Who Chooses the Choices?

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By emjaybee

Just saw this story over at Birth Sense, and thought it was an interesting peek into the commerce of hospital treatments. The Birth Sense blogger mentions as product called Gynacare Interceed, which is described on the Gynacare website as a lightweight, tissue-like “fabric” adhesion barrier that your doctor can apply to organs to protect and separate them during the healing process. The fabric eventually dissolves as your body heals.

Now there are two interesting things about this product. The first, as Birth Sense points out, is that it is being marketed under the assumption that any woman with one c-section will have another; VBAC is definitely not the expected norm. At the same time, the problems associated with adhesions, such as placenta accreta, are on the rise, but still not moving ACOG to do much to increase the VBAC rate.

The other thing that struck me is that when you go to the Gynacare website, you find that they are marketing directly to you, the patient. You are told to urge your doctor to use their product during your next c-section to prevent adhesions. Which is more than a little odd. Should patients also voice opinions about the type of scrubs, brand of instruments, choice of sponges that their surgeons are going to use? Since when did this fall under our responsibility? And how on earth would we know whether their claims have any validity?

While the manufacturers would no doubt respond in flattering terms about patient choice and autonomy, I can’t help thinking that what we’re dealing with here is the “illusion of choice” phenomena; in other words, being told to choose between lesser options and to ignore the fact that better options are being kept off the table.

This happens a lot in pieces directed at women, who get asked questions like “Will you be a man-hating feminist or perfectly submissive? Do you marry a wimpy nice man or an abusive he-man? Are you a Madonna or a whore?”

The first lesson of resistance is: question the assumptions. Who decides what choices go on the list? Who decides what your possible answers are? Who decides what the questions are? And why should you give them that power, anyway?