More than 140 operations on the hearts of babies in the womb. Five thousand intrauterine procedures. Professor Marzena Dębska co-created one of the most important centers of perinatology in the world. Gynecologist, women's rights defender and obstetrician. She can talk about the miracle of birth for hours. Educator. She cares about the health of women of all ages. First menstruation, pregnancy, infertility, menopause, prevention of gynecological tumors. A doctor on a mission. Our woman of 30 years.
Why do you have such love for women?
MARZENA DĘBSKA: This is the usual solidarity of the ovaries!
(Laughter) And seriously, women are portrayed as weaker, in need of care. I am a zodiacal Libra and have a great sense of justice. Treating us as inferior arouses my objection. Yes, women require tenderness and empathy, but the more I get to know them, the more often I find out how strong they are. I admire them and think they are omnipotent. They can be great in the same areas as men. I really like people regardless of gender and I don't like feminism, which is born out of hatred of men. But women really need our support in these times.
It is not easy to be a gynecologist in Poland today.
I will admit that I did not go into medicine with the idea that I would fight for women's rights. This came over time, when I realized that it was very necessary. I became a gynaecologist because I loved motherhood. When I witnessed my first birth in college, the miracle of birth enchanted me. I also chose medicine a little out of spite.
Such a challenge?
I didn't like biology. But when the educator told my mother not to pay for medicine because I had no chance, I was tempted to prove otherwise. I like challenges. When I think about it today, being a gynecologist is definitely one. It requires not only medical knowledge and empathy, but also the courage to help patients expect. We gynecologists are with women throughout their lives from adolescence, during pregnancy or pregnancy problems, through childbirth, after menopause... Partners change, and we don't. There is a lot of psychology in our work. In addition to professional professionalism, patients need ordinary support, a frank conversation. This is especially important in difficult situations that arise when conducting pregnancy and prenatal diagnostics, which I deal with most often. In the case of an unsuccessful diagnosis, a defect in a child, not only that it is a psychological drama for a woman, but the situation in our country so far makes it impossible for her to decide for herself. This creates additional suffering and trauma. These are things to which we, doctors, cannot be indifferent.
In recent years, you have become the voice of women. She has explained in the media the effects of the anti-abortion law, defended the rights of patients, participated in demonstrations, encouraged participation in the last elections. And it happened — on October 15, the women took matters into their own hands.
Years later, we fought for each other. Now we should make sure that we make decisions about reproductive issues, not allow this discussion to be conducted exclusively by men. The effects of the 2020 law, which makes it impossible to terminate a pregnancy due to severe fetal malformations, must be eliminated. It is inhumane to force a woman to give birth to a child who will die or be deformed. I am in favour of extending the right of women to decide on many medical issues.
So give a choice.
Yes. For the sake of women and their well-being, everything should be done so that unwanted pregnancies do not occur. And we will not achieve this by banning abortion, but by liberalizing the law, educating and facilitating access to contraception. In many European countries, birth control pills can be purchased without a prescription, and in some they are free. The experience of many countries — those liberal and those with strict anti-abortion laws — shows that bans do nothing good. I am in favour of easing the law, as well as education in schools and readily available contraception. It has to go together. After what has happened to women's rights in our country, I'm a little apprehensive about tipping the pendulum the other way. Abortion is not a method of regulating conception.
The possibility of choice is also universal access to in vitro.
I hope that the reimbursement of in vitro fertilization will come as soon as possible, because in many cases it is the most effective method of infertility treatment and the only chance to have children. It is also a way to stop the biological clock. Women are increasingly opting for later motherhood, living in the belief that they are healthy and will become pregnant after stopping contraception. And this is not always the case. Freezing embryos causes the biological clock to stop ticking - the embryo can be transferred to the uterus at any time, it does not have as short an expiration date as eggs (laughs). In vitro fertilization also works in situations of unexplained infertility, when patients
have good test results and fail to get pregnant. We do not know why this is happening, but what is certain is that further progress is
caning will cause a woman to enter the age of menopause. We have a lot of problems due to insufficient education. One of them is the lack of knowledge about the treatment of infertility and the criticism of in vitro fertilization. Hence, many couples reject this method and lose their chances of having offspring, and in the public space there is nonsense about babies born with IVF. And these are always wanted and loved. Fertilization outside-
The physiological one differs from the natural one in that the egg and the sperm meet not in the fallopian tube, but in the test tube, the resulting embryo does not move to the uterus as a result of the movements of the fallopian tubes, but is transferred there with a special pipette. This is where the differences end, because we have no influence on whether these cells combine. Therefore, in vitro does not give a guarantee of pregnancy, and the frequency of fertilization is similar to that in natural conditions. It's still a miracle.
Women over the age of 35 freeze their eggs, investing savings. It's still a topic for the wealthy.
In Poland it is a legal procedure, unfortunately it is not a reimbursed procedure. To make matters worse, women are rarely informed about it. I talk about this with patients who are not biologically the youngest and have not found the right partner. It is difficult for them to decide to have a child with someone who does not suit them. This is the modern world. In some companies in the West, when a woman is at an important moment in her career and the employer cares about her, it offers and pays to freeze her eggs. However, it is worth being aware that not all eggs will survive the freezing process, we will recover much less of them. I urge patients who have maternity plans not to delay. I myself thought that I would not have children, and I am a mother of three sons and I cannot imagine life without them. That's why when a patient says she doesn't want to, I'm talking about freezing her eggs. Just in case.
“Out of a lack of awareness or need, women care most about what is seen, and often it's a mistake.”
Thirty years ago, we had about 500,000 births, two years ago — 280,000.
The number of births is decreasing for various reasons. In Poland, there is a lot of talk about this in the context of restricting women's rights. A big problem
there is a fear of getting pregnant, being in the hospital and giving birth. We are in the 21st century, and 85% of patients give birth in pain. In addition, they usually have no influence on what will happen to them when they cross the threshold of the hospital. They have lost confidence in a system that has succumbed to the influence of politics and ideology. There are a lot of problems. And it is necessary to take care of them as soon as possible. For obvious reasons, falling birth rates are a problem for many developed countries. As a state, we should do everything to ensure that there are as many children as possible. It is also necessary to help those couples who want to have offspring and cannot. There are many reasons. Just look at the smog map. It's like we live in a chimney. It is not surprising that men have decreased sperm parameters, and increasingly younger women have various health problems. And you know that there are too many people in the world. For the good of our planet, it would not be bad to slow down a little, but I do not mean Europe, which is aging dramatically.
Where do you get the strength to work despite so many difficulties? The death of her husband, Prof. Romuald Dębski, leaving the hospital, the inability to perform operations that saved the lives of women and their children...
I will always remember my husband with pride. He was someone special. I always went my own way and that allowed me to survive, even though I was left with three children and had to face many problems. I lost my sense of security. Not just me, but many women in this country as well. Encountered
Me things I don't want to remember. But I got a lot of support from friends and patients. Fortunately, I am a pathological optimist. It's a mix of ADHD and excess endorphins, as someone recently diagnosed me. I get hooked on working and helping. I didn't stop doing it for a moment. And it saved me. Years later, I have so much sense of meaning and fulfillment that it carries me. When I see patients' thanks and photos of their children on social media, it motivates me to do even more. And really, when a woman comes to me, I immediately think what I can do to help her to be happy. That's my goal. I have an innate gift of empathy, usually I can quickly assess the situation, find the problem. I shorten the distance, talk to patients, support, hug. The longer I work, the more I appreciate the value of these seemingly secondary things that happen in the office. I believe that positive thinking is important in recovery, pregnancy reporting.I am a professional in my profession, but it seems to me that even half of any therapy is word treatment. I'm not ashamed to talk about it.
“When a woman comes to me, I immediately think what I can do to help her to be happy. That's my goal.”
You are involved in education, including on HPV.
I don't want to see women suffer. Especially when it can be prevented. On the issue of cervical cancer, we are a dozen years behind the civilized countries of Europe and the Americas. There it becomes a rare disease. There are such places where doctors learn about him only from books, and in a moment
They will come to Poland, Russia, Ukraine or Uganda to see it. In 2008, the Nobel Prize was awarded for the discovery of the connection of the human papillomavirus, or HPV, with cervical cancer. Many countries have already vaccinated people against HPV. We woke up in June 2023. During this time, almost two thousand women died in our country a year, and another three thousand were diagnosed with cancer. HPV can also cause cancer of the vagina, vulva, anus, neck and head. It also attacks men. Today we finally have an HPV vaccination program, covering 12- and 13-year-olds. But everyone should get vaccinated. For now, this is a small percentage.
How can we change that?
School education is key. Adolescents should comprehensively learn about ways to lead a healthy and successful life, including preventive examination schemes, the principles of proper nutrition, the importance of regular physical activity. It is necessary to teach about menstruation, contraception, sexually transmitted diseases, civilization. About what symptoms should worry, when to see a doctor. It sounds trite, but how are people supposed to know that? The school should instill habits of self-care for one's health. In my clinic, I organize such meetings for students of one of the Warsaw high schools. We talk about prevention, the first visit to the gynecologist, I deceive it a little - I show how the cytology is taken, what the examination looks like.
Nick. We laugh, they play, they fool around, they do ultrasound to each other. This is what it might look like in schools, and from what I hear, family education classes are often tragic — teachers don't have the right knowledge. But I am glad that there are more and more awareness actions, related to health prevention: breast cancer month, cervical cancer, the Movember campaign. There are various opinion-forming people active on social media, which are viewed by young people. I like these activities and I get involved in them myself. It is important that we doctors are present in the media and speak in a simple way about difficult things. We need to build trust in medicine, dispel myths and superstitions, of which there are many in Poland.
What is still taboo in the office?
Sex. If a woman herself does not start talking about him, then the doctor is unlikely to ask. I do, especially patients in the preme-nopause and postmenopausal period, because they most often have problems. They think they are too old, that they no longer need to have sex. Many of those in their fifties and older do not coexist at all. Sex is often a taboo subject, we do not know how to talk about it, what terms to use. How to name a pussy? Vulva or vagina? The vagina is the vagina, and the vulva sounds like something terrible. “Pussy” is a pretty nice word, though I know it sounds frivolous to many. I recently wrote an article about pussy — under the funny and catchy title that it's better to have a nice pussy than a pumped up mouth. For lack of awareness or need, women care most about what is seen, and this is often a mistake (laughs). I observe that even in a big city like Warsaw, even among strong, educated women do not have full freedom to talk about their expectations. They often do not know that if they do not have an orgasm, they suffer from vaginal dryness, its stretching after childbirth or urinary incontinence - then these problems can be solved. Among other things, that's why I dealt with the so-called aesthetic gynecology, which is actually more regenerative, functional, therapeutic, because it allows to restore the proper function of the female genital organs.
Indeed, many ladies suffer from troubles in the intimate sphere caused by age or childbirth. Often the fear of natural childbirth arises from this, but it is not necessary to immediately resort to cesarean section, because this is not at all the best solution.
How have patients changed in the last 30 years?
Very much. When I started working, the doctor in the hospital was a god. Patients drank information from our mouths. Nobody asked questions. Now women have knowledge, they often argue - not every doctor is ready for this. In my opinion, it is great that the patient is educated, can be presented with different options and jointly choose the method of treatment. This reduces her stress, gives her a sense of agency, and also causes the distribution of responsibility for decisions and possible complications. Because the thing that most doctors dream about is that if something bad happens, they will be dragged through the courts. Therefore, they often do not even come up with proposals for more non-standard or risky, but perhaps more effective therapies. The so-called insurance medicine has spread. Allowing the patient to make decisions is the best way for her to have comfort and we have fewer claims. Many doctors will have to get used to new standards, teach that a woman has a voice.
Don't you miss the hospital? You haven't had heart surgery in over a year.
I missed it, but I just got a contract offer at one of the best clinical centers in the country. And going back to what has happened in recent years — you have to reckon with the fact that every action has consequences. It is also in favor of women's rights and public speaking on difficult and uncomfortable topics. It is safest and most profitable to sit quietly, most do. My passion is pregnancy pathology, prenatal diagnosis and therapy. Only I performed intrauterine procedures on the hearts of fetuses in Poland and I hoped that even in an unfavorable political climate, the value of what I do for patients would protect me. But this did not happen. At the time, I was worried about the patients, because I didn't have a way to help them. I missed work in the field of perinatology, but nature does not tolerate a vacuum. Over the past year, I have developed the activity of my Dębski Clinic. Now I am starting to realize my dream — I am creating a foundation named after my husband Romuald Dębski. I plan to deal with the support of women who were found to have various pathologies during pregnancy. Being a doctor is not only a beautiful profession, but also a mission and a duty.