Contraception 

Kids need their parent's permission to read this post. If you are a child, then go ask one of your parents if you can read this post.  

My weekend off ended at 8 am today. I received a call from a patient starting labor. This is her second baby. She had a Cesarean a few years ago with her first baby because the baby would not come out, despite strong pushing effort.  She is now 38 weeks. She was scheduled for a CS in a week, at 39 weeks. When she arrived in labor she was in a lot of pain, and she progressed to full dilation while we were preparing to do the repeat CS. Because the labor appeared to be going well, I asked her if she wanted to try to push instead of moving to the CS. She said yes, so we pushed. Over the next 60-90 minutes She moved the baby down, but then it got stuck at about +2 station. So we wound up doing the CS anyway. The patient, her  husband, and her son have a really beautiful family. They are from Brazil, and they are bankers. So, during the Section I played Brazillian Jazz music via the Pandora internet music service. The music was great. It was really relaxing. Everyone there enjoyed it. Everyone was fine. The baby came out well. It was apparent after the delivery that the babies head was crooked. We call this type of crookedness asynclitism. The cone head he had was on the side of his head, not on the top. As I mentioned in a prior post, the most common reason for a Cesearean is that the baby didn't fit through the pelvic canal. And Crookedness, or asynclitism, is not too uncommon. So I have decided that my next blog post is going to be about VBAC, or Vaginal Birth After Cesarean. It is sometimes called Vaginal Delivery After Cesearean. VBAC is a complicated and stressful subject to talk about in the business of Obstetrics. VBAC is not completely safe. Many Ob's and hospitals are trying to talk patients out of a VBAC because of the risk. But the risks are well understood, and can be mitigated. My college of Ob/Gyns, called ACOG, does support doing VBACs, but only with proper understanding of the risks, and proper mitigation of those risks. So now, as of today, this family has two beautiful little babies. She does not want to get pregnant now, so we come to the need for today's post: Contraception. 

Contraception is very important. It is doing something to prevent getting pregnant. The whole field of contraception is filled with stress, anxiety, misunderstandings, and failures. But, when contraception is done right, there are some really important benefits. The benefits are physical, social, spiritual, financial, and much more. 

But before we get to the meaning of contraception, I would like us to take a look at what a conception really is, in the grand scale of things. 

When a man and a women, acting under the guidance of love and hope, come together and unite their goals, and merge their bodies as one, in an attempt to conceive a human, they are engaging in an activity that connects them to the beginning and end of time. The engagement of this connection is a way for the couple to connect to the spiritual values of all humanity, and this connection will go on forever. Connecting to this endless chain of life is one of the most spiritually valuable activities that a human being can do. And people can feel this giant connection. If one allows oneself to really feel this connection, the meaning, the inescapable waterfall of meaning, of this Karma, is overwhelming. And it is gigantically worthwhile. This value is not only to the parents, but to the child as well. So, conception, in my mind, has some deeply valuable meaning. And the opportunity to have these feelings is exceedingly rare. You get to do these things just a few times in your life. 

If you are a pre-conceptional parent, Think of it this way: "I can connect to the beginning and end of time today. I can, with God's help, create a human being. This person that I create may be one of the most important people ever born. This person may unite all of the worlds governments for peace. This person may cure cancer. This person may create more happiness and love in my own life than I can ever possibly imagine". 

So, this is a big day. It is an important day. This day, and this moment, is at least as important as a wedding, and may be even more spiritually valuable than a childbirth. 

And using artificial means to help conception doesn't interfere with the meaning of these things at all. 

Sometimes, after an intrauterine insemination of her husbands sperm,  I will ask the patient to have a quiet evening with her husband or partner. I will ask them to get some inexpensive champagne, some strawberries, and have a quiet night at home. If there is no contraindication, I will ask them to engage in intercourse. But they don't have to. Then, I will ask them to visualize the embryo as it is being created that night. Ask them to try to feel the meaning of it. Ask them to try to feel the moment it happens. If the egg is available, the conception will happen a few hours after the IUI. Hopefully they will be at home to enjoy the process. About a week later they may get a spot of blood as the embryo implants. 

So, those few paragraphs are, in my opinion, the deep meaning and values of conception. 

Therefore, in my mind, poor contraception will rob someone of these beautiful experiences. They will never get the experience and the happiness of trying to get pregnant. Poor contraception will, instead, create a human being under the karma of failure, rather than success. 

The act of creating a human being under this umbrella of failure is "inauspicious". This is a word and a concept that I am borrowing from the eastern philosophies, such as Hinduism, or Taoists. Most parents will love their baby, even if they did not try to get pregnant. They may love this baby even more than all the rest. But the start of the human life under a mode of failure, is inauspicious. The human life should start as a success, instead. The choice of values is stark. 

Good contraception also prevents abortions. Everybody with a brain realizes that preventing abortions is a worthy goal. Even people who support the freedom of choice (to have an abortion) will agree that abortions should be available, safe, and rare. People who are pro-life (which means they are politically anti abortion) also support the need for good contraception. Even the Catholic Church supports some forms of contraception (at the very least, the Pope supports abstinence when appropriate, and the calendar method). 

Poor contraception will also mean that there will be rare or no sex, and all of the conceptions that happen are unplanned, or even unwanted.  Good contraception will mean that sex will be more common. And sex is, of course, a good thing when it is appropriate. We all know that married men live longer than single ones. (We don't know why).  So, when a women engages in sex with her husband, she is in a way, helping the marriage stay strong, and helping her husband to stay married to her. Therefore, she is wishing for him to live longer. This is good for her children as well, as keeping her children's father (same play on words as a prior post, with roles reversed)  married may keep him alive longer. Don't minimize these effects. 50 percent of marriages break up in divorce. Anything that keeps the marriage strong prevents at least a few divorces. So, contraception helps keep marriages strong. Lack of contraception weakens marriages.

So, what are the options for contraception?  

There are barrier methods and there are hormonal methods. 

Barriers: 

-Condoms.

-Female Condoms.

-Diaphragms. 

-Cervical Cap. 

-Sponges. 

-IUD's of various sorts 

-Vasectomy

-Tubal Ligation 

Hormonal methods: 

-Postcoital Emergency morning after pill 

-Nuvaring vaginal ring

-Three month shot of Depot Provera 

-Monthly shot of contraceptive hormones 

-Implanon or Nexplanon (a surgically imlanted capsule of hormones, good for three years). 

-Birth control pills, monthly, three monthly such as Seasonique, noncyclic 

-Minipill, progesterone only pill called POP's. 

A large percentage of women, when asked if they are contracepting at a Gyn checkup, will say no. I might know that they are married. I might even know the husband from a childbirth in the past. Then, when I ask if they are trying to have a baby,  they are sometimes a bit surprised, wondering where the question came from. From my point of view, if they are truly open to getting pregnant, then I must prepare them for a pregnancy. If they are open to a pregnancy for years, but are not yet pregnant, then I must search for the pathology that is preventing the pregnancy. There might be something seriously wrong.  If they are not actively trying to get pregnant, then I must help them understand which method of contraception is best for them. Which one will minimize their risks. All methods have benefits and risks, and failure rates.

What most women really mean when they say they are not contracepting, is that they are not on the Birth Control Pill. But most of these women are using some other birth control method. Therefore are not concerned when they are not pregnant. 

And all of this ties in with their social situation. 

For instance, Orthodox Jewish women must minimize bleeding. Everytime they have menstrual type bleeding, they have to do a special bath called a Mikvah, to get on with their married life. And observant Catholics should not allow an embryo to be physically rejected by the body. And they must not "spill the seed", either. 

Now that you have the importance of contraception, I am going to stop and continue tomorrow with an analysis of the different methods. VBAC will have to be a day or two after that. 

Thank you sincerely, 

John Marcus MD Ob/Gyn 

Ridgewood, New Jersey. 

Office number 201-447-0077 

Post edited late on 6/12, to remove excessive wordiness, and tighten the prose.