Know your options before you talk to someone about birth control

The first bit of good news: there are many birth control methods for you to choose from. Whether you are selecting an option for the first time or hoping to switch to one that’s a better fit, it’s likely that you can find a method that accommodates your needs. Your first step should be to speak with a healthcare provider and make an appointment to figure out a good fit. They can talk you through all of your options, answer any questions, and, if necessary, give you a prescription or schedule placement of a long-acting option.

Tips for talking with a provider

There are a number of different types of providers that you can speak with. You can work with your primary care provider, an OB/GYN, a certified nurse midwife, or a nurse practitioner to learn about your options. And you can do so in any number of different settings — like at a hospital, a private medical practice, a health or family planning clinic, or a community health center. Find a provider that you feel comfortable with at a convenient location.

Be honest

You should speak with your provider honestly about your general health, your period and your cycle health, your medical history, your lifestyle, and if or when you have any plans to have children. If you feel uncomfortable disclosing certain medical or sexual history, (for example, abuse or previous abortions) that is okay. It can take time to develop a trusting relationship with a provider. It is very helpful to talk about any experiences you’ve had in the past when taking birth control. Birth control isn’t one size fits all — when you are open about your needs and concerns you are more likely to find a good option!

Talk about your priorities

Does it make sense for you to take a pill every day or would you like to opt for a longer lasting option? Do you want something that will help you manage your period? Is effectiveness at preventing pregnancy your top priority? Make sure you talk with your provider about what’s most important to you.

Ask questions

Your provider is there to help you learn more about your options and ensure that you leave feeling good about the one you’ve chosen. You don’t need to have all the answers, so ask any questions that are on your mind and ask for clarification if anything is unclear. Do you want to know more about side effects? Or about how to use the method you’ve decided on? This is the time to ask away!

Choosing a birth control method is a very important — and very individual — decision. Speaking with a provider you trust is the best way to get started.

Reviewed by the Ovia Health Clinical Team

Read more

• How much do you know about birth control?
• Which birth control option is right for you?

Sources

• “Birth control methods.” Office on Women’s Health. U.S. Department of Health and Human Services, April 24 2017. Retrieved March 31 2020. https://www.womenshealth.gov/a-z-topics/birth-control-methods.
• “Choose the Right Birth Control.” MyHealthfinder. U.S. Department of Health and Human Services, February 5 2020. Retrieved March 31 2020. https://health.gov/myhealthfinder/topics/everyday-healthy-living/sexual-health/choose-right-birth-control.
• “What do I need to know about birth control?” Planned Parenthood. Planned Parenthood. Retrieved March 31 2020. https://www.plannedparenthood.org/learn/teens/preventing-pregnancy-stds/what-do-i-need-know-about-birth-control.

Gina Nebesar, Co-Founder of Ovia Health

I was so excited to speak with my two dear friends Becca and Jean Ann recently. Just this year they started on the crazy journey that is parenthood with their beautiful baby girl, Roz. They’re total badasses at home and at work, they’re incredible people, and now they have this gorgeous family. Their TTC journey took them a little while, and IVF helped them get pregnant, and I’m really grateful they could share their story – including incredible advice about choosing and buying sperm, real talk about IVF shots, and really candid conversation about adjusting to life as new moms.

IVF success stories: Two moms talk about growing their family… and how

I want to start by saying congrats! I know you just celebrated your 5 year anniversary, a big milestone. And an even bigger milestone is the birth of your baby girl! I’d love if you could start by telling us a little about your beautiful family.

Becca: We did just celebrate our five-year wedding anniversary, and in April we had our baby girl Roz. She’s almost 5 months old. And it’s been great so far!

I just left town for the first time, and left her alone this weekend with Jean Ann, her other mom. And in that 48 hours she learned how to roll over, without me there! And now she sleeps on her stomach, so I came home to a totally different baby. But I feel like she’s changing every single day, so it’s really awesome.

I love hearing about how people make the decision to start a family. Could you tell us a little bit about your journey to becoming parents?

Jean Ann: Because we’re two women, one question that I asked a lot is how we decided who will carry. And when your partner basically says, “One thing I’ve always wanted to do in my life is be pregnant and give birth, like, totally unprompted,” you’re like, “Cool, that seemed too easy.” Becca had always wanted to do that, and I’m still sort of on the fence – it doesn’t seem like something I have to do. So Becca had decided that she was excited about that a few years ago, and eventually I got more excited about it.

The first thing we had to do was choose a sperm donor. That was probably one of the biggest decisions we’ve ever made. Because you have to decide if you want an anonymous donor or someone you know. And we actually had a good friend who offered. And we took it pretty seriously, but ultimately decided it was important for us to have our own separate family unit. So then we looked at a lot of the websites for sperm. It’s basically like a KAYAK for sperm, and you can sort for different things.

Becca: It’s almost like online dating!

Jean Ann: We wanted someone that hopefully shared a lot of my characteristics. So were able to find someone who was half-Asian, he was getting a graduate degree in chemistry. We could even listen to a 45-minute interview with him where he talked about his favorite books, and he just seemed very thoughtful, quiet, serious, and nice.

Becca: We spent a lot of time looking for sperm – really thinking about these profiles and listening and narrowing it down. I remember we had all these pieces of paper on the kitchen table – we had written down the different donor numbers and which ones we liked – and then we narrowed it down.

And we actually had kind of had a long journey. It was about two and a half years from buying sperm until having Roz. Buying the sperm was step one. I remember, they were having an end-of-year sale, so we had to get it in before the end of 2015!

Were they really? Like, they were really having a sale?

Jean Ann: Yeah, it’s expensive. It’s something that there’s a lot of in the world, but it’s not cheap!

Becca: Well, it wasn’t quite a sale, but they were like, “We’ll throw in an Amazon gift card if you buy today!”

Jean Ann: “And three years of free storage!” But, yeah, we’ve actually spent several thousands of dollars on sperm, if you can believe it.

So, obviously, you found a great deal, but how did you get started with that process?

Becca: Really, we just Googled.

Jean Ann: There’s three or four big sperm cryo websites.

Becca: The one we went with is called California Cryo, one of the largest ones. For us, they felt right— it was a good website experience, and their customer service has been great. We did look at the big ones, some other small ones, and some local ones.

Jean Ann: But I think, for us, wanting a donor who was half-Asian like me was important, and that actually narrowed it down a lot. It went from like 550 to like, eight.

Becca: So then we could spend our time kind of really thinking through those people.

Jean Ann: You can definitely get a situation where there’s a run on the sperm. So we had this total disaster about a year later, where we had used up half the vials that we’d bought, and we were getting really low, and we went online, and they had sold out! And the donor had stopped donating! So we recommend you check what’s in stock a lot.

Becca: Yes, check frequently! And if you can afford it, buy more than you think you need.

Jean Ann: Buy a lot!

Becca: Because you can store it, and you can sell it back if you don’t need it.

Jean Ann: Nothing is worse than the feeling of having decided on someone to be your sperm donor and being very excited about them, and being halfway through the journey, and then realizing that if you want to have more than just one kid that you’re going to run out of sperm.

Becca: You’re going to run out and you may have to use different sperm.

Any other advice about that process for others that are just starting out with sperm donation?

Jean Ann: Just check your sperm stock frequently. And if you’re really excited and settled on someone, I would buy more than you need or just be willing to have a weekly reminder to check that it’s not running out.

Becca: I think the other thing is I would pony up for the extra access to information. Because I think, for us, the interviews with the sperm donors, that was the most impactful. You can only tell so much from a baby picture and some  generic likes and dislikes – which is the basic info you get – but I actually think you can get a pretty good feel for a person from something like an audio interview. It’s like a typical website where it’s like, “Pay to unlock this feature!” but it’s worth it to pay for that premium membership.

So, in December 2015, once you made that decision about your donor, how did things progress from there?

Becca: So that winter when we were back home from the holidays, we started trying to get pregnant, and we were doing IUI.

Jean Ann: You basically have two options, you can do IUI or IVF with donated sperm. IUI is basically artificial insemination.

Becca: Turkey baster!

Jean Ann: The turkey baster method, but at a facility. So we started with IUI.

Becca: I actually got very lucky with the first IUI try in February 2016. I was tracking my ovulation – I was using the Ovia app – and I was peeing on sticks and all of that, and when my ovulation test said I was ovulating we went in for the IUI, we did IUI, and I got pregnant that very first time. And it was amazing! We were so excited! First try!

And then in the spring at about 12 weeks I had a miscarriage. So I got almost through my first trimester, and I had a miscarriage. That sucked, that was a setback and sad, and that was really hard.

So the summer of 2016 was kind of recovering from that, and then it takes a while to get back on track, especially when you have a miscarriage when you’re that far along there’s a lot that your body has a lot to process and then re-regulate. And then we didn’t have a chance to try again until September of that year. So we got back on the horse and started trying again. And we were gonna continue to do IUI at that same facility because it had worked that first time.

And I started tracking my ovulation and going back in monthly, but something was wonky with my cycles. I would think I was ovulating, but I would go in and I wasn’t ovulating. I think one or two times we did get an ovulation, and we tried, but I didn’t get pregnant.

Jean Ann: And that’s when we started running out of sperm. And we realized that there wasn’t more. So that’s when we panicked, realized we couldn’t get anymore, and so we decided to move to IVF. But neither of our insurances, we thought, really covered IVF.  We were both on my insurance, and it wasn’t explicit. It was basically like, “Your IVF is covered, if it’s for a medical reason.”

Becca: “Medically necessary.”

Jean Ann: Yeah, “medically necessary,” that’s the phrase that’s used – and so I went down this whole rabbit hole to figure out if that means coverage if you’re gay. It took forever. But basically, no, being gay was not a “medically neccessary” reason, so it wouldn’t be covered. So I fumed about this for a while.

And then I ended up talking to our company’s head of HR kind of randomly about something else, and I just kind of mentioned this to her and didn’t expect it to go anywhere—I just figured this would sort of take some kind of lawsuit situation to change it— but she was like, “Oh, really? I didn’t know that!” Then two days later somebody that worked for her called and they were like, “Oh, we added it for same-sex couples to our insurance, so it’s covered now!” So I guess some advice would be to know that in terms of your health insurance, you may be able to change the coverage for something like this, depending on your company.

I constantly tell women to ask for those benefits, because they might end up with that exact same story. I was in a meeting recently with a health plan and an employer where we we pointed out in the language of the plan how it was alienating to same-sex couples. And the woman didn’t even realize it and was like, “I’ve gotta change it!” She had just never read the fine print before, but then took action to change it as well. I’m so glad that you asked about it, and I wish more people would!

Becca: Yeah, it was pretty awesome. So, we started IVF in the summer of 2017, and there’s a whole series of tests and all sorts of painful things they need to do to make sure you’re ready for it. And that takes months— you have to wait a few cycles, you have to get on the right timing. So I remember this being such a frustrating time in our lives. It felt like everything was going slowly and like everyday I had to be at the doctor doing some other painful thing. It was a rough period. It is funny now looking back on it, because it all feels like such a blur in retrospect, but at the time it felt really pronounced and painful.

Jean Ann: As someone that has now done IVF three times myself – and Becca has done it once – it’s not as bad as people think it is. It sucks giving yourself the shots, but it’s fast. It’s like a two week period of shots.

Becca: At this point we’ve both done it, because as the journey continues, we ended up having a baby and decided that we wanted to at least give ourselves the option to having another baby in the future with Jean Ann’s eggs.

Can you share more about that experience and what it’s like? Again, I’m sorry to hear about this part of the journey. I just can’t imagine having the 12 week miscarriage, that’s just awful, and the fear of the sperm running out, and then going through the pain of IVF. And I know you say it’s not that bad, but I think maybe you’re just tougher than many – that sounds really hard to me!

Becca: Honestly after being pregnant for nine months, you can barely remember the IVF, it’s like a blip. But I think that the shots – for us at least – I think the shots look scarier than they end up being.

Jean Ann: I feel like the first and second time you’re really just like, am I really going to stab myself in the leg with this needle?

Becca: The thought of it is tough. The first time is the hardest, because you’re just staring at this needle and you’re like looking at your leg, and you’re just like, so I’m really just going to push this in, huh? But it’s a needle, and it’s made to go in. I actually think over the two week period of shots, it gets progressively more painful toward the end. So the last few days are the worst. I think at that point you’re feeling a little bit bloated, you’re not allowed to go to the gym, you’re giving yourself shots every single night. For some reason those last few nights hurt the worst. At that point you’ve shot yourself everywhere on your legs, everywhere on your stomach, and you’re looking for a new spot. So those last few nights, you just want it to be over.

Jean Ann: And then you have the trigger shot, and everybody makes a big deal of the trigger shot. Somebody else gives you that one, and it has to be at an exact time – like, 1:45 in the morning, 10:30 p.m. – so when you go in to have your eggs be retrieved, it’s exactly 36 hours after the trigger shot.

Becca: And then for the egg retrieval process you do go under.

Jean Ann: Under some very temporary anesthesia. You’re all the way under, but it’s very short. And then you’re done!

Becca: And then there’s some anxiety as you wait to hear your egg count. For us we were doing embryos, so right when they retrieved the eggs they fertilized them with our frozen donor sperm. So after that you’re kind of waiting on eggshells – no pun intended – to hear how many of your embryos made it to day 3 or day 5, or just what the status of them is. And we’ve been on both sides of the spectrum. For me, I was really fortunate, I had a pretty high egg count, and with just one retrieval I got enough embryos that we felt comfortable and were able to freeze them. For Jean Ann, on her first and second try she didn’t get that many, and so she’s had to go through the egg retrieval process three times now.

Jean Ann: I will just add that for anybody that’s getting close to age 35, 35, you can get a blood test that will give you your AMH number. It basically tells you how many eggs, roughly, you have left. It’s a very good indicator or whether IVF is going to be a breeze and you’ll just have to do that once, or if your egg yield is going to be low and you’re going to have to do it multiple times like me. It is also a good predictor of if you will have to do IVF at all because the same number is also a good indicator of whether or not you will naturally be able to get pregnant. It’s a very easy first step.

Did you know about this AMH (or Anti-Mullerian Hormone) test before starting the IVF process, or did you learn about that after?

Jean Ann: Actually, someone at work told me about it. Because I was like, “I don’t think I want kids for a few years,” and this very matter of fact 40 year old man was like, “How old are you?” And I said, “35.” And he was like, “Just go get your AMH number. My wife had a low AMH number and it took us 5 years of trying and then we ended up adopting.” I was like, oh, my gosh!

And then I got the test, my AMH number was bad, and, indeed, it took me multiple times to do IVF. So I feel like this AMH blood test is pretty much free information.

A lot of healthcare providers might say no to that sort of testing, but I always suggest that people go to their provider and just insist on it. So, through this process, who was supporting you along the way? Obviously, you had each other. Was there anyone else in your life who was particularly helpful during this time?

Becca: Each other, for sure. I’m not a big oversharer, but it’s been really helpful for me to share, because what I’ve found is that as soon as I start talking about it, everyone has either a similar story themselves, or their friend does, or their sister does. So when I had my miscarriage, it was really helpful for me to tell people about it – even at work – and then people would share these success stories, and that made me feel better. And it was similar when going through IVF. I would talk about it with my friends, and they all had someone they knew who had been through it. At the time, I was really the first of my very good friends who was having a lot of trouble getting pregnant, and I felt a little bit alone, so their IVF success stories were helpful for me.

Jean Ann: But since then, now we know several people who’ve been through this.

Becca: We know people who’ve had miscarriages, been through IVF, and now I’ve been able to help them because we have this success story. So, for me, I would tell anyone who’d listen! And that helped me a lot.

Jean Ann: Then you had a pretty good pregnancy.

Becca: Yeah, and the IVF really worked well for us. We did an egg transfer, and I got pregnant on that first one, and then I had a pretty good pregnancy.

Jean Ann: And you have to give yourself these progesterone shots for the first 12 weeks.

Becca: No one talks about this!

Jean Ann: No one talks about this, but these are actually really terrible shots. And every night for the first 12 weeks that you’re pregnant—

Becca: You give yourself a progesterone shot in the butt.

Jean Ann: That was probably the worst part.

Becca: I think some doctors will allow you to do a suppository instead. So I went, like, running in after three nights of shots and was like, “Give me the suppository!” And they were like, “No, we highly recommend the shots.” They wouldn’t do it. So you’re giving yourself shots for 12 weeks. So much worse that the two weeks of IVF shots! It’s so much longer! So you’re basically so sore in the butt for the entire first trimester. But once we got through that, things were okay.

Jean Ann: Smooth sailing.

Becca: Yeah. I had a lot of heartburn, and that was my main symptom really.

Jean Ann: Then because you were a geriatric pregnancy, they told us that they wouldn’t let you go past one week over your due date. So we got an induction date for almost a week past your due date.

Becca: Yeah, 5 days past my due date they scheduled us for an induction. We went in, I got induced, and like these things do, it took forever to get a room, it took forever for the induction to start.

But then, like, once it started, it really started.I had pretty strong contractions for a long time, for like 15 hours. But I really wasn’t dilating. So, it was kind of sad, I kept having these big contractions and the doctor would go away and then come back a couple hours later to check my cervix and every time I was like, “Oh, I think I’m making progress!” and then she would check and be like, “Nope, still 3 cm. You’ve barely made it to 4 cm.” So I just wasn’t dilating. And then at some point, in about hour 16 or 17 of labor, I got a fever, and they said we’ve got to do a C-section. So we went in on a Thursday night, that Friday night at 11:30 p.m. she was born via C-section. And she was great!

Jean Ann: There’s so much pressure to not have a C-section and to be able to breastfeed right away and all this stuff, and, like, if you walk out with a healthy baby, that’s the goal, that is 100% success. I feel like people shouldn’t put that much pressure on how they want everything to turn out.

I know. There’s so much pressure for birth to be this perfect experience, just as planned. And I remember, too, even with me, I had a C-section, just feeling guilt, feeling like a failure, and realizing that, like, my baby’s awesome, and I really don’t care about how I got her! Do you remember what the first couple of days after Roz was born were like?

Becca: It’s funny, it’s such a blur. And I remember at the time saying to myself, I’m totally lucid and I’m recovering fine and I’m gonna remember all of this. And now I realize I don’t remember much of what those days were like!

I remember stumbling out of bed in the middle of the night and either feeding or pumping, and I remember napping a lot. Because I was recovering from a C-section, I needed a lot of help both during the days and the nights. So luckily I had Jean Ann to help, we had family, we got some help for me during the day when she went back to work. We were fortunate to be able to do that because I couldn’t lift the baby, but it’s all such a blur.

I do remember her being so cute. Like everything she did was so cute. I would feed her, and she’d fall asleep on me right after, and it was the cutest thing I’d ever seen! This weekend, actually, I saw a picture of Roz from her first few weeks. And I remember at the time looking at her and thinking, My newborn is so cute! She doesn’t look like a weird scrunched up newborn like every other one! She’s a perfect baby! And, like, five months later I realize that she definitely looked weird! But you just don’t see it at the time.

You do have an exceptionally cute baby! So what is it like now versus what it was like then?

Becca: I just feel like we’re getting more into what our life will look like for the next few years. Those first few weeks in my maternity leave I just kept thinking about how it was a temporary time – and it was wonderful, and I really enjoyed it – but now we’re trying to figure out what our real life looks like. Like how we manage the jobs and the baby, how we manage finding time for ourselves, how we manage time for the extended family who wants to visit. So, it’s different – I’m much more lucid, I’ve recovered from the C-section, all of that kind of blurriness is gone – but I’m in this, like, this half-place where I feel like, we don’t quite have enough time for everything. And I don’t know if this is just what the new normal is, or if we’re still figuring it out. So that’s kind of the phase we’re in now.

I feel like our journey has taken a lot of different turns. And where we are now – we’re so so happy and so lucky that we have this wonderful healthy baby – but it took a while. And it took a lot of different types of interventions, and along the way there were times when it felt like it wasn’t going to happen, but now she’s here, and she’s perfect, and it makes the last two and a half years feel like a blur, like just a blip. So it was all worth it.

Jean Ann: But at the time, it was tough. It can be very tough.

Becca: Yeah, and I guess some advice we would give is to try to release some of the expectations that you have and some of the perfection that you’re striving for, because you really just don’t know how things will turn out. Like, you might not always be able to hit that exact timing for getting pregnant that you want. Or we thought we wanted a boy, but we obviously love our baby girl! It turns out it doesn’t matter. So just to try to release some of that, to the extent that you can, because the journey is hard enough.

Common questions about the MTHFR gene: Answered

First off, what does the MTHFR gene do exactly? It’s responsible for making the enzyme, methylenetetrahydrofolate reductase (hence the MTHFR acronym and wordy gene name). This, in turn works with the B-vitamin folate to help to reduce the level of homocysteine in the body.

What does it mean to have a MTHFR gene variant?

There are two common gene variants (which is when the DNA sequence of a gene is different in different people) of this gene, and these are called C677T and A1298C. Studies have shown that women with two C677T variants have an increased risk of having children with neural tube defects (though these defects are rare, so the risk is still low). Men and women with the same two variants and elevated homocysteine levels may have an increased risk of blood clots (and people who have elevated homocysteine levels rarely have elevated levels just from the gene variants, so they should be evaluated for other risk factors that are known to cause this). Too much homocysteine in the body can be one risk factor for blood clots and heart disease, however many environmental and genetic factors influence risk for this.

Can the MTHFR gene affect pregnancy?

Associations between these common gene variants and a number of complications have been speculated and evaluated for in different ways, but no association has been found. These gene variants have not proven to be a risk factor for problems that may arise during pregnancy such as blood clots, pregnancy loss, or other negative health outcomes. Because of this, the American Congress of Obstetricians and Gynecologists (ACOG) do not recommend testing for MTHFR gene variants. If genetic testing does show a MTHFR variant, these variants on their own will not impact an individual’s medical treatment. And a medical geneticist will work hard to do a thorough and appropriate evaluation of symptoms to prevent incorrectly attributing medical problems to positive MTHFR status, which is not uncommon.

And what this all means for pregnant individuals is that prenatal care – including recommendations for prenatal vitamins or folate supplementation – will not change in major ways based on the presence of an MTHFR gene variation. Impacts include if, for example, a person has high homocysteine levels, medical providers will seek to identify all possible causes, and pregnant individuals will be advised to take standard folate dosages to reduce the risk of neural tube defects. Or, to use another example, if other symptoms indicate that it’s necessary, an individual may be referred from a medical geneticist to a hematologist or maternal–fetal medicine specialist for further evaluation.

Talk to your healthcare provider if you still have questions or concerns

If you have any questions or concerns about this, talk to your healthcare provider, as they can answer your questions.

Read more

• Genetic testing before pregnancy
• Getting healthy for fertility and pregnancy

Sources

• Scott E. Hickey, Cynthia J. Curry, and Helga V. Toriello. “ACMG Practice Guideline: lack of evidence for MTHFR polymorphism testing. Genetics in Medicine. 15(2): 153-156. February 2013. Retrieved August 28 2018. https://www.acmg.net/docs/mthfr_gim2012165a_feb2013.pdf.
• “Basic information about the MTHFR Gene.” Kaiser Permanente. The Permanente Medical Group, Inc., May 2018. Retrieved August 28 2018. https://mydoctor.kaiserpermanente.org/ncal/Images/GEN_MTHFR_tcm63-938252.pdf.
• “MTHFR gene variant.” U.S. Department of Health & Human Services, National Institutes of Health, National Center for Advancing Translational Services. Genetic and Rare Diseases Information Center, April 18 2018. Retrieved August 28 2018. https://rarediseases.info.nih.gov/diseases/10953/mthfr-gene-mutation.

Advocate for your health, here’s how

The goal here is, of course, for you to be able to have a say in your care options and to be sure you’re making informed decisions that are best for you and your growing family, but it’s not always easy to feel empowered when sitting in a provider’s office. After all, they’re the expert and it can feel like they have all the power.

But an ideal patient-provider relationship will actually involve the two of you coming together to work toward improved health care and health outcomes for you. A few ways to ensure that you can work with your provider in this way and act as an advocate for your own care include:

Asking questions

Communication is key in creating a good rapport between you and your provider. This can, of course, be challenging if you don’t know the ins and outs of what’s being discussed, if you’re at all nervous or ill, or if your provider is not necessarily the best communicator to begin with. Your provider should speak to you in plain language that you can easily understand, but it’s also important for you to feel free to ask for explanations if anything is unclear, even if that feels tough.

It’s common to feel reluctant to be a bother, or to be embarrassed to speak up, but helping your understand your own health is part of your provider’s job. Let them know if you don’t understand something they’ve said, if you need further explanation, or if you have follow-up questions.

Knowing your goals for the appointment

Sometimes it’s hard to get as much time with a healthcare provider as you might like, so it helps to be prepared before heading into an appointment. Before you walk in, try asking yourself what you want to get out of the meeting. Making a list of questions, symptoms, or concerns you might have in advance of the meeting can be helpful, since it’s easy to lose track of some of your thoughts or questions when you’re put on the spot.

Bringing up questions or concerns that are especially important to you early on in the appointment can help you make sure that the questions you especially wanted answered don’t get rushed through or brushed off at the end of the meeting.

Doing your research

Knowing your healthcare history, and being prepared to talk about it with your provider can help them give you the best possible care for your unique personal history, and can help to give you a sense of control over your health – after all, your provider may be the expert on healthcare, but you are the expert on your own body. And if you’re someone who likes to do a bit of external research on your own before an appointment, that can also be helpful for familiarizing you with terms and ideas you might be hearing about, but it’s also important not to get overwhelmed, and to make sure you’re getting your information from a trusted, reputable source.

Taking notes during an appointment can also be helpful for making sure you’re keeping track of all the important information you’re given, as is keeping track of any paperwork or care info you’re given when you leave an appointment.

Sharing your knowledge and preferences

Your healthcare provider – whether they’re a doctor, nurse, or midwife – is a medical expert, but you have knowledge to share too. You know your health history, you know what’s normal for you and what’s not, and you know what sort of recommendations for care are likely to suit your lifestyle and actually stick, and that’s all information that can help your provider give you the best care possible. If specific courses of care are discussed, are you comfortable with them? Do you want to talk about the risks and benefits of certain treatment options? Alternative options? Are you worried about cost or invasiveness? These are things to have an honest discussion with your provider about so that they can help you consider all your options.

Knowing when it’s time to call it quits

Ideally, you should be working with a provider who takes you and your health concerns seriously, who treats you with respect, and who you feel you can trust. Every once in a while, it’s worth checking in with yourself to make sure you feel like you’re working with a good partner in your care. Are you comfortable with the care and options being provided to you? Hopefully the answer is a resounding yes, but if you just don’t feel like you’re being heard – or worse, if you’re feeling disrespected, pressured, or like you’re not being taken seriously – then it could be time to get a second opinion or find a new healthcare provider.

Call your healthcare provider if you experience these complications

When new symptoms appear, you might find yourself wondering if you should wait things out or call your healthcare provider right away. Some reasons that you should, indeed, go ahead and call your provider include:

If you experience unusual bleeding

Everyone’s periods are different, and what’s normal for one person might not be normal for another. Some women have light periods, others heavy. And for some women, irregular periods or spotting between regular periods might be par for the course. But if bleeding becomes different than what you’re used to – like, say, bleeding profusely during your period (enough to change pads or tampons every hour) or spotting between periods when this just isn’t typical for you- then you’ll want to be in touch with your healthcare provider to figure out just why these changes are occurring.

If you experience a lot of pain during your period

Many women experience cramping during that time of the month. But if you experience pain during your period that is extremely painful or incapacitating, pick up that phone and be in touch. Major pain could be a sign of a bigger problem. And even if it’s not, you shouldn’t suffer, and your provider can work with you to try to find ways to mitigate your discomfort.

If you notice vaginal itching, burning, odor, or an unusual discharge

Vaginal discharge is common – and you likely know what sort of a discharge is normal for you during different stage of your cycle – but if you experience a discharge that’s a bit different than normal, especially if it’s accompanied by an unusual odor, then touch base with your healthcare provider. Same goes for if you’re experiencing any vaginal itching or burning. These symptoms could be signs of vaginitis, a sexually transmitted infection (STI), or a yeast infection.

If you experience discomfort when you urinate

If you experience pain or discomfort when you urinate, it could be a sign of a urinary tract infection (UTI) or a sexually transmitted infection (STI). Sometimes pain while peeing might also be accompanied by a strange odor or discharge, or by fever, chills, or pain in your back. If you’re experiencing any of these issues – you guessed it – get in touch with your provider.

If sex is painful

Sex should be pleasurable, but if you’re experiencing unwelcome pain, give your healthcare provider a ring. There are a number of reasons this discomfort could be happening, and talking through just what exactly is painful with your provider can help you get back in the saddle – comfortably – in no time.

If you experience pain, fullness, or discomfort in your abdominal or pelvic area

If you have discomfort in your abdomen or pelvis area, talk things through with your provider. There are a range of reasons you might be experiencing feelings of pain, fullness, or other discomfort – everything from pelvic inflammatory disease, to ectopic pregnancy, to fibroids, to cysts, to endometriosis, to infection. This really runs the gamut, and an expert opinion is needed to determine whether the pain is a symptom of something critically threatening, or benignly uncomfortable.

If you have trouble getting aroused or climaxing

If you notice that you’re having trouble when getting intimate, either getting aroused or orgasming, your healthcare provider can help you work through these problems. Whether there are some underlying physical issues at play or it just takes a few small refinements in the bedroom, you deserve to have a healthy sex life, and your healthcare provider can help you work through these concerns.

If your period suddenly stops

If you’ve been sexually active and your period suddenly stops, the most likely explanation is that you’re pregnant. If you’ve been actively TTC, this might be just what you’ve been hoping for! You know what to do – pee on a stick and call your healthcare provider. And if you haven’t haven’t been sexually active, then obviously there might be something else at play, so be in touch with your provider to figure out what’s going on.

If you’ve been TTC for a while

Just what is a while? If you’ve been trying to get pregnant for a year (or six months if you’re over 35) and have not yet had a positive result, it could be time to be in touch with your healthcare provider to see if there are any underlying issues that might be preventing you from getting pregnant or if you need some extra help along the way.

If you have questions or concerns about your current method of birth control

If you’re not presently TTC and aren’t feeling so hot about your current birth control – maybe you’ve been experiencing side effects or just don’t think you current option jives with your lifestyle (perhaps you’re forgetting to take that daily pill?) – then your provider can help you find another option that will work best for you.

If you notice any other major changes

You know what’s normal for your body. And you might have noticed that much of the above list involves changes that signal something is different. So as a general rule, any major change that signals something is out of sorts is definitely worth being in touch with your healthcare provider. What if it’s something that doesn’t seem quite so major but definitely seems slightly off? Give them a call anyway. Err on the side of caution, and let your provider give you some guidance on what is likely a-okay and what warrants an office visit to have things checked out further.

Sources:

• The American College of Obstetricians and Gynecologists. “Benign breast problems and conditions.” ACOG. American Congress of Obstetricians and Gynecologists, June 2012. Retrieved September 26 2017. https://www.acog.org/Patients/FAQs/Benign-Breast-Problems-and-Conditions.
• The American College of Obstetricians and Gynecologists. “FAQ136: Evaluating infertility.” ACOG. American Congress of Obstetricians and Gynecologists, June 2012. Retrieved September 26 2017. https://www.acog.org/Patients/FAQs/Evaluating-Infertility.
• “Annual Exams.” Dartmouth-Hitchcock. Dartmouth-Hitchcock, Retrieved September 26 2017. http://www.dartmouth-hitchcock.org/gynecology/annual_exams.html.
• “Contraceptive Options.” Dartmouth-Hitchcock. Dartmouth-Hitchcock, Retrieved September 26 2017. http://www.dartmouth-hitchcock.org/gynecology/contraceptive_options.html.
• “Infections and Pelvic Pain.” Dartmouth-Hitchcock. Dartmouth-Hitchcock, Retrieved September 26 2017. http://www.dartmouth-hitchcock.org/gynecology/infections_pelvic_pain.html
• “Menstrual Problems.” Dartmouth-Hitchcock. Dartmouth-Hitchcock, Retrieved September 26 2017.
• “Period Problems.” Dartmouth-Hitchcock. Dartmouth-Hitchcock, Retrieved September 26 2017. http://www.dartmouth-hitchcock.org/gynecology/period_problems.html.
• “Sexual Health.” Dartmouth-Hitchcock. Dartmouth-Hitchcock, Retrieved September 26 2017. http://www.dartmouth-hitchcock.org/gynecology/sexual_health.html.

Learn about the different reproductive healthcare providers available

Having these options is pretty great, since it means you can seek out the care that you think would be best for you based on your views and values, your medical history, the level of care you will need, and, if you’re TTC, your pregnancy and childbirth preferences. You can choose from:

Certified nurse-midwife

These nurses have a nursing degree and additional training in midwifery. They provide women’s health care, prenatal appointments, and will be present for the labor and delivery of a baby.

Midwives are able to care for most pregnancies as well as labor and deliveries that are low-risk – and most women do fall into this category – as they can treat women who need little medical intervention. Their care is also based in the idea that pregnancy and childbirth are normal processes.

Many women who share this view may decide to choose a midwife for their care for this reason and because they want minimal medical intervention. Many midwives work with OB/GYNs so that if complications do arise and a pregnancy or delivery becomes high-risk, then a patient can receive more specialized care from doctors as needed.

Family practitioner

These are doctors who can also care for women with low-risk pregnancies. They are primary care physicians with a broad range of medical knowledge and so can provide a broad range of care – for everyone from children to older adults.

These doctors have three years of additional training after medical school and some may decide to focus on additional training in obstetrics during this time. Some women prefer to work with these doctors if they saw a family practitioner as their primary care doctor before trying to conceive or getting pregnant and so enjoy having continuous care with someone they already know. And these sort of doctors may simply be more common in rural areas or at particular hospitals.

However, because labor and delivery is only a part of their training and not their focus, much like midwives, they may need to refer women with certain issues to an OB/GYN. And while some will perform vacuum and forceps deliveries if needed, most do not perform C-sections.

Obstetrician-gynecologist or OB/GYN

These doctors have completed four years of training in obstetrics and gynecology after medical school. Their care focus and expertise is pregnancy and women’s reproductive health and they can provide a range of women’s health services.

Many of these doctors can deal with a range of healthcare needs – everything from low-risk pregnancies and deliveries to many types of high-risk pregnancies and deliveries, such as when interventions like a C-section may be needed.

These doctors typically provide prenatal appointments, will deliver the baby at the time of birth, but may not necessarily be with you throughout labor – rather, labor and delivery nurses or midwives may be present for that.

Maternal-fetal medicine specialist

These doctors are also called perinatologists, and they are trained to deal with the highest risk pregnancies. These doctors will not only have completed medical school and standard four-year training in obstetrics and gynecology, but also an additional two or three tears of training to deal with high-risk pregnancies.

If you are seeing another health care provider and any major health issues arise during pregnancy – such as multiples, preeclampsia, or chronic health problems – you may be referred to this type of specialist. These specialists will typically work in collaboration with your other doctors or nurses and may not necessarily attend labor and delivery.

Don’t be surprised at your next PCP appointment, here’s what to expect

But even if you’ve been to a PCP before, it may have been a while ago, or you may have never before had an appointment at a time when you were trying to conceive. So just what can you expect once you’re there? Your visit may include:

General physical exam

The general physical exam may be done by a nurse assisting your doctor, or done by the midwife. This usually consists of a height and weight check, as well as taking your blood pressure.

They may also ask you some basic questions, such as if there have been any major changes to you health since you last visited, what medications or supplements you’re currently taking, and if you have any major concerns that you’d like to discuss during the visit. They will also likely ask your the last dates of your period and about your period history.

Discussion of health history, concerns, and questions

This kind of visit also dedicates some time to speaking with your healthcare provider about your personal and family medical history. You may also discuss sexual history, options for contraception, fertility, and plans for conception.

As you discuss all of this, your provider will probably ask you a number of questions, and if you’re honest with your answers, your healthcare provider will be able to provide you with the best and most appropriate care. This is also the time for you to ask any questions you may have – no matter how personal, and even if you feel a bit embarrassed. Your healthcare provider is there to provide you with reliable medical knowledge, support, and to answer any and all questions you have.

Whether you’re actively trying to conceive or not, your provider will discuss reproductive health options that will work best for you. And if you want to try to conceive in the near future, this is the time to tell your provider about these plans so that they can share just how you can remain in good health as you TTC.

Physical exam

An accompanying nurse may or may not stay in the room with your healthcare provider during the physical exam. During this exam, you will likely be undressed and wearing a medical gown that opens in the front and a paper sheet to cover your lap, and the exam might include a pelvic exam, a bimanual exam, a breast exam, and a rectovaginal exam.

During the pelvic exam, your provider may examine the outside of your vagina, including your vulva and vaginal opening. Your provider may also examine the insider of your vagina and cervix with the help of a device called a speculum, which will hold open the vagina. They may also do an internal bimanual exam by placing gloved fingers inside your vagina as they place their other hand on your lower abdomen where your reproductive organs are located to feel them.

The provider may also do a rectovaginal exam as needed, which involves them placing one gloved finger in your vagina and another in your rectum.

The breast exam may involve your provider looking at and feeling your breasts for lumps or other abnormalities. They may also feel your neck and throat. As they do all of this, this they will aim to see and feel that you are healthy, and that they don’t observe any abnormalities.

During the physical exam you may feel some pressure or slight discomfort, but none of this should not be painful. If you do feel discomfort or pain, make sure you let your provider know.

Lab tests or screening

Based on your medical history and discussions with your provider, there is a chance they may recommend lab tests or screenings – whether routine or specialized – based on your healthcare needs. These might include a blood draw, a urine test, STD tests, or a Pap smear. These tests may happen before or after you meet with the provider.

Pap smears are done during the pelvic exam and involve your provider swiping your cervix with a small brush. (The cells taken from the swipe are then tested at a lab for cervical cancer and other abnormalities.)

No matter what type of provider you see, your healthcare provider is meant to be a partner in your care, helping you to maintain good reproductive health at every stage of your life.

What happens after a miscarriage?

The process of recovering from a miscarriage can be made even more difficult by the fact that certain experiences aren’t talked about as much as others. Here are five things you might experience after a pregnancy loss, and ways to handle them.

1) Seeing babies or other pregnant women might be really difficult for a while.

After experiencing a pregnancy loss of any kind, it can be difficult for women to see or hear anything related to pregnancy and babies. Things like seeing a baby bump or hearing women talk about their pregnancies might make you feel sad, angry, or might even make you start to cry. This might catch you off-guard, but it’s a completely normal reaction when you take into account the fact that you’ve been through a traumatic experience, and being reminded of babies can make you revisit that trauma.

Consider writing in a journal as a way to get these feelings out. If writing doesn’t appeal to you, find someone who you can talk to who has been through a similar situation, or who understands that these responses are an acceptable and natural part of the grieving process.

2) You and your partner may grieve in different ways.

Two people can react to the same situation in completely opposite ways, and this is especially true for something as intense and devastating as grief. Perhaps your partner needs to talk a lot, and you don’t. Or maybe it’s the opposite and your partner shuts down whenever they are sad. It’s possible that your partner feels as though they need to be strong for you so they push their grief aside completely.

No matter your grieving styles, you’ll be able to get through any pain you’re both feeling by communicating with one another. Ask each other questions. Be sensitive to the answers, and respect each other’s boundaries. Be gentle with yourselves and with one another. Remember that healing will take time for both of you.

3) People might say things that are hurtful or offensive to you.

Grief is an extremely difficult thing for people to deal with, and most people won’t know the right thing to say to you. You might hear things like, “at least you weren’t further along,” “at least you don’t have to buy maternity clothes!” “it was God’s will” or “everything happens for a reason.” Other people may tell you life goes on or that you’ll feel better soon. While they come from a well-intentioned place, these comments can be hurtful and cause you more pain when you least expect it.

No matter what anyone says, you should never feel wrong or foolish for caring as much as you do. Anyone who has been through this kind of experience could tell you that your feelings are entirely appropriate, and there is no wrong way to grieve. You don’t need to listen to or believe people who say things that make you feel bad, or even mildly annoyed. If you find yourself in a conversation with someone who is making you uncomfortable, let them know you appreciate their support but that you would rather talk about something else.

4) You might feel a need to memorialize the loss.

Some women mark their pregnancy loss with a special ritual that helps them celebrate and remember the babies that they loved, and will always love. After all, when our loved ones pass away, we have certain personal and familial traditions that we undergo. But in the United States at least, miscarriages have largely remained private and unceremonialized, which can contribute to women and their partners feeling restless, or like they have to move on faster.

Women who are searching for a way to memorialize their baby may want to look into the Buddhist tradition of mizuko kuyo. This is a ceremony offered by more and more American Zen Centers. Some women might also find comfort in writing letters to their babies, planting plants or trees in honor of their babies, or purchasing customized jewelry to remind them of their babies.

5) You might blame yourself or feel like you are a failure.

Many women feel as though the loss of a pregnancy was somehow their own fault. They may get mad at themselves or their own bodies. They may start to obsess over every little thing they did, ate, or felt – searching for the moment they could have prevented the events that unfolded. But the truth is, miscarriages can happen to anyone. They are more common than anyone talks about. You are not the failure, and you are not to blame.

Sources

• “Miscarriage.” PlannedParenthood. Planned Parenthood Federation of America Inc, 2016. Web.
• OBOS Pregnancy and Birth Contributors. “Miscarriage in the First Trimester.” OurBodiesOurselves. Our Bodies Ourselves, Apr 9 2014. Web.
• “Miscarriage.” MarchofDimes. March of Dimes Foundation, Jul 2012. Web.
• “Pregnancy loss: How to cope.” MayoClinic. Mayo Foundation for Medical Education and Research, Jun 25 2016. Web.
• Elizabeth Leis-Newman. “Miscarriage and loss.” APA. American Psychological Association Monitor on Psychology. 43(6)56. Web. June 2012.

Possible first signs of a miscarriage

Light bleeding or spotting during their first trimester of pregnancy isn’t abnormal, but you should always report it to your provider to be on the safe side. This helps your provider better monitor the rest of your pregnancy. If the bleeding seems especially heavy or gets heavier, that could be a sign of a miscarriage, and women who notice heavy vaginal bleeding during pregnancy should contact their provider for a medical exam.

Heavy bleeding can also be a sign of an ectopic pregnancy. An ectopic pregnancy occurs when the fertilized egg implants in a location other than the uterus, such as in the fallopian tube. Women who are at risk of ectopic pregnancy should also make sure to call their provider right away if they notice this, as ectopic pregnancies can be life-threatening.

Other indicators

There are a few other common symptoms of miscarriage that a woman might experience.

• Abdominal pain or cramping to varying degrees of intensity. Cramping may feel like light pressure in the abdomen, or it may be severe and extremely painful
• Lower backache, often intense
• Dizziness or lightheadedness
• Tissue with clots or pink/white mucous passing from vagina

When you’re at the provider’s office

A healthcare provider will likely perform a pelvic exam, an ultrasound, and blood tests to determine if a woman is miscarrying. If this is the case, her provider may let her choose between letting the miscarriage happen naturally and without medication, or undergoing surgical or medical intervention to help complete the process. Medical interventions might be among the following:

• Rh-immune globulin:

Rh-immune globulin is a simple injection given to all pregnant women who have Rh-negative blood cells, as well as Rh-negative women who have miscarried or had an ectopic pregnancy. An Rh-immune globulin injection is important because if an Rh-negative woman has an Rh-positive fetus, the woman’s immune system will create antibodies against the Rh proteins on the fetal blood cells. This doesn’t impact the current pregnancy, but if a pregnancy occurs in the future and the fetus is Rh-factor positive, the mother’s antibodies will attack the fetus’s blood cells. By administering Rh-immune globulin, or RhoGAM®, the woman’s immune system doesn’t make the antibodies and there is no risk for future pregnancies.

• Suction aspiration, or dilation and evacuation (D&E):

For early miscarriage, and sometimes second trimester miscarriage, the healthcare provider may perform a suction aspiration or a D&E. During suction aspiration, the provider numbs the cervix, dilates it, and removes the remaining tissue using a small, gentle suction device. During a D&E, those same steps are performed and forceps are then used to remove any remaining tissue. Women are asleep during a D&E. They can have someone in the room with them for the procedure, and they also need a partner, family member, or friend to drive them home and monitor them for the rest of the day.

• Medicine to help the uterus contract and pass any remaining tissue:

This is the most common type of management for women who experience a second trimester miscarriage.

• Pain medication:

Late miscarriage is less common, and usually happens in a hospital. It can also be more painful than an early miscarriage. Pain medication might be prescribed for a late miscarriage while the process runs its course.

Any procedures or medication depend on a woman’s individual circumstances, but either way, her healthcare provider will help her understand her options, and make the best choice possible.

After the provider’s office

Bleeding and cramping from a miscarriage may last anywhere from a few hours to a few days. Sometimes the blood looks like heavy menstrual blood, or if a woman is later in her pregnancy, it may appear more clotted. Women usually are advised to avoid intercourse and using tampons for about a week after they receive a miscarriage diagnosis. They may also use over-the-counter pain medication to reduce the pain from cramping, as well as sanitary pads, hot water bottles, or a liner for their beds, depending on how much bleeding they are experiencing. Once the miscarriage is complete, it can be normal to continue to spot or bleed lightly for four weeks or more; symptoms of pregnancy, such as nausea and breast tenderness, tend to resolve quickly. Ovulation and your period usually return within four to six weeks after a miscarriage.

Some women have a follow-up appointment after the miscarriage is complete. This may be especially helpful for women who are looking for closure after a miscarriage. These appointments are called “pregnancy loss follow-ups,” and they can help a mother and her partner process what they experienced with the miscarriage, as well as give them an opportunity to plan for the future.

Sources

• OBOS Pregnancy and Birth Contributors. “Miscarriage in the First Trimester.” OurBodiesOurselves. Our Bodies Ourselves, Apr 9 2014. Web.
• “Understanding Early Miscarriage.” UCDAVIS.edu. UC Regents, 2015. Web.
• “Miscarriage.” MarchofDimes. March of Dimes Foundation, Jul 2012. Web.
• Mayo Clinic Staff. “Rh factor blood test: Why it’s done.” MayoClinic. Mayo Foundation for Medical Education and Research, Jun 23 2015. Web.

Things to consider about sex after a miscarriage

Individuals and couples who have experienced a miscarriage often report feelings of hesitancy towards resuming sexual activity, for both physical and emotional reasons. What is most important is that you take care of yourself, and keep the lines of communication open.

What factors influence when someone can start having sex again?

Sex after miscarriage is a very personal and individualized situation. That being said, there are some physical and mental factors that most people will want to take into consideration after experiencing any kind of pregnancy loss.

• Physical factors:

After a pregnancy loss, women are generally advised to maintain ‘pelvic rest’, including no tampon use or sexual activity, for two weeks after miscarriage. This is partially due to the fact that the cervix and uterus are more dilated in the weeks following a miscarriage, which makes infection more likely. A pelvic exam from a provider is the best way to know for sure if you’re medically ready to have sex again. Sexual activity can typically be resumed after this time. However, a healthcare provider may give different recommendations about when it’s safe to resume sexual activity based on their assessment and your experience.

• Emotional factors:

Many people don’t feel quite ready to start having sex again for some time after a miscarriage. This is very normal. Open, honest conversation between partners should be encouraged in order to remain connected and work through these feelings.

Your healthcare provider is a valuable resource to help you determine when it is safe to resume sexual activity and, if you’re ready, to try and conceive again if that is something you want. Your provider will base their recommendation on multiple factors including the type of loss, the gestational age at the time of loss, and the your personal experience.

When does the menstrual cycle return?

You may ovulate as soon as two weeks after a miscarriage, but it is also normal for ovulation to take longer to resume.  Healthcare providers usually recommend waiting at least one menstrual cycle before trying to conceive again, and that people not try to conceive until they feel emotionally healed. These recommendations may be different for those who have had more than one miscarriage. As always, it’s a good idea to ask your healthcare provider for their opinion about when it’s safe to start trying again. In the meantime add a safe method of protection, if that’s necessary for you, until you’re cleared.

Long-term grief

It’s normal to experience a shift in mood, or strain in a relationship after a miscarriage. While short- and medium-term grief and sadness are expected, if you’re experiencing grief or depression lasting for months and it’s impacting your  ability to perform daily activities, seek the help of a specialist. There are many options to get the help you need. This could be a therapist, a psychiatrist, a support group, or a combination of them; the most important thing is that you feel comfortable talking to your healthcare provider about how you’re feeling and any concerns you may have. Sexual activity after loss might be emotionally or physically difficult at first, but as long as both partners are respectful of one another and understand where each other are at in the healing process, things will get easier over time.

Sources

• “When can I resume sex after a miscarriage or pregnancy loss?” UTMBHealth. The University of Texas Medical Branch at Galveston, 2016. Web.
• “How soon can couples have sex again after a miscarriage?” ISSM. International Society for Sexual Medicine, 2016. Web.
• “Getting pregnant: when is the best time to get pregnant after a miscarriage?” MayoClinic. Mayo Foundation for Medical Education and Research, May 17 2016. Web.