“Fat and anxious”

It probably wasn’t the greatest idea to read the searing Ockenden report (on maternity care at the Shrewsbury and Telford NHS Trust) whilst recovering from a gynae op myself. Reeling from the misogyny of my own experience there was so much evidence to point to the fact that I was not alone.

A year later I don’t remember much detail from the report, just the miserable stench of its accounts of patriarchal and hierarchical condescension towards women patients in their hour of need, sometimes with their newborn baby’s life hanging in the balance.  One comment, however, lingers in the memory: “Fat and very anxious”. 

A third or fourth degree in childbirth (a tear from the vagina to the anus) is legendarily painful. On p 132 of her report on the Shrewsbury and Telford NHS trust Ockenden highlights the following account: “In 2014 when a woman was reviewed in this clinic after a third degree tear the doctor wrote in the notes: “Well but fat and very anxious [my italics]. Can try for a vaginal birth, risk of re-occurrence low”. This has echoes of a 2022 Panorama interview with a woman with a fourth-degree birth tear who, when she alerted doctors to the fact that she was passing stools through her vagina, was initially dismissed as having a “bit of a fanny fart”. 

Fat and anxious. This also stopped me in my tracks because it mirrored my own hospital notes from last year saying that I was “concerned about going up a dress size”. This was a clinician’s description of my request (after being gaslighted for 7 weeks) for an urgent review after a catastrophic reaction to the insertion of a coil which had seen me go up from a size 12 to a size 20 in a matter of days. I reached out for help on ten occasions, on nine of these I was told it would all settle down. Only on one occasion, at A and E, was I taken seriously. Much was made on the other occasions of my anxiety. Wouldn’t anyone be racked with anxiety when a medical device had caused them to expand like a barrage balloon without explanation?

The Scottish Medicines agency says that 89% of women experience some kind of adverse reaction to one of the coils that are in common use. By adverse reaction they include major reactions like expulsion of the device (3%) and so-called minor reactions like acne, hair loss and loss of libido. Yet when I reported a severe reaction to a coil and was admitted as an emergency a staff nurse called me “a conundrum”.

The obstetric and gynaecological disasters of recent years illustrate not just a few hard luck stories but a devastating pattern. Ockenden alone has reviewed thousands of cases. The Cumberlege report on mesh surgery also highlights the belittling of women’s suffering “down there”. How many more times will women be gaslighted in some way for questioning their treatment?

The NHS must address misogyny and listen to women. In the obstetric context, at minimum women’s dignity, continence and future birth chances are at stake. At most their very lives and even the lives of their babies are on the line.

* Ruth Bright has been a councillor in Southwark and Parliamentary Candidate for Hampshire East

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5 Comments

  • Thanks for posting this. It really concerns me how often it is female doctors and nurses who exhibit misogyny, and not just male members of staff.

  • Graham Jeffs 13th Sep '23 - 3:38pm

    Hi Ruth. Yes, utterly appalling. Nothing I’m going to write detracts from that.

    But is ‘misogyny’ a too useful dustbin for this sort of thing?

    Our behaviour as a society seems either to worsen by the day or become more apparent. There has always been that 10% (?) of the population whose navel-gazing selfishness/ nastiness has been a national blight. My perception is that it is getting worse. There is an arrogance and indifference towards others that manifests in what you write about but is far from being an isolated example of simply horrible behaviour.

    There is a serious cultural issue within the NHS in respect of accepted behaviour, the way failings are not ruthlessly addressed – coupled with a propensity that people who complain should be sent to a therapist (and I speak from personal knowledge). Sandy refers to the failings of female staff towards female patients – and that can be extended to female colleagues.

    So, there is a mountain to climb at the NHS. But let’s not delude ourselves that it is unique in this regard. The cult of the “entitled” who think it’s OK to have no concern for others, who complain about everything under the sun but then won’t do anything to help because “it’s not my job” is in full flow.

    As a party we should not only be homing in on specifics but should also not be so reluctant to speak out about the overall need for human decency and the state of society.

  • I have respect for what you say Graham, however I think misogyny is the right term. The august reports I mention catalogue time and time again women’s own accounts of their own bodies not being trusted. In the UK it takes on average eight years for women to be diagnosed with endometriosis. I believe that myths about women’s pain thresholds and stubborn taboos about menstruation are part of this.

  • Ruth Bright 14th Sep '23 - 8:14am

    Large new survey reported today. 51% of women 16-40 say they were not taken seriously when they sought medical help with heavy periods.

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