Belly Tales

The Diary of a New Midwife

Lions and tigers and tenaculums, oh my!

Filed under: Education, Academia, Contraception — The Midwife at 11:23 pm on Tuesday, January 24, 2006

The IUD, I’m beginning to learn, is a much maligned form of contraception. It got a terrible reputation in the US because of all of the furor surrounding the Dalkon Shield in the 1970s, however, the two modern versions of the IUD (ParaGaurd, aka The Copper-T, and Mirena, aka The Hormonal One) are actually safe, effective, more or less painless, and for many women, an ideal form of birth control. In fact, IUDs are one of the most popular forms of birth control in other countries—in most of Europe, actually.

Which is all well and good. In fact, great! Go IUDs. I will happily recommend them to all of my clients who want a no-fuss, highly effective, low cost (expensive at the outset, but cheap given that they last 5-10 years), low side-effect contracetive choice—especially my clients who have already been pregnant once. Nevertheless, tenaculums give me the heebies. The teeth of these gruesome little things are actually inserted into the tender flesh of the unsuspecting cervix, and then the instrument is gradually secured, one click at a time, followed by gentle traction in order to straighten out the axis of the uterus so that the IUD can be properly placed (and we spent most of the afternoon practicing this skill on models). And while I am well aware of the fact that supposedly the cervix has very few nerve endings, and antiseptic washes followed by anesthetic gels are applied before the tenaculum, and the entire procedure is done slowly and gently, one step at a time…even so: my initial reaction was a full-body grimace, and the mental thought of OUCH. Ouch ouch ouch. Poor cervix!

However, don’t let this bias you against IUDs! Insertion is not without its discomforts (usually cramping for the first few hours, which can be managed by a trusty dose of advil or motrin), but luckily, as a consumer of IUDs, you never have to watch the actual insertion process. As a student midwife, watching will probably be the least of it—actually using a tenaculum?? It makes my hair cringe just thinking about it (and the professors had the cheek to say, with eager, chipper voices “Hopefully you’ll get several opportunities to insert IUDs during your upcoming clinicals!”.) Yeah.

I. Can’t. Wait.

8 Comments »

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Comment by kyra

January 25, 2006 @ 10:18 pm

Oh my. Oh wow. I didn’t realize they were inserted into the cervix. And they have teeth, hmm. The concept sounds lovely but the actual insertion does sound painful, it’s kinda making me squirm just thinking about it!

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Comment by The Student

January 26, 2006 @ 9:15 pm

It’s inserted through the cervix into the uterus, where it lives for the next 5-10 years. And yeah, I’m prolly just adding to the bad press on IUDs with this post. Here’s my disclaimer as a future primary care provider: IUDs are a fantastic contraceptive option, and while the insertion process might be *uncomfortable*, it’s probably not excruciating–especially not to a woman who’s already given birth! However, this post was written from the point of view of a student midwife, in which case, tenaculums intimidate me!! Aiiieee! I’ll let you know what I think after I’ve actually had to use one. Maybe my entire perspective will change. :-/

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Comment by heatherw

January 27, 2006 @ 8:58 pm

Poor cervix? Tenaculum? Baby’s head? I’ve had both in my cervix in recent months, and… well… I’m not afraid of that tenaculum. Little teeth cannot compare to an entire cranium. Really, it was just a little pinch, no worse than any other gynecology procedure.

(Yes, I did see the tenaculum before it was used because I rifled through all the equipment when they left me to take my pants off. I should stop that. I was a bit more turned off by the long bent stick.)

What the IUD needs is a new image. Perhaps it should be called Petunia-Gard and have some commercial with hippie chicks in it. I got one anyway, but when I think “IUD”, I think “cramping and heavy bleeding”, and the image that comes to mind is Tim Roth in Reservoir Dogs.

One thing to keep in mind for when you are a primary care provider - the manufacturer insists that they be inserted during a menstrual period. Consider that many of your clients will breastfeed, and therefore, won’t get their period for about six months. But as it is nonhormonal, the copper IUD is a great method for the breastfeeding mom. My OB/Gyn happily put mine in 9 weeks postpartum, but he also knew I was breastfeeding. He knew how *well* I breastfed, because I still had milk from my first child when I came in pregnant with my second. What would your criteria be?

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Comment by The Student

January 28, 2006 @ 8:59 am

That sounds about right to me: the only reason they recommend insertion at the end of the menstrual cycle is that then you’re 100% certain that you’re not pregnant before insertion. With breastfeeding moms who aren’t necessarily doing on-demand feedings and haven’t had their first period yet, it’s hard to know with certainty that they’re absolutely not pregnant (although I guess a pregnancy test before insertion might do the trick, or maybe an ovulation preditor test). Anyway, I think my criteria would be similar: if I know my client well, and know that she is actually doing true on-demand feeding, and is still amenorrheic, I’d prolly go ahead and insert the IUD–but now that you’ve raised this point, I want to go check out the literature and find out what the official recommendation is for breastfeeding moms…if there even is one. (You wouldn’t believe how many drugs and medical devices never even bother to take breasfeeding women into account…or maybe you would).

That scary bent metal thing is the uterine sound, which is what you use to measure the depth of the uterus so you know how far in to place the IUD. And it’s a bit intimidating, too. Our professors told us that you’re more likely to perforate the uterus with the sound than with the IUD itself, which is why they recommended just holding the sound up to the cervical opening and gently gliding it in, without using *any* force or pressure at all, and helping the woman use deep breathing and visualization techniques to relax her cervix and help guide the sound in. It sounds like slow and gentle is the key to the entire thing.

Anyway, I’m glad the IUD is working so well for you! Tell all your friends, so that some more good IUD press can get out there and begin to combat all the heresay. And yeah, it definitely needs a new image…and a new name. Maybe we should just start saying Mirena and copper-T all the time, because at least those names sound a little bit less freaky than IUD, which sounds like a some weird, futuristic alien probe.

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Comment by heatherw

January 30, 2006 @ 11:14 am

Well, honestly, I’m not so happy with it. It really was like a Quentin Tarantino movie for a little while, and I told all my friends that if I had sex, the Wolf was going to have to buy me a new bedroom set. The damn thing has ruined all my panties. Sexy, sexy. Not a good image.

By the way, ParaGard is advertised on Baby Center. The ad is something like, “Sick of your birth control”? Because that is the best that they can come up with. Might I suggest, “Because I never want to change diapers again!” or “I’d rather die than have to drive a mini van.” Or, “Yes, we’ve been married ten years and we still have sex every once in a while.”

Indeed, I am aware of how frustrating it is to have to consider medication when breastfeeding. I asked my OB/Gyn to recommend a breastfeeding-friendly primary care practitioner, because I had such difficulty with that after I had my first child. He laughed and said, “Move to California!” Fortunately, my local Walgreen’s pharmacist ALWAYS remembered, and was extremely helpful. He would tell me before I actually filled the scrip that I couldn’t take it.

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Comment by miriamjoyce

February 16, 2006 @ 12:33 pm

Heather–Can I ask how heavy your bleeding was before the IUD? I’ve heard of heavy bleeding as a common side effect, but I don’t know how it correlates to how heavy ones periods were beforehand.

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Comment by The Student

February 16, 2006 @ 2:01 pm

Miriam: I’m not sure about the correlation between how heavy your period was beforehand and what it’s like afterwards (maybe Heather can give us more information on that), but I do know that if you use the hormonal IUD (Mirena), your period generally becomes much much lighter over time, and often disappears completely after about 6 months. At least, so sayeth all my books, and the information we were taught regarding IUDs (the Copper T is the one that may make your period heavier).

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Comment by heatherw

February 18, 2006 @ 2:47 pm

Miriam-Joyce

Just checking back in on this. My bleeding was not heavy before I got the IUD. When I was nursing my first child, I could go with pantyliners for all but the first day of my period. However, I bled pretty heavily for about 5 weeks postpartum after my second child, and the IUD was inserted 9 weeks postpartum. I have yet to get a menstrual period, as my exclusively breastfed baby is only 15 weeks old. Supposedly, exclusive breastfeeding is supposed to minimize bleeding in general, but that has not been the case with my second baby.

But as an update, it has calmed down considerably. It was inserted on Dec 30. I am almost ready to go out and buy new panties. I have lost nearly all the baby weight, so I’m due for a clothes-shopping spree anyhow.

I did not choose Mirena because, although they claim it doesn’t interfere with breastfeeding, I don’t entirely believe them. I have a couple of challenges with hormonal birth control, as well. The first time I tried it, I got on the lowest dose available at the time and ended up at the psychiatrist with depression. (Magically, it disappeared two weeks after stopping the pill). Also, I weigh around 100lb, so with medications in general, I tend to need a kiddie dose. Thirdly, I work full-time and pump. So I don’t need any more challenges to my milk supply. My OB/GYN agreed wholeheartedly with me.

HeatherW

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