She Says… Decisions, Decisions

At my 6 week checkup with my OB after Owen was born, I remember her asking me what kind of birth control we were planning on using. Ha! Birth control! I thought at the time. How ironic. I couldn’t even GET pregnant without the help of two doctors, several cycles of monitoring, lots of needle sticks and ultrasounds and drugs, so I wasn’t really worried about an “oops baby”, thankyouverymuch. And shouldn’t someone who struggled with infertility be overjoyed with a freebie, after all of that work?

Besides. I was NOT one of those women chomping at the bit to, uhh, how shall I put this delicately… get back on that horse right away.

So we I put off the decision entirely.

As you know, it took another 10 months for my period to even come back, and in that time we were using the dreaded condom method. You know, umm, most of the time. Bottom line? We were being REALLY stupid since we were/are not ready to have a sibling for Owen yet. But can you blame us? Condoms are a real buzzkill!

But something scary happened at the end of last week. After three relatively normal cycles, I was late. I hadn’t been writing any dates down because I’m trying to be totally laid back and let my body do its thing for now… but I knew I was late. The first day I chalked it up to not counting correctly. The second day I blamed it on stress. The third day my stomach was upset all day thinking about the possibility. I finally mentioned it to Benjamin because I couldn’t think about anything else. Then HE was stressed too. The fourth day we started to have some very serious conversations about the future of our family — and then stopped, because really, that was a bit premature. I did everything I could to “bring on” my period. I wore white pants. I left the house without a tampon. I told myself I would take a pregnancy test on Saturday morning. Then finally, thankfully as soon as I got to work on Friday, it came. Almost a full week late. Hence no blog post on Friday. Too many thoughts to make sense of.

I learned a few very important lessons:
1. We need to figure out a better form of birth control. I can’t take that kind of stress!
2. I have kind of long cycles, so I shouldn’t be counting 28 days like a normal human being. I should start writing this stuff down.
3. It’s ok to not be ready for another baby yet, even if it was excruciatingly hard to conceive Owen.

I am pretty much convinced at this point that my infertility was caused by using birth control pills. I essentially stopped my body from ovulating for a decade, and then expected it to start right back up again as soon as I stopped taking those little pills. Obviously that didn’t go so well. As a result, I’m 100% unwilling to put hormones back into my body again. I refuse to change what is happening naturally. I am so, so thankful that things appear to be in working order again and I will do just about anything to keep them that way. Hence the condom method. But that severely limits the birth control options available to me!

The other option I’m considering is ParaGard (copper IUD that doesn’t contain hormones). Reasons I’m scared about this method?
1. I know someone who has gotten pregnant on an IUD. It’s super unlikely, but scary nonetheless.
2. Insertion can hurt. The pamphlets say that after you’ve had a vaginal delivery, insertion shouldn’t hurt at all, but I’ve heard testimony otherwise.
3. Complications like the device perforating my uterus and requiring a hysterectomy.
4. Feeling it poking me during sex. Or Benjamin feeling it poking HIM during sex. Eww.

It’s time for a little field research. What birth control method did you choose post-partum? How do you feel about that decision?

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41 responses to “She Says… Decisions, Decisions

  1. I’m looking forward to reading these comments! My baby is due in 2 weeks and I’m already thinking of possible birth control methods. I’m anti-hormone, too and have heard good things about Paraguard, BUT it still freaks me out a bit about the complications that could arise, like the device perforating the uterus- eeks!

  2. oh man, this is timely for me. my baby is 7 months old. I was prescribed the minipill but quit taking it because we weren’t havng sex much due to excrutiating pain the first 6 months out. somewhat sadly, we won’t be having another baby due mostly in part to finances. now I need protection, but am being noncommital about it just like you are. I’m thinking of getting the hormonal iud since it’s still not NEARLY the amount of hormones as the regular pill. it doesn’t cause heavier bleeding like the copper iud can either.

  3. Would you ever consider doing the fertility awareness method (FAM)? You should read Taking Charge of Your Fertility. It only requires a little bit of work (taking your basal temp at the same time every morning) and is very accurate as long as you have had enough hours of consecutive sleep + haven’t been drinking. Check it out!

  4. I should add that I was also an infertility patient and haven’t gotten my period yet (still exclusively bf’ing and underweight). If I was having regular cycles, I’d just be doing natural family planning.

  5. um sorry for the third post. by NFP what I really meant was FAM as Rhodey mentioned 🙂

  6. What about FAM? As a bonus, it will help you get pregnant once you are ready.

  7. I had the paraguard IUD and I hated it….I kept it in for 9 months, but during that time, my periods were long and painful, and it wasn’t worth it. I won’t use any hormonal birth control either, so the options at that point were limited. To a diaphragm. Which we used. But, I have to tell you–condoms are a buzzkill, but diaphragms are like an 80’s style buzzkill. Retro! 🙂

    What about using the old withdrawal method? It’s totally not full proof, as you know. But……yeah. I got nothing.

    Good luck, though!

  8. I had the copper IUD. I chose it because I didn’t want the hormones of the other IUD but I also didn’t want to deal with remembering to take birth control everyday or having to change something every week or few months. I am lazy!
    1. It was mildly uncomfortable to have it put in but I have a great midwife who always does a great job. I had some mild cramping for the day but after that was fine.
    2. I never felt it, it never got in the way.
    3. I always had very very light periods, like barely anything for only 3 days so I took the risk of the “heavier periods” that come along with the copper IUD.
    4. that was a mistake….every period lasted a full 7-9 days and it was so heavy that i would be bleeding through super absorbent pads and tampons every hour. It never stopped doing that, so i eventually had to have it removed…I got pregnant a few months later 🙂

  9. I’m 18 week postpartum and totally against putting more hormones into my body again, so this is pretty timely for me as well. I’m breastfeeding and my period still hasn’t returned. But I think we’re going with condoms (blech) until my period does return and then we’ll probably move on to FAM. I was a fertility patient as well and really didn’t want to start messing with the hormones in the pill again.

  10. I totally wear white pants to taunt my period into coming too! I always want it to come mid week so I don’t get stuck on the period day 1 and a long run. 🙂

    I do the pill, but I don’t love it. I had to try several types after I had the baby because my body didn’t respond the same way.

    If I didn’t do the pill, I’d probably look into getting a diaphragm or cervical cap. I can’t do an IUD, that’s just gives me the heebie jeebies.

  11. “I wore white pants”<– haha! Happened to me last month!

  12. The iud was made for tired parents who can’t think about birth control. Yes, insertion hurts a bit but I had mine six weeks postpartum when things were….tender down there, and I survived. Hubby hasn’t felt a thing, nor have I.

  13. I had the paraguard for the total of five months. Hated it. Hurt horribly going in, I had spotting every day of the five months and Ah hem, my husband didn’t like it either! I am like you clone though! I used birth control for 3 years then my husband and I decided to try and 3 years later we finally got our miracle. My fertility doctor assured me he didn’t think my body stopped ovulating due to birth control but I believe it with all my heart!

  14. I’ve been a total lurker so far but have been reading your blog for over 1 year now.
    I had the hormonal version before getting pregnant and afterwards the minipill while bf-ing. The IUD sucks to be implanted, it hurts and it hurts for a while afterwards. Still a very easy method though! We didn’t experience any poking :-). Overall, it was a good method.
    I also tried a cap, (http://www.nuvaring.com/Consumer/index.asp). it worked fine but i was a bit paranoid about it falling out. You still get hormones but way less.
    Good luck with making up you mind!

  15. It’s totally OK to feel like you’re not ready yet! Sometimes I think I am … and other times I think “hell no, I want to enjoy my time with Maya!” Like you, I’ve had a horribly irregular period made even more irregular being off the pill … and I haven’t been on since May 2009 — almost a full year before I got pregnant; we just used other forms of BC) and I don’t intend to go back to hormone-ville. Good to see perspectives on other forms of BC. We aren’t quite ready for #2 — I’d like them to be about two years apart — and had an almost scare this weekend, too. It’s a good reality check.

  16. The Laundry Lady

    I went back on birth control for a while but ultimately we did stick with condoms for a while. That being said, I know women who used a diaphragm for years without any problems and found it to be less of a buzz kill than condoms. My sister is a big fan of using the Take Charge of Your Fertility Method (in concert with barrier methods at the appropriate time), it helped her get pregnant pretty quick. Personally I won’t touch an IUD with a 10 foot pole. I’d sooner go back on the pill, but I’m still researching other options. Spermicide and a diaphragm will probably eventually be our method of choice, but we’ll see.

  17. We tried spermicide for a while when Paisley was first born and let me tell you, don’t ever do that! We both got like chemical burns from it, so I’m not quite sure if we were doing something wrong or what.

    As a PA, I’ve had lots of patients with IUD’s that LOVE them. They shouldn’t hurt to put in, and people never feel them there. It’s just a tiny flexible T-shaped device. I have had people complain that they cause weird bleeding though, but others say they stopped having periods at all.

    We’re going with the let’s-see-what-happens approach since it took over 2 years to have Paisley and my cycles are still not regular from having her…

  18. Between Juliet and Finn, we used FAM (though it was only really applicable for one period because then we tried to conceive again). I love FAM because you can choose to either use condoms or avoid sex for less than one week a month. It was nice not to use condoms all the time. We also used that for the year before we conceived Jules. After Finn, we went back to FAM until Jack had a vasectomy. However, last week my period was 5 days late and we had some minor panic/hope at the thought of being the 0.1% that get pregnant post-vasectomy.

  19. Elizabeth McCracken

    I just wanted to pipe up and say make sure you check your health insurance guidelines! IUDs are expensive, and I have heard tales of women wanting to take them out before the 3-5 year marker, getting them out, and then insurance refusing to pay for another form of birth control. Not to say this happens to everyone, but it is always important to know what your insurance says about your medical decisions- can you afford an IUD, or to be pregnant again, or whatever…

    I have the Mirena. It hurt to put in, but not as bad as labor hurt. (Let’s put it this way. I hired a babysitter for the procedure, but was able to drive home afterwards.) I haven’t had any wacky bleeding, but it is a hormonal IUD. The poking can happen, and has happened to my hubs. But it’s not constant, and you can move the strings around so it feels better.

    Complications can happen. They can happen to anything you do. No procedure is benign! That being said, the likelyhood of pregnancy on an IUD is less than a percent. If you go to an experienced gyn, you should not have a problem with insertion, especially as you’ve had a vaginal delivery.

    Good luck. Birth control options can be overwhelming. I think next time, for me, I’m going with Implanon.

  20. After my twins were born, I got the Mirena (IUD with hormones). I took the pill with no problems for many years before that, but knew there was NO CHANCE I would manage to take it at the right time every day with two infants in the house. Getting it in wasn’t tons of fun, but wasn’t much worse than your average pelvic exam. It wigged me out for the first few weeks, but then I pretty literally forgot about it. For the two years I had it in, I had no real cramping, and no more than a few odd days of spotting. That’s right, no real period for a LONG-ASS TIME. I was happy with it.

    But then I had it taken out because I thought I might want to get pregnant again. I thought I would go on the pill in the meantime, since that was easier to stop on a whim if we decided to get pregnant again. Only then did I realize how BONKERS and ANGRY the hormones were making me. I ditched the hormones and told my husband he was in charge of pregnancy prevention. Eventually, of course, we decided to give it another go.

    Now, post-Ellie, I cannot even express how DONE DONE DONE I am. Not rolling the dice again. But I am also DONE DONE DONE on hormones, so M gets to deal with condoms until such time as he makes the appointment for the big snip.

  21. I have had both the copper IUD (Paragaurd) and the hormonal IUD (Mirena). I had Paragaurd after my first child for about 5 years. Insertion hurt a lot, but it had been 2 years since my baby was born. my periods were heavier, but it was worth it to me, since I really did not want another baby at the time. I had it removed and was able to get pregnant right away when we were ready for another baby.

    We did not use BC after Baby #2. We were ok while exclusively breastfeeding, but once baby started eating solids, my period returned. We used NFP method, which worked fine, until we were ready for #3. However, we always wanted a third baby and were ok with whenever it happened.

    I had Mirena put in 10 weeks after my third baby. It did not hurt nearly as bad this time. So far it has been great. I do not have a period at all (but am still nursing, so am not sure if it will return.) I am (almost) positive that we are done, so I did not want to risk getting pregnant anytime soon, or probably ever again.

    My husband has felt it occasionally, but it didn’t hurt him. If it is really bothersome, your doc can trim the strings. It has been so worth it to me, both times. Even the heavier periods on the copper IUD I could deal with, if it meant no condoms and no babies!

  22. Hi Kate,
    I had the Mirena IUD put in April of 2010, and I absolutely love it in that I never think about it. If you are set on not having hormones of any kind (which I totally understand), then I would throw out the Mirena option. But consider this: the amount of hormones that the Mirena releases is very, very low because it is already in your uterus: it’s target. As opposed to the pill which has to travel through your small intestine and break down in the liver, etc. for it to reach it’s ultimate target of the uterus.

    I’ve never given birth or been pregnant, and although the insertion wasn’t pleasant, it was FAST. Like, I counted to 20 and it was done. I cramped heavily for the rest of the day and a moderate amount the day after, but it’s been heavenly. And neither my fiance or I have ever felt anything ‘poking’, ever. Give it some thought!

    -Katen

  23. Sorry about all the “it’s” that should be “its”. College was a while ago.

  24. I have my postpartum check up on Wednesday. Eek. I have to figure this out too. My husband is not hot on the IUD and I’m not so hot on the condoms.

  25. I work at a family planning clinic out in Amherst (western Mass) and I counsel women on all types of birth control, and I’ve had a Paragard myself!
    I’ve never been pregnant (therefore never delivered vaginally), so I was a *little* nervous about the insertion, but I found it really helped to talk with one of the clinicians I work with and step-by-step review exactly what will happen at the insertion. That way, I knew exactly what to expect and I could mentally kind of keep track of how far we were. My insertion was really quick and really low discomfort. If you think about it in the long run though, a few minutes of discomfort at the insertion can be pretty worth it for up to 10 years of birth control.
    Unfortunately, I believe mine was placed wrong (shame on me for having my PCP insert it instead of a practiced midwife or OB!) and I expelled it after 9 months. Glad I didn’t get pregnant during that time – it was sitting in my cervical canal and wasn’t protecting me!
    Uterine perforation is so, so rare, but I totally understand the scary feeling/nervousness. It’s one of those risks you just have to take if you want an IUD.
    Also, I know every body is different, but I’ve *never* heard of a properly placed IUD poking anyone during sex. The strings that are in the vagina are like thin monofilament, and even though it seems like cutting them short would be the best thing to do to prevent irritation, it’s counter intuitive — WAY better to leave them on the long side (~2 inches?), and they will soften with your warmth/vaginal secretions and generally curl right up against your cervix, and usually partners can’t feel them at all.
    In my opinion, the Paragard is absolutely the way to go for maintenance-free, non-hormonal, *really* reliable birth control.
    As for your friend who got pregnant on the IUD – yes, it definitely can happen. My uneducated guess would be that her IUD wasn’t placed correctly, and was hanging low like mine was. You can remedy this by requesting an ultrasound right after they insert the IUD for you, to make sure it’s in the right place.
    Also, your periods will likely get heavier and crampier, but generally it smooths out after about 6 months. Ibuprofen is a very beautiful thing!
    GOOD LUCK!

  26. Well, you know where I stand on this one! We are VERY CAREFUL about ALWAYS using condoms (seriously, ughhhhhhhh), and it feels like the most RIDICULOUS thing EVER with my annovulation history, plus the fact that I’m still pumping/BFing 4x/day! But with two little ones—no matter how hard we worked for them and how much we want another some day—we can’t risk that someday being now.

    I guess my plan is to use continue using condoms and hope and pray I get lucky like you and my cycles/period comes back someday! And then, if that day ever comes, to use the FAM method until further notice? I 200% agree about never ever ever putting BCPs back into my body. NFW.

    xoxo

  27. I have the hormonal IUD (mirena) and Love it. It was a really minor procedure to put in (after you’ve survived childbirth, you won’t think twice about it!) and was really quick – 15-20 seconds. I did have to go back in and have the strings snipped a bit because it was poking my husband, but the midwife who inserted it had warned me that that may be the case, and she preferred to keep the string long to start. My sister has the same IUD but hasn’t had kids, and complained a lot more about the procedure. Apparently a perk of childbirth!
    I had the IUD inserted about 10 weeks after baby #2, and haven’t had a period since (15 months later) – although we are still breastfeeding. I do love life without a period!
    I understand your issues with the hormonal IUD, but for me it has been fantastic. I wasn’t willing to risk the cramps and heavy periods that come with the Copper IUD, but certainly would knowing what I know now about the convenience of the IUD (no pills, condoms, patches, etc…) and the ease of insertion, especially if I had previously had trouble with a regular period.
    Bottom line – we need better birth control options!

  28. My period came back just a bit before yours and I started tracking it on an iphone app because the whole reason I didn’t know I was pregnant was because I was irregular and it turns out that my cycle is now “regular” (i.e. I’ve had 3 periods in a row) but is now 40 days. I’ve also said no more birth control pills and it’s been good ol’ condoms. I don’t know what to do either and I can’t decide when I’ll be brave enough to try for a sibling! Decisions!

  29. Wow, thank you all so much for sharing your experiences! You have given me lots to think about. My biggest takeaway is that NO MATTER what we choose, there’s always going to be a chance that something could go wrong, and that I am going to worry I could be pregnant. That’s actually a really important lesson for me.

    For those who suggested FAM, I have read “Taking Charge of Your Fertility” cover-to-cover. Twice. In theory I totally agree with the idea, and in practice I even think I’d be diligent enough to do it (when I was on the pill I only missed 1 pill in 10 years), however I think with a 1 year old at home who can get me up at weird hours sometimes and, frankly, not having anything physical blocking the sperm, I think I would be terrified every cycle. Or, you know, just never wanting to have sex if we’re anywhere NEAR ovulation date. I can’t deal with that right now. I need something a bit more concrete.

    Lots of great points on the IUD front as well. Unfortunately it sounds like more people have negative things to say than positives, but obviously those are things I’ll have to figure out for myself.

    Thank you again for your awesome comments!

  30. ariannacassidy

    i work in women’s health, and i have to chime in here. the paragard is fabulous, and IUDs are the most effective method (besides abstinence!) out there. i have a paragard myself, and, while it’s true that insertion was unpleasant (though i’ve never been pregnant, so my uterus isn’t used to having much in it), it only takes a couple of minutes. the risks associated, while real, are very, very unlikely. and i have never heard of a woman being poked during sex! if that happens, you’d probably want to tell your ob/gyn, as it would indicate a problem.

    ALL of the ob/gyns i work with wholeheartedly recommend IUDs. many of them have them.

    another thing to consider is the cost. the up-front cost of an IUD can be high, so you might think about when you’d want to conceive next.

  31. i guess i never knew condoms were such a “buzzkill” !! it is all i’ve ever known. because of all the breast cancer history in my family lately ( in the last 10 years it was my mom, twice, and my grandma once), i absolutely dont want to “mess with hormones” in anyway by any type of birth control. that being said, i definitely dont want another baby for AT LEAST four more years!!

  32. I had the Mirena shortly after birth but decided to conceive again. I suffered from infertility for quite some time and am now on my second round of Clomid…needless to say, birth control for me was a bit of a joke. Not even Clomid can whip my ovaries into shape! I didn’t hate the IUD and it came highly praised from the staff at the OBGYN. Good luck…

  33. I use a Mirena IUD. The one with hormones for me because of other issues with SUPERPERIODSFROMHELL and stuff. But, I think they make a non-hormonal one.

    It did not hurt to have it inserted. A had a little bit of crampiness for an hour or so. And I’ve never had a baby, vaginal delivery or otherwise.

    It has never poked any of my sexual partners. Ok, actually, the first one I had inserted, one of my partners could feel the wire a bit and I went back to my gynecologist and she trimmed it and there’s been no incidents of sexual partners noticing at all since then.

  34. We don’t use anything that messes with my ovulation or with any stage of an egg being fertilized/implanted in my uterus. So that leaves us with condom, diaphram and spermicide. We used spermicide (the films) after getting married and they worked well for us. The few times we “cheated” the waiting time is when I ended up pregnant. Lesson? Follow the directions 🙂
    Now we use a diaphram, with no spermicide, and I don’t mind it at all. Because you can keep it in up to 12 hours I think, I don’t have to go rushing to the bathroom right before the act. I can prepare ahead of time if I think we will have sex later and pop it in. I don’t feel it, my husband doesn’t feel it, and so far we haven’t gotten pregnant. 🙂
    It does stink that anything non-hormonal just doesn’t feel great or has lower success rates or whatever.

  35. You can also check into the Creighton Method of NFP. No temps to take, its mucus only, so it might be a better fit. I’ve been doing it for over 2 years now and love it!

  36. I have an IUD. I got the Mirena because I’m not against hormones completely. Ours was covered by insurance so that helped because it is an upfront cost. The risks are SO low that it made sense to me. Plus, I’m still nursing my 17 month old so I couldn’t take pills or anything that would excrete hormones to him. The insertion was a little uncomfortable but it was fast and over very quick. We are hoping to have one more child in a couple years so this method should work great for us until then and then I’ll just see my family doc to have it removed. Best form of birth control I’ve ever used. No side effects (for me at least) little to no periods, and I don’t ever have to think about it!

  37. Spermacide- the kind that comes on little sheets called VCF on its own if you are feeling risky or with diaphragm/condom if you want to play it more safe. no IUDs! Family planning is an option but so difficult if you have an irregular/long cycle and its a pain! (at least thats been my experience). Or perhaps, a combination approach?

  38. In response to Goddess in Progress above: “I ditched the hormones and told my husband he was in charge of pregnancy prevention.” You are my hero!

  39. Hi Kate,
    Sorry to follow up on such an old post, but I was curious if you had made a final decision on this, unless it is too personal? I am still trying to decide what we are going to do for the near term. Much appreciated!

  40. @Megan, We decided to… not decide. To be honest I became overwhelmed with the pros and cons of the various options and none seemed to be “perfect” for us given all of the different variables. So we’re sticking with condoms until Baby #2 (if/when that happens), and then I will NOT hesitate to get a copper IUD implanted as soon as possible after that. No waiting around for periods or tracking cycles. This time it was important for me to figure out if my body was working properly, and now that we know that it is, I feel that we don’t have THAT long until we might want to get pregnant again, so it’s not the right time frame for an IUD. That said, we are being MUCH more diligent about condoms now. No more scares, thankyouverymuch!

  41. Kate, thanks so much for the info. I am so overwhelmed with the various options as well and nothing seems perfect for me either.
    Interesting that you say the copper IUD, since I feel like my OB was only interested in the other IUD (Mirena). I am probably going to wait until we are done with #2 (or at least decide that #2 is not happening), before going the IUD route.
    It’s great that we have so many options now, but options can be overwhelming.

    Thanks again!

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