Privacy, disclosure and past medical records

February 23, 2007 8:50 PM

Is there any medical reason to disclose a past abortion (uncomplicated, several years ago, at 8 weeks) to my new OB-Gyn, who will (hopefully) be ushering me through a successful pregnancy and birth? There is no existing medical record that I know of, since the procedure was done at a clinic in another state, and wasn't claimed on insurance, because I didn't have any at the time.
posted by anonymous to health & fitness (18 comments total)

It is pretty much always best for physicians to have a complete medical history. It may well be nothing, but is that a chance you're willing to take with your health, and that of your child? What you tell your doctor is privileged.
posted by dirtynumbangelboy at 8:58 PM on February 23, 2007

IANAD (and I'm male, but a parent), but, unless you had the abortion for medical reasons or there were complications of some sort, I can't think of any reason why it would matter.

I wish you'd mentioned why you don't want to tell your new OB/Gyn this. If you don't feel comfortable being open and honest with your doctor, and especially an OB/Gyn, I would think you might be better served finding a different doctor.
posted by cerebus19 at 9:00 PM on February 23, 2007

I'm the type of person who thinks there should be no secrets or surprises between a doctor and a patient. For one thing, I'd want my doc to be as open and honest with me as possible, and I therefore feel it's important to extend the same courtesy to him/her.
posted by Brittanie at 9:05 PM on February 23, 2007

The only issue I can see is if you have a negative blood type and didn't get the Rho-gam shot. More info here. Or if you had any complications.

If you tell your doctor, it will be noted on your record.
posted by frecklefaerie at 9:23 PM on February 23, 2007

You could tell your doctor about it and ask that it not be entered into your record, if that would ease your concerns.
posted by yohko at 9:33 PM on February 23, 2007

I went to a new GP a while back. She was friendly and we chatted for a little bit but when we were covering my medical history and I told her that I had previously had two terminations her demeanor changed. Even though she was clearly trying to hide it, I couldn't shake the feeling that I was being judged. I do not feel that my quality of care was affected, but that doesn't change how shitty I felt sitting in that room in a backless gown reliving the horrible feelings of shame and grief.

That is, I suspect, the reason most women do not want to mention it to their doctor. On the flip side, when I told my new gynecologist about my abortions she was warm and compassionate without being condescending or judgemental and it was such a great thing, she set the benchmark for bedside manner for me. I feel much more at ease with her and I think that is what elevates her from a good doctor to a great doctor.

I will continue to tell any new doctors if they ask, but it is as much to see their reaction as it is for my medical records. Certainly if I was going to a doctor that was ushering me through a pregnancy I would want to know that I could disclose my past without feeling guilty or ashamed. I think the key distinction is whether you feel uncomfortable mentioning it to any doctors or just this particular doctor.
posted by deadlypenguin at 10:01 PM on February 23, 2007

I am not a doctor, but I have had four abortions and two children. I am told that, yes, it is relevant medical history: the cervix can be affected by abortion, potentially causing problems in carrying (it won't stay shut) or giving birth (it won't open evenly). I am told that scarring of the uterus is also possible, which would make it harder to get pregnant.

But I am not a doctor. Your doctor is, though. It is sometimes a hard thing to talk about, I grant you, but it just isn't "none of his business." It's definitely his business to help you bear this child, so you want to tell him.

If there's someone else who doesn't know -- your husband perhaps? -- you want to tell him also, even if that is hard, especially if that is hard. When you are pregnant, all sorts of weird emotions get jarred loose -- you may well find yourself grieving for the baby that might have been. Anne Sexton's Abortion poem really did a number on me when I happened upon it while pregnant. It might help you to come to terms with your own feelings about your abortion to read it. (But maybe make sure you're alone and free to react... however. Yeah.)
posted by Methylviolet at 10:30 PM on February 23, 2007

I think the only person that can tell you whether or not it's relevant medical history is your doctor. Catch-22, I know.

So on the "tell your doctor" side, we have the possibility that your doctor might in fact need to know for good medical reasons that will improve the chances of a successful pregnancy and birth. And on the "don't tell your doctor" side, we have, well, no good reason that I can think of.

It's not an easy thing to talk about, not at all, but honesty is always the best approach. Good luck.
posted by finding.perdita at 4:39 AM on February 24, 2007

And on the "don't tell your doctor" side, we have, well, no good reason that I can think of.

finding.perdita, meet deadlypenguin:

when we were covering my medical history and I told her that I had previously had two terminations her demeanor changed. Even though she was clearly trying to hide it, I couldn't shake the feeling that I was being judged. I do not feel that my quality of care was affected, but that doesn't change how shitty I felt sitting in that room in a backless gown reliving the horrible feelings of shame and grief.

You may not think "reliving the horrible feelings of shame and grief" is a good reason, but I can certainly imagine its bothering me.
posted by languagehat at 6:39 AM on February 24, 2007

It is pretty much always best for physicians to have a complete medical history. It may well be nothing, but is that a chance you're willing to take with your health, and that of your child?
posted by dirtynumbangelboy at 10:58 PM CST on February 23

You may not think "reliving the horrible feelings of shame and grief" is a good reason, but I can certainly imagine its bothering me.
posted by languagehat at 8:39 AM CST on February 24

Two very compelling reasons on both sides, but really -- your physical health and the health of your baby far outweigh your feelings. Even if your doctor turns out to be a silently judging jerk-off.
posted by puritycontrol at 6:55 AM on February 24, 2007

I think you should tell your doctor. As a doctor, I am hearing everything my patient tells me, and I am integrating the information and making correlations and decisions at a rate that I am sure my average patient would find unlikely, if not incomprehensible. When my patients withhold information, at best my job is made more complicated; at worst, it causes me to make a wrong recommendation or a wrong decision.

I try to leave moral judgments out of my examining room, because I don't think they're appropriate there. Most doctors do the same. I've known a few OBs who didn't perform abortions because of their personal values, but I've never yet met one who would not hear a complete, true patient history because of their personal values, and I'd like to think that there aren't any docs like that.
posted by ikkyu2 at 8:29 AM on February 24, 2007 [1 favorite]

I think the most frequent reason that people don't share obstetrical histories with their doctors is that they are worried that somehow the information might make it's way back to their current partner. But, it is usually clearly documented on the chart if the partner does not know. This sort of thing happens all the time and OBs are pretty well trained not to pursue the nitty-gritty of your past in the presence of your partner.

The most compelling reason to disclose your history to your MD is the blood type mentioned by freckle. If your blood type is negative, and you did not get a Rhogam shot at abortion, then there is risk to your fetus. Routine early pregnancy bloodwork alerts your doctor to this issue anyway, which would cause him/her to watch your pregnancy more carefully. In the meantime you could probably check your bloodtype yourself, or simply ask your MD.

The risk of infertility following a single D&C is very low, but possible. If you have problems getting pregnant, then there is significant value in knowing that you have successfully created a pregnancy in the past.

It is also worth remembering that a D&C is not synonymous with a therapeutic abortion. Many (many) people have had the procedure for varying reasons.

In the end, with the exception noted above, a history of a D&C rarely effects the management of pregnancy, labour, or delivery. In some circumstances, it may help explain complications, but usually this does not effect their management.

Good luck.
posted by commissioner12 at 8:40 AM on February 24, 2007

There are reasons. For example. And you'll be messing with their terminology...

You might run into problems if you hide it; if you see any other practitioner during your pregnancy, "Have you ever been pregnant before?" is invariably the first question. If you run into complications, and it comes out, you'll have ruined what might've been a good relationship with the ob/gyn.

If your doctor does turn out to be a 'judging jerk-off,' it might be a good excuse to ditch her and go look for a midwife. (Caveat: I'm pregnant myself, and have some biases.)
posted by kmennie at 8:59 AM on February 24, 2007

your physical health and the health of your baby far outweigh your feelings.

I don't disagree. I was taking issue with the ridiculous overstatement that there is "no good reason that I can think of" not to tell, which implies the poster is an idiot. One can make one's case without that kind of thing.
posted by languagehat at 9:00 AM on February 24, 2007

...when we were covering my medical history and I told her that I had previously had two terminations her demeanor changed. Even though she was clearly trying to hide it, I couldn't shake the feeling that I was being judged. I do not feel that my quality of care was affected, but that doesn't change how shitty I felt sitting in that room in a backless gown reliving the horrible feelings of shame and grief...

As mentioned above there are valid medical reasons for disclosing this information, but I think the above quote is also an argument for being upfront with your history. I work with the local Planned Parenthood in an advisory capacity and I can assure you that many, many women have had an abortion and physicians should be comfortable dealing with that. If your physician is judgemental about your history, then perhaps you should find someone else. Other questions may come up in the future and you would want a physician who shares your views on these things. The best way to find out is to be honest and watch their reaction. I hope you will find they aren't bothered, but if they are, you still have time to find someone who is more suited for you in what could be an intimate, long-term relationship (there are certainly many women out there who keep their OB-GYN longer than their husbands).
posted by TedW at 11:52 AM on February 24, 2007

I wanted to share my experience so that the other posters could understand why one might be reluctant to disclose this information, but like I said in my post, I will continue to disclose it to my doctors and urge you to do the same.

That said, there are some seriously tasteless doctors out there and some women do not have access to more than one doctor, so sometimes the answer isn't as easy as "find another doc."
posted by deadlypenguin at 2:30 PM on February 24, 2007

Let's see, how many other women would fail to disclose this? -- thousands and thousands. That is the situation in which OBs work. If you don't want to tell, you will just be one of the many where your OB doesn't know every twist of their history. So?

In the next 5/16/25/50 years you are going to take lots of decisions about your child that go against what looks best on paper or to people who don't have to get up close and personal with the side-effects. Weigh up how this one balances out to you, and go with your choice.
posted by Idcoytco at 1:36 AM on February 25, 2007

I would disclose it for two reasons.

First, because it's relevant medical history, as others have noted, and you want your doctor to be able to help you as best s/he can.

Second, even if you don't disclose it to your OB now, it may come up before your child arrives. A friend of mine had an abortion in college. Many years later, she was in labor (second pregnacy, first birth) being admitted to the hospital. The admitting nurse asked if it was her first pregnancy, and she had to tell them it wasn't. It wasn't the way she wanted her mom, who was with her, to find out about the abortion.

Abortion is legal in the United States. You have nothing to be ashamed of.
posted by stonefruit at 1:53 PM on March 6, 2007