I bet the Pill prevents pregnancy-induced insomnia. I never have trouble sleeping, except during the last weeks of pregnancy. I have been tossing and turning and thinking about an exasperating exchange with another blogger, and I have given up trying to sleep.
I read a variety of blogs, written by women with a variety of different views. Usually I am content to listen to their opinions even if I disagree with them, but occasionally I'll jump in and comment. Last night I ran across a paean to the Pill. Did you know it prevents ectopic pregnancy? Of course it does so in the same way that any form of birth control does: if you don't conceive, you can't have an ectopic pregnancy. By that logic, the Pill also protects against placenta percreta, pre-eclampsia, and postpartum hemorrhage, as well as the pregnancy-induced insomnia that has me awake and writing this grumpy post.
It didn't start out as a grumpy post, though. I left what I thought was a courteous comment last night saying that it was incomplete to list benefits of the Pill without also listing its risks. I provided links to mainstream documentation of what I acknowledged were low-incidence complications. And the blogger wrote back to say, "Hi, Jamie! Thank you for your thoughtful comment. For some women, the risks of the Pill do outweigh the benefits, although I personally think the Pill is great."
Okay, actually, she didn't say anything remotely like that. But I have this silly hope that people who disagree can have civil conversations and acknowledge their common ground, and I am frustrated by the elusiveness of what seems like a modest goal.
I have long been frustrated by the way the risks of the Pill are presented. Articles that say, "Although the Pill may have undesirable side effects, it is safer than pregnancy" -- they drive me up the wall. I have read that such comparisons are statistically invalid, because the studies available at the time I was reading about it compared morbidity and mortality for populations of pregnant women and populations of Pill users -- without correcting for the fact that Pill users tend to be young, healthy women with access to health care. No doctor who valued his license would prescribe the Pill to a 42-year-old brittle diabetic smoker with uncontrolled high blood pressure, but she is free to become pregnant. Obviously, her risk of health problems is far higher than that of a 19-year-old healthy nonsmoker. (I have to think that there are better studies available now, but I don't keep up on the literature at all -- Alicia? anybody know?)
But the larger issue is the false dichotomy: either you take the Pill or you get pregnant, so make your decisions based on those two options. I used to say it was like comparing apples and oranges, but that doesn't quite get it. Oranges are cheap, nutritious, and tasty -- much like apples. Here in my insomniac grumpy state I'm going to say it's like comparing apples and fugu, the expensive and occasionally deadly Japanese fish whose popularity leaves me scratching my head.
Fifteen years ago I would have found that a preposterous analogy. I grew up in a mainline Protestant denomination, in a family that viewed contraception as normal and responsible. When I heard that there were some people who didn't use contraception, I thought, "What's the matter with them?"
In the year after I finished college, I found myself unexpectedly drawn to the Catholic Church. I didn't understand the teaching against contraception, but I was willing to follow it. My mother has seldom been so angry. In her view I was waving my hand in the air, calling, "Oh, boot heel of the patriarchy? Come on over and grind me into the mud, please!"
What I have never been able to explain satisfactorily to my mother is that NFP is empowering. For my college friends and me, our fertility was something capricious if not downright malicious -- something lurking in the corner until it could smack us upside the uterus with a pregnancy. It wasn't until I took an NFP class that I realized my fertility is a gift, whether or not I am in a position to get pregnant in a given cycle or a given year. NFP showed me that I could live in harmony with my fertility instead of bludgeoning it into not-quite-submission.
One criticism of NFP is that it takes some learning, and that's true enough. You can learn how to use the Pill in one visit to your doctor, but it can take months to get comfortable identifying changes in your cervix. Once you have the knowledge, though, it's yours forever. You don't have to wonder if you're pregnant or just late. You don't have to wonder what's going on when you're nursing a baby. You don't have to be afraid that you only have two unappealing choices: either synthetic hormones or perpetual pregnancy.
When we were engaged, I was really stressed about NFP. I envisioned long years of abstinence and anxiety. The reality has been something else entirely. If I follow my previous pattern after the birth of this baby, I will have had a total of five periods in the eight years between January of 1999 and January of 2007. (I do love breastfeeding.) In only one cycle since January 1999, the one immediately following my miscarriage last year, have we sought to avoid pregnancy. A couple of times when my youngest was a toddler and I was unsure how working would affect my fertility, I said, "Talk to me in a day or two; I'm not quite sure what's going on today." And that's it: we've had no worries about surprise pregnancies, no doctor visits to discuss birth control, no side effects from synthetic hormones, no pharmacy bills, no "oops I forgot to stop at the drugstore" moments. Somebody should market that! Except -- wait -- it's free. And it's way too uncomplicated for a technophilic culture like ours.
All right, I'm back after a shower and a cup of coffee, and I'm feeling more measured. A couple of disclaimers are in order: I know the Pill is safer than fugu; I know that our practice of NFP has been made easier by my longer-than-average stretch of postpartum amenorrhea; I know that my situation as a married Catholic woman with a faithful husband is different from the reality many women face. I know there are lots of happy fugu eaters out there. Although some NFP advocates call for a return to the Comstock laws, I'm not looking for a fugu ban. I'm just saying we should have more apples in the grocery store.
I still think it's a little odd that the Pill is so widely accepted. Is any other normal body function routinely suppressed in healthy women? Is there any other case in which we blithely use synthetic hormones to interrupt the conversation of hypothalamus and pituitary, to squelch normal organ function? Absolutely, the risk of complications like liver tumors, stroke, heart attack, gallbladder disease, retinal thrombosis, and death in Pill users is tiny. But every single case -- as well as every case of nausea, headaches, mood swings, and the other less alarming but far more common side effects -- every single one is iatrogenic, caused by medical intervention that interrupted a normal physiological process. If I were a doctor who had pledged "first do no harm," that would give me pause.
Very few doctors seem to agree with me, though. I am not the poster woman for successful NFP use, because I had severely irregular cycles in my teens and twenties. Every doctor I asked about it offered me the Pill. I don't want to take the Pill, I told them. As soon as I said that, the conversation was over. The bag of tricks was empty.
And yet the solution (discovered when my NFP teacher sent me for help) was so simple: I gained five pounds and implemented some stress reduction strategies. Hey presto -- the improvement was remarkable. I will never have ovaries you could set your watch by (especially not now, while they're on the biennial plan), but I have no complaints.
No complaints, that is, except about the difficulty of getting to this point. In the pre-Web days when I was trying to get started with NFP, good information was absurdly hard to find -- even from a doctor. Not enough has changed on that front.
Some of my girlfriends who took the Pill in their twenties have said things like, "I'm never taking the Pill again," and, "I told my doctor I was unhappy with the Pill, but he said it was better than getting pregnant." Sometimes I hear it from women at breastfeeding support groups, too: they don't like the spotting, or the mood swings, or the sudden drop in milk supply. One woman's doctor told her that it was better to supplement with formula than to get pregnant at three months postpartum. (Excuse me. The memory causes me to stop and -- pound pound pound -- beat my head on my desk for a minute. I'll stop now, though.) Why doesn't he know that LAM is more effective than the mini-pill?
Women are going to their doctors and saying, "I'm looking for something sweet and crisp and vegetarian that starts with A. Can you help me?" And in response too many of them are hearing, "Well, today we have fugu sashimi and fugu soup..."
I am thinking about all the delicious apples in the world -- Braeburns and Fujis and Galas and Honeycrisps, versatile and inexpensive and good for you. Calendar rhythm is the Red Delicious in this analogy: nearly worthless but still mysteriously ubiquitous, held up as an object of ridicule whenever apples are on the table. And did anybody else ever see that book on astrological birth control? If you're a Scorpio and he's a Leo, you can groove on the 3rd, the 5th, the 7th through the 13th, and from the 18th to the end of the month. I wish I had bought it when I saw it in a used bookstore; the memory makes me laugh. Maybe that one is like a crabapple: unfit for use unless modified beyond recognition.
The birth control issue can be a litmus test for both Catholics and non-Catholics. For some Catholics, the degree of a person's opposition to birth control is a measure of her allegiance to Rome; for some advocates of reproductive freedom it is a handy gauge when evaluating for wingnut-fruitcakeness. I disagree with both points of view.
We are closing in on twelve years of marriage, in which we have never used contraception. I cannot offer it as evidence of personal piety, though. If all I had to do to get to heaven was stay away from contraception, you could plan my canonization Mass now. Unfortunately, that "love thy neighbor" business still kicks my butt.
I would also dispute the opposing conclusion, that a woman who says "I will not use contraception" is a rabid militant hyperzealous far-right-winger ill-equipped for life in this millennium. I am none of those things, but I'll still say no thanks to fugu.
For a while now I've been kicking around ideas for an NFP post. At first I was going to say that I had decided to give up teaching NFP because my heart wasn't in it anymore. Then I was going to say that one of the things I like about PCT is that it's in a diocese with an excellent (and less politically charged) NFP program, and maybe I wouldn't give it up after all. As I have been thinking about these issues, remembering how glad I was as an engaged woman to hear a friendly voice on the phone saying, "Yes, I used to have trouble finding my cervix, too," I am feeling an obligation to keep teaching.
Not everybody wants an apple. It may be that I hear so many women complaining about the fish of the day because my own sympathies lie that way. But my hope is that reliable information about reliable natural methods of family planning will become as mainstream as apples in the produce aisle. Maybe I can help to make that happen.
If I put a pot on my head, will you call me Jamie Appleseed?