While I was a medical student, I rotated at the local regional government hospital for a total of 15 days. Though I was there for only a short period of time, I came to the conclusion that there is no need for any further legislation (i.e. the Reproductive Health Bill) regarding the use of contraception or sterilization. The mechanism is already in place right at this level.

As soon as an indigent patient is brought to the delivery room,and subsequently advised to undergo a second caesarian section (or succeeding thereof), one is immediately advised to have a bilateral tubal ligation as well and then wife and husband are asked to sign a consent form. I observed this to be the standard operating procedure. No further explanations are made to help the patient in labor pains to come to an informed decision. I guess the few staff around were too busy attending to more patients coming in that giving said patient all the information she needs such as explanations of what to expect, pros and cons, including possible side effects (i.e. ectopic pregnancies in the blocked fallopian tube) would take too much of their time.

I was completely appalled when one mother about to have a third caesarian section was berated and bad-mouthed by resident physicians, nurses and midwives for deciding not to have a bilateral tubal ligation at the same time, what is known as C/S + BTL in medical parlance. The said patient was already crying (from the emotional barrage and the pains of labor) but firmly stuck to her decision. The husband was also unwilling to sign the consent. I decided to whisper to her to be strong and stick to her choice. The residents gave as reason that there are usually a lot of adhesions (Aren’t there surgical SOP’s done to prevent this from happening?) and when the next caesarian section is done, the procedure becomes technically difficult. A good enough argument, yet are not doctors supposed to honor the patient’s decision (without coercing her to change it by emotional abuse) and render their expertise with competence? If the uterus thus becomes so scarred after having been cut open several times as to render it diseased, hysterectomy thus may be performed without violating the bioethical principle of bodily integrity. I know of several persons who have had multiple caesarian sections (one had at least 7) and may have had difficult deliveries but mother and children come out fine, thanks to medical advances and the proficiency of attending OB-GYNE’s.

My personal experience with conscientious objection to assisting the OB-GYNE resident in performing a bilateral tubal ligation after doing a caesarian section was met with rolling of eyeballs and snide remarks in the operating room. In other circumstances, it might also mean a few more days rotation within that department (serving an extension, as we call it) or other such sanctions. With the passage of this bill, I pity the young aspiring doctors who want to be consistent with their faith and ethics who would now be faced with large fines and/or imprisonment for such actions.

At the out-patient services department, mothers who have at least two children are at once instructed on the different methods they can avail of during their first post-natal check-up. There is bias for artificial contraceptives, of course as all manufactured products have shelf lives and need to be disposed of as soon as possible (not a few of these contraceptive devices are surpluses from elsewhere). Anyway, in medical school there is little mention of natural family planning (NFP) which is always mentioned while dismissing it as “highly unreliable”. I wish they also gave us time to learn how to teach these methods to couples as part of our medical curriculum, in the same manner that they teach us to write prescriptions for artificial chemical contraceptives or show us how to insert IUD’s in medical school. In that way, there would be absolutely no bias for those wanting to go in this specialized field of medicine to just write down a prescription rather than take time to explain a method.

It also seems that government hospitals may also have a certain quota for sterilization procedures as one friend of mine noted that during an endorsement, the chairperson of the department of obstetrics and gynecology queried her residents regarding the fact that their census for said procedures had gone down for the month. They did not know that it was thanks to the way my friend tactfully and slowly explained to the mothers in the delivery room NFP and the value of openness to welcome another life even in the midst of poverty: Not another mouth to feed but two more hands to help.


Note: I initially wrote this as a letter to the editor (It was never published.) I think I then posted it I Oppose the RH Bill facebook group discussion forum. It was eventually placed in 100% Katolikong Pinoy facebook community page (using just my initials) without my knowledge. I eventually acknowledged it as my post and I now wish to post it here in my personal blog as well. 

Let me add some of my impressions in the midst of the big issue on the RH Bill...
While I was a medical student five years ago, I rotated at the local regional government hospital for a total of 15 days. Though I was there for only a short period of time, I came to the conclusion that there is no need for any further legislation (i.e. the Reproductive Health Bill) regarding the use of contraception or sterilization. The mechanism is already in place right at this level. 
As soon as an indigent patient is brought to the delivery room,and subsequently advised to undergo a second caesarian section (or succeeding thereof), one is immediately advised to have a bilateral tubal ligation as well and then wife and husband are asked to sign a consent form. I observed this to be the standard operating procedure. No further explanations are made to help the patient in labor pains to come to an informed decision. I guess the few staff around were too busy attending to more patients coming in that giving said patient all the information she needs such as explanations of what to expect, pros and cons, including possible side effects (i.e. ectopic pregnancies in the blocked fallopian tube) would take too much of their time.
I was completely appalled when one mother about to have a third caesarian section was berated and bad-mouthed by resident physicians, nurses and midwives for deciding not to have a bilateral tubal ligation at the same time, what is known as C/S + BTL in medical parlance. The said patient was already crying (from the emotional barrage and the pains of labor) but firmly stuck to her decision. The husband was also unwilling to sign the consent. I decided to whisper to her to be strong and stick to her choice. The residents gave as reason that there are usually a lot of adhesions (Aren't there surgical SOP's done to prevent this from happening?) and when the the next caesarian section is done, the procedure becomes technically difficult. A good enough argument, yet are not doctors supposed to honor the patient's decision (without coercing her to change it by emotional abuse) and render their expertise with competence? If the uterus thus becomes so scarred after having been cut open several times as to render it diseased, hysterectomy thus may be performed without violating the bioethical principle of bodily integrity. I know of several persons who have had multiple caesarian sections (one had at least 7) and may have had difficult deliveries but mother and children come out fine, thanks to medical advances and the proficiency of attending OB-GYNE's.
My personal experience with conscientious objection to assisting the OB-GYNE resident in performing a bilateral tubal ligation after doing a caesarian section was met with rolling of eyeballs and snide remarks in the operating room. In other circumstances, it might also mean a few more days rotation within that department (serving an extension, as we call it) or other such sanctions. With the passage of this bill, I pity the young aspiring doctors who want to be consistent with their faith and ethics who would now be faced with large fines and/or imprisonment for such actions. 
At the out-patient services department, mothers who have at least two children are at once instructed on the different methods they can avail of during their first post-natal check-up. There is bias for artificial contraceptives, of course as all manufactured products have shelf lives and need to be disposed of as soon as possible (not a few of these contraceptive devices are surpluses from elsewhere). Anyway, in medical school there is little mention of natural family planning (NFP) which is always mentioned while dismissing it as "highly unreliable". I wish they also gave us time to learn how to teach these methods to couples as part of our medical curriculum, in the same manner that they teach us to write prescriptions for artificial chemical contraceptives or show us how to insert IUD's in medical school. In that way, there would be absolutely no bias for those wanting to go in this specialized field of medicine to just write down a prescription rather than take time to explain a method.
It also seems that government hospitals may also have a certain quota for sterilization procedures as one friend of mine noted that during an endorsement, the chairperson of the department of obstetrics and gynecology queried her residents regarding the fact that their census for said procedures had gone down for the month. They did not know that it was thanks to the way my friend tactfully and slowly explained to the mothers in the delivery room NFP and the value of openness to welcome another life even in the midst of poverty: Not another mouth to feed but two more hands to help.
As you may have well guessed, I am totally pro-life and uncompromising with regards to my Catholic Faith.

To Doctors and Nurses

Likewise we hold in the highest esteem those doctors and members of the nursing profession who, in the exercise of their calling, endeavor to fulfill the demands of their Christian vocation before any merely human interest. Let them therefore continue constant in their resolution always to support those lines of action which accord with faith and with right reason. And let them strive to win agreement and support for these policies among their professional colleagues. Moreover, they should regard it as an essential part of their skill to make themselves fully proficient in this difficult field of medical knowledge. For then, when married couples ask for their advice, they may be in a position to give them right counsel and to point them in the proper direction. Married couples have a right to expect this much from them.