About half of pregnant women surveyed are unaware that pregnancy is more dangerous than contraception, according to results of a recent survey conducted at the University of Rochester’s family planning clinic and presented at the annual clinical meeting of the American College of Obstetricians and Gynecologists (ACOG) .
The following conversation, is one that I’ve had with many patients:
Me: “Are you using any kind of contraception right now?”
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Patient: “No.”
Me: “Are you trying to get pregnant?”
Patient: “Oh no. I don’t want to get pregnant.”
Me: “So why aren’t you using any form of contraception?”
Patient: “Hormones are dangerous. They can give you a stroke or a blood clot. I’ve heard those commercials on television. “
Women give many reasons for not using contraception. Some say they find condom use awkward and uncomfortable. Others complain that there are too many side effects from hormones or that they can’t remember to take a daily pill.
Yet it is always puzzling to me when a woman who says she doesn’t desire pregnancy takes such a big risk by using no form of birth control.
Couples who don’t use contraception have about an 85% chance of pregnancy during the course of a year, according to the Guttmacher Institute. Those are some pretty bad odds to bet on when you do not wish to become pregnant.
There are so many great options for contraception today, but so often patients only know about the pill. At a recent conference I attended, the push was to begin contraceptive counseling by talking about long-acting reversible contraceptives (LARC) like IUDs or Nexplanon – the most effective methods – and work down from there. This is a very new way of looking at birth control education for me, but one that I am willing to try.
More importantly, as clinicians, we need to do a better job of educating patients about true risk, which is not always the easiest thing to convey.
The overall risk for death among young healthy nonsmokers using oral contraceptives (OC) is 240 times lower than the risk of death from pregnancy-related complications, according to ACOG.
Furthermore, the risk for developing potentially deadly blood clots in pregnancy is five times greater than the risk of blood clots from OCs, with the highest risk occurring during the immediate postpartum period.
Whenever patients use the potential side effects or risks of birth control as an excuse not to use it, I list the potential and very real side effects and risks of pregnancy. We as healthcare providers need to be the ones reframing the way patients think about contraception.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.
