- Hello, this is Jane Sanders. And let me thank you for joining us tonight for a feminist perspective. This weekly radio broadcast is sponsored by the Women's Resource and Career Planning Center which is a program and information services. The Dean of Women's Office two 20 Strong Hall. Located in the Women's Resource and Career Planning Centers is a large lending library, which contains vast amounts of information, news clippings, government documents, magazine articles, research studies, and books pertaining to the many aspects of the women's movement. The goal of this radio program is to provide a forum for women themselves to speak publicly and to help inform other women and men on issues of concern to them. We would like to invite you to come in and browse or take advantage of our resource center in two 20 Strong Hall. And to call us tonight to give your comments or questions on this program. Again, the number is eight six four four five three zero. Our topic tonight is "Women and their Bodies." We will be exploring the concept of self-help for and by women. We have a panel of three tonight. First of all, Sue Leminska, who works with human sexuality counseling and with self-help here at KU and is a pre-med student. We have Sharon Lee another pre-med student active with self-help and both of these women are involved with the women's coalition here. We have Dr.Evelyn Kendale who serves as the director of the maternal and child health commission of the state health department and has an appointment as associate clinical professor of human ecology at the University of Kansas Medical Center. I think the proper place to begin this evening is actually defining our topic for this and the audience who might not know. What exactly is self-help? - Well, I prefer to call it self-help because as far as I'm concerned it's an educational device for women to learn about their own bodies and about how to take care of their bodies so that if they have any problems they'll be able to get help, professional help part. - What do you do in a self-help group or a session? - Well, usually the way we've worked at in Lawrence is by sort of teaching modules, maybe four weeks in succession. And we begin by teaching basic reproductive anatomy and physiology, and talking to summer back I'm going to control the menstrual cycle and probably discussing birth control methods also. How they work, how effective they are, why one method might be more suitable for a person than another method. And then for the women you wanted to continue. We teach women how to visualize their own cervixes, how to do breast self-examination. And sometimes we go on with individual research in any area that people are particularly interested in like Sherine and I did some work around with the reproductive cycle of rats for our biology project this semester and worked it in some way. There were some classes too and learn how to do grad hysterectomy and things like that. - Is there any difference between self-help and just basic sex education? - Definitely. I think that with self-help, self-help people are learning more about their internal organs and especially that I think the cervical examination is the most important part of it, really because when people learn how to visualize their cervixes then they can find they can catch infections early. The first stages of gonorrhea and syphilis is an internal thing that if a woman didn't it, wasn't watching herself internally. It wouldn't show up for a long time. - Now, when you're talking about visualizing you're not talking about just imagining are you? - You're using a speculum and a mirror and a flashlight by reflecting a lot of the flat by upon starting the spectrum on gradually and then flashy then reflect your line off of a mirror. A woman can all by herself looking around cervix. - I think what we just heard as a definition of self health or self-help is really very constructive kind of thing that's happening because for years in practice and in some of the same kind of activities you all have been involved in sex education and abortion counseling and in pregnancy counseling and use of contraceptives. One of the biggest problems has been lack of real information and imparting information you're talking about is more than just facts because a whole range of attitudes are developed through that process. And these are really fine educational process in terms of protecting women and helping them to protect themselves. - I think a really important factor of the self-help process is that the woman is very much a participant in her own educational process. It isn't passively sitting in a classroom and seeing someone draw and a reason you have a reason to uterus on board she's helping educate herself. It would seem to me that a woman who would take the risk of getting up on the examination table in front of a group and exploring herself that this is a very great risk to see that a woman would already have achieved some level before she could do this. - Yeah, a lot of people are somewhat afraid to do it at first. And we know we never, of course require that anybody do it. We never pushed anybody into it and just adjust that when they feel that they're ready to do it, that will help them with that. But we usually find that once people do get up the nerve to try it, they're really excited about it. And then, you know, they're very glad that last they get a chance to look at whatever it is that the doctor has been looking at under a sheet for all these years. And they never knew what it was before. - Actually it's a really relaxed atmosphere too. And like Susan was saying during the first session we usually jump right into this cervical examination. So that women have a chance to kind of get to know each other a little bit. And we talk about sexuality. We're already talking about very intimate things. So that by the time the second baby comes when usually people are ready for it - I think this is not a lot different than what we found, you know years ago and the intentions of examination of the breast. It was an awkward situation for women, not many seem to feel that it was even though it was a nurse generally who would first introduce them to the technique and later the physician who would come in and help them to recognize their own geography. So to speak of the breast and the same thing as what is being attempted here. I think the concern that a lot none of us have had, has been for the groups in which diagnosis and self treatment are the result of visualizing the cervix. Because obviously 'cause the rest of the pelvis and the bimanual examination and the feeling of detection of the ovaries and size of uterus and the rest of that can't be determined by visualizing the cervix. But knowing what the healthy cervix looks like by darling, and certainly, you know, really one of the first preventive steps rather than waiting for one of the kinds of signs and symptoms that we've all been taught to look for which are really much too late when those are detected. But what is it that problems? What is it that you can see? What various changes? What various symptoms can be discovered through self-examination? - Well, probably the thing that women find most often is yeast infections which normally if you catch them early that they're not that serious. You can pretty easily take care of them. Like the doctors prescribed what is it like tell me what it's called? Anyway, there's a prescription that doctors can give you to take care of it real easily. And if a woman knows about it and catches it early enough. - And then there really needs to be a differential diagnosis because there are other vaginal infections that imitate yeast infection. And that's a really important part. Plus the fact that kind of real infection really doesn't cause any different look to yeast infection. And for one reason for so many years, we've been distressed by not determining a way to detect them. - Does it cause a different appearance than a normal cervix, a normal vagina? - Gonorrhea? - Yes. - Actually not. That's been the problem because Lilola Hamilton save them vagina very much like it normally happen to them now. Saying don't cause you any trouble until witnesses Lord or whatever. In the case of gonorrhea, that's means venereal contact and the secretions are already there. And the guna coax are very difficult to identify in the past. Now we have a new test for quick identification and can be detected by microscope, separate from the rest of the vaginal discharge, the real vaginal discharge. But otherwise, if a person has a discharge and has gonorrhea they probably won't be aware of twin reason. So often they nifty neurology and discovering gonorrhea has been so difficult for women. Whereas with men it's fairly obvious or it used to be because now we have a strange gonorrhea. - Silent gonorrhea. - Silent and needing some very particular kind of examination for the male that most probably will not go in for unless you're pretty sure you've been exposed. - I have read some things that indicate a woman can determine if she is pregnant or not by the appearance of the cervix. Is that a myth or a truth? - It's a shame that it's done so glibly and y'all might wanna join in on this because really the changes in the cervix don't occur. So that they're that noticeable, the increased vascularity and the change in color until probably eight and a half weeks, and lots of times when you read the description of self, how says you can detect yeast other kinds of vaginal infection and probably signs of pregnancy. And it really isn't quite that early. It would be a little late before we had the vascularity change. - I think the self-help groups are just exploring the changes in a normal cervix which hasn't been done very often before. I know of a woman who was part of a self-help group in Wichita, who's been taking excellent slide of services stage by stage throughout the monthly cycle and she's hoping to come up with changes that do occur through a regular cycle that people haven't really been aware of before because they just have pictures of abnormal cervixes and gynecological tests and things like that. So they're helping to discover things like that. I know that they can detect early pregnancy by changes in the cervix. I don't know as to what you know, whether they can verbally say that they can do it at this point in time or just trying to see what more we can find out. - I think everything that can be learned about the normal cervix means that you're gonna have a healthier individuals and so much of a women's diseases are concentrated in the cervix and vaginal canal. That primarily the cervix through the childbearing and various infections that we're talked about. And the other thing that concerns me and I'd like to ask both of you about it is we frequently hear my colleagues and in the future your colleagues who will indicate to a girl that a vaginal discharge is normal. She'll say I'm having a discharge and is dismissed with, well, it will go away or that's normal. Whereas a matter of fact, physiologically it isn't normal for a person to have a continuing vaginal discharge. And I think that's part of what could be introduced in self-help the knowledge of what kind of cervical injury day there might be so that when it increases or when it becomes changes in color or when it becomes bloody or whatever else, the individual knows that it's time to have something done. - That's one thing we try to teach as much as we can. You know, with the training that we have is to differentiate between what is a normal amount of discharge and what texture, what color of discharge is normal, whether it indicates an infection or some other type of disorder that should be checked out. - Also with the cervix, because the cervix, you can find sometimes the cervix will have what is called an erosion on it. And if a woman goes to the doctor and the doctor says, well, you have a cervical erosion, no one doesn't know who that is. It sounds horrible. But in reality, it may not be. She may need to get it treated, but it probably isn't as bad as it sounds. It's just a kind of a red spot on the cervix. - So we're also recommending that when women are examined they begin to ask questions about what is being said. And if nothing's being said, ask the doctor, you know what's going on. And I think it's certainly not inappropriate. And I hope we would begin to help women to recognize this when they are undergoing a normal pelvic examination or routine examination to ask the doctor to move the mirror where they can see-- - I have considered to ask that before. I taken away. - And let's talk about what we're seeing and feeling. It seems to me an informed patient a doctor should be very happy to have an informed patient. - Yeah, they gonna need much help, the patient. - You may have to pick a few doctors across the floor. - I agree with you idealistically but my next question was going to be Dr.Gendel? What is realistic about your colleagues? - Well, as a matter of fact there are quite a number of the obstetrician gynecologists as well as general practitioners who do a lot of gynecology. And who are already very sensitive too. And when I call, I've always been telling doctors as they examine you, they tell you what they're doing. And they ask if you would like to see your cervix. There's the same doctors who let you watch your own delivery. And there are a whole group like that, and always have been there are others who perhaps, maybe any majority but I don't think we've really done a pull nationwide yet. To say hmm hmm and I called there was none telling doctors they are, does not make them any less competent in what they do but at the same time they have a passive patient who needs to be able to say, say doc, you know, what's going on. And I think after awhile with enough of that kind of conditioning that realistically then. - Yes, well, I think that as the nonmedical member of this panel, I guess that's my position at this point. And I know that I would feel somewhat apprehensive if the doctor were examining me for bronchitis and would tell me the specific type of inflammation I had in the bronchial tubes. I would not know what to ask him. I'm not aware of the anatomy of my lungs that, well, just as I feel I'm not completely in control of my awareness, of my entire anatomy. I would feel I don't know what to ask? I don't know if he's giving me a line? How specific he's being? - I think in general, the specificity is all right, if a patient feels that what's being said is something that you know, you really don't understand, then that's when the next question comes. - What does this mean? - What does this mean? And I think most doctors who find that the patient really is interested, we'll go ahead and explain this in terms that are very easy to understand. There are some physicians who say the patient really doesn't want to know, and for some patients that's true. But for many, there are those who would like to ask but are afraid that when they do they'll understand what they're telling me, what kind of thing you just mentioned but I would hope that what we can do is help to train patients. And I must say this for men and women patients to ask questions about whatever examination is being done if they do have questions about it. - Well, I tell people pretty often that they should make up a list of any questions that they might have before they go in for the examination. And I have it right there so that if they lose their courage while they're in the examine room they have that to refer to. - And it's a shame to have to say to lose courage because I did something, it's interesting that our third year medical students, a couple of years ago said, that they M D A D does not necessarily make a physician. And that has hung over for a long time. It would be very nice if, although I'm sure physicians that we need to be in a sense of authority figures. It's inhibiting factor to the patient many times. And perhaps the patient does not learn as much as they might otherwise. So that some of that I hope is changing in training of medical students at this particular time. - Well, in the interest of education and information. What should happen in a ideal examination, a gynecological examination between a very responsive physician and an interested patient, what would be the procedure? - How about a patient who comes in, whose viewed her cervix and is determined that she thinks she has an infection. So she goes into the doctor's office and tells the physician that she thinks she has an infection, the physician checks, and yes, she does have an infection. And the physician lowers the mirror and removes the class and the woman, can participate in the physician's view of the cervix. And then the woman would then be told what the medication is being prescribed and works exactly how to use it and how it works. - And I said, you know, Ray, very sensible because it is a patient that has to apply medication. And she's often doing it quite blindly or with an inserter the same way that certain kinds of medications have been prescribed all along, how much better for the patient who knows where it's going and what it's going for. I think the same thing is true. And as I mentioned earlier, that male patients deserve the same kind of assistance just because they're a particular, in this case we're talking about genital organs are all out there should be seen everyday. Doesn't mean that all of them understand the, you know the total reproductive and sexual workings. So that a number of young men who joined the movement and the concept of questioning their own physicians about some of their own functions. - This leads me to another question. How did the emphasis of self-help happened to become centered on the female reproductive system? If indeed the issue is a political one and some of the literature indicates it's control of one's own body. All right, so I don't know the anatomy of my reproductive system, but I neither do I know the anatomy of my respiratory system. Why is the emphasis in it in one place? - I think Dr.Gendel put it out two minutes ago that women oftentimes, it's common to have infections, you know, in the vagina. And since she hasn't played out that man's reproductive genital is tracking ways on the outside and the women's is inside. I think that's probably the main reason why the emphasis is here. Also perhaps because the women's movement right now is more political than the men's movement. - Well, I would move it back, it's not from political per say but I think it's the nature of the examination and the fact that there are very few people who have are privy to examine the vagina. And so for this reason, between something very special for most women, and you will find many people who say, oh, I don't mind my gynecologist. And I really have to work out some kind of adjustment for themselves, a father figure or some kind of relationship that really isn't a person to person relationship. And that's probably what it really ought to be. And I think they, at least from the women that I've talked with who have really been active in the movement as you all have been. Primarily has been to say, look, I'm another human being. And just because this is my sexual anatomy which happens to be obscured from me, can I share anything about it? And will you help? And to be able to ask that without feeling intimidated or paternalized or whatever it is that so many women do. Don't feel inhibits, they're asking those kinds of questions and finding out more about that themselves. - I think that a major reason why the women's movement is zeroed on understanding of the reproductive organs is that a misunderstanding of the reproductive organs can vastly change a woman's life by an unwanted pregnancy. Politics is a very simple misunderstanding and that can change her with identity for some years to come. - The other thing is that women go regularly for much more regularly for examination because the kinds of lesions that would be, that would go on unseen or quite dangerous, we're talking about cancer of the cervix and uterus, so that they really are the consumers. They consume a lot more than the medical care system in relation to the genital tract. Part of it that really concerns me is that unless that out of the movement very constructive thing is what we're talking about here. On the other hand, there's some people who feel that it's very difficult to get into a medical care system and consequently they're gonna take care of themselves and we're back to the old, do it yourself care. Some of which could be very good much of which may not. And part of which can be quite dangerous when individuals send off for devices or whatever to use on themselves without this system and other people. And since I'm re interested in preventive aspects I hate to see us catch up with a crisis after it occurs. - I think it's really important for doctors to be sensitive to the self-help movement right now and to be zeroing in on the needs of women. Because if they don't, like you say, it can become a very dangerous thing. - The women will turn away and that's not constructive. If they turn away then the, and do their own thing separate from professional health. And I don't mean that it always has to be the physician or nurse clinicians and many care professionals and being developed to help work with the physician. But by moving completely away from this, then in a sense this doctor feels he does not have to take the responsibility. And consequently, the system won't change. The constructive part is the kind that does the educational type of thing in which you all are involved, which I've been involved and a number of other women in the state and elsewhere. - All right, we're going to pause now for a brief station break. I'd like to remind you that our telephone number is eight six four four five three zero. And we welcome your questions and your comments and now we pause for a brief station break. Goodevening. Our topic tonight is "Self-help Women's Bodies and themselves." Our guests are Sue Leminska and Sharon Lee students at KU in the pre-medical program who are active in human sexuality, counseling and self-help program here. And Dr.Evelyn Gendel whose with... Again let me remind you, our telephone number is eight six four four five three zero. And we welcome your questions. We've been exploring some of the aspects of self-help and we explored a little bit the political implications of it. Why do you think the self-help movement came about? It's fairly recent, as I understand in the feminist movement. And what reasons would you give for it's emergence at this time? - Carolina, it has been around as a primary movement, for Carolina and Los Angeles but as far as a nationwide movement it's been around for several years. And I think women finally started waking up and really vocalizing their desire for more education about themselves, why it was suppressed for so long I don't really know, except there's always been a subculture of women's swapping information about themselves in relation to the reproductive organs, whether or not it was accurate information or not, women pretty much have always taken care of their own needs when there wasn't professional medical health available, or when professional amount medical health wasn't meeting their needs for centuries, there have been midwives and there have been unfortunately, or fortunately amateur abortionists among women themselves where they've swapped methods that they thought were abortive against whether they were in fact or not. And just talks about it. - Of course, it goes back even further historically on the front of the moon. I mean, what Margaret Sanger, I suppose would be called one of the first people interested in the health of women when she saw what was occurring with multiple pregnancies and with no opportunity for a contraception and the long horn fight that she had to introduce this, a method respectably into the medical honoritarian which today of course is a perfectly accepted as part of medical treatment. And the same thing is true about the concern for rights on the one's own reproductive track is related to choices in pregnancy. As many of you certainly been involved in pregnancy counseling. - I think that one of the things that happened with Margaret Sanger, I said, when she was trying to get contraception advanced by the medical profession I remember a quote of one of the doctors that she talked to said he had no intention of letting women take care of their own reproduction because after all then he'd be putting himself out of work. - I think that this is a recurring theme in some of the literature I've been reading about self help. About the primarily male physician who assumes control and more and more people appear to be questioning his right to control. I read an article concerning a doctor in Southwest who conducted a test of the oral contraceptive pill by giving poor Mexican American women. Half of them, he gave just sugar pills and they assume they were taking an oral contraceptive and out of 76, 10 became pregnant. And this, I've heard things such as this tend to undermine a woman's confidence in her male physician. - Well, it isn't just, and I phrase this exactly but it's the way we have been trained in medicine rather than just the male physician. And it appears that way because there are more male physicians than there are females but it always has been to, in a sense be in control of what condition is on the other hand are you exploiting that control for quote scientific reasons is in the case of the placebo given to the Mexican American women that's pretty much playing around people's lives. And whether a female physician or a male physician would do this and the interest of science would be hard to sort out. But the matter of the fact isn't majority of the physicians are male, and this is a lot, you know to legitimize some other problems that women have. For instance, justly concept of menstruation as a disability. We've heard the profession has legitimize that when all of us know and most women know somewhere that is a normal physiological biological process, which in many cultures is a celebrated occasion and never considered a disability much last days off work, et cetera. And so I guess mainly women live up to the expectancy of this being a disabled period. And consequently we still have physicians who write excuses. So girls don't have to take gym or whatever which wouldn't occur to them. If they had a young man with a mild disability trying to get him some kind of physical activity is very important to the boys but part of our bodies, I think too is the excitement of using it. And I think women have been denied this opportunity. Number of barriers. - Nicholas Van Hoffman a liberal columnist for the Washington Post commented on this study with the Mexican American women and drew a conclusion a little bit different than yours. And I'd like for you to comment on Eddie, he was saying that the thing that distressed him about the study was that the doctor was trying to show that fertility was all in a woman's head rather than in her uterus. If she thought was she was protected she would not become pregnant. He was equating this with the idea that in many medical textbooks, menstrual pain is it's all part of being a high strong woman. It's all emotional labor pains are natural and women and overemphasize them answered and doctors are supposed to hold screaming women in disdain and Von Hoffman was taking the point of view that male physicians have been have not been taking women's physiology serious enough by attributing it all to their quote, overactive emotional structure. - I think that's, you know maybe one that maybe how the profession often reacts at the same time telling women that this is normal physiological process could have stopped a lot of that emotion. And that's what I meant by legitimizing. The fact that, that these pains occur rather than saying or rather than helping a woman to understand that it's a normal process where this could reduce. Some of the anxiety and some of the quotes psychological pain. - I think there's also another side to that coin and that is the physician who has a patient who's actually in distress with her periods may pass a lot of clots or something, and is in quite a bit of pain and writes her off as saying, you know it's in your head if this period is bothering you that much. That's another thing I think that Nicholas Von Hoffman mentioned was a study that some people had done asking physicians what they thought about periods where they thought periods were painful or not and also studying some of the medical texts and the way the attitude that the textbooks had about menstrual periods where that, you know, they weren't that painful. And so for the woman who does have some pain involved in it, sometimes she can go to the to a doctor who assumes that she's pretty much faking it. And so I think that both of these there's problems on both of these sides. And I think that one of the things that has to be done is that women have to understand that it is a natural process but I also think that the same way that doctors need to become sensitive to the patients until they understand that, you know some people do have pain involved with menstrual periods. - Well, this is what I try to do. 'Cause I think you're right there. Both of these sides have something to them. And again, it comes back to the consumer's knowledge. If your understanding is if an individual's understanding is that the menstrual period is a normal physiological process and should not cause discomfort. And as a matter of fact, the more active they are the less hurt they are to have difficulty. But that when there's difficulty, when there is pain it's enough to cause a day home from work, a day home from school or vomiting and they pass it off. Women do too and say, well, that's, you know what's supposed to happen. Or some physician says, well, you know that's the way it is. They really need to demand, should demand a full examination. And so it really happens on both sides that women expect that this is okay, this is what's supposed to happen so they don't seek care. And then when they do see care somebody tells them, well, you know, it's pretty normal. So forget it. And don't give them a full examination. And I won't mention the university, but I did have an opportunity to review 160 freshmen women records. And the, in the history, the menstrual history was what my daughter call hairy, you know, just terrific pain, disability, irregularity, et cetera, in the history. And then when it came to the physical exam when the physician had to write whether or not the historical elements were pursued, came to pelvic and not indicated. And, so we have a lot of educating of ourselves to get done. Which is a great reluctance on part of the medical profession to examine young women. - I think that also something that's kind of contributed to this is that since the women's movement has a lot of opponents, as well as proponents, some doctors have been determining that when women have problems with their menstrual periods or when women have problems with pregnancies, that they are rejecting their role as a woman. And I think that it's sort of a reactionary thing that's gotten worse since the women's movement has become more active. I myself had some runnings with some physicians on this basis, determining that the reason I had any kind of gynecological problems was because I was a women's liver. And therefore I was rejecting my womb. - I think I could quote Van Hoffman on this. This was something that I underlined in his article. He was discussing the concept of morning sickness which he says that more than three quarters of all pregnant women experienced morning sickness and some either a mild or severe form. He says there's good reason to suspect it is caused by a hormonal substance called estrogen. But in the medical literature, you can read that nausea in pregnancy quote may indicate resentment and bivalence and inadequacy in women, ill prepared for motherhood. - Yeah. I think that that's a really important part of healthcare services. Pretty much. I don't think that it's stressed pretty much in medical school. It's that attitude that physicians should be taking toward patients. A lot of times medical ethics and things are taught but the attitudes between the physicians and the patients isn't stressed that much. That leads me to something else. It seems like that so far we've kind of established on a golden mean as an ideal and informed woman and a responsive physician. How do we get either or both? What do we do now, here? - There are a number of things developing, I think. Of course, in our bodies ourselves there's really a checklist for a woman to determine the type of physician that she might wish to choose by finding out what tests he offers whether or not there's the opportunity to meet with a physician prior to examination period. So like there's an opportunity to discuss with him sort of eyeball to eyeball on what her feelings and perhaps presenting complaint may be or she may even be there for routine examination and will be able to say I'm one of the women who would like to have a kind of an examination in which we are all about what's going on with me and you helped me do this. And she become confident enough to do it. At least that's one part of what some of the self-help groups are doing. Developing a checklist, that a woman can really use. I hope we will develop it for all patients at the same time. I think we have to begin at the other end in medical education to learn ourselves both as teachers and working with students that this is a way of the world is gonna be, but it isn't gonna be easy. I agree with you. It's not gonna come tomorrow. - I would like to see self help launch more into public clinics instead of being just a function of as my university community and having educated university people. I think probably even more especially women who are having children who've had children need this type of education. So I really like to see self-help brought into free clinics in this area are public health connects as it is in other parts of the country. - Dr.Gendel, do you think that's feasible? - Yes, I think this is something that we're planning clinics have our pre good setting for this type of thing perhaps not during the evening of the clinic and patients are there for particular services but to offer group meetings with nurse commissions on alternate evening, when women come in and see the kinds of slides and have in a sense establishment, not just public health clinics but in other states planned parenthood clinics where they related to family planning but there's no reason why they shouldn't be related to total female health. And that this would be one part of what's offered in some physicians offices, as well as in clinic settings. A kind of educational program, a participatory education. And this is gonna require the instruction and a learning process for everybody concerned both the educator in this case, perhaps the physician, nurse, clinician, as well as the learner, the consumer. Well, we've explored the ideal a little bit. I'd like to push you a little bit and find out where your boundaries are. What is the extent of self-help? Some of the articles I've read, I was talking about a resurgence and the midwife and having communities of women who help one another deliver their babies at home. This to me seems like it might not be a practical extension, but at least a logical extension of the concept of self-help. Where do you draw the line? - Well, I think the midwife, we would require more training than just a four session self-help clinic. I think that for women with their years is in the normal position. Who do you see a physician or at least a paramedic who has a real knowledge of what's happening during the pregnancy? I don't, I think that probably a midwifery can be a part of the medical services. I think that sometimes though emergencies arise during birth which I think that there has to be a hospital assessable. So... - Well, many states do licensed nurse midwives? And part of that is to leave the shortage in hospital primarily. Some countries such as England, you don't see a physician unless you really have some kind of complication and you've delivered in a lovely nursing home rather than in a hospital with all the sterile trappings. And the physician is on call if he's needed. And it does have all of the necessary equipment for an emergency. But the setting among you is quite different. And the opportunity for rooming-in for husbands do present this kind of thing is part of a number of other medical cultures and has not been apart of the culture, the medical culture in the United States in recent years. - Although I think that there is a-- - But there is a movement back, I believe. - I think there is a midwife training school in Tennessee and there's quite a few around the country but unfortunately midwives aren't recognized legally in Canada, so we can't make use of them here yet. But I think there definitely is a movement toward more people are interested in becoming midwives and more people are interested in using the services of midwives, as opposed to just having an obstetrician there when they're delivered midwife can frequently work with a mother through her prenatal period, and being with her more of the time throughout labor and delivery, instead of just showing up at the time when delivery occurs and also see the mother afterwards and many rural and also urban inner city areas the midwife isn't a bad combination, obstetrician, social worker. I really think that midwives can have more of an important function in our society now. - The interesting part is how many men are going into nurse who are very sensitive to working with the patient. And on the other hand, if you've done home deliveries, I love the vintage that dip deliver the last of the home deliveries attorney hospital in New Orleans. And that's a pretty scary experience. It's fine, as you say when there's a normal delivery, but even with the patient who is not only having a normal delivery but maybe on her fifth or sixth the uterus can just decide to just stop at some point in time as I know you're aware and that kind of an emergency simply can not be handled either in the country, if you were doing a rural practice without unless you have all the equipment with you and have blood on hand, et cetera. And so consequently, that's been the move into bringing patients into the hospital. I brought all of my rural patients into the hospital to be delivered simply because so many of them had had more than one baby and more pregnancies and more accurately have complications. And generally, also, this is true in the first pregnancy. So it's really for the protection of the mother but it doesn't have to also be all that sterile and all that institutionalized as it has become that goes right along with women demanding and asking to be part of this marvelous process and be wink. I don't know how many of my own colleagues women I've asked, you know, what was your delivery like? Never remember because they were sound asleep and that period hopefully has diminished but we use less anesthesia, but the self prepared or prepared children certainly could be aided by a midwife who would have more time. - Hmm. Okay, it sounds as if we have agreement at that extreme let's move it back a little bit to a procedure that is attacking a lot of attention at least in the popular press at this point, than menstrual extraction which is, correct me if I'm wrong in the technical details. Basically it says sectioning out of the contents of a woman's uterus, if up until the point 10 where her menstrual period would be 10 days late so that the contents of the uterus, whatever they might be a beginning pregnancy or just a delayed menstrual period the contents are sectioned out. This menstrual extraction has been described as a fairly simple procedure physicians across the country are beginning to perform it in their offices. And some of the self-help groups are doing this also. What's your feeling on this? Is this too extreme for the concept of self-help or is it a very viable part of it? - Well, I think that with the proper training and I wanna stress that the paraprofessionals can do menstrual extractions but I also feel that the medical profession is finally becoming partially sensitive to this area. And they're finally opening up a little bit. And I think that it should be something that like, Dr.Gendel said earlier, the medical profession keeps their doors close to women areas such as this and women will do it themselves. And I think that for women to be able to get a kit and to do an extraction on herself with no training, with no one with her is dangerous. So I feel like that at this point, I'm really hoping that more doctors are gonna start doing this and that the price goes down. I think it's... It's such a simple procedure. It doesn't need to be as expensive as it is now here in Lawrence, in Kansas City. But I do think that it's dangerous for women to try that on themselves when they've had no training. - Even if it weren't dangerous because you'll see several articles. Those are pros, those that are cons about whether or not the soft tip of a common, can a looking girl, penetrate through a uterus or even cause infection. Both of which have already happened so that it can occur even with the best of training. The real concern is that just by doing menstrual extraction because the period is late, there are two of the several other things that are necessary. The patient may have other pelvic pathology and you weren't gonna find that by just doing a menstrual extraction. A late period can be due to a lot of different things. Primarily a late period in the person who's ordinarily regular and who's been exposed to pregnancy obviously is pregnancy. So evacuating the uterus within 10 days is an excellent concept. But at the same time, the entire pelvis needs an examination because it may be some ovarian problems and maybe an ovarian cyst. That can be anything else that may have caused this delayed period. And with the tendency not to examine the contents and send them to a pathologist the opportunity to miss a moral or a tumor growth is another part of the danger. Plus it's such a poor health education experience because it's, you know, it's why taking a drop of blood and only doing one test on that drop of blood. When you could do 30 on the same drop of blood in a patient that much more information. You're simply doing a menstrual extraction and hoping that that's the problem. And then it is a pregnancy and perhaps missing for other things. The patient not having the opportunity to know that a full pelvic could be done at the same time and shouldn't be done. I don't think anyone does menstrual extraction in their office or in the hospital without complete thought again, pap smears. - Please tell the doctors that I refer people to... - All right, well, to sum up then, what can we conclude are the basic benefits of the self-help movement at this time in America? - Well, for one thing, I think that improving the quality of health of the women who participate in it because of increased awareness of their own bodies of changes in their bodies. Things that indicate health and things that indicate illness or disease. I think it's making more educated consumers that of women and therefore keeping the medical profession on its toes more and more. And may be changing some medical practices like lowering the cost of abortion so that women don't have to resort to performing abortions on themselves because they can't afford to go to a doctor. What else can you think of? - I agree, I just think that the general awareness, the level of awareness is going up. I think that's the most important part of the self-help movement is to sort of aid that upward motion of the awareness. - I'm encouraged by the same thing. I tend to feel a little bit, my dentist does. It's going to be be awhile before this becomes universal. And consequently, those of us in the profession who are already working in medicine ought to be providing more opportunities for physicians to get together to discuss this problem together and what they're going to do about it. There is a group called the Institute for the Advancement of the Study of Humanities and Obstetrics and Gynecology, having 15 gynecologists who recently met to have other people look at the profession through nonrose colored glasses. And some of us were privileged to participate in that kind of a conference, perhaps more like that. Well, increase that awareness. - I would like to thank our guest Sue Leminska, Sharon Lee and Evelyn Gendel for tonight's very informative discussion on self-help. I like to invite all of you to listen again next week when our topic will be divorce and the program is a feminist perspective.