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Wednesday, March 21, 2012

A Dialogue on the Harmony of Church Teaching and Women’s Health

Courtesy of the Roman Catholic Diocese of Harrisburg, PA:

A recent roundtable discussion that included obstetricians and gynecologist at Holy Spirit Hospital's Center for Women's Health along with clergy and lay specialists, provides both insightful and informative in the living out of the faith in such important matters. The discussion relates the core of the Church's instruction on artificial contraception, sterilization and abortion-inducing drugs to the care and treatment of women patients and their partners.

A Dialogue on the Harmony of Church Teaching and Women’s Health

On March 8, Msgr. William King, Diocesan Vicar General, sat down with Dr. Faith Daggs and Dr. Damon Cudihy at The Birthplace, the OB/GYN floor at Holy Spirit Hospital in Camp Hill, to discuss the relationship between the Church’s moral teachings and women’s health. Mrs. Victoria Laskowski, Diocesan Director of Marriage and Family Ministries, and Fr. Paul CB Schenck, Diocesan Director of the Respect Life Office, joined in the conversation.

The purpose of the discussion was to relate the core of the Church’s instruction on artificial contraception, sterilization and abortion-inducing drugs to the care and treatment of women patients and their partners. Dr. Daggs and Dr. Cudihy were very informative and insightful in their discussions about the positive application of their faith as practicing Catholics to their effective practice as physicians dedicated to providing their women patients with the best of care and therapies.

What does the Church teach about contraception?
Is contraception, or sterilization or abortion-inducing drugs necessary and essential to women’s health?

Dr. Daggs: I would not say that these are essential and necessary to women’s health care. Certainly, they have been incorporated as treatments for a variety of gynecologic disorders. In particular, oral contraceptives have been used as a medical panacea for many women’s health conditions – painful periods, irregular cycles, ovarian cysts, endometriosis – when actually there’s not great data that this therapy is effective for all of those conditions.
Sterilization doesn’t serve any purpose other than destroying the tubes and disrupting one’s fertility. It doesn’t treat any known medical conditions, and there is some research that shows it actually may produce problems for a woman. It can potentially lead to adhesions or scar tissue within the abdomen and pelvis, and in some cases may even be related to future disruptions of a woman’s cycle and/or pain.
Abortion generally is not used as a treatment – therapeutically, so to speak – for a pregnancy. There may be some very rare medical conditions in a woman where there may be a consideration to terminate a pregnancy because of her failing health. The main one that comes to mind is cardiomyopathy or primary pulmonary hypertension. However, even in that realm in the last ten years, there are small case series, particularly in England, of other therapeutics being able to be used to manage those women medically to carry them through pregnancy, at least to viability.
I don’t see them as essential and necessary, particularly since there are a variety of medical and surgical therapies that are alternatives and available, and that were used even prior to the advent of contraceptives or have been developed subsequent to the availability of contraceptives.

Dr. Cudihy: The short answer is no, I don’t see that contraceptives are ever an actual form of women’s health care. When it comes to contraception, a woman’s fertility is actually a healthy condition. If a woman is able to conceive, that means there is something working right with her reproductive system. There’s not a malady in need of treatment. … Our first approach is not to do harm. If I make a decision to destroy a woman’s reproductive system, I’m actually doing harm to her normally functioning system.
Unfortunately, contraception is treated like a panacea. I think it’s more of the snake oil of modern medicine. … If I thought it was an effective treatment for endometriosis, for polycystic ovarian syndrome or for irregular cycles, I would use it. But there are much better ways to treat those conditions that actually get to the heart of the problem.
When it comes to abortion, there are some situations where a continued pregnancy may pose a significant risk to a woman’s health. There are other situations where a woman’s health may be endangered, for example uterine cancer or an ectopic pregnancy. These are situations where there may be a procedure necessary, but the action in these situations is not a direct abortion. The child’s unfortunate, unavoidable death is a secondary effect. But I want to be clear that I don’t believe that direct abortion is ever necessary for a woman’s health. …

Is contraception ever a threat to a woman’s life or health?

Dr. Cudihy: Very much so. Few people are aware that the World Health Organization, as of 2005, has included hormonal contraceptives as what they define as a Group I carcinogen. [Emphasis mine. F.G.] Carcinogens are those things that we know cause cancer. Some examples of other carcinogens in this category would be asbestos, radioactive phosphorus, tobacco products and radon. For the World Health Organization to make that statement was pretty striking. That means that they looked at the evidence and saw that there was really no debate anymore about whether or not this is a cancer-causing agent.
The types of cancer that are most associated with the birth control pill would be breast cancer, cervical cancer and liver cancer. One of the unfortunate things that has been promoted is the idea that birth control pills are actually preventive against cancer. It’s important to understand that although there are studies showing it probably does decrease the rate of ovarian cancer and potentially uterine cancer, when you look at the net effect – because breast cancer is so much more common in particular – it is an increased risk of cancer.
We’re hearing that contraception is basic preventative health care. I’ve said more than once that it is preventative, but not in the sense that people think. When it’s used to apparently treat endometriosis, irregular cycles or pelvic pain, many times it’s preventing the woman from ever receiving a proper diagnosis and preventing her from having a treatment that will cure the disease. Contraception is not preventing a disease – it’s preventing diagnosis, treatment and cure of the disease. It’s an easy way out for us physicians to avoid having to address it. … An approach that actually seeks to diagnose the problem and treat it requires more work. It requires some imaging studies, some blood work, even surgery. And while it’s more work, it’s what the woman deserves if we are really concerned about her health.

In the delivery room, immediately after delivery, some physicians will ask a woman what type of birth control she would like to start, or if she would like to have a tubal ligation. Is that a necessary follow up to delivery?

Dr. Daggs: No. Certainly, there are situations where undertaking another pregnancy and another delivery is a particular concern to a woman’s health. However, the delivery room is not the most appropriate place to enter that discussion, even if the woman has no risk factors. There’s quite a bit of study looking at women who were counseled regarding tubal ligation during pregnancy and shortly after delivery and who accepted those procedures. Afterward, they showed a particular amount of regret.
Family planning is an important discussion to have. We’re truly called to be responsible parents. For some families, it may be that they can be open to many children; for some families, it may not mean that for a variety of reasons. If a woman has post-partum depression, she might not be ready to entertain another pregnancy.
It takes two people to conceive, and so the responsibility is shared. Ideally, it’s a shared decision – not just one person has to take a medication, wear a device or have a surgical procedure.

Dr. Cudihy: There tends to be an attitude that women are somehow hapless victims of their own fertility, that somehow the potential for them to conceive is a disease state. It breaks my heart to hear a woman tell me about how she was pressured into having a sterilization the day of her delivery. She delivers and then is convinced to be sterilized the same day.

Pope John Paul II taught that there may be reasons for a woman to delay pregnancy, where it may be morally incumbent upon her to do that for her health and her family’s sake. Would you say at that time that oral contraceptives would be appropriate?

Dr. Daggs: I would not say that oral contraceptives would be appropriate because we have legitimate medical means for a woman to know and understand her body, and for she and her partner to work together to use that in order to space or avoid pregnancy altogether.
Natural Family Planning has many names: fertility awareness, Billings Ovulation Method, Sympto-Thermal Method, the Creighton Model. All of these are based on a 50-year science of knowing what’s going on in a woman’s body hormonally, and using the biological indicators of that can be readily taught and observed regardless of the amount of education or training a woman has. Often, these methods are an aid to their health. We use Creighton Model in our practice. That’s been medically adapted to help us manage a whole host of gynecologic conditions.

Dr. Cudihy: Unfortunately, in those rare situations that we have a patient that we may need to advise them to avoid having children again, there is no reason why we should feel that we have to put them on some kind of birth control pill or sterilization when there are more effective or equally effective methods that do no harm to her body.

Knowing the harm that contraception, sterilization and abortion cause, and knowing that there are safe, moral and effective methods regarding family planning, why are women still choosing the former?

Dr. Daggs: It’s ease. It’s the almighty dollar. In general, Natural Family Planning is not a moneymaker so it’s not well known to people. Also, I think there may be a sense that women feel like it is totally their responsibility in a relationship, that society has shifted this responsibility totally to women. Particularly with the legalization of abortion, it’s really allowed men to abdicate in a significant way their responsibility as partner in this decision for a family. Certainly there are contraceptives that men use and men can be sterilized, but we’ve really allowed men as a society to abdicate their responsibility.
I think women maybe feel that they have no other choice, particularly if their spouse or their partner is not participating in this very important part of their relationship. I’m sure they participate on other levels in terms of finances and child-rearing, but often this is pushed off onto the woman. The women’s movement said to women, “You need to grab what’s yours in terms of education and career,” and that’s all good. But how incredibly sad – from a woman who is a career woman and a mother and a wife – that a woman would assume that she had to deny her ability to be a mother and to destroy what’s part of her feminine genius in order to have a career. I have been blessed with more than the usual number of children, but I don’t feel like that’s been a hindrance to my career. [Emphasis mine. - F.G.]

Is the Church’s teaching as it addresses contraception, sterilization and abortion-inducing drugs in conflict with good health practices for women?

Dr. Daggs: I do not believe so. What we do day-in and day-out is take care of women, and we do it in a manner that is consistent with our faith but medically cogent and scientifically sound, without using sterilization procedures, contraceptives or referring for termination of pregnancy. It allows us to be better physicians. … From a medical standpoint, I feel like I am really managing women’s health care in terms of using investigatory tools and then treating in ways that are complementary to their body that aren’t going to mask something that’s going to cause further damage.

So it’s not a matter of Church against medicine, or medicine against Church?

Dr. Cudihy: Not at all. The teachings of the Church encourage us to want to provide the very best medicine and the very best health care for women. It’s such a false argument to suggest somehow that the Church’s teachings on this matter are in conflict with good women’s health. In fact, it’s the Church’s teachings on the matter that keep us on track in seeking to provide the very best for women. The Church’s positions on this in no way are harmful to women. It’s not because the Church doesn’t care about women that she teaches that contraception violates her human dignity; it’s actually precisely because the Church does care about women that she teaches that. Because of the guidance of the Church on this issue, it’s helped us to be better physicians. In no way do I feel constrained somehow that this is holding me back from providing the best care.
Even though I know this is impossible, if somehow the Pope came out tomorrow with a statement that contraception was now acceptable, it wouldn’t change the way I practice. I see through and through the medical and scientific side that it’s just not good medicine. The Church is helping point us in the direction of good medicine.

Medicine, with the application of Catholic moral principles, is not pure science, but human science. We treat the human person with the dignity of a creature of God, but also with solid scientific principles.

Dr. Daggs: I’d have to say that it’s allowed me to flourish. I was not always of this mind. When I was in my professional education, I had a very different viewpoint that I was kind of saving my fertility and I had a plan. Fortunately, I had a conversion and it profoundly affected my personal life, my marriage and the bounty of life that my husband and I have been blessed with. But also, it profoundly affected by professional life and the way that God has been able to use me to work with women and to be continually humbled by the human body and its complexities, and the gift of fertility. It’s allowed me to achieve more than I could ever do on my own, and even push my own limits in terms of being a professional and being a wife and mother.

Dr. Cudihy: I see the truth of these things being affirmed every day in the office. Most of our patients aren’t Catholic. They come to us not because they know that we don’t prescribe contraception and we don’t recommend In Vitro Fertilization, but because they hear in the community that they’re going to be treated with respect and care. It’s consistent with good science. Good science means we really care about the person. The longer I do this, the more I see the truth being reinforced. Never do I feel that the Catholic Church is holding me back from being a doctor. The teachings of the Church and the guidance of the Church have helped me to be a better doctor.

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