Belly Tales

This is an interesting story about how difficult it was for a woman to obtain Plan B from Walgreen’s, over on the Consumerist.  Apparently the folks at her local Walgreen’s in Oxford, MS, tried to insist that she wait for one hour before getting the Plan B, as well as giving her literature on adoption, as well as just giving her a hard time and writing down her drivers’ license number.  I’m curious: has anyone else had difficulty in obtaining Plan B?  It seems like there’s a lot of confusion about it, especially in terms of the fact that it’s actually BIRTH CONTROL and not an abortion.

One week after our historic election of Barack Obama as the 44th president of the United States, here’s a very interesting article on what his presidency might mean for Women’s Health (of the non-”airquotes” variety), namely improved access to birth control and sex education (i.e. the federal government no longer funding abstinence-only programs), a reversal of the “conscience” legislation which is now allowing doctors, nurses and pharmacists to legally refuse to perform any service they morally object to, including prescribing birth control, and stopping the global gag-rule which prohibits federally-funded health clinics in foreign countries from performing abortions or even referring women to other facilities that will. It’s all good stuff, and worth checking out (with a nod to Women’s Health News who found the article in the first place).

South Dakota’s Measure 11 was soundly defeated: “South Dakotans have affirmed by their votes tonight that no vague law can account for every individual circumstance. And that is precisely why women and families, not the government, should make these personal healthcare decisions,” said Sarah Stoesz, President and CEO of Planned Parenthood Minnesota, North Dakota, South Dakota.

The New York Times, in the midst of all the election craziness, published an article on new links between depression and premature delivery which have been recently reported in the Journal of Human Reproduction. The study interviewed 791 women and ultimately gave them scores based on how many depressive symtoms they exhibited–the higher the score, the worse the depression. The study found that the higher the score, the greater the risk of preterm delivery, even after controlling for prior preterm deliveries, miscarriage, socioeconomic status, education and other variables. This is particularly fascinating considering that so little is known about how depression affects pregnancy, and vitally important since depression during pregnancy (and the mental health of women during pregnancy in general) are so often overlooked in prenatal care.

The New Space for Women’s Health (formerly Friends of the Birth Center) is having a fundraiser on November 18th at Babeland called Women Come First. The event, which is co-sponsored by Ricki Lake and The Business of Being Born, offers an opportunity to not only raise money for the new free-standing women’s health and birth center in New York City but an exclusive cocktail party and shopping opportunity. Sounds like a lot of fun! I’d be there if I wasn’t already working that day…

Finally, I’m sure this is going the rounds on the internet, but I think everyone, everyone, needs to watch Keith Olbermann’s special comment on Proposition 8:

This just arrived in my inbox, moments ago. I can’t find a single news story written about this yet, in any of the papers. Is it really possible for a blog to beat the newspapers when it comes to a story? Neato!

We did it!
At 9:20 a.m. today, the FDA approved over-the-counter access to the “morning-after” pill!

Dear *******,

Thanks to the letters, petitions, and support from people like you, the FDA finally overcame the political pressure from the White House, Congress, and anti-choice lobbyists, and approved the morning-after pill for over-the-counter sales.

Medical experts and scientists at the FDA have asserted for years that the morning-after pill - which can prevent an unintended pregnancy if taken within 72 hours after sex - should be available without a prescription. It’s safe, it’s effective, and it’s a commonsense way for women to prevent unintended pregnancy.

Thank you again for helping achieve this victory for women - your action does make a difference.

My best,

Nancy Keenan
President
NARAL Pro-Choice America

Wow, is this for real?? HOORAY!!! It only took two years too long, but let’s hear it for strong scientific evidence finally winning out in the end. I’ll update with more articles on this as they are written, because I’m sure this will be in the news today. This calls for a real celebration, though, and a thankful prayer for a return (even if, perhaps, momentary and fleeting) to rational, evidence-based thinking on the part of our government. I’m thrilled! Just got back from a long shift at work, and am off to bed, but with news like this, I’m off to bed HAPPY.

(I really hope I don’t wake up later today and find out that this was all a dream. Someone pinch me, please.)

ADDENDUM:

This news is now in The New York Times, so it must be true. Wheeee!

Feministing maps out the conservative response to today’s news, with unabashed glee.

Better late than never: check out this article from the New York Times magazine last weekend, which featured a long, in-depth look at the growing anti-contraception movement in America. A few highlights includes a detailed description of the entire Plan B over-the-counter approval-process debacle which happened last year, culminating in the resignation of Susan Woods, then director of the FDA’s Office of Women’s Health…and we’re still waiting for a response from Lester Crawford, acting Commissioner of the FDA, aren’t we? We may be waiting for quite some time. At least “Senators Hillary Clinton and Patty Murray are holding up the nomination of Andrew von Eschenbach as F.D.A. commissioner until the F.D.A. issues a verdict on the drug.” Go go Senator Clinton!

Oh, and this is very interesting:

One thing that happened, which Dr. Wood and many others may have failed to notice, was the change in conservative circles on the subject of contraception. At a White House press briefing in May of last year, three months before the F.D.A.’s nonruling on Plan B, Press Secretary Scott McClellan was asked four times by a WorldNetDaily correspondent, Les Kinsolving, if the president supported contraception. “I think the president’s views are very clear when it comes to building a culture of life,” McClellan replied. Kinsolving said, “If they were clear, I wouldn’t have asked.” McClellan replied: “And if you want to ask those questions, that’s fine. I’m just not going to dignify them with a response.” This exchange caught the attention of bloggers and others. In July, a group of Democrats in Congress, led by Representative Carolyn Maloney of New York, sent the first of four letters to the president asking outright: “Mr. President, do you support the right to use contraception?” According to Representative Maloney’s office, the White House has still not responded.

Apparently the White House can’t give a straight answer to what should be a very straightforward question. Three cheers Congresswoman Maloney for asking the question repeatedly in the first place, though (in fact, Congresswoman Maloney a deserves an entire post of her own just to list all of the amazing work she’s done on behalf of women, children and women’s rights).

A few other chilling highlights:

In addition to providing an information center for the abstinence industry that has blossomed in recent years, [Leslee Unruh] takes her message directly to kids. Besides “Girls Gone Mild,” she sponsors “Purity Balls,” which fathers attend with their teenage daughters. “We think the relationship between fathers and their daughters is the key,” she told me. At the purity ball, a father gives a “purity ring” to his daughter — a symbol of the promise she makes to maintain her virginity for her future husband. Then, during her marriage ceremony, the daughter gives the ring to her new husband. Abstinence Clearinghouse’s Web site advertises the purity ball as an event “which celebrates your ‘little girl’ and her gift of sexual purity.

Better yet, check out Feministing’s take on the subject: Daddy’s little hymen.

Women’s Health News also had a very astute break down of the entire article, which is well worth reading.

As the 2007 federal guidelines for program financing state, “It is required that the abstinence education curriculum teaches that a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity.”

I can’t even touch that, it leaves me so angry.

Seems like ever since the FDA announced that two more women have died after taking RU-486, one of the drugs used during a medical abortion, the abortion debate has reached a new pitch as pro-lifers have eagerly added this news to their arsenal and pro-choicers have feverishly girded themselves for pitched battle. Naturally, this has been reflected in the blog community, and several very well researched, well-written and articulate posts have emerged. As an avid reader, I don’t even know where to start. Here’s the cream of the crop. (Extra points if you stay up past your bedtime reading blogs on nights before exams):

Rachel at Women’s Health News has a very thorough and astute break-down of the issue, complete with linked resources and recent research on the subject, reminding us that at this point, further research is needed on both approved and off-label uses of mifepristone (RU-486) and misoprostol before any firm conclusions can be drawn. She also points out that the maternal mortality associated with RU-486 still appears to be much lower than the maternal mortality associated with live birth, and that no one has bothered to look at the mortality rates associated with other prescription drugs.

Via Feministing: Speaking of other prescription drugs, Media Girl was very quick to point out that the current death toll caused by Viagra is 5,640…and no one seems much concerned about this.

The link between abortion, women’s rights and women’s sexuality has become increasingly clear as fundamentalist groups begin to take aim at their next target, birth control (I guess because banning abortion seems to already be in the bag?) Salon has written a very bone-chillingly scary feature on this subject, highlighting Mary Worthington’s blog, No Room for Contraception, which promotes the idea that contraception causes health problems, destroys a woman’s fertility and can even lead to the spread of sexually transmitted diseases by encouraging sex. (Check out her post on how the use of contraception opened the door for homosexuality by allowing sex to be seperated from procreation.)

Which has led to Dan Savage’s painfully funny (funny because it’s Dan Savage, painful because it’s so true) plea for a Straight Right’s Movement (also via Feministing):

Straight Rights Update Earlier this month: Republicans in South Dakota successfully banned abortion in that state. Last week the GOP-controlled state house of representatives in Missouri voted to ban state-funded family-planning clinics from dispensing birth control. “If you hand out contraception to single women,” one Republican state rep told The Kansas City Star, “we’re saying promiscuity is OK.” On the federal level, Republicans are blocking the over-the-counter sale of emergency contraception and keeping a 100 percent effective HPV vaccine—a vaccine that will save the lives of thousands of women every year—from being made available.

The GOP’s message to straight Americans: If you have sex, we want it to fuck up your lives as much as possible. No birth control, no emergency contraception, no abortion services, no life-saving vaccines. If you get pregnant, tough shit. You’re having those babies, ladies, and you’re making those child-support payments, gentlemen. If you get HPV and it leads to cervical cancer, well, that’s too bad. Have a nice funeral, slut.

What’s it going to take to get a straight rights movement off the ground? The GOP in Kansas wants to criminalize hetero heavy petting, for God’s sake! Wake up and smell the freaking holy war, breeders! The religious right hates heterosexuality just as much as it hates homosexuality. Fight back!

And finally, the coup de gras: Bitch PhD has assembled an impressive mini-carnival on articles pertaining to the recent deaths, anti birth control trends, and the humbling, human cost of unwanted pregnancies that is so rarely taken into account whenever this cold, legal debate comes up.

While you’re there, be sure to check out her Heroine of the Week, Cecilia Fire Thunder, President of the Oglala Sioux in South Dakota, who has personally vowed to start up a Planned Parenthood facility on the Pine Ridge Reservation, where the laws of the State of South Dakota don’t apply.

Seriously, forget your homework. Spend the rest of the night reading. It does a soul good.

I inserted my first IUD today! I did it mostly on my own, with my preceptor checking my sounding and talking me through the procedure, and I was amazed by how simple it was. After learning all of the steps in school, and being tested on them during our IUD check-outs, it seemed like a much bigger deal than it actually was. And thankfully, there were no tenaculums involved. Instead, the clinic uses Allis tissue forceps in place of tenaculums, which was a little bit less intimidating. Basically, the prongs of the Allis are placed at the 11 O’Clock and 1 O’Clock position at the very top of the cervix, and then the axis of the cervix is gently straightened out for the insertion. Both the uterine sound and the IUD itself just slipped right in! I was amazed. Of course, it didn’t hurt that the woman we were inserting the IUD into had had six kids, and 2 previous IUDs, her last one in for 10 years. She was a big fan of them, actually, and was so gentle with me. Having had the procedure done two times prior to my insertion, she knew what to expect, and didn’t need much calming or reassuring—in fact, she was reassuring me! Funny how the one thing I was feeling particularly squeamish about ends up being one of the very first things I end up doing. And you know what? It really wasn’t that bad at all. I wasn’t as nervous as I thought I’d be. My hands weren’t even shaking—in fact, my preceptor told me that I had good hands during the procedure. What a compliment! She also mentioned that there are usually two or three IUD insertions a day to do at this clinic, and promised me that next week I’d do more. How exciting. I’m really looking forward to getting good at the technique, and feeling confident about it.

I only saw 4 patients, but two of them were annual exams, which were long and involved and fun. One woman was here because of the IUD, and one woman was here for a Depo Provera shot. I got to write a nice long SOAP note, and do full exams on the women. Lots of practice inserting speculums, and collecting specimens. We even looked at slides under the microscope again to determine that one of the women did indeed have a yeast infection. My preceptor was a lot of fun to work with today, too. She was the smiley one, and this time, instead of letting me go off on my own, she kept closer tabs on me, which I was really appreciative of. What a great day in Family Planning! I hope most of my clinical rotations are this much fun.

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.

The curse, the red tide, my period, my monthly, my friend, on the rag, on the spurt, and on and on. All the jokes, all the whining, all the bitching, all the unfair media portrayal, the cultural stigma, the fear, the shame…menstruation gets such a bad rep that, at the very least, I felt it deserved to be paired with a word like “magical” for a refreshing change of pace, if for no other reason than its very complexity. Do you have any idea how many hormones are involved in your monthly menstrual cycle? Take a guess: 2 hormones? 3? 4? I can’t even tell you. Our lecture today covered the ups and downs of the 5 major hormones that are involved, but the lecturer kept slipping in little comments like: “and of course, prostaglandins, and inhibin, and [insert other hormone names that I wasn't even able to catch] also play a part, but I’m not going to get into that today.” Damn straight it’s magical. It’s absolutely amazing! If we ever tried to reproduce the entire cycle in a laboratory setting, there’s no way in hell we’d ever be able to get it right. Do you have any idea how many things are all happening at once? It’s a bit mind boggling.

Mind-boggled. Yup, that’s pretty much how I feel right now. This semester is going to be a TON of work. I have so much on my plate already that I don’t even know where to start (hence, this delightful post: why start in on your homework when you can procrastinate and post to your blog instead?). And as for the menstrual cycle…this is something we studied in nursing school, and I had a hard time grasping it then. This is something I’m going to have to go over again and again and again until I know it forward and backwards, because it’s so damn important (and so damn complex). This is the reason and the beginning, the why and the how, of pregnancy. The hypothalamic-pituitary-ovarian axis, the follicular phase, the proliferative phase, the secretory phase, the luteal phase…all these names for something that your body does automatically, naturally, without fuss and often with very few mistakes, every single month for most of your adult life.

Lecture today was great. The guest lecturer was smart and sassy and a lot of fun—material that could have been really boring was actually made fascinating, which says a lot. And lots of little fun facts tossed in for good measure. For example, did you know that bleeding is not actually necessary at all during the cycle if you’re on birth control? Because of the presence of progesterone from the very beginning of the cycle, the lining of the endometrium doesn’t ever proliferate very much at all, but just stays steady at about 2 mm of development, and can stay that way for quite some time, if you ever want to just go through a few pill packs back to back and skip the week of placebos that allow for bleeding. In fact, apparently the only reason the placebo week was structured into the pill cycle was because of a decision made by a very Catholic man in the 1950s, who felt that monthly bleeding was necessary in order to help remind women of Eve, and the fact that they’re women, I guess. There’s a new pill out now that will charge you an arm and a leg for the privilege of only bleeding four times a year (Seasonale), but you might as well save some money and just take your regular pills back to back (although talk to your midwife/health care provider about it first, of course).

Another interesting fun fact: the Morning After Pill (aka EC or Emergency Contraception) really truly IS birth control, and not an abortifacient, and yes, I already knew this, but now I understand why. EC is basically just pure progesterone, and it works best during the follicular phase of the cycle, where the sudden burst of incoming progesterone is enough to prevent the release of leutenizing hormone that triggers ovulation. In other words, EC works best if it’s taken before ovulation occurs, in order to prevent ovulation. However, if ovulation has already occurred, the surge in progesterone may slow down fallopian tube motility and therefore possibly prevent implantation (in which case, I guess I could see how conservatives could potentially argue that this prevention of implantation is in fact the killing of a baby, but I do think it’s a rather thin argument). However, the little fun fact I didn’t realize is this: as soon as you’re pregnant (i.e., as soon as the trophoblast has implanted), the corpus luteum begins to make progesterone in vast quantities, and if you happen to take EC at this point in the cycle, it won’t disturb or prevent the pregnancy in any way whatsoever. In other words, if you’re already pregnant (i.e., the trophoblast has already implanted), EC does not end or harm your pregnancy in any way. In other words, it’s NOT an abortifacient. As soon as that trophoblast implants, the corpus luteum is working its ass off to produce massive amounts of progesterone anyway just to keep the pregnancy afloat until the placenta can take over hormone duty; a little extra squirt of EC progesterone at this time does NOTHING to disrupt this. FYI. (Why do I feel that if more people actually understood how EC worked, so many of the objections to it would just disappear, and the FDA might finally get around to approving it for over-the-counter use? Righto. Get the word out, ladies.)

Four pharmacists were suspended in Illinois for refusing to fill prescriptions for emergency contraceptive (Plan B). ABC has the full article here.

A few weeks ago, when Governor Pataki vetoed the Emergency Contraception bill, I mentioned that the FDA was going to issue a ruling on the safety of selling EC over the counter on September 1st. Well, September 1st has come and gone…and the ruling has failed to materialize. Lester M. Crawford, the FDA’s newly appointed Commissioner, decided to delay the decision (in a decision-making process that apparently involved very few of the top officials at the FDA). To say that this delay comes as a shock is a bit of an understatement; Crawford’s appointment was only confirmed by the Senate after he’d promised them to come to a ruling on the safety of EC by September 1st.

In other startling news, Dr. Susan Woods, the FDA’s Director of the Women’s Health Office, was so disgusted by Crawford’s delay and lack of decision that she resigned on the spot. In the e-mail she sent to coworkers explaining her decision, she stated: “I have spent the last 15 years working to ensure that science informs good health-policy decisions…I can no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended by the professional staff here, has been overruled.”

Crawford’s reason for the delay was questionable. While he conceded that Plan B (the morning-after pill) was safe as OTC medication for women 17 and older, he was concered that women 16 and younger would not be able to use it correctly and wanted Plan B to be only available by prescription for this age group. He delayed the ruling because he was unsure of how to properly enforce this distinction between age groups. However, when the FDA first raised this concern last year, it was suggested by the pharmaceutical company which makes Plan B that the age limit could be enforced the same way that drugstores currently enforce the age limit on cigarette and alcohol sales.

To quote USA Today’s article on the subject, “‘there’s fairly widespread concern about the FDA’s credibility’ among agency veterans as a result, Wood told The Associated Press hours after submitting her resignation Wednesday”. Senators Hilary Clinton and Patty Murray urged a Senate hearing on the matter, saying that “Science has taken a back seat to politics in the FDA’s decision-making process for Plan B”.

There was no firm statement made by Crawford about exactly when another ruling would be made, although he’s opened the question to public comment for at least another 60 days. So I think the message here is: don’t hold your breath.

Frankly, I can’t quite believe this has happened again: politics trumping good science and well-written bipartisan legislation, again. To quote Dr. Wood one more time (this time from the NY Time’s article on the subject): “I feel very strongly that this shouldn’t be about abortion politics…This is a way to prevent unwanted pregnancy and thereby prevent abortion. This should be something that we should all agree on.”

(The LA Times also wrote a fabulous article on the story.)