An Intrauterine Toss of the Dice?

4.30.07: My out-of-control feelings about birth control


You may want to file this blog post under "Too Much Information." I was a bit hesitant to write it, since the subject matter is pretty personal (as if the rest of this blog isn't?), but then a friend reminded me that this is something that every woman has to think about after having a baby, so I should write about it. And, that, well Â… by now, you all have probably figured out that Will and I "do it." So...

At my six-week postpartum checkup, I needed to make some sort of a decision about birth control, since we all know the result of our aforementioned "high school" method of birth control. I decided I should probably have a slightly more proactive plan for family planning this time around. After all, we have two children. And, while we haven't ruled out a third, I'm certainly not anxious to get pregnant again anytime soon.

Putting the "plan" back in family planning

This is probably the kind of decision that shouldn't be made at a six-week postpartum check-up. When you're exhausted. When you're hormonal. When you're carrying around an extra forty pounds and a belly that flaps around in the breeze. When the very last thing on your mind is another baby.

I went into the appointment not really sure what to do. Even though we've supposedly got this wealth of birth control options to choose from these days, none of them really seem to work for me. The hormonal methods send my blood pressure through the roof, so those have been ruled out. I've tried some of the barrier methods, and well... let's just say that there's a reason why they're called barrier methods. What was I left with? Abstinence? Prayer? Hopping backwards nine times during a full moon?

My doctor, in whom I have the utmost faith, recommended an IUD—because of its very low dose of hormone, because we already have two kids, and because we're still on the fence about whether to have a third. And, because if we do decide to have a third baby, an IUD is completely and immediately reversible.

My first instinct was to say "No way!" My mother was one of the women in the 70's who had complications from the Dalkon Shield. She got pregnant with it, and made the decision to leave it in during the pregnancy, since taking it out meant a serious risk of birth defects and possible spontaneous abortion. She ended up having a two-pound baby, three months early (my sister), and almost died of sepsis following the delivery. So, you can see why the thought of an IUD scared me. My doctor assured me that the Dalkon Shield had a specific design flaw, that the IUD has had a great track record for the past 30 years, and that it's a perfectly safe and effective option. StillÂ… it went against all instinct for me. To me, it just seemed fundamentally wrong -- and, well, foreign -- to have a foreign object stashed away inside my uterus.

I walked away from that appointment birth-control-less, thinking that maybe abstinence really is the best policy? And, besides—even though Charlie was a big surprise, it was the best surprise of my life. Would another little surprise really be so bad?

Doing my market research

I went home, read up on the IUD, and talked to some friends who've had them. They all, hands down, raved about theirs. They liked the convenience of not having to think about birth control. And, there's the added benefit that, with the Mirena IUD, you pretty much stop getting your period after the first few months because the uterine lining stops building up. That sounded great to me—I mean, who needs it? But, then, my instincts scolded: you do.

In any case, I did something I normally don't do. I ignored my instincts. I decided to trust my doctor's judgment and go back and get the IUD, really for lack of a better option. And ever since, I've been completely conflicted about it. First of all, I made the mistake of flipping through Jane magazine's "Guide to Birth Control" as I sat in the waiting room waiting to get the IUD. I couldn't get past the first paragraph:

Smart women have been trying to prevent unwanted pregnancies pretty much forever, though the process used to be decidedly more indelicate—can you imagine inserting a crocodile dung/honey/sodium carbonate suppository after sex, like ladies did back in Cleopatra's Egypt? Or gulping down a post-coitus mercury cocktail, as was the preference for women in ancient China?

While it was meant to assure readers that today's birth control options are laughably much more sane, I couldn't help but wonder if, generations from now, people will be laughing at the thought of sticking a little plastic thingie up your wah-wah? I mean, it is a little absurd, right?

I closed the magazine and thought about canceling the appointment. But, when the nurse called my name, I went ahead with it. And for the first week, it was great! All that not-having-to-think-about-birth-control freedom! Then came the month-long period—and this was after I'd just gotten through all those weeks of post-partum bleeding. "No wonder this is 99% effective at preventing pregnancy," I thought. Then, there was the issue of the too-long strings, which had me back in the office getting them shortened. And, maybe this is all in my head, because I am obviously pretty weirded out about having this IUD in the first place, but...I feel like I can feel it. It's not pain, or even uncomfortableness, that I feel -- just this niggling little feeling that I can feel it, especially when I have Julia or Charlie on my lap. And, well, you're really not supposed to be able to feel it.

My doctor's office scheduled me for an ultrasound to make sure that everything's as it should be. So, that's where I was the other day. Sitting on the table in the ultrasound room, staring at the grey monitor with a white paper sheet across my lap as I waited for the ultrasound tech to come into the room. I've seen that very same ultrasound screen about 20 times in the past year, since we had every-two-week ultrasounds during my somewhat complicated pregnancy with Charlie. Even with the nervousness and uncertainty of those ultrasounds, it was so exciting to see our baby up there on the screen. And, as the weeks passed, and each ultrasound showed him growing right on track despite sharing the womb with a large pool of blood, they got to be really fun. But this time...this time I sat and stared at that screen realizing that, for the first time, I wasn't going to be seeing a baby on it. And I started to get the most hollow, empty feeling in my stomach. It was sad. And that is what has had me most conflicted about having an IUD.

What If's

When I had the placental abruption/subchorionic hemorrhage during my pregnancy with Charlie, we weren't really sure what was going to happen in those first few weeks: A miscarriage? A premature baby? A potential birth defect? I knew that once you've had a placental abruption, your chances of having another one increase with each subsequent pregnancy. So my worst-case-scenario-self prepared myself for the worst possible outcome with the thought that if we never had another baby, we had Julia. And she was more than I could ever ask for.

But now -- now, I have Charlie. And I know the indescribable joy of having another baby. And all I can think is:

Holy crap. What if we never have another baby?! What if I did have a complication from this thing? What if I end up being one of the rare few whose future fertility is compromised by the IUD?

And what if I'm just being totally irrational? The ultrasound showed that everything is as it should be. Still, I left there thinking: "Is it?"

I'm just not sure I can get past the idea of this plastic device in my uterus, where a baby once was.

Join's Managing Editor Dana Rousmaniere each week as she chronicles life with a new baby.

Read the next entry: 5.7.07: A Happy Mother's Day