Birth Control-
Which One Is Right For You?

CHOOSING A BIRTH CONTROL METHOD IS AS INDIVIDUAL A CHOICE AS CHOOSING A PAIR OF JEANS FOR MANY WOMEN

Finding the perfect fit can prove just as frustrating, too. How does one choose when there are so many choices? Birth control pills, the patch, the vaginal ring, IUD, diaphragm, condoms with spermicidal foam, hormonal injection, natural contraceptive methods and permanent sterilization are amongst the choices.

First, a summary of some of the more popular methods. All methods work to prevent unplanned pregnancy. The birth control pill can either be a combination of progesterone and estrogen or progesterone alone. The “pill” changes cervical mucus to prevent a hostile environment for sperm. The pill also prevents ovulation. The failure rate if taken correctly is one to two percent. Advantages can include more regular and lighter periods and a protective effect against ovarian and endometrial cancers.

The birth control patch and vaginal ring also contain estrogen and progesterone. They deliver medication subcutaneous and intravaginally-respectively. It is worn for three weeks and left off for one week in the case of the patch. The vaginal ring is worn intravaginally for three weeks and removed for one week. Benefits and risks are similar to oral contraception.

Intrauterine contraception (IUD) is placed in the uterus through the cervix by a gynecologist to prevent pregnancy. It does so by interfering with sperm transport so that implantation does not occur. The Paragard copper IUD is hormone free and effective for 10 years. The Mirena IUD secretes levonorgestrol and is effective for 5 years. Menses are generally lighter and with less cramping with the Mirena IUD.

The diaphragm is a flexible rubber disk fitted with spermicide and worn so that sperm cannot reach the uterus. A professional must fit it and spermicide must be used for it to be effective. The failure rate is generally 6-18%. Condoms are another form of barrier method. It can be used only once and is most effective when used with spermicide. Condoms can be made from latex, polyurethane or “lambskin”. Only non-petroleum based lubricants such as K-Y jelly should be used with the condom to reduce breakage.

Injectable hormones are a form of progesterone. Contraception is for 1-3 months. This form of birth control works by inhibiting ovulation, changing cervical mucus to create a hostile environment to sperm and by changing the uterine lining to prevent a fertilized egg from implanting. Failure rate is around 1%.

Natural contraceptive methods can include exclusive breastfeeding. Women who proved all of their infant’s nutrition through breastfeeding postpartum can inhibit ovulation for up to 6 months. Effectiveness is somewhat variable between women, however. The “rhythm” method involves periodic abstinence dependent on the 10 most fertile days of a woman’s menstrual cycle. This fertile period is best determined by various methods such as recognizing changes in cervical mucus. Failure rate of this method can be as variable as 14-45%.

Permanent sterilization or tubal ligation can be accomplished by various methods including tying or burning the fallopian tubes thus occluding the tubes such that sperm cannot pass. This form of birth control is considered permanent and irreversible. Risks can include an ectopic, or tubal, pregnancy should pregnancy occur.

So with all of the choices, how does one decide which method is best? Factors to consider include ease of use, method of delivery, duration of time between intended pregnancies and possible side effects. For instance, a woman who had had a child or two and is considering a third might want to try the IUD. This option gives her long term birth control, ease of use and reversibility. A young woman who has a difficult time remembering to take her daily pill may want to consider the patch, the vaginal ring or an injectable hormone to provide reliable birth control. A young woman who does not want to take hormones might want to couple natural methods with the condom to prevent pregnancy. A woman who has had as many children as desired may want to consider the 5 or 10 year IUD or the tubal ligation to prevent unintended pregnancy.

Choices regarding birth control are best made between the patient and her partner in consultation with their healthcare provider. Together, they can choose the best option available to provide optimal compliance and the most effective pregnancy prevention.

Dr. Mala Freeman-Kwaku MD
Board Certified OB/Gyn

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Postpartum Depression
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IF YOU"RE FEELING ANXIOUS, DEPRESSED AND MOODY; REMEMBER THAT YOU"RE NOT ALONE

Many women have strong emotional reactions to the hormonal changes that happen after the birth of a child and experience some form of depression. Childbirth is a major event that affects your body and mind. It’s not unusual to have mixed feelings or even resentment while you’re recovering from childbirth and caring for your new babies. Don’t be embarrassed or afraid to discuss your feelings with your health care provider, family or friends. Many times, just seeking out the help that you need will make you feel better.

The pregnancy hormones estrogen and progesterone and also the thyroid hormone are thought to contribute to postpartum blues and depression. Therefore, that makes some of your feelings beyond your control.

Postpartum (Baby) Blues (30-80% of moms) This is the least severe and relatively short-lived. You may have problems sleeping, feel overwhelmed, anxious and irritable. You may even cry. The symptoms usually begin 3-4 days after the babies are born and last about 2 weeks. It is important that you talk to your doctor if your sadness lasts longer.

Postpartum Depression (15 % of moms)
This is more serious and can occur anytime up to 1 year after childbirth. If you have no history of depression, you have about a 10% chance of developing PPD. If you do have a history of major depression, you have 25% chance of becoming severely depressed after childbirth. If you’ve had PPD before, it’s even higher. Make sure you tell your OB/GYN if you’ve had previous episodes of depression.

Signs and Symptoms: uncontrollable crying; trouble sleeping; decreased appetite; difficulty concentrating/making choices; fatigue (can’t do normal tasks); anhedonism; too concerned or unconcerned about the babies; anxiety/panic attacks (don’t want to be left alone with babies); fear of harming your babies; and thoughts of suicide.

Why? Hormone levels, emotions (preterm delivery, unplanned pregnancy, sick/birth defects, loss of freedom, loss of identity, loss of figure and feeling undesirable, pressures to be perfect mom/have perfect babies.

Postpartum Panic Disorder Presents like bipolar disorder and women often are later diagnosed with it. Signs and Symptoms: anxiety; excessive worry; no trigger for attacks; chest pain, shortness of breath; hot/cold flashes; palpitations; sensation of choking/smothering; may awaken you from sleep.

Obsessive-Compulsive Disorder (3-5% of moms) This often occurs in conjunction with anxiety disorder. Mothers often don’t disclose their symptoms openly because they’re afraid of losing their child or being judged as “crazy”. Signs / Symptoms: intrusive, repetitive thoughts/persistent thoughts or mental pictures; thoughts about hurting/killing babies; tremendous sense of horror and disgust about these thoughts; thoughts may be accompanied by behaviors to decrease personal anxiety (hiding knives)

Postpartum Post-traumatic Stress Disorder
Signs / Symptoms: recurrent nightmares; extreme anxiety; reliving post-traumatic events (sexual, emotional, physical or childbirth)

Postpartum Psychosis (1-2% of moms)
The onset is the first week postpartum or after weaning the babies. There is a 5% suicide and 4% infanticide rate. Signs / Symptoms: confusion; suspiciousness; paranoia; delusional thinking (infant death, denial of birth, need to kill baby); visual/auditory hallucinations; bizarre behavior or speech; irrational thinking/speaking

Postpartum psychosis requires immediate medical help. This is an extremely serious emergency and will not go away without professional intervention and hospitalization.

What can you do? Psychotherapy, medications, get rest (don’t try to do it all); ask family, friends, spouse for help; take care of yourself (shower and dress everyday, get a sitter, meet friends, join support groups)

Why some women experience postpartum depression and others do not is not fully understood. What is important is that it can and should be treated. If you have any of the symptoms that I have described for more than two weeks please talk with someone and get help.

Dr.Octavia Cannon
Board Certified OB/Gyn

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