Mr H. came requesting vasectomy. He was a small businessman whose wife helped in the playgroup. Their children were older and starting secondary school. The doctor pictured his wife as an intensely earthbound mother putting continued efforts into child rearing and understanding the needs of parents and their desire to procreate. Mr H. spent most of his time at the shop.
The doctor asked him how he would feel about never being able to father a child again. He paused, quietened and said how he loathed the shop. He had hoped that his wife would put more hours in serving to let him do other things. No, he really did not want a vasectomy either, he was wondering about becoming a mature student and doing primary teaching. Neither member of this couple really wanted sterilization despite peer pressure.
One cannot assume that the marriage will benefit from vasectomy (Howard, 1979).
*153/197/1*
To those who decide the time is right for the wanted baby, a pregnancy is achieved by the majority of couples within the first two years of trying to conceive. Modern contraception has encouraged people to feel in control of their lives so that when its use is discontinued, expectations of an ensuing pregnancy occurring immediately are very high. When one does not occur, the emotional anxieties begin to feature very largely in the daily agenda of the woman, and sometimes of the couple.
The most common single problem, accounting for a quarter of all infertility problems, is that of sperm defect or dysfunction. Nearly a half are caused by a mixture of female problems, another quarter by unexplained reasons, and finally 6% due to coital problems. These are useful figures to remember when trying to put infertility problems into perspective and form a balanced view of the cause, if any. However, they do not give any indication of the amount of emotional disturbance felt by the individuals involved. The feelings of failure, utter disbelief and sometimes denial that they are in this situation can be seen in such statements as, ‘We’re not ready for children yet’ or ‘We’re quite busy enough with our dogs at the moment’.
*116/197/1*
Miss A. came to the family planning clinic accompanied by her fiance. She requested a pregnancy test which was positive. The couple came into the office beaming with pleasure. Miss A. had missed a few Pills but they really ‘couldn’t understand’ how she had fallen pregnant. However, they felt sure of parental support and would just hasten their wedding plans. This apparently unplanned pregnancy was obviously not unwanted. The doctor wondered how unplanned this pregnancy was but further discussion at this point seemed irrelevant. The couple wanted the doctor to share in their good news and point them in the direction of antenatal care.
Some very definitely planned pregnancies may turn out to be unwanted. This may be due to a change in circumstances such as deterioration in the relationship, bereavement or redundancy, making the woman feel unable to care for a child or change her objectives. Sometimes a woman may like the idea of becoming pregnant, but once faced with the prospect of having a baby in a few months, she makes a more realistic appraisal of her circumstances.
*80/197/1*
Certainly, once inserted, the woman has nothing more to do. Few women even check for the threads of the coil, although all are taught to do so. Most women, after the first few months of anxiety – how can such a tiny thing be effective? Has it got lost? Will the bleeding ever stop? – seem to forget that the coil is there, between periods, anyway. Menstruation is frequendy heavy, sometimes painful, sometimes preceded and followed by spotting or a brown discharge. Surprisingly, most women are content to put up with this, it seems to be natural, acceptable. It is a price they are prepared to pay. Indeed, sometimes the heavy bleed is seen as a letting out of bad blood, and therefore a good thing. There are women who are grateful that the long menstruation provides an excellent excuse for avoiding intercourse. Other women may return for a check because of a particularly heavy bleed, but if all is well clinically, they go away cheerfully. It is as though the regular, heavy, monthly bleed is actually reassuring – proof that the coil is there, proof that it, and the women themselves, are working.
*43/197/1*
Mrs A. did not believe in contraception, and although she said it was not because of her religion she said, ‘It’s just that you should have what God sends along and not interfere.’ She was in her late 20s and had nine children from 12 pregnancies. After each pregnancy the use of contraception was suggested by the midwife, health visitor or doctor. Each time the answer was the same, and given in such a way that the professionals felt almost like child killers for even mentioning contraception. Eventually Mrs A. reached breaking point with her tenth child and a difficult delivery. Tired and worn out, she attended the doctor’s surgery frequently for various ailments, both her own and those of her children. Finally, she managed to bring herself to ask for a sterilization. Fortunately, the doctor refrained form saying ‘I told you so’ and managed to expedite the operation in an understanding and friendly way.
This patient illustrates a well-known situation where the actual experience of childbirth and child rearing can change attitudes towards contraception. For Mrs A. there were further factors in her urge to have all the children she could have. She was the unwanted illegitimate child of a holiday romance and in her childhood she had been pushed around from pillar to post with no one to call her own. Her children were her bastion against the world, her own tribe as it were. Her sense that it was morally right to have what God sent fitted her unconscious inner need for a large family.
*6/197/1*