at minimizing patient’s problems. I know, because I have been that patient and I have been that nurse advocating for that patient (double whammy against my credibility, I know).
      I find it interesting that you say that you are worried about the baby, and yet you disregard completely the health of the mother. Perhaps you thought, as many physicians do, that she was exaggerating? But shouldn’t any good physician have stopped her right there and said “Wait, what do you mean when you say you haven’t slept in 4 days? Do you mean you actually have not gotten one. single. moment. of sleep? Or do you mean you have only slept in 2 hour increments? What exactly do you mean by this?” And I would hope that if her response was, “Doctor, I really, honestly, have NOT slept AT ALL in 4 days” that your reaction would be more than to talk to her and tell her there is nothing you could do or to come back in 3 days to see the psychiatrist. I would hope you would realize that at that level of exhaustion, she now might be at risk for being unable to successfully deliver or need a csection, or she might have other medical complications that we all know can happen from serious lack of sleep. But you, like so many other medical professionals, choose to take her comments and chalk them up to your patient exaggerating. You fail her immediately when you refuse to take her first complaint with any seriousness (and I think Simcha is right in thinking this happens more to women with larger families). Women are told again and again to ‘stay healthy for the baby’ but as soon as that involves doing anything outside of the norm of diet and exercise and all things natural we are made to feel like failures and treated as though we didn’t have the best interest of our child at heart.
      If I come across as angry about this its is because I really am, and, quite frankly, it is time more people spoke up and got angry. I have been treated as though I knew nothing about my own body and what was happening and had my problems minimized so many times it has, quite literally, nearly killed me on multiple occasions. I had a surgery and was told afterward that my pain was normal, my blood pressure was low only because I had ‘not had anything to drink’ and the fact that I couldn’t pee was only a result of ‘too many pain medications’. I was sent home with an extremely bloated abdomen (not a hard thing to see on my 115lb frame!) and told to return for my regularly scheduled appointment in 3 days. I spent three days in utter agony before returning and immediately being sent down to the ER. Why? because everyone had ignored my complaints and chalked them up to exaggeration and so failed to catch that I had a massive abdominal bleed which lost me 2.5 liters of blood and earned me over a week extra in the hospital. And thats not the only story I can tell you about doctors refusing to listen. This past pregnancy I spent months in utter agony, telling my OBGYN that I was having severe stomach pain, radiating to my ears, that was preventing me from sleeping. Her response? “Thats pregnancy. Its just hard sometimes.” or “Its nerve pain, there is nothing we can do for it. It would be bad for the baby”. I eventually ended up in the ER and was diagnosed with a stomach ulcer. It took getting to the point of not being able to keep food down, and literally not sleeping for 48 hours (because the pain was so severe- and clearly THIS is all good for my baby) to get a doctor to listen to me and do something about it. And it wasn’t my own OB who listened, I might add. Up until she saw the medical reports/records I don’t think she believed it. The most maddening thing about all this? She kept insisting there was no medications that I could get for my problem. It took an OB at a separate hospital to say “no, thats not true” and give me some much needed relief in the form of some drinkable lidociane, sucralafate, and nexium. I know, I know, “but the baby?! what are you doing to that baby you evil woman?!”. No longer going into pre-term labor because my body was so stressed from the pain/lack of food/sleep. Thats what I was doing. And the baby? She is totally fine. She is a fat, happy, healthy, 8 month old.
      And I am pretty darn sure she is as healthy as she is because I was treated and able to carry her to term and have a healthy delivery. I thank God that the doctor I finally saw when I went to the ER actually listened and stopped treating me like I was exaggerating and also had the guts and know how to take on whatever ‘risk’ might be involved in treating a pregnant woman. Geez, sometimes its like we are medical lepers! I will stop now with my medical stories, but I could go on and on and on. After 8 years of being a nurse and 15 years of dealing with a chronic condition, I know of so so many stories like my own (and theres more to mine!).
      Sorry to Simcha for hijacking her post with this rant, but if I can even get one doctor out of this mentality of not actually listening to what there patient’s are saying or exploring it more thoroughly then I will consider it did some good. Because this time Simcha came out fine, but perhaps at some point she, or another patient will come to you with a complaint and it won’t turn out fine and something tragic will happen. Sadly, it does often enough. So please, for the love of all things, LISTEN to what your patients are actually saying. You talk about wanting to treat people with dignity, that also involves empathizing and listening (especially to that mother with multiple children). I think part of the reason Simcha wrote this post is because she was angry she hadn’t even been heard. Not that she had just been judged with all her children, but NO ONE LISTENED to her complaint or took it seriously. Because, I’m sorry, but you are not taking someone seriously if they honestly haven’t slept in 4 days and your response is to tell them to come back in 3 days to see a psychiatrist. Doctors can do better than that, that is for sure. And I’m sorry, but just because a woman is pregnant is no reason not to treat her if she has a serious medical problem that is debilitating to her. As a physician, you should be able to weigh the risks and benefits to your patient’s care pregnant or not, present the patient with the options, and have the guts to actually treat them instead of causing them to suffer so greatly that you inadvertently cause damage to the mother or child’s health.

      1. Kathleen,

        First, let me just say that I am so sorry for your negative experiences with your healthcare providers. I have yet to meet anyone who has never had a bad experience with a doctor and, as I said in my original comment, I am certainly no exception (either as someone who has interacted with doctors, or as a doctor that people have had a bad experience with). One of the most important facts about a physician or any other healthcare provider, as with a police officer or a soldier or a priest, is that they are a human being and thus prone to sin and error. My goal in commenting was not to defend the profession (though I would argue there is some of this needed in our culture in general), but to point out some of the medical facts that might be mitigating in Mrs. Fisher’s story. She has responded with clarification that sheds new light on her experience, and our exchange can be found above.

        I could not agree more that one of the fundamental jobs of a physician is to listen to their patients. Beyond being therapeutic in its own right, listening well is absolutely essential for careful diagnosis and treatment. I do not think I can be found guilty of your charge of “brushing a patient aside,” at least in this case, as Mrs. Fisher was never my patient… but I am also not sure what I said in my comment that caused you to think I would have failed to listen to or promptly address her concerns. No matter, though; if I would have been innocent of the charge in Mrs. Fisher’s case, I certainly have been and will be guilty of it in the case of other patients. In fact, and if I’m being very candid, in listening well in this case I would have had all of the advantages of natural sympathy; it would not have been a mark of professional discipline or conscientiousness for me to find the time to listen to a white, educated, native-English speaking woman with a large family with complaints related to pregnancy. The measure of a physician listening well to his patients is not taken from his interactions with patients that have so much in common that they might be his own grandmother or uncle or sister-in-law, but from those interactions requiring the greatest efforts to overcome divisions of background, education, culture, and language. Listening very, very well to patients who by all externals are very unlike yourself is the standard we have to hold physicians to.

        I digress, but my point is that even if I had listened very well to Mrs. Fisher, it would not be to my credit as a doctor, and if I think your accusation of my being dismissive is spurious in this case, it is not out of some fruitless self-defense but because I would like to clarify, if I may, a finer point of clinical care that you have touched upon. And that is this; people DO exaggerate their symptoms, very very much of the time. They also report their symptoms 100% accurately, or downplay their symptoms. Sometimes they do all three within the span of a 15 minute visit. They do so for a variety of reasons: because they don’t want to be admitted to the hospital, because they do; because they don’t want medicine, or because they do; because they don’t want their family members to worry, because they are in denial about the seriousness of their condition, because they desperately want someone to delve more deeply into their social situation, because they want to score some pain meds, because… well, you name it. One of the most challenging jobs of a physician is to listen well to what your patient is saying, and then ask lots and lots of follow-up questions to try to figure out what your patient actually means. Too often we rely far too heavily on snap judgments (though ‘gut’ feeling has to remain a factor), and not enough on deep, multi-faceted analysis, or even on supernatural discernment. If you’ve ever tried to determine which of your children actually started the fight, you may have an idea just how challenging this can be. I am sorry if that analogy is insulting (it is just an analogy; I am not saying patients are like children), but it is the only other thing I have experienced that matches this element of patient care in pure frustration from not knowing what is true or even how to find out what is true. It is very, very hard.

        If we take a case like Mrs. Fisher’s, if a 39 weeks pregnant patient came to clinic and told me that she had not slept in 4 days, I would have immediately assumed not that she was “exaggerating her symptoms” but that she was speaking in a very common and mild form of hyperbole. This is a common form of speech (Mitch Hedburg: “I haven’t slept for 4 days. Because that would be too long”) and is meant to convey an impression rather than precise clinical information. A few of the questions in my very thorough sleep history would have looked something like the questions your posed, but the point would have been the same; to gauge how much she was actually sleeping and how severe her insomnia and sleep deprivation really was. If she had responded that she had REALLY not slept AT ALL in the past 96-114 hours, I would then have had the very difficult job of figuring out whether she was telling the truth. As an insomniac (and at time a severe one) myself, I recognize that she may even genuinely believe she hasn’t slept despite having as much as 3-4 hours of sleep per night on average, and that is especially challenging diagnostically. At that point of sleep deprivation I would expect some changes that I could pick-up on objectively; jitters, pressured speech, flushed skin, changes in vital signs… maybe even some mild altered mental status, confusion, or hallucinations. I would gently ask if it was possible that she had slept for 10-20 minutes at a time, off an on, without realizing it. This is not ‘brushing aside’ the patient, but trying to build a coherent clinical picture of what really has been going on, taking into account all the information at your disposal INCLUDING the patient’s own account.

        In the end, I suspect we would have found that her sleep deprivation was very advanced but somewhere short of a full four 24 hour periods without a moment of sleep. We would have had the discussion I mentioned in my original comment, about sleep hygiene, caffeine and other diet issues, breathing techniques for sleep and anxiety, etc. We would have talked about meds and what was or wasn’t safe. We would have talked about hydroxyzine and ambien, and if it really did seem like her sleep deprivation was affecting her health or the health of her baby (again, the latter can be checked somewhat objectively; fetal heart rate, movements, reactive strip on a non-stress test), then we would have talked seriously about risks and benefits of those medications. On the other hand, if it became obvious that she REALLY hadn’t slept in 4 days, if she were having confusion and mild hallucinations and high blood pressure and the rest, we probably would have talked about the risks and benefits of stripping her membranes or even getting her over to the hospital to induce labor.

        I hope this helps clarify my perspective a bit. It doesn’t change the fact that lots of doctors don’t listen well, and none of us listen perfectly. Your doctors might have been of the former variety, and for that I am really sorry. But I just can’t buy the idea that doctors, in general, are dismissive and don’t take our patients seriously, just because we don’t take symptoms at face value. We certainty weren’t taught that in medical school. And the doctors that I know out in practice, by and large, care very, very deeply about finding out exactly what is going on with their patients and treating it in the best way possible. We put our kids to bed and then stay up late reading about your different medical conditions to see if there was something we or someone else might have missed. We send you to specialists in the hopes that they will be smarter than we are and figure it out. We meet together to discuss challenging cases and seek the advice of our peers when it would be more fun to play Ticket to Ride or watch a movie. I have heard many patients say to doctors, “you aren’t listening to me.” The response, if doctors would be frank, ought to be something like, “I am listening to and thinking very, very hard about you.” Or, time permitting, “I’m sorry you feel that way. I have been listening, let me summarize what you’ve said to make sure I’ve understood…” But most of us don’t verbalize that, and the myth that most doctors don’t listen to their patient’s persists. And so I find myself in the ridiculous position of having used another lunch break typing up far too many words trying to change someone’s mind on the internet. But, if I can get just one person out of this mentality that doctors are the enemy, that we aren’t on your team or don’t care about your problems or take them seriously, I’ll feel like I’ve done some good.

        Thank you, Kathleen, for engaging with me on this topic.

        1. Thank you for your service as a doctor and for your excellent medical explanations. Her doctors could have been much clearer about the lack of safe medications and alternate methodologies to try, but I tend to find those suggestions are more common to get from PAs or naturopaths or psychologists than MDs/psychiatrists.
          I do not doubt the author’s experience (as the capstone of years of suspicious reactions to her family size), but I also recognize that lack of sleep can skew perceptions of care and other’s motivations. Sever lack of patience and mild paranoia are common reactions to exhaustion/pain and clarity of hindsight doesn’t always erase that misperception in your memory. …just my 2 cents.

  5. After my fifth child was born, I had a severe gall bladder attack. I ended up in the ER, and they took one look at me and said the gall bladder had to be removed. I told them they could remove my heart if it would make the pain stop. 🙂 Then, the surgeon came to talk to me about the emergency surgery. He said, “Well, you’ve got a red hot gall bladder! I see you also have five kids. Do you want me to tie your tubes while I’m in there?” I looked up at him and said, weakly, “No, thank you.”

    I thought of so, so many many things I could have said, later, when I was not screaming silently and internally from the pain.

  6. Actually the problem is even bigger than you realize. If you only had one or two, if you are solidly middle class in income and assets, the doctors still have only contempt for you as a person with a brain. Also hospital nurses. I have talked a little bit about this with my friends who are doctors, and they acknowledge that what I say is true, but they don’t seem to realize that it is a problem.

    The Washington Post has a regular feature about medical mysteries. You know the kind of thing “She had a pain in her back that got worse for years…” or “He used to be a mountain climber but now he could barely climb the stairs” and completely undiagnosable. All of the people featured have visited numerous doctors, had reams of tests and have done everything that medical science could suggest. Sometimes it really is a weird affliction that maybe only a handful of people have ever had, but it is surprising how often when they find the doctor who does figure it out, it is something that the patient himself suggested to the first doctor, only to have the first doctor completely dismiss the idea. Or the doctor who finally figures it out is the first doctor to listen to what the patient says, instead of just running tests on machines.

    The problem is not that our medical profession looks down on large families, the problem is that our medical profession looks down on PEOPLE. Large families are just one subset of people.

    1. I agree with you, although I’d say the “possessing a uterus” is the biggest factor in medical people being dismissive. I went through six or seven doctors trying to get help/pain relief from endometriosis and large uterine fibroids. My husband and I were trying to get pregnant, but every doctor told me to “just go on birth control.” When I refused, the doctors – every single one – told me that I must “not want to get well” and needed to “go see a psychiatrist”. I had several accuse me of drug-seeking. NONE of them offered any kind of real way of dealing with chronic pain and infertility (short of demanding I do IVF). After four years of this, I finally had to travel to another city 700 miles away in order to have surgery that addressed the actual diseases that were actually affecting my body.

      All of that also affected my mental health – to which doctors responded by telling me not be “hysterical.”

  7. My wife and I are blessed with six kids. We are fortunate to have a good doctor who supports us, but I completely understand. I had a co-worker tell me to “get off of her” when the subject of kids came up. She didn’t even think she was being offensive! People can be amazingly ignorant.

  8. Something similar just happend to me today except with speech therapists and the school district. I have 6 soon to be 7 kids. The oldest 4 attend the local Catholic school in the next town over. 2 of the bigs and one of the littles needs speech therapy. We tried to get the school in the next town (blocks away from the Catholic school) to do the speech therapy, but we have to return to our home district for it.

    Today we had a meeting discussing our 2 1/2 year olds transition from the birth to three program (county level) to the school district (town level). I was at an OB check and let my hubby (a perfectly intelligent capable attorney and fully hands on dad) to handle the meeting. This was my first mistake, apparently they don’t usually talk to the dads and were really confused as to why he was there and had to give him the 3rd degree on that.

    He was then given the lecture intended for me on missing appointments and being late because of course I am so overwhelmed by all of my evil children (not their stupid policies). Now I am a time nazi. Before I had kids, I was never ever ever late, and I admit that’s slipped a bit and it bugs me. Buuuuuut the school district and speech people make this impossible. Each week I have to get 3 kids to speech appointments. I am available with NO problems or conflicts every day of the week from 8am to 12pm. Afternoons are hard for me because I have to pick up kids in the next town over by 3pm and my husband is at work (he has mornings off which makes mornings super convenient.

    Neither the school district or the birth to three program have morning appointments. With one exception, the only appointments I was offered were on either Monday or Friday either at 1 or 2pm. So for the older kids this means an hour before they are supposed to leave for speech, I drive to their school, then turn right around and drive back. They get speech therapy for a 1/2 hour, then I drive them back to school. If my 2 year old needs speech therapy that day, I race back home, have her appointment, then race back to the kids’ school to pick them up (often late). If she doesn’t need it, I find something to do for an hour in the next town over with two toddlers instead of driving like a mad person back and forth. So I am late a lot and miss appointments.

    This entire situation is created by the school district, its not because I have lots of kids. Kids attending public school get pulled out during the day whenever its convenient for the speech therapist. The parents don’t have to pick them up every week in the middle of the day. If they have a test or special event at their school, the therapist works around that. The kids go in the morning and come home at night, mom is not responsible for driving all around two towns like a mad woman. This would be an issue regardless of how many kids I had. Normal offices have a variety of times for appointments during business hours 5 days a week. It would be helpful if I wasn’t expected to be in two places at once.

  9. I’m going to pre-duck upon asking this question, but I’m confused as to why it was wrong for the psych to ask about your previous deliveries if you said your anxiety was delivery related? Maybe trying to see if you’d had traumatic deliveries that would cause that level of anxiety or if you had underlying untreated anxiety? Maybe because it’s because I’m intimately and extremely familiar with this kind of appointment many times over, but asking what seem to be odd questions is what they do. There are reasons though. It seems like the Dr came to the conclusion that you just were a mom who needed sleep so prescribed a mild sleep aid? That mild sleep aid does work for some and starting out with mild is pretty standard. Like I said, I’m ducking, I don’t want to offend, but I’ve read the post a few times and I’m trying hard to understand. Believe me I agree that doctors can be and are dismissive in a myriad of ways so I’m not defending, just trying to understand.

  10. I found this through a friend of mine, and please note that before I comment, I want you to know that I believe and empathize with you and your experiences.

    Now I wanted to say where your article threw me out. Your analogies fall flat for me. I’m a fat single woman who has been constantly denied health care because of my weight and appearance. I have gone to the doctor for a sore throat to be told to lose weight and sent away with maybe two minutes being spent on my throat and the other 28 being spent lecturing me about my weight. That’s one example only of a long adulthood dealing with chronic illness (all of which has nothing to do with my weight and that I had to fight for medical care for). So, no – not anyone. Few people, actually, from what it sounds like.

    I’d also caution you when you’re speaking about transfolk. They have an overwhelmingly tough time accessing medical care and are often kicked to psychiatrists before they receive the care they need. They are misgendered at best, treated like they aren’t real people deserving of care at worst.

    While I believe every word you say and again, empathize, your analogies don’t work. If you want to make one, use a straight white thin man. They are almost always believed and always given the care they come in for.

    Just a few thoughts. Thanks for the article.

    1. “Trans” people should get psychiatric care–they are so mentally ill they think they are something they objectively are not. I’m not sure the extent to which a doctor can ignore that giant elephant in the room when such a person comes in for psych/pain meds.

      The fat phobia stuff is very real, and I’m sorry you’ve had to deal with that. I had an OB who berated me for every single pound I gained during pregnancy. I was at a healthy weight to begin with, but if I had gained more than a half pound between appointments, ugh. He must have been a bigger nightmare for fat mothers! 😡

      1. Do you realize that trans people must spend years seeing a mental health professional as a mandatory part of their transition? It is to make certain that they are a good candidate for gender reassignment surgery and to help them through the struggles and stresses of transforming their entire identity.

        Trans people are NOT mentally ill. I can’t even begin to express how ignorant and ridiculous that sounds. Just because you don’t understand a person’s heart or approve their personal choices doesn’t make them ill or wrong. Your atttitude is EXACTLY the same one doctors take when they refuse to see past one aspect of a person’s life that they do not approve of or understand, whether it be the number of kids or the color of their skin or how much they weigh or their gender.

  11. Oh, this makes me fume. During my pregnancy with #3, I was high risk(full story: http://www.arkansas-catholic.org/news/article/3071/Responsible-parenthood-Monitoring-fertility-cycle-following-Gods-will). My doctor–the most wonderful man to ever catch a baby (the first thing out of his mouth when the baby was finally born was “Jesus loves you!”)–anyway, my doctor prescribed a sleep aide for me to help with the anxiety and insomnia that I experienced during that time. It was sweet, sweet sleep.

    Fast forward a few years to my next pregnancy. . .my beloved OBGYN retired, so I had a new OB at a university practice. In my third trimester, I suffered a terrible case of pneumonia. After cracking a rib, almost passing out from coughing, and several nights of no sleep from the debilitating pain, I was admitted to the hospital. After they hooked me up to an IV for antibiotics, I requested something stronger than Tylenol for the pain and was told by the resident “We don’t give anything stronger than Tylenol.” Lies. Then, I asked for a sleep aide (at least!) and was told by the same resident, “Sorry, no. Pregnant women often have trouble sleeping.” Oh, the rage. As soon as I could speak English again, I called my husband (also a physician, who was home for the night with our other children) and told him that I would rather die at home than remain in this establishment. He came and took me home.

  12. I agre with your main point, but your analogies are off. Ask fat women or trans women or black women about being dismissed by medical professionals.

  13. As an NFP only doctor, mother of four, and tenth child I would like to present a different perspective. When any patient comes in for any type of mood or sleep medication there should be a discussion about their life. This includes the number of children and the stresses related to caring for them. The only one I fault in your story is the primary doctor who should have known you well enough to offer a sleep aid. An anxiety medication requires more discussion because of the potential for addiction. Also note that pregnancy is a higher risk than post partum for depression. Therefore what you saw as a simple request needs to be taken more seriously by your doctor. We are responsible for not taking an adequate history if you were to suffer a bad outcome. Please don’t assume they thought you were crazy because of your kids. They just needed to be sure you weren’t in trouble. I have some patients who appear to be in the perfect marriage and attend church regularly who are living with abusive or unfaithful spouses. They need to know there is a safe place to talk about it. That can’t happen if I don’t ask the right questions.

  14. I never had trouble with my OB/gyns (other than always being offered birth control after a birth. However, a father of two who lived across the street loved being “funny” and mocking our huge (6 kids) family. When I planted a flower garden alongside our driveway, he asked if we were growing corn to feed all those kids. When we came to the neighborhood pool, he’d loudly make jokes about maximum capacity. I was always tempted to ask him if he’d run out of sperm (just because he was so rude), but finally after about 8 years of his joyous bonhomie, I settled for, “If we had stopped at 2 kids, your daughter wouldn’t have a best friend.” He never said another thing.

    1. Annie, what a beautiful, gentle response! I’m so glad it apparently made him stop and think a little. (Gotta admit, though, that I kinda like your other comment, too!)

  15. Sorry you were not in our neck of the woods in Brooklyn. Our Hasidic communities have big families, and our docs are very well acquainted with the demands of “culturally competent care.”

  16. I grew up part of a big family and hearing stories like this. Now my doctor brother in law (who is young, Catholic, and just married) wonders why I go to midwives for prenatal care and delivery when its ‘safer’ to go to a hospital.

    Gee, I wonder…

    When you grow up hearing these horror stories, you tend to prefer other options.

  17. Yes, what’s with this? I’m pregnant with our 4th (so, you know, Duggar-style crazy.) We did have the first 3 kids in three years, so yes, I get that that’s intense. But it seems like 3 kids is the last socially acceptable number. In the words of my MIL, “God help you!” I would have needed God’s help with zero kids!

    1. My husband’s grandfather told me, as I lay on the bed an hour after my third child’s delivery, “Slow down, girl!” I thought maybe congratulations were in order, but he just couldn’t get over the fact that I had three boys in three years, either.

      We got him back when we named our fourth son after him. He thought we were joking and it made him cry. 🙂

    2. I remember an uncle telling me, after he started a new job, that his new coworkers were blown away that he had 4 kids – some of whom had 3 kids themselves! There really seems to be a dividing line in the cultural consciousness right between 3 kids and 4 kids.

  18. We are blessed in that my family doctor is pro-NFP and so was my OB/GYN. But. I have four boys. If I had a dollar for every time somebody assumed I must/should be a gray-haired wreck, I would…have lots of dollars. I went for a long-overdue haircut (not overdue because of allthoseboys, but because I am cheap and miserly with both my money and time), and during the usual casual conversation my stylist learned I have four boys, and she said, “Oh! Wow! FOUR boys..and you’re not white-haired from stress! Wait til they start driving…”

    Now, this lady is a perfectly nice person, and did a great job on my hair, so it is not her fault that I got a little snarky and said that in fact my oldest is already driving and is a FANTASTIC driver, it’s in fact my five year old that gives me fits….I’m just a little tired of the stereotype that mother of all boys=mental patient.

  19. THIS IS ME. I had a heart problem; I needed a valve replacement. The rapid heartbeat and sleeplessnes were diagnosed as panic and post-partum. The other symptoms were variously depression and anxiety. My cardiologist had a stethoscope on my chest while asking what kind of car I drove (cause 7 kids) and how did I keep track of all their shoes? Then he said I sounded pretty good and that the near-blackouts after vigorous exercise were “probably normal.” Eventually a family member, who is also a medical professional, interceded. And guess what? It turned out heart surgery healed my panic and post-partum depression and anxiety. But not my abnormally large family.

  20. The focus on family size it just wrong and weird. Doctors do this to me because of my weight; they are preoccupied with it being the underlying cause of any complaint I have. Thankfully this phenomenon is recieving some attention now and I notice younger doctors being much better about it. But I don’t think that it’s unusual that you were asked to see psychologist and that she asked you a bunch of seemingly unrelated questions. Relieving acute anxiety like that in the last days of pregnancy would be a very tricky proposition. Often times, stressful situations that become acute are the result of underlying issues that have just stayed at a manageable level, until something pushes it over the limit and you end up being desperate enough to ask your doctor about it. I am sorry that you weren’t able to have your sleep and anxiety ameliorated before you gave birth, and I hope you are feeling better now.

  21. My family doctor is great, but I once went to get stitches at a local clinic after cutting my hand badly while doing recycling and had to bring my 4 kids with me while pregnant with my fifth, and the FIRST thing the doctor said to me (in front of my kids) was “was this pregnancy an oopsie?”

    1. You held out your hand, bleeding all over the floor, and said, “No, this is the “oopsie”. How about you fix this?”

  22. Yes! I avoided the doctor for years because every time I went all she would talk about was how I needed to be on the pill. Nevermind it was counter indicated because of my migraines and the fact that I became severely depressed every. single. time. I was on it in college. It would solve all my problems. When I went in with what would later cause another doctor to say I had Meniere’s disease she would not address the problem but told me that my son (who was less than a year old and not present) was probably going to nurse until he was ten if I didn’t wean him soon and tried again to push a script for the pill on me. I never went back. And it was years before I went out looking for a doctor who wasn’t a total jerk.

  23. There are so many negative cultural assumptions about large families. At one point it dawned on me that when people see horribly misbehaving siblings with parents who are not controlling them appropriately in public, they say (sometimes out loud) “That’s what happens when you have so many kids.” But you can also see ONE child or two kids horribly misbehaving with parents who are not controlling them appropriately, and no one says “That’s what happens when you only have one!” or “when you only have a few!” They say “What appalling parents!” (Or, if they are polite or charitable like we ought to be, they don’t say anything and refrain from passing judgment on strangers. What a concept.)

  24. YES. I haven’t received that from my doctors…thank God…but from everybody else around me. Late for an appointment? Too many kids. Tired today? Too many kids. Forgot a deadline? Too many kids. Weird headache for weeks? Too many kids. Car breaking down? Too many kids.

    And I only have six. SIX. Although I am stupid enough to homeschool them. So obviously that’s why the van keeps breaking down.

    1. I “only” have five, and like you I haven’t had any problems with my doctors, but I feel some of those assumptions from others. It’s hard to admit that you’re having a hard day (or a hard year) when you feel like anything negative you say about your life makes people feel justified in their judgment that you were just wrong to have “so many” kids.

      It is amazing how judgmental people have become in general about things that (I think) used to be considered none of their business.

  25. And then there’s this: “the rich are blessed with many children, the poor breed like rabbits”- my (ex) father-in-law………a doctor.

    1. Betsy, I’m uncertain; are you offended by the quote? It seems like a very sensible thing to say; it hits the nail on the head in terms of class prejudice.

  26. Yes, so much yes. Mom of 10 here and I spent YEARS living in a state of unusual exhaustion. Every 6 months or so I would go to the doctor in utter desperation and say, “I am so tired all the time. I am bone achingly tired. No amount of rest, or food, or coffee, or anything fixes it. Please help me.” And whatever doctor it was would tell me that, well, I had X number of kids and what did I expect?

    Finally, finally! My NFP only ob/gyn went through every blood test possible and found a few problems. There were both hormonal issues and some severe vitamin deficiencies. And you know what? Once those were dealt with I felt like a normal human being again. Even though I still had ALL THOSE KIDS.

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