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Endometriosis affects approximately  1 in 10 women, disproportionately affecting women in their 30s and 40s. For most individuals, getting diagnosed with endometriosis is a difficult process. On average, it takes anywhere from 3 to 11 years after the onset of symptoms to reach the final diagnosis. Social media is rife with personal accounts of healthcare failures exacerbating endometriosis. For example, YouTubers who have gone through the diagnostic journey themselves shed light on why it takes such a long time to reach a diagnosis, whether it be doctors dismissing their pain or reaching another diagnosis that might explain the symptoms that they are experiencing. Buzzfeed’s As/Is channel on YouTube uploaded a video in 2019 titled “A Week In My Life With Endometriosis,” which documented one individual’s daily life while they deal with this condition. Clips of her laying in bed with loose, stretchy pants, shopping for “safe foods,” and keeping a heating pad on while sitting at her work desk felt extra relatable to me, as there are days where my pain confines me to oversized sweatshirts and loose leggings but I still have to attend classes or take care of errands. “The extra steps that I have to take every single day just to be comfortable, just to exist in a way that’s comfortable to me, is something that I wish the average person understood a little bit better” is a sentence that still resonates with me to this day.

Like the woman in the YouTube video, my mother ranks among the countless people who have suffered from both the physical and institutional consequences of endometriosis. Since the age of 18, she suffered from bad periods. “My cramps were so severe that I would double-over in pain and take an unrecommended amount of aspirin just to get by,” my mom explained to me. This pain stayed for another 3 years, until she started using birth control pills to prevent an unplanned pregnancy. Four to five years later when my parents started to discuss having kids and my mom stopped the birth control, the bad periods returned and her pain was at an all-time high. When she talked to her gynecologist at the time about her symptoms, she was told that she was just experiencing severe hormone imbalance due to stopping birth control. “Every woman has cramps,” they said to her. It took switching to a new gynecologist and eventually being referred to a fertility specialist at age 27 for my mom to be diagnosed with severe endometriosis.

My story is a little bit different from my mom’s. I started experiencing bad periods when I was around 12 years old, and at age 14, I went to my mom’s OB/GYN so that I could be given the Nexplanon birth control implant. From the next 4 to 5 years, my birth control seemed to work wonders for me. However, in the past two years I’ve noticed that some of my previous symptoms are returning, I’m experiencing new symptoms I haven’t before, and something doesn’t feel right. I am 21 years old, and I am experiencing a lot of the same symptoms my mother was experiencing right before her diagnosis. In addition to talking to my mom, I’ve started to do my own research, and here is what I have found so far.

So… what exactly is endometriosis?

Endometriosis is a condition in which endometrial-like tissue that typically lines your uterus starts to grow outside of the uterus. Endometrial tissue in your uterus thickens each month and will break down and shed with your menstrual cycle. However, the endometrial-like tissue that grows outside of the uterus on your pelvic organs (or even outside the pelvis region entirely) has no way to shed your body, so it becomes trapped and eventually becomes irritated, leading to scar tissue and adhesions. It is the scar tissue and adhesions that often are the source of the pain people with endometriosis commonly experience, and also the source of fertility problems that may only be discovered when one is planning to have children.

What does endometriosis feel or look like?

While endometriosis can vary from person to person, there are many common symptoms that individuals can face. These symptoms include:

• Painful periods
• Pain with sexual intercourse
• Pain with bowel movements or urination
• Excessive bleeding during or between periods
• Infertility
• Fatigue, diarrhea, constipation, bloating, nausea, headaches/migraines, and more

It should also be noted that the stage of endometriosis one may get diagnosed with may not correspond to an individual’s pain levels or experience of other symptoms.

How is endometriosis diagnosed, and why does it usually take so long?

To diagnose endometriosis and rule out any other conditions, your doctor will typically ask you to describe all of the symptoms that you are experiencing and will conduct a variety of tests, such as pelvic exams, abdominal and/or vaginal ultrasounds, and MRIs. With all of that said, laparoscopies are often referred to as the “gold-standard” for official diagnosis, as this procedure allows doctors to see the inside of your abdomen and see if there is any endometrial tissue growing outside of the uterus, which is often removed at the same time. Biopsies are sometimes performed during these laparoscopies so that the tissue can be tested later in the lab and the diagnosis can be histologically confirmed. Laparoscopies also allow for doctors to determine the stage of endometriosis, ranging from stage 1 (minimal) to stage 4 (severe). 

Diagnosis often takes such a long time because endometriosis and its symptoms can be confused with a number of other conditions and diseases, including pelvic inflammatory disease, ovarian cysts, and irritable bowel syndrome. Pain can sometimes be dismissed by doctors that think it is “normal,” or the condition may not even be an issue until an individual starts to encounter fertility issues.

How is endometriosis treated? Is there a cure?

Unfortunately, there is no cure for endometriosis. However, there are many effective treatments that are available today, and because endometriosis is unique to each individual, individualized treatment plans are important. Treatment for endometriosis typically involves (but is not limited to) laparoscopic surgeries, pain medication, and/or hormone therapy. Some individuals may continue to experience pain or have pain return years after treatment, which can be the case when endometrial tissue that was not visible and/or removable during initial surgery, in which medication or even a hysterectomy is the next step to manage symptoms.

For my mom, most of her symptoms alleviated three different times – when she became pregnant, after she started DepoProvera birth control, and when she entered menopause. Countless people have anecdotes of their endometriosis symptoms improving after becoming pregnant, but the problem with this is that many are infertile as a result of this condition and have a difficult time conceiving, and there are also many who do not plan on having any children for a while or ever. As for my own journey and my future, I do not plan on ever having children and I think that sometimes my symptoms or treatment options have been overlooked multiple times due to the fact that I am not actively working to become pregnant. Additionally, I am not interested in starting DepoProvera since I am happy with my current form of birth control, and as a 21-year-old, I am not even close to starting menopause. However, after actively advocating for myself at my appointments with my gynecologist, I am in the process of being referred to a surgeon who can do the diagnostic laparoscopic procedure for me at the end of this year. Both my mom and I have our concerns about having the surgery done, but we know that it is important for me to get answers for the sake of my own health and work towards a future with minimal pain. In the past year or so, I’ve learned that not every person’s case of endometriosis is the same, and with that knowledge in mind, I want to be able to share important information and spread awareness so that people like me will know when to start a conversation with their doctor.

For more information, you can visit acog.org or find an OB-GYN here.

CW: description of eating disorders, numbers

At only 17 years old, Mary Cain was on the road to being the next Simone Biles, Serena Williams, or Katie Ledecky of track and field. She was a record-breaking athlete, the youngest American to ever join the World Championship team, and preparing for the Olympics. In short, she was a phenomenon. But before Cain had the chance to make history, her career fell into shambles due to the abusive culture of the elite track team she was signed to, Nike’s Oregon Project. During her time with the team, Mary Cain was pushed by her male coach to eat less and less to lose weight. Refusing to diet would mean losing her place on the best track team in the world; for a young athlete with big dreams, her choice was clear. However, instead of receiving the nutrition she needed to thrive as an athlete, Cain was eating so little that she didn’t menstruate for three years, broke five bones during her time with the team, and was having suicidal thoughts. 

Mary Cain came forward with her story after leaving the Oregon Project, but she is certainly not the only athlete to have experienced this abusive culture; this is a picture all too common in women’s athletics. Almost any athlete would agree that nutrition in athletics is just as important as training. Great athletes are conscientious of what goes into their bodies, but this conscientiousness can develop into a disordered fixation as a result of intense pressure and performance standards. Eating disorders are a serious issue, and women athletes are at a higher risk for developing them than male athletes or non-athlete women. 

There are currently eight eating disorders with diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Of these, the most well-known, and the one that most commonly affects athletes, is anorexia nervosa. Anorexia nervosa, often shortened colloquially to anorexia, is a disorder characterized by intense restriction of food intake which leads to unhealthy weight loss and an unexpectedly low weight. Those diagnosed with eating disorders are often distressed at the thought of gaining weight, and consistently exhibit behaviors to prevent weight gain. There are two subtypes of anorexia nervosa—the binging/purging subtype, in which the affected individual engages recurrently in self-induced vomiting, the use of laxatives/diuretics, or binge eating, and the restricting subtype, in which these binging/purging behaviors are not engaged in. In athletes, heavy restriction of food intake along with intensive exercise is often referred to as anorexia athletica, a specific subtype of anorexia nervosa that affects athletes but has no official diagnostic criteria. 

Something important to note about eating disorders like anorexia nervosa is that, contrary to the beliefs of many, they are not choices—they are real, treatment-warranting illnesses. There are many causal factors that can lead to the development of an eating disorder, and like most psychological disorders, the causes are not yet fully understood. What we do know is that genetics, culture, biology, and environment all have a role to play. Athletes are at a higher risk because of the environment they spend much of their time in—one that links low body weight to high performance, thinness to winning, and struggle to success.

When it comes to athletics, another condition, orthorexia, warrants discussion as well. Having no official diagnostic category, this condition is often filed under “Other specified feeding or eating disorder,” the “catch-all” diagnostic category for disordered eating practices that do not fit elsewhere. Restrictive in nature just like anorexia nervosa, orthorexia is characterized by an intense fixation with “healthy” food, with fear or distress being caused by the consumption of any food seen by an individual as too “unhealthy.” Orthorexia, like anorexia nervosa, is likely to lead to nutritional deficiencies and low body weight, and the individual often lacks awareness of the severity of their body’s condition. 

The problem with women’s athletics is that symptoms like osteoporosis (brittle bones) and amenorrhea (lack of the menstrual period) are seen as normal in the context of the sport, attributed falsely by coaches and athletes alike to intense exercise when they’re truly a result of nutritional deficiency. This is a dangerous lack of recognition. Weight and size are rewarded an undue emphasis in athletics as well; in sports with subjectively judged aesthetic components, like diving, gymnastics, and dance, there is intense pressure to have a certain body type, and in sports requiring speed like track and swimming, having “less weight to carry” is seen as advantageous. Athletes often weigh in right in front of their coaches and teammates, the number on the scale displayed for all to see. On top of all these added pressures, female athletes are subjected to the same everyday beauty standards that affect us all—things like unrealistic body standards seen on social media and photoshopped magazine covers. It makes sense that there’s an eating disorder epidemic in women’s athletics, but that doesn’t mean it’s acceptable. 

The fight against this culture in women’s athletics begins with women like Mary Cain. What happened to her should never have happened, and by making her experiences publicly known, she is taking a step to making sure it never happens to another girl. It starts with athletes like Gracie Gold, a figure-skating prodigy who has told her story of food restriction, binge-eating and purging, depression, and suicidal ideation after a coach told her that 124 pounds was “a big number.” And it starts with Yulia Lipnitskaya, who retired from figure skating to seek inpatient treatment for anorexia nervosa after competing in the Olympics at age 15. These are devastating stories, but these women’s courage in speaking out is a step towards destroying the sinister food culture in women’s athletics. We can only hope to continue building awareness and recognition for this issue, so that the faces we see on every Olympic stage to come are smiling and healthy ones.

If you or someone you know is struggling with an eating disorder, contact the NEDA Helpline for support, resources, and treatment options.

Featured Image: Gracie Lam for The New York Times

What is a C-section? 

A Cesarean section (C-section) is a surgical procedure to deliver a baby through an incision in the abdomen through the uterus. C-sections can be a life-saving alternative to vaginal deliveries for mothers experiencing certain medical conditions or complications. Often, the need for a first-time C-section cannot be predicted until the mother actually goes into labor.

A brief history of C-sections

C-sections weren’t always a readily available procedure. Before the advancement of anesthesia and antisepsis, C-sections were considered a last resort. The concept of cutting into the abdomen of a mother to deliver a baby is not something that just emerged with modern medicine. C-sections had been crudely performed for centuries and it may even be considered the first surgical procedure in human history. The ancient Romans were the first to develop and document C-sections as a medical procedure. Contrary to popular belief, the procedure was not actually named after the emperor Julius Caesar who was reportedly delivered via a C-section. The term “caesarean” is actually derived from the latin word caesus meaning “to cut.”

Until relatively recently in human history, a C-section was usually not even considered until the mother was close to dying or already dead. The Romans actually had a written law called the Lex Caesaria that required the baby to be removed from the womb if the mother died during childbirth. In short, C-sections were not a procedure that a mother was expected to survive. If the baby made it out of the womb alive, they usually suffered severe and sometimes fatal complications.

With medical innovations and the legitimation of surgery as a field of practice in the 19th and 20th centuries, the C-section became a life-saving procedure rather than a life-ending one. Further, there has been a major shift from the home to the hospital as the place of birth over the past century, making C-sections readily available to most. An estimated 98.4% of babies in the United States are born in hospitals, making them the most common place of birth in the United States. Now C-sections can be safely used to proactively improve health outcomes for mothers and babies at the first sign of complications. 

Why are C-sections performed instead of vaginal deliveries? 

C-sections are one of the most commonly performed surgeries globally for a variety of reasons. Major improvements in the execution of this procedure have drastically lowered preventable causes of maternal mortality and infant mortality. 

• Stalled labor: The cervix does not open enough for a successful deliver despite hours of strong contractions
• The baby is in distress: The baby is not receiving adequate blood flow or oxygen during labor. This condition may even result in an early delivery if this occurs during the pregnancy. 
• The baby is in an abnormal position: Babies in the uterus are normally positioned head-down with the chin tucked to the chest. During delivery, they enter the birth canal head first. If the baby’s feet or buttocks enter the birth canal first or if the baby is positioned sideways, a C-section is a safer approach to delivery. 

Source

• Multiple babies are being delivered: When there is more than one baby in the womb, they may end up in an abnormal position.
• Placenta previa: The placenta covers the opening of the cervix 
  • Prolapsed umbilical cord: Part of the umbilical cord slips through the cervix ahead of the baby
•  Mechanical obstruction: If the birth canal is obstructed it is difficult to deliver a baby in a healthy condition. Some examples are fibroids, pelvic fractures, or an enlarged head of the baby. 
• Pre-existing health conditions: C-sections are often recommended for mothers with severe heart or brain conditions. Mothers with an active gential herpes infection at the time of labor are also recommended C-sections. 
• Previous C-sections: A vaginal birth after cesarean (VBAC) is possible depending on the type of uterine incision used in the previous C-section and other underlying factors. Healthcare providers sometimes recommend a repeat C-section for mothers that don’t meet the criteria.

Why do mothers choose C-sections as an elective surgery? 

The global C-section rate has drastically increased in less than a generation. In 2000 C-sections accounted for 12% of all births; in 2015 this rate rose to 21%. In the United States, 1 in 3 babies are delivered via C-section. However, there’s much more to these statistics than mothers just wanting to avoid delivering a baby vaginally. In reality, only 3% of women elect to have the procedure because they are afraid of vaginal birth. 

What’s really going on?

The reason for the drastic rise in C-sections is actually perpetuated by healthcare providers. Patients trust their maternity care providers even though they may not have received a thorough explanation of risks and possible alternatives. According to the national Listening to Mothers survey, women may go through with recommended treatments even if they have little awareness of the extent to which their care and health outcomes are affected by practice variation, side effects, and other nonmedical factors. Thus, it is the providers making the recommendations that contribute most to this growing C-section epidemic. 

Health insurance companies put a lot of pressure on healthcare providers to work as “efficiently” as possible. Unfortunately, this leads to the practice of quantity over quality. The more patients the providers see and the more services they provide, the more money they make. C-sections are a much faster procedure to perform than vaginal deliveries, which makes C-sections especially convenient if the provider is paid the same amount for either procedure. There is even greater incentive for performing C-sections when hospitals are financially reimbursed more for cesarean birth rather than vaginal birth. Essentially, providers and hospitals are increasing their rates of C-sections for the sake of making profit. 

Healthcare providers may also show a preference for C-sections for the sake of their personal lifestyles. Now more than ever, providers seek and even expect a greater work-life balance than what was possible before. This usually makes them less willing to attend births at night and on weekends and holidays. Planned C-sections, especially on weekdays, are a convenient way for them to maintain that balance sometimes at the expense of their patients. While C-sections offer many benefits to a patient, an unnecessary operation could be harmful. 

What makes unnecessary C-sections so dangerous? 

Just like all other surgeries, a C-section carries many risks. 

• • Infection: The lining of the uterus may become infected.
  • Postpartum hemorrhage: Heavy bleeding during and after delivery.
  • Reactions to anesthesia: Most C-sections are done under regional anesthesia, which numbs only the lower part of your body. In an emergency, general anesthesia may be used. Adverse effects are possible for any type of anesthesia.
  • Blood clots: A blood clot may develop inside a deep vein. If the blood clot travels to the lungs and blocks blood flow, the damage can be life-threatening.
  • Wound infection: The incision site may become infected. 
  • Unintended surgical injury: On rare occasions incisions may accidentally be made to surrounding organs.  

The mother is often at a higher risk of developing severe complications in future pregnancies after a C-section than a vaginal delivery. With each subsequent C-section, there is a higher risk of the placenta becoming abnormally attached to the wall of the uterus or the opening of the cervix. For mothers that attempt a VBAC, there is also a higher risk of the uterus rupturing if there is a tear along the scar line from a previous C-section.

The baby is also at higher risk for chronic medical conditions and diseases

• Breathing problems, especially for babies in future pregnancies 
• Childhood-onset diabetes 
• Allergies with cold-like symptoms
• Asthma

If it is not medically necessary, there is no need to put a mother and a baby at risk for these complications as well as extended hospital stays and a longer recovery period.

How can expecting parents navigate birth options?

While it is important to build a trusting relationship with the maternal healthcare provider, mothers should be wary of their intentions. The provider may be recommending the procedure to address a health concern. Although the provider is already legally required to share the risks and benefits of the procedure, make sure to also ask about the risks and benefits of an alternative vaginal birth. Another possible indicator of the provider’s intentions can be seen in the C-section rate of the hospital. You can check https://www.cesareanrates.org/ and https://www.leapfroggroup.org/ for information about your state’s C-section rates and the rates of many hospitals.

Feature Image: https://lafuk.tumblr.com/

Pregnancy is already a long journey, and the emergence of COVID-19 has brought along physical and mental burdens to mothers and mothers-to-be. Pregnant people are at a higher risk of contracting COVID-19 or experiencing more severe effects of lung and cardiovascular strain.  Worries about their health also affect pregnant peoples’  mental states and can further contribute to ill health. This stress is compounded by isolation as many people have had to deliver babies without loved ones around them due to current no visitor policies in hospitals. 

The Physical Impact of COVID-19 on Pregnancy

Although research on pregnancy is still far from complete, some trends have been observed.. Firstly, data suggests that pregnancy causes women’s bodies to be more susceptible to severe COVID-19. This is partially due to the coronavirus’ main points of attack being the respiratory and cardiovascular systems, both of which are already under additional stress during pregnancy. As the uterus expands, it presses against the lungs and therefore affects pulmonary function. The higher vulnerability to COVID-19 also stems from pregnancy altering the immune system. According to Dr. Akiko Iwasaki, an immunologist who studies at the Yale School of Medicine, a pregnant woman’s entire immune system is geared towards not creating any sort of anti-fetal immune response, so “the mother has to compromise her own immune defense in order to preserve the baby’s health.” 

In September of 2020, the Centers for Disease Control and Prevention (CDC) conducted a study on the birth outcomes of 598 pregnant women confirmed to have COVID-19. They found that pregnant women with COVID-19 were more likely (6 times more likely according to the Public Health Agency of Sweden) to be hospitalized and admitted to the Intensive Care Unit as opposed to their non-pregnant counterparts. Moreover, there was a slight increase in preterm deliveries. Another study found that pregnant women were 70% more likely to need ventilators. 

The Mental Effects of the Pandemic on Pregnant Women

In addition to the physical strain of pregnancy, there are several mental stressors on pregnant women during this pandemic. From worrying about their baby’s health  to their own wellbeing, people are spread thin juggling the physical and emotional labor of pregnancy.

Working as a medical assistant at a gynecologist’s office over this past year has given me personal insight to the perspectives of pregnant individuals during the COVID-19 pandemic. I heard many admissions of distress and anxiety, and the OB-GYN I worked under shared her fair share of saddening stories of what it is like in the operating room. Many hospitals have a limitation of one visitor per patient- meaning that some expecting mothers’ partners must be home to take care of their other children and that there is an absence of the usual flood of friends and family who would shower love upon the new mother and child. As a result of this policy, there are patients who must deliver on their own or with their loved ones through a phone screen. Additionally, the one visitor policy can lead to conflict of who the expecting mother would like as her companion during the delivery. This could be between their partner, a parent/parental figure, a doula (a trained professional who provides the mother with emotional, physical, and mental support before, throughout, and shortly following childbirth), a best friend, etc. Although this rule is extremely useful in the prevention of COVID-19 spread within the hospital, the loneliness and lack of support in labor and delivery are not insignificant issues. These problems and prolonged isolation from quarantining in general most definitely have a negative impact on the mental health of these mothers. Bringing life into this world is usually an event that is filled with lots of joy and loved ones, but the pandemic has transformed it to being a lonely and stressful experience. Studies have proven that after only 50 days of quarantine, pregnant people showed a pronounced “increase in depression, anxiety and negative affect” compared to the non-pregnant people. With a normal pregnancy lasting about 9 months, these emotions are further prolonged and amplified. 

During these trying times, it is important to do what we can in order to take care of ourselves but also to help the others around us, especially those at high risk. While this does include the elderly and those that are immunocompromised, a more subtle population that is still at high risk during this pandemic is pregnant people. It is extremely important that pregnant people take care of their bodies, as they are working to provide for themselves as well as another being. In order to stay physically healthy during the pandemic, pregnant people can follow the typical guidelines for pregnancy such as: eating nutritious meals, exercising regularly (staying at home or socially distanced is best), and getting plenty of rest and sleep. To maintain mental and emotional health during these times, it is essential for pregnant people to keep loved ones close (physically or virtually), as they can aid in the navigation of any anxiety, stress, or depression. Also, speaking to a provider about their mental health can be helpful for pregnant people. There are often support groups offered by hospitals, such as Chester County’s Hospital’s Mommy Wellness Network program. 

Helpful and links to resources that can be shared by non-pregnant people to aid the expecting mothers in their lives:

• FAQ about nutrition during pregnancy: https://www.acog.org/womens-health/faqs/nutrition-during-pregnancy
• FAQ about exercise during pregnancy: https://www.acog.org/womens-health/faqs/exercise-during-pregnancy

Featured Image: The Little Poster Shop