Pregnancy and Birth Control 101

by Leah Torres on May 20, 2013 in Biology with 7 Comments

In order for a woman to get pregnant, three things have to happen:

  1. Ovulation
  2. Fertilization
  3. Implantation

Even if all of these steps go perfectly, there is no guarantee that a woman will remain pregnant. But let’s pretend she does remain pregnant and that it’s an unplanned, undesired pregnancy. So she goes to the doctor… like me, for example:

“Hello, I understand you’re pregnant.”
“Yes.”
“How are you feeling about this news?”
“I don’t want to be pregnant.”
“OK, I understand. Please let me take the time to explain all of your options with this pregnancy. You may continue the pregnancy such that you will have a new baby in your family, you may continue the pregnancy and when you give birth place the baby in adoptive care, or you may end the pregnancy by having an abortion.”

This is a simplified version of how I personally counsel all of my patients who are newly pregnant with an unexpected pregnancy about which they are uncertain. (Note: women who answer the first question with “I’m very excited and can’t wait to have my baby!” do not receive counseling on the other options for obvious reasons.)

But, wait a minute! If people use birth control, there should be no such thing as an unplanned pregnancy!

Ah, if only more than just death and taxes were 100% in this world…

BIRTH CONTROL: HOW it works and how WELL it works

Methods that prevent Step #1: Ovulation

  • Nexplanon implant: >99% effective with typical use
  • DepoProvera injection: 94% effective with typical use
  • The Patch, the Ring, and the Pill (AKA combined oral contraceptive pills): 85% effective with typical use
  • Lactational Amenorrhea Method (breast feeding): 98% effective with perfect use in first 6 months postpartum
  • Emergency Contraception (Plan B, ella): the sooner after unprotected intercourse the better! 56-89% effectiveness, though studies are limited. It is ineffective if ovulation has already occurred, thus it is NOT an abortifacient

Methods that prevent Step #2: Fertilization

  • Sterilization (male and female): >99% effective with typical use
  • Mirena IUD (progesterone): >99% effective with typical use
  • ParaGard IUD (copper): >99% effective with typical use
  • Condoms: 80-90% effective with typical use
  • Natural Family Planning methods (withdrawal, calendar, basal body temperature): 75-80% effective with typical use

Methods that prevent (or disrupt) Step #3: Implantation

  • NONE

So, you see, no method works perfectly every time. Human beings are sexual beings and we will have sex. Even when we do everything right to prevent an unplanned pregnancy, our technology is not such that it can be prevented 100% unless one is not sexually active. But what’s the fun in that?

For more info, check out the links on the right under “Knowledge is Power.” Also, the CHOICE Project out of Washington University in St. Louis has a great video on the different methods and how to use them!

Resources: Contraceptive Technology by Hatcher et al, Practice Bulletins by the American College of Obstetricians and Gynecologists

7 Comments

End of Life Care Before It Begins

by Leah Torres on April 2, 2013 in Medicine with 16 Comments

Question:

What would you do if a premature baby, so premature that it didn’t have working lungs yet, were suddenly born right in front of you?

A) I would give it comfort care until it passed away on its own.

B) I would put a tube down its throat for breathing and insert multiple needles into it to place lines for fluids and medicines knowing that there was a 99% chance it would die anyway and a 100% chance that it would be severely incapacitated, possibly vegetative, if it lived.

C) I don’t know because I’m neither a doctor nor a person who has ever had to face that situation.

This is the impossible question posed to a Planned Parenthood representative in the video posted below that has made its way around the Internet. There are a few things you should be aware of prior to watching it:

1) The Partial-Birth Abortion Ban Act of 2003 ensures that any physician who desires to continue practicing medicine will not allow a live birth of an aborted fetus.

2) Asking someone who is not a physician what they would do in a clinical scenario is like asking someone who is not a pilot what they would do if the right jet engine went out. It is unfair and akin to trying to squeeze water from a stone.

The video:

http://www.youtube.com/watch?feature=player_embedded&v=qEv1afKaLhA

This woman was not qualified to answer medical questions, regardless of how they are phrased. That being said, it was no wonder she was uncertain 1) what they were asking and 2) how to answer.

I, however, am qualified to answer their questions and I will.

During an abortion in the 2nd trimester, specifically after 22 weeks, it is general practice to perform feticide (injection of a lethal medicine into the amniotic cavity or into the fetal heart) to essentially euthanize the fetus prior to the dilation and evacuation (D&E) procedure. It is therefore not alive once the abortion procedure is started. This is routine practice due to the Partial-Birth Abortion Ban Act passed in 2003 and requires physicians to perform the invasive procedure of intra-amniotic injection (putting the woman at risk of injury and infection) prior to the D&E. That being said, for an abortion to be “botched” (which is an unprofessional and inappropriate term to use) and the “baby to be born alive” will not happen. It cannot happen if the physician wishes to stay out of jail and continue practicing medicine. The baby cannot be born alive during an abortion because of the Partial-Birth Abortion Ban Act. The entire discussion in this clip is moot.

I’ll tell you what I would do if this impossible scenario were to happen, however: I would do whatever the patient wanted me to. The newborn would be unable to make medical decisions for itself and therefore medical-decision making would legally fall to the parents. There comes a difficult legal area, however, and if the infant were able to survive outside of the womb (> 24 weeks), were able to be resuscitated, the pediatricians may presume control over the care of the newborn if its life were in danger due to the parents’ decision. This gets into a whole legal battle I am not qualified to speak to, however, as previously stated, the scenario of an incomplete abortion with the fetus being delivered alive would not happen.

Even in cases of 3rd trimester abortion, the fetus is euthanized. This is not only due to the Partial-Birth Abortion Ban Act, but it is also humane medicine. It would be very traumatic to the mother, father (if present), and caregivers (physicians, nurses, etc) if during the induction of the abortion the baby were born alive then left to die. How horrific! Despite popular opinion, we are not monsters. We are physicians who seek to minimize the trauma of this difficult decision. In the rare cases of 3rd trimester abortions that are most commonly performed because of severe, lethal fetal anomalies that would not allow the newborn to live for very long (and suffer significantly if/while it did live), the fetus is euthanized and therefore not born alive.

As an OB/Gyn who takes care of women who are young and old, pregnant and not pregnant, my responsibility is to my patient. In the case of a pregnant woman, my responsibility is to her. When a woman comes to me for an office visit and her pregnancy test is positive, my first response is: “How do you feel about that? If you are not sure, I want to talk to you about all of your options which include continuing the pregnancy and keeping the baby, continuing the pregnancy and giving the baby up for adoption, or terminating the pregnancy by having an abortion.” If she desires I care for her and her pregnancy, I will do so and provide her with the best prenatal care I can so that she can have a safe, healthy pregnancy and childbirth experience. If my pregnant patient wishes to have an abortion, I will perform that as well so that she may have a safe procedure and termination of her pregnancy. My responsibility is to provide safe, evidence-based, comprehensive medical care, and that is what I do.

16 Comments