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Birth Control

I know a lot of pregnant women are shocked when asked about their post-baby birth control plans.  Birth control hasn’t been a part of your life in a long time (depending on how hard-won your baby is, possibly in a VERY long time).

However, there is a term for people who don’t have a game plan about post-baby birth control–parents of another kid.

Yes, breastfeeding CAN suppress ovulation.  Until six months or the FIRST time you go six hours between start of feed and start of feed.  That suppression is not effective in 100% of women.  You can’t rely on breastfeeding to be your birth control.  Even if you’d like another child-there are many reasons to wait 18-24 months before getting pregnant–another pregnancy so soon will be very difficult on your body and raises your chances of problems during pregnancy and pre-term birth.

If you’re on the fence about what method you want to use or are interested in a new option, may I strongly encourage you to check out Planned Parenthood’s website on birth control?

Personally, I’m getting another Mirena

I have tried many forms of birth control over the years, and this is the easiest by far.  Yes, it hurts to have it inserted, and it’s a good idea to plan to be home in bed that day (and possibly one more day).  BUT, once it is in, you are clear for sex without any secondary measures (like condoms) and you are pregnancy-free for five years before you need to get it re-moved and new one inserted.

I don’t plan to have more children, but if you want another (as I did after the LM), you can just get it removed and fertility returns immediately.  I got pregnant 2 months after my last Mirena was removed.

I am not being paid to shill for Mirena–this is a product I’ve used and that I like.  I suck at the take a birth control pill every day, much less every day at the exact same time.  The shot can cause issues with bone density. I didn’t like the ring.  The patch irritated my skin and gave me a rash.  Condoms are too easily forgotten in the heat of the moment.  The copper IUD isn’t recommended for women who have bleeding disorders (as I do).  Hence, Mirena is really my best option.

If we were in the US, I would likely be getting the Essure female sterilization procedure done, but no one in my current home country is licensed to perform it, so back to Mirena I go.

I had a C section-Why can’t I use tampons?

Here’s something I learned only a few weeks ago.

I’d been thinking about my c section and comparing it to the LM’s vaginal delivery.  Obviously the two experiences are, overall, quite different, but one thing remained consistent–NO TAMPONS during the lochia bleeding post-delivery.

I understood what the risks were with tampons and vaginal delivery-the cervix had been opened, and there was an open wound where the placenta had been attached to the uterine wall-creating potential for infection.  I also had torn during my delivery and had stitches in my vaginal wall, creating another spot vulnerable to infection.

But why couldn’t I use them now?  Hadn’t I gotten cut open, completely bypassing that whole “cervix opened” issue?

I asked my OB, and it turns out that during the c-section, they open your cervix anyway, to help aid with the passing of the lochia.  Internet research says that not all doctors do this, so it may be okay’ed your individual physician.  However, it’s worth noting that you still have an open wound at the spot where your placenta connected to the uterus, and that it remains at high risk for an infection.

So, inconvenient, messy, and just kind of gross or not…best to use a pad after delivery for the few weeks that you’ll bleed.  Once you’ve stopped and your “normal” period returns (which can take up to six months if you breastfeed), you’re welcome to return to other methods of blood collection like tampons/diva cups/what have you.

For the record, I’m not being paid to recommend these, but with this birth I used the loquaciously named “Always Extra Heavy Overnight Maxi Pads with Wings”  and found that unlike after E where I put two pads (one front, one back, kind of overlapping in the middle) on, I had very little staining and only had to throw out one pair of panties.  They’re easily found in the US, but I had to bring them back as I couldn’t find a product with equivalent coverage here in Singapore.

The A Word–review

The A Word–a film by Lindsay Ellis

“The A Word” is not an easy film to watch.  It is a 30 minute look at how the experience of abortion affects women who have had abortions…including the film-maker, Lindsay.

The uncomfortable truth that had me squirming as I watched the movie, is that both sides of the abortion debate are so focused on the fetus that we don’t really spend enough time on the women who’ve gone through the procedure.

We meet the head of a post-abortion counseling hotline, Aspen says it best when she says that

The pro-choice/pro-life debate in the US hurts a lot of things.  And it certainly hurts women who’ve had abortions.  The goals of either side is  to keep the arguments as simple as possible, and to shut down anything else that sort of doesn’t align with that message.

What happens is that all the yelling at each other keeps the voices of women who’ve actually experienced abortions from being a part of that discussion in any way.

As a pro-choice woman, perhaps especially because I’ve volunteered with Planned Parenthood…I’m guilty of this, too.  I want to cheer in triumph when reports come out saying things like Abortion Study no long term ill-effects on emotional well-being, and if I’m being totally honest, shove it into pro-life demonstrator’s faces.  My gut instinct when I see things like the moment in Ellis’ film where she interviews a pro-life woman who had four abortions and she holds up a sign saying “I regret my abortion” and says that all the women who attend the rally will hold that sign…is to doubt the veracity that every woman who’ll be holding the sign actually had an abortion…because I don’t want to believe that so many women do.  I want the side of the debate that helps justify the hours of my life I’ve spent with Planned Parenthood, the letter writing campaigns, the hatred I feel for protestors who harass women coming in and out of the clinics.

It’s not easy to have a documentary teach you a lesson you may not want to learn.

Growing up, the idea of going through an abortion didn’t seem like a big deal to me. It was distant, impersonal, uncommon and more just something people debated about during election seasons. But my circumstances changed.  And with a change in circumstance comes a change in perspective.

Lindsay is struggling with her decision to have had an abortion.  She doesn’t fit neatly into any of the little boxes that the pro-choice or pro-life lobbies would like her to be in.

We see her talk with her mother, who has far less ambivalence than Lindsay does about her own choice to have an abortion following a rape, and Lindsay’s choice to have one.  She talks with the baby’s father, who comes across largely as frustrated that they’re still talking about this, with one exception when he asks her if she’d named the baby.  In taping a pro-life rally, Lindsay is moved to speak to step from behind the camera to the front and speaks to the crowd… about how isolating the experience is.

One of the key things that comes up is that with very few exceptions, there is almost no support for women who’ve had abortions.  The post-abortion counseling that does exist is largely Christian and conducted by pro-life groups.  Which is not necessarily helpful for many women…as they will have expectations for you to feel guilt in the same way that my compatriots expect you to feel good about your decision.  There doesn’t seem to be a lot of room for ambivalence, and ambivalence is Ellis’ primary emotion.

It is actively painful at time to watch.  I was moved to tears more than once. I knew Ellis was good–I’ve been a fan of hers for over a year.  But I had no idea that her potential was this great.  This is a movie that deserves, NEEDS to be seen…and if you’d like to see it to, read about how you can obtain a screening copy and help fund submitting the movie to various film festivals here.

Is it a perfect movie? No.

My first wish is that it be longer.  I think the subject is so meaty and that Ellis is such a strong film-maker that a 60 or 90 minute documentary could have been even more powerful.  However, having read her blog, I know she struggled with funding the documentary as it is, so that may be a key reason that it isn’t longer.

My second is that I wish Ellis had given a little more time to pro-choice groups.  We see a pro-life woman say some things that are inaccurate (that there’s documented prof that abortion causes emotional damage and that it has physical consequences…there is no such documented proof).  I’m worried that perhaps there aren’t enough pro-choice organizations thinking about aftercare.

Lindsay–if you ever read this…I just want to say thank you.  Thank you for sharing your story.  Thank you for saying an uncomfortable truth.  I promise to actively try to open my mind and legitimize opinions that aren’t my own, and to not shove you or women who have gone through what you have in the box I’d prefer that you/they fit into.

Singaporeans don’t like condoms

I found this article, critiquing Singapore’s condom-phobia particularly interesting.

As a married (and at the moment monogamous) woman, I haven’t really experienced the dating scene here, so I can’t speak from personal experience as to how widespread the aversion truly is.

What I can speak to, from anecdotes shared with me anonymously from Filipina domestic workers, is that it is common.  There isn’t a domestic here who doesn’t know another girl who was sent home because she tested positive for pregnancy during a six-month routine medical check (specifically they’re testing for pregnancy and STD/STI’s…the presence of any will get them deported).  I’ve asked why condoms aren’t used, and it seems to be a mixture of women who don’t feel empowered to ask, the cultural (I’m unclear if this is a Filipina, Singaporean, or Asian culture) implication that requesting a condom means that the person requesting condom usage thinks their potential partner is “dirty,” and flat out male refusal to use them because “it doesn’t feel good.”

The frustrating aspect to this is that domestics don’t have much in the way of other options.  Hormonal birth control is denied to them, and is too expensive to be considered even if it were available.  While abortion is legal and available (I would have no trouble having one, if I so desired), domestics don’t.  I haven’t seen much in the way of other options, like spermicide, so condoms are the one option domestics have.

Some argue that domestics shouldn’t be having sex.  For many of them, the local pay (while better than what they could earn in the Philipinnes) is not enough to both live on and send money home.  Some women engage in sexual activity for groceries, or money to supplement the earnings they send home.  Others are young women alone in a foreign country, and are lonely.  Sex is a natural progression with a partner who makes you feel less lonely.  Further, I would argue that a woman does not give up her sex drive when she goes to work, and that they have every right to a personal life as I do.

Faced with deportation and the stigma of single motherhood, many women (again, every domestic I’ve talked to knows at least if not several) turn to herbal abortifacients.  Many don’t work, and the girl is left still pregnant, sometimes ill from the effects of the herbs, or with an infection that she doesn’t have the money to treat.  They are sent home.

But as long as condom usage is low in Singapore, it will continue to be domestics who suffer most.  Sent home in disgrace, abortion is unavailable back home.  Some of these domestics have to go home and face a husband who is not the father of the child they carry…and will suffer for that.  Others will face the social ostracism that comes with single parenthood.

Regardless, it’s a disturbing side effect that no one seems to care about.

My Mirena Story

I hesitate to tell my story about my experiences with Mirena.  I hear so much vitriol hurled in their direction that I don’t want to serve as further ammunition.  I genuinely feel that while I had a negative experience, that my story is a rare one, and that Mirena is one of the better contraceptive options available today.

I chose to use Mirena after the birth of my daughter in 2008.  My obstetrician at the time advised a 10 week wait time before insertion to give the uterus time to return to normal as well as the cervix.  I found the insertion process to be painful, but within a day or two I was fine.  I had the occasional break-through bleed for 1-2 days at various points throughout the two years that I used it.

I did find it odd that I had a long (5-7) day bleed in November, but didn’t really think anything of it.

In early December, having arrived at the decision that my partner and I were ready to move forward and have a second child, I chose to have the Mirena removed.

Two days after removal, I had began to bleed.  The first day was a light to moderate bleed, and nothing that seemed out of the norm for me.  Day two was a heavier flow with some clots, but again…nothing out of the realm of “normal.”  It wasn’t until day three when things began to worsen, rather than improve or stay stable that I began to feel concern.  By day five, I was soaking through a pad about every two hours and each time I sat down, large clots (alarmingly large…easily the length and width of my index and middle finger held together) were passing.

I had called my gyn (not the same doctor that inserted it…I was living in the US during insertion and now live in Singapore) to report my bleeding and express concern.  I was metaphorically patted on the head and told that I was imagining/exaggerating the extent of my bleeding.  This just isn’t how Mirena works, or what women experience after removal, I was told.  I fired him.

I searched for, and found another gyn, and was able to get an emergency appointment.  She too, at first, thought I was exaggerating, but did a pelvic exam and seemed quite concerned about the clots she had to clear just to visualize my cervix.  I was sent for an ultrasound, which showed I had grown a very thick endometrial layer within my uterus and had several large potential polyps present (in the analysis done later, it was shown that they were merely large clots).  An emergency D&C (dilation and curettage) was scheduled for the morning.  This was reassuring, as I was officially hemorraghing by this point…I was soaking through a pad an hour, passing large clots, and was beginning to feel the strain from all the bleeding.

I’d had a D&C in 2007, related to a miscarriage, so I knew what to expect (which is good because no one felt the need to review the procedure with me, unlike in the US where they went over it at least 3 times).  I did not expect to have to beg and scream and cry for painkillers, which led to more than an hour wait before the pain was treated such that I didn’t want to pass out.  This is the opposite of the vicodin I had poured down my throat once I regained consciousness in the US.

Within two or three days I felt fine, and my uterus has returned to normal.

What I find disturbing is the lack of information that Mirena provides on this as a potential reaction.  I do not doubt that it’s rare..rare enough that the gyn here said she wouldn’t hesitate to put me back on it after a second child’s birth, which I was surprised by.  But I do think that even if it’s a 1 in 10,000 reaction, that there should be some admission by Mirena to that effect.  I’ve certainly found enough anectdotes online to indicate that it’s hardly as rare as 1 in 10,000 (a number I’m just making up.).

I have had some truly frightening experiences in my life, so I would not rate this as “the scariest,” but my partner and I were genuinely frightened by the hemorraghe.

In the service of educating others about contraception and their pluses and minuses, I feel it only right to share my story.

Volunteering for Reproductive Freedom

  • First Published-September 16, 2009
  • Edited-December 30, 2010

For about five months in 2009,  I chose to donate my “free” time to a pro-choice organization.  I did this rather than go see a movie, shop, or run errands that would’ve been easier to do without my daughter along…or write, for that matter.

Why?

  • Because it needs to be done.
  • Because I can.
  • Because it’s my way of thanking all the women who have come before me to give me reproductive freedom.

Reproductive freedom is at the root of all female freedom.  When a woman can control her fertility she is less likely to end up in poverty.  When a woman controls her fertility she is acknowledged as a full person, capable of making decisions, rather than a passive vessel from which future generations will spring.  She has the freedom to work and to progress in her career, only taking child related breaks on her terms.  Economists unanimously agree that a key step in a country’s progress towards “first world” status is female self-control over one’s fertility.

You may argue that in this day and age, control over fertility means access to the pill and other contraception.  I disagree, saying you need to include access to abortion to have full reproductive freedom.

Abortion isn’t a pleasant procedure to contemplate.

In later stages of pregnancy, the procedure become downright gruesome.

However, a woman should not be held hostage to her body because she was raped, had a contraception failure, made a bad decision, or was coerced into unprotected sex because of cultural/social taboos.

The American right would like us all to give these unwanted children up for adoption, which makes for a pretty fantasy.  Of course, that fantasy only works if you assume that every child, regardless of physical, emotional, or behavioral needs would be adopted.  That every child, regardless of the parent’s ethnic background(s) would be adopted.  The truth is that children with special needs, children of mixed race, and minority children are not as “desirable” to prospective parents, and thus are less attractive to potential adoptive parents.

Putting all that aside for a moment, it assumes something far more insidious…that women need only step back and gestate and all will go well.  Anyone who thinks that has never been pregnant.  Never experienced the literal growing pains of a uterus.  Never become diabetic with pregnancy (and as someone who stuck herself a grand total of 14 times a day-10 for blood sugar checks and 4 to give myself shots of insulin I can attest to what it’s like to feel like a pincushion).  Never puked for all 40 weeks of pregnancy (I know what it’s like to come close to being hospitalized because I was practically dehydrated from all the puking).  Never had the heartburn.  Never had their lungs infringed upon by a 3rd trimester fetus.  Never gone through labor. Never experienced the joys of having their vaginal walls tear as the baby entered the world.

It’s also a pretty fantasy where no woman ever gets pre-eclampsia.  Never gets diagnosed with cancer while pregnant.  Never is faced with a situation where it’s your life and death on the line.  Keep the baby and you both die, or abort the baby and you live…which would you choose?

There’s no discussion of where restrictions on reproductive freedom would end.  These “pro-lifers” are often the same people rallying against “big government,” saying that the government has no right to get involved in personal affairs.  But what is more personal than a pregnancy?  How would they force me to stay pregnant?  Would there be a law that all women of child bearing age take folic acid, just in case?  What if I forget to take my prenatal vitamin?  Chose not to control my pregnancy induced diabetes?  Would I be sent to jail for negligence?

What about miscarriage?  How would they prove the difference between a natural miscarriage and the ingestion of herbs known since time immemorial to cause “accidents” for pregnant women?  Would every D&C (such as I had after my first pregnancy did not pass naturally after her/his heart stopped beating) be cause for a police investigation?

I don’t know how it ends, except that I suspect it would look a lot like “A Handmaid’s Tale” by Margaret Atwood.

And so I volunteer.

Each time I volunteer I park my car near the clinic.  I scan the perimeter of the clinic for protesters.  The legal line is drawn on the ground in yellow paint, and I often see the protesters put a foot over it, or pace it like an angry lion pacing his too-small cage at the zoo.  A frequent protester is an elderly woman, who often gets away with more small transgressions because it would be bad press to have her arrested for every small infraction.

I enter the double doors and pass through a metal detector.  I hand my purse to a security guard for inspection.  I sign in using my first name and last initial only…for my protection.  I exchange my id for a badge that will open the elevator or give me a code to use on the numerical pad that changes the order of it’s numbers regularly.  I know where the panic buttons are in case of emergency.  I know when to call 911.

My path does not lead me through the waiting room, but I’ve been there as a patient.  There is an air of sadness, and quiet resignation.  No one is happy to go to the abortion clinic.  Relieved, yes…but never celebratory.

I work in an area far removed from the medical procedures.  It could be any office.  There’s a water cooler, a copier that breaks frequently, staplers that jam, files that need alphabetizing, and envelopes that need stuffing.  Like any non-profit, there’s money to be raised and lobbying to be done on our behalf.

But there are also industrial shredders, and no piece of paper is thrown away without first being shredded.  Those who dislike what happens behind our doors could harass a doctor, a patient, an employee, or a volunteer like me.

When my time is done, I use my badge to descend to the main floor, and exchange a few words with the guard as I pass back my badge and sign out, receiving my ID once more.  I push the heavy doors to the street open, and again glance around to look for protesters before making my way back to the car.

I drive back to my sitter’s home to pick up the little girl I love more than any other child in this world.  Because a morning away from her to help fight to secure her reproductive freedom is a far better use of my time than getting a manicure.