Dear Planned Parenthood, I Love You, But We Need To Talk
/ Internet Link“Here’s where it gets interesting… you, dear reader, know what I do for a living. Therefore, I have massive amount of information stored in my brain about all things pregnancy related. I will never begrudge a care provider telling me things I already know, because it means they are doing their job with regards to ensuring informed consent.
That’s a good thing. That level of explanation should happen every visit, every time.
What I do bite back on is what the staff member said to me on the phone. It started off reasonably well and went downhill from there.
The staff member said that if I take the IUD out, I should use other birth control, and so on. Which, for most people makes sense. I also understand that she was doing her job and trying to provide me with informed consent before scheduling the procedure. I respect that.
I let her know my intention was to try to get pregnant and therefore other methods of birth control were irrelevant and implied that she didn’t need to continue in that vein.
She didn’t listen. So, I repeated myself, “I want to have a baby and therefore I need my IUD to be removed.”
Again, she repeated her script on needing additional birth control.
I was beginning to get annoyed.
Active listening, as a care provider, is paramount to being able to treat a patient appropriately. If you don’t listen, you can’t hear what the problem is and you will possibly make assumptions that could cause harm.
Then, she said something that raised my ire. She said the provider would need to have a discussion with me about whether the removal of my IUD was appropriate.
She went on to say that the provider could refuse to take my IUD out based on medical reasons, social reasons or financial reasons.
That stopped me in my tracks.
What she’s really saying is that I don’t have autonomy over my own body to make these decisions and that I need to cede my power to a provider.”
This study describes the reasons for IUD self-removal as documented in internet forums by IUD users discussing self-removal.
In our current climate focused on improving access to IUDs, it is essential to address and reduce barriers to IUD removal when desired, in order to preserve reproductive autonomy.
Reasons for discontinuation of IUD:
Bleeding Pattern (27.5%), Pain (25%), Weight Gain (5%); Other Reasons (42.5%)
Baseline generalized pelvic pain may not be a risk factor for IUD discontinuation within one year of placement.
A 28-year-old woman presented with a malpositioned intrauterine device (IUD) that was fragmented and significantly entrenched within the cervical canal and myometrium. IUD malposition with concomitant device fragmentation and embedded segments, albeit rare, should be a consideration given the device's prevalence.
IUD self-removal is an option that some patients may be interested in. Addressing concerns about safety may make self-removal more appealing to some patients. Addressing physicians' concern about "hasty" removal may require additional training so that providers are better able to support patients' decision-making around contraceptive use. Implications: The option of self-removal could have a positive impact on reproductive autonomy and patient-decision making.
LARC methods such as etonogestrel contraceptive implants and IUDs provide effective pregnancy prevention, but discontinuation rates are higher among adolescents and young women than among adults.
We encourage contraceptive counseling and removal protocols that directly address historical reproductive injustices and that honor patients' wishes.

November 12, 2022
Gawker