skyglide Explore Beyond
‘Would love to see men push a watermelon out [of] their penises and be offered… sterile water as pain relief.’ ‘Mind-boggling advice from NICE – to use injections of sterile water for pain relief for labouring women.’ ‘Look, we know the placebo effect is a thing, but I suspect this wouldn’t have made it into the guideline to treat testicular torsion pain.’
The online responses to the news that NICE – the body that issues clinical guidance to NHS medical practitioners – has recommended sterile water injections as a treatment for back pain in labour was rapid and rageful. It was also not limited to individuals. The Obstetric Anaesthetists’ Association noted that the evidence base for the intervention was graded ‘poor’, save for one ‘vague’ piece of research.
‘Because it is cheap and unlikely to cause harm is an inadequate justification for a recommendation, especially as NICE does not recommend other non-pharmacological therapies such as acupuncture and hypnosis,’ read the organisation’s comments on the practice.
True, some people have said that they found the injections, which are administered in four regions of the lower back, to be helpful. Many, though, have interpreted NICE’s move as illuminating an issue saturated in hundreds of years’ worth of frustration. Namely, that mainstream medicine doesn’t take female pain as seriously as that of men.
Examples of this are coalescing. At the start of the month, one NHS trust’s maternity service was questioned after recommending that women in labour hold a comb in their palm as a pain distraction technique during labour.
Don’t be salty
Such instances thread into a wider picture of women being told to grit their teeth and deal. And the spike in this conversation is not limited to our island, either: The Retrievals podcast tells the story of women undergoing the egg retrieval process required for IVF at Yale Fertility Centre in the US; women who unknowingly had saline zipped into their veins rather than the opioid fentanyl. (A nurse, feeding an addiction, was syphoning the drug off and replacing it with salt water.)
In the series, multiple women tell of being made to feel hysterical when they cried out in agony as needles punctured their ovaries while they felt every slice and stab.
It’s not news that there is a chasm of knowledge when it comes to female health. Until the nineties, much biomedical research was conducted exclusively on male bodies (usually white). This was for a few reasons, including concerns about hormonal variations – the menstrual cycle; perimenopause – complicating findings.
And many people were dismayed to learn that the first study to use actual blood, as opposed to saline, to analyse the absorbency capacity of period products was only conducted this year.
There’s a library of existing thoughts about why we’re here. Things like how pain is feminised and normalised; how blood and gore is presented as a core part of the female experience, something to be endured not evaded; how our bodies are framed as a canvas for male sexual desire and tools for sustaining the next generation but not as conduits for our own pleasure and thriving.
What is endlessly fascinating to me is how this sticky, complicated mess makes women more likely to experiment with alternative health.
This truth has been shown in multiple analyses. An example: one big study found women were twice as likely to have visited a provider of complementary and alternative medicine, such as homoeopathy, acupuncture or hands-on healing, over the past 12 months.
Forced to the fringes
It’s a phenomenon that feels personal. I was recently told by a consultant gynaecologist that it’s extremely likely I have endometriosis.
This follows almost 20 years of asking various GPs for help with my gnarly period pain, the sort that’s left me incapable of anything but lying on my bed, trying to move breath into my diaphragm and Nurofen down my neck, and of being side-eyed by medical professionals when I suggested I might have the condition.
The treatments I was routinely offered were hormonal birth control (works for some, various forms haven’t for me) or super-strength pain relief, which makes me drowsy until I give myself over to sleep.
It means I’ve slotted together a bag of tricks for managing. Some have scientific evidence to support them, like magnesium for cramps. (The mineral is thought to be key for muscle functioning, therefore helping reduce pain when your uterine wall muscles contract. I’ve found it helps.) Some don’t. Reiki – a form of energy healing – is one such example. (I didn’t find it diluted the pain long-term, but it has blissed me out no end, something I’m happy to pay for.)
This, I think, isn’t inherently problematic. Big picture, my lens on therapies for which hard evidence is pending or which skews ‘woo’ is that so long as you’re not being financially exploited or lied to – ie. told that something is undoubtedly the solution to your suffering – then, crack on.
I’ve had electric and edifying and expansive experiences with much in these categories. That’s included ecstatic dance (try it, it’s great) and psychedelic therapy (though there’s much to consider before engaging with the nascent industry, see my previous reporting).
It’s when women feel that this is their only route to feeling understood and not having their pain dismissed that I have concerns.
Because while I’ve met reams of people working in alternative health who are sincere and truly desirous of helping people, so too are there are charlatans promising the world in return for significant amounts of cash. (Goop’s vaginal jade eggs, the subject of a 2018 lawsuit, come to mind).
Health for the few
Such services – not all, but many – are expensive. Acupuncture, to take one example, is often around the £60 mark for an hour, making weekly sessions out of the realm of financial possibility for most of the UK. Especially in the current climate.
Like with most things, it means that people with more cash can get access (one English survey found not just that women were more likely to access complementary and alternative medicine, but that this was especially pronounced for those in higher socio-economic brackets and those living in the south of the country.)
The creation of a two-tier system when it comes to taking control of your health, especially for women, is something I reported on recently. In the October issue of Women’s Health (on newsstands now) I spoke to many women using various cannabis-based medicines for endometriosis, migraine and chronic pain manifesting in myriad ways.
For many, it’s softened the sharp edges of their suffering. But, in lieu of the randomised controlled trials necessary for the UK’s regulatory bodies to licence cannabis for these conditions (among other hurdles, the whole thing is horribly complicated) they’re paying for it. Often at a premium.
This drug is something I’m currently exploring for my own period pain. I am fortunate enough to be able to afford to plug the gaps where mainstream medicine has failed to find a solution that fits. I can explore it as an option and drop it if I don’t see results, or if I fear it’s impacting me negatively, all under the supervision of a specialist, who, again, I’ll pay to see. Many others don’t have this option available to them. It’s an intense injustice.
As I see it, people should be able to choose whichever systems and modalities bring them relief – again with the caveat that they’re not being physically harmed, taken for a ride by tricksters or led down the ‘you can cure your [insert serious physical ailment] with the power of your imagination’ route. (That’s that sort of thinking that can lead some to consider abandoning evidence-based mainstream medical treatment for life-threatening illnesses).
But it should not be incumbent upon them to seek out expensive and scantily-evidenced treatments simply because the health system they pay into provides inadequate options.
If we believe access to healthcare should be free at the point of service (and, according to 2017 data, 90% of the public support the founding principles of the NHS) then evidence-backed, easy-to-access healthcare should be available to all who want it, regardless of how much money they have.
When our medical bodies are advocating for salty water injections as a method of handling pushing a baby out of your body, though? I fear such a muddle, in which women are grasping for something – anything – that might work, and often paying a premium for it, is likely to continue.
