When We Close Our Wombs

“The Visitation,” 15th century, Heimsuchung von Maria und Elisabeth. Taken from unbornwordoftheday.files.wordpress.com

The biological nature of each person is untouchable in the sense that it is constitutive of the personal identity of the individual throughout the whole course of his history. Each human person, in his absolutely unique singularity, is constituted not only by his spirit, but by his body as well. Thus, in the body and through the body, one touches the person himself in his concrete reality. To respect the dignity of man, consequently, amounts to safeguarding this identity of the man as “one in body and soul,” as Vatican Council II says. — St. John Paul II

I have a dear friend in Lafayette, Louisiana, Dr. Damon Cudihy, who is a radical witness of the lay vocation lived out under the form of husband, father and Ob/Gyn. He demonstrates daily how the synthesis of faith and life is not only possible but beautiful to behold, though its beauty has, for him, only been wrought by a steady dose of costly grace. I admire his kindness, his work ethic, his brilliant mind, his even-handedness and his joyful love of Christ, the Church and the people who cross his path every day. You can see more about his work here.

My main reason for referring to Dr. Cudihy today is to bring to your attention his recent response to an article by a theologically degreed Protestant Christian, Suzanne Burden, called, When We Close Our Wombs (see here). Her main point is summed up in the article’s final paragraph:

…most women will face many choices regarding their reproductive system in their lifetime, and many will face a decision about whether to end their fertility for health or personal reasons. Whatever choices we make, we should do so with reverence, care and the support of spiritual companions. As we do, we agree that our reproductive systems are a good gift from God. And we affirm that decisions about them should be filled with intention, care and the Christian hope that God will continue to bear his good fruit in us whether our wombs are open or closed.

When I read it, I wrote Damon and said, “Would you comment on this?” He graciously did and, though his comment has not yet (as I write this post) been approved for viewing on the “her-meneutics” website where the article first appeared, I thought I would post it here for your edification.

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Dear Suzanne,

My heart goes out to you as it does to all my patients who suffer with infertility and the heart wrenching decisions to undergo procedures which result in their permanent sterility.  As a gynecologist who has dedicated his professional life to addressing the problems of female infertility, painful periods, and heavy menstrual bleeding, and as a fellow Christian, I’d like to offer a unique perspective for both you and your readers.

The symptoms of infertility and pelvic pain (menstrual-associated or otherwise) are the most common symptoms of endometriosis.  Despite the fact that this condition is typically treated with birth control pills, the best treatment for the pain and the only treatment that restores (or preserves) fertility is surgical removal of the endometriosis.  Unfortunately, however, in the age of using birth control pills as a cure all and of IVF as the answer to infertility, fewer and fewer physicians are able to provide a more specific diagnosis and treatment plan that actually corrects the abnormality.

Your situation sounds very similar to many patients I’ve treated over the years.  More specifically, the combination of tubal sterilization and endometrial ablation.  Since I don’t perform either of these procedures, they became my patients when they experienced a fairly common condition resulting from this combination known as “Post-ablation tubal sterilization syndrome (PATSS).”  This condition of intense menstrual pain results of blood becoming trapped in the tubes because of the sterilization occlusion on one end and the scarring of the uterus (caused by the ablation) on the other.  The best treatment for these situations is usually a hysterectomy (often, in retrospect, would have been the best treatment to begin with).

One of the medical principles I strive to follow is that of “first, do no harm.” Accordingly, when surgery is necessary, I do everything possible to do so in as minimally invasive a manner as possible. (Fortunately, modern surgical technology has allowed the once morbid hysterectomy to become one where the recovery period is much quicker and less painful.)  Because fertility is a healthy condition, I would be causing unnecessary harm to a woman’s body if I were to perform a direct sterilization.  By direct, I mean a procedure where the sole purpose is destroy her capacity to conceive children.  When I perform a hysterectomy for a genuine problem (i.e. intense pain, excessive bleeding, etc), the sterility that results is indirect—one that we accept as an unavoidable (yet accepted) consequence to the best treatment for her medical problem (diseased uterus, etc).  If a woman is in a situation where a future pregnancy in unadvisable for whatever reason, there are much better ways to avoid pregnancy that maintain a more complete respect for the woman’s body as created in the image of God.  For married women, this simply entails learning one of the various methods of Fertility Awareness (often derisively called the “rhythm method” by those unfamiliar with its actual effectiveness).  Among all creation, only humans have been granted free will.  Regarding sexual intimacy, this is why mutual consent is universally recognized as absolutely essential–even among atheists.  Using a Fertility Awareness Method to avoid pregnancy is as simple as learning to identify the fertile days in a woman’s cycle and avoiding marital intercourse on those days.  While at first this may sound like an excessively scrupulous method to obtain the same end, if we thoughtfully and prayerfully reflect on it further we can see why this is the best way.

Sadly, a contraceptive mentality has contributed to our increasingly hedonistic society.  When we fail to recognize children as the supreme gift of marriage, we see them instead as inconveniences, burdens, health hazards, or even enemies to be avoided at all costs.  No wonder then that our federal government has now codified law that literally regards fertility as a disease—one that all insurances must pay to cure. (On the contrary, the legitimate problem of infertility is never covered by insurance.)  Since we are a people following the one who is “the Way, the Truth and the Life” (John 14:6), we must be careful that our actions always reflect a reverence for our “bodies as temples of the Holy Spirit.” (1 Cor 6:19).  In doing so we give witness to God’s plan for marriage and the essential good of children—even when, paradoxically, we suffer the cross of infertility.  Since we believe that God designed our bodies and commands us to “be fertile and multiply,” we should joyfully accept children as a gift from the Most High and should be careful that any means used to avoid or postpone new life is completely respectful of our bodily integrity and the truth that openness to children is an essential purpose of marriage.

In Christ,

Damon Cudihy, MD

4 comments on “When We Close Our Wombs

  1. Jennifer says:

    Oh how I wish I had this wisdom when I needed it! I have had four children delivered by C-section and while I was not practicing Catholicism at the time of the youngest’s birth (though still actively Christian) I did know the Church was against sterilization…though I did not understand why. I take responsibility for my lack of research into the richness of the Church’s teaching on this. I lazily and wrongly assumed it was all about popupation size. I was advised by my ob/gyn at the time of my first C-section that I should probably not have more than four surgical deliveries. Flash forward to the time of my fourth delivery and we automatically went aling with having a tubal ligation at the time of the c-section. My husband and I told each other within hours that we both were having second thoughts about the procedure.
    Shortly after my son’s birth I returned to Catholicism. Meanwhile the foolishness of my decision continued to be revealed. I learned that in my case (afterwards of course…when i bothered to ask) that my womb was likely in fine shape to have another pregnancy, and I began to hear from other women who were suffering from the post-tubal complications explained by Dr.Cudihy above. Fortunately I have been spared. I now can only say that i deeply regret the hasty, uninformed decision that I made. I am hopeful that i will one day be able to have this procedure reversed…even if it means we never have another child. Unfortunately my dear husband, despite his initial regret, dies not share my conviction. Please pray that he will come to understand the Church’s teaching and reasons. Thank you Doctor for your sensitive letter and I hope it is received with grace and that ut reaches many hearts.

  2. queenie says:

    I appreciate Dr. Cudihy’s appeal to the common bond of following Christ – and his steering away from the denominational shoals on which even common ground could be wrecked. . . .

    By the way, Dr. Cudihy’s comment is up now, followed by the following reply by Suzanne Burden:

    “Thank you for your thoughtful reply. Children are a good gift from God, but I don’t believe they are the “supreme gift of marriage.” The gift of marriage is that in coming together, a husband and wife experience the beauty of community that first occurred in the Trinity and then occurs between them as they seek to become one. As they become one, then, they image and spread God’s love to the world around them. If I didn’t believe this, I would feel that God had chosen not to give me his “supreme gift” in marriage, and that in some way my marriage is less-than. As I study God’s Word, I believe that nothing could be further from the truth.

    “Additionally, we must also realize that the command in Genesis is not a command in the strict sense, but a blessing. And we have carried out that blessing—we as humans have filled the earth as God said. We must value the ability to give life and to treasure it; we must have thoughtful conversations about stewarding our fertility; and in my opinion, we must allow grace for believers to steward their fertility and health (as we steward the rest of Creation entrusted to us). I draw the line in a different place than you do, but there is much we agree on. Peace to you.”

    I see in Ms. Burden’s first comment an oblique reference to the Catholic/’other’-Christian divide. She sees in the reference to children as the “supreme gift of marriage” a supposed focus of marriage exclusively on producing many, many children (according to the shallow stereotype of Catholic teaching). Ironically, Dr. Cudihy never used that expression in reference to children; she did. And if Dr. Cudihy had so spoken, the reference would have been to a gift given (if at all) only in marriage – and not outside of marriage. The question has never been one of how “blessed” one’s marriage is, based on whether or not children are conceived. . . .

    Much work is still required from both sides of the divide to overcome the misunderstandings. Blessings and peace both to you and to Dr. Cudihy in your work. And I’ll ask His blessings and peace also for me, on mine.

    • Thanks for positing a comment, queenie. I think what Dr. Cudihy was referring to by using the “supreme gift” of marriage language was the teaching of the Second Vatican Council’s (among Catholics) famous #50, which offers a helpful summary of the Catholic tradition’s approach relative to our exchange:

      Marriage and conjugal love are by their nature ordained toward the begetting and educating of children. Children are really the supreme gift of marriage and contribute very substantially to the welfare of their parents. The God Himself Who said, “it is not good for man to be alone” (Gen. 2:18) and “Who made man from the beginning male and female” (Matt. 19:4), wishing to share with man a certain special participation in His own creative work, blessed male and female, saying: “Increase and multiply” (Gen. 1:28). Hence, while not making the other purposes of matrimony of less account, the true practice of conjugal love, and the whole meaning of the family life which results from it, have this aim: that the couple be ready with stout hearts to cooperate with the love of the Creator and the Savior, who through them will enlarge and enrich His own family day by day.

      Marriage to be sure is not instituted solely for procreation; rather, its very nature as an unbreakable compact between persons, and the welfare of the children, both demand that the mutual love of the spouses be embodied in a rightly ordered manner, that it grow and ripen. Therefore, marriage persists as a whole manner and communion of life, and maintains its value and indissolubility, even when despite the often intense desire of the couple, offspring are lacking.

      This last sentence affirms that the integrity of the gift of marital communion, itself a sacramental gift for the baptized, is not itself denigrated by the absence of the blessing of children. But marital communion is ordered toward procreation and so the absence of children is, in a real sense, the privation of a “good of marriage,” a privation of its “supreme gift.” Life is filled with privations of blessings natural to the human state and willed by God, privations over which we have no control (though those privations of God-willed goods we do have control over we call sinful privations, i.e. murder is a chosen privation of another’s God-willed life). God permits, in His mysterious providence, such privations, though always permitted by Him in lieu of the greater good He can draw out of those privations. That’s the heart of the “word of the Cross”! We might call the often painful experience of these privations the “tragic” dimension of human life that finds meaning and redemption in the Paschal Mystery of Christ. We need not deny that these privations are genuinely tragic, or say that because we are beset by tragedy God somehow loves us less. But we do affirm as Christians that that temporal privations, like childlessness, need not be seen as definitively tragic as we always have hope that God brings good out of evil, light out of dark, healing out of pain, life out of death, etc. In this view, those who suffer from childlessness in marriage are given, in Christ, the opportunity to turn that pain and ache into a redemptive and sacrificial offering and place its fruits in service to the salvation and good of humanity. Ave crux, spes unica, “Hail to the Cross, our only hope!”
      I appreciate the insights you have shared and for being willing to bring them to my own Blog.
      May God bless your marital love abundantly and, on this Sunday called Trinity Sunday in the Catholic liturgical tradition, I will think of your own witness to Trinitarian love.

  3. Dr. Cudihy says:

    In response to Ms. Burden’s reply wherein she disputes my assertion that children are the greatest gift in marriage, I’d like to offer additional clarification. I agree marital love is designed by God to mirror the love of God, though the image used by St. Paul seems to indicate more explicitly the particular love of God for his bridegroom, the church. The Trinitarian love wherein the love between the Father and the Son becomes personified in a third Person as the Holy Spirit seems to be more completely reflected in the physical love between husband and wife that results in the creation of a third physical person—their child. The fact that a particular couple has not been given a particular gift, in no way diminishes their dignity and the love God has for them. God, whose ways are far above ours, will give to whom he chooses—even when we can’t understand it. I think we need to make a distinction about the essential nature of marriage and the graces God gives us through it versus the unique gifts that may or may not be given to the married couple. Similarly, without devaluing marriage itself, we should keep in mind that marriage is a temporary state (ending with the death of either spouse) designed to aid us in our journey to our heavenly home. Just as not all married couples receive the gift of children, not all people are called to marriage—though our Father loves each one of us infinitely.

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