Transcription:

Deborah Howell (Host):  Welcome. And thanks for joining us today. Today, we'll be finding out about types of birth control options and family planning after a baby. This is the podcast series from Deaconess, The Women's Hospital, A Place For All Your Life. I'm Deborah Howell and our guests today are Dr. Kristopher Beickman and Dr. Sarah O'Nan, who are both OB-GYNs at Deaconess Henderson. Welcome Doctors Beickman and O'Nan.

Sarah O'Nan, DO (Guest): Thank you.

Deborah Howell (Host): Let's start our discussion with you Dr. O'Nan, many couples want to plan their families these days. What kinds of birth control options are available? And can you tell us a bit about each?

Sarah O'Nan, DO (Guest): Sure. Most commonly by the time patients come to see me, they're wanting to discuss some hormonal options. And so, in that regard, I usually start out talking about combined hormonal contraception. And that just means that there's two hormones in it, estrogen and progesterone. And I usually start out with those because they're the most common, this is what people typically known as the pill.

And so, they come in pill form. They also come in patch form and they also come in a ring form. And so, these are great options for women who prefer to keep their monthly cycles pretty regular. And then there's some options that are progesterone only. So, these come in pill form and injection form.

And also a form that we sometimes discuss, as long-acting reversible contraception, and that is an IUD or an intrauterine device or an arm implant. And then lastly there's some non-hormonal options. So, that would be like a copper IUD, another intrauterine device. And then, ultimately like sterilization or a vasectomy for a man.

Host: And who would be a good candidate for these options?

Dr. O'Nan: Yeah. So, we really decide who's a good candidate, probably on a case by case basis. So, that would just probably be based on the history I take. So, that would be based on the patient's desires. You know, their medical history. Certain medical conditions can steer you one way or the other. What their fertility planning is, what their desires are for future pregnancy. So, that's probably a case by case kind of thing.

Host: And what are the advantages of each option?

Dr. O'Nan: Sure. So, for the combined options; so, the pill, the patch, the ring, the nice thing about those is they really make your period more regular and a lot of women will experience a lighter and shorter cycle with those. We use them oftentimes to reduce menstrual cramps. So, if that's something that the patient struggles with, that would be a good option. Some people, it can be used to improve acne. And it's also known to kind of decrease the risk of different cancers, uterine, ovarian, and colon cancer. So, with the combined pills, you get those advantages of all those things. And then with the progesterone only ones, a lot of people like the injection or the long-acting one, just because it's easy to use. You don't have to remember taking a pill every day. Not too many medical problems prevent the use of those ones. And a lot of times we do end up seeing some decrease in menstrual pain and bleeding with those options as well.

Host: Sounds like a miracle situation. I didn't even know about the acne. That's pretty good. Dr. Beickman, now to you. When patients come to you to discuss birth control after having a baby, what are some of your recommendations?

Kristopher Beickman, MD (Guest): Well, the first thing is whether or not they're breastfeeding or not. There are certain pills or alternatives that we would use for breastfeeding than if you're not breastfeeding. So, if you're not breastfeeding, pretty much everything's open with the only caveat being that we don't like to use the estrogen and progesterone combinations or any estrogen containing product for the first few weeks after delivery because of concern of in the postpartum period, increased risk of blood clots. But after we're past that window, then all options are open. So, all those things that have previously been mentioned, would be on the table. But with breastfeeding we are a little more selective on what we do, so we don't interfere with that process.

Host: Sure. Now I've always been curious about this, is birth control after a baby different than before giving birth?

Dr. Beickman: The only concern we would have is again, the timing of initiation because of that window right after delivery, where we could have some increased coagulopathy, otherwise, it's really based on, when are we thinking we may want to have a pregnancy in the future, what's our timing going to be? Do we want something more long-acting or short-acting? And then again, from the breastfeeding standpoint, we don't want to interfere with that. So, we choose an option that we make sure meets both requirements. We can breastfeed and we have good birth control.

Host: And now can you please tell us what cycle control means?

Dr. Beickman: Well, the nice thing about birth control is that we do get other benefits and those benefits, other than birth control can be shorter periods. They can be less painful periods, which many women like. Additionally there's various combinations shall we say, that how we use the hormones that could extend the normal duration of cycles instead of being once a month, maybe once every two months or three months based on how the pills can be manipulative. And based on that, you can, you know, control when your cycle is and so forth. Many women like that, some prefer to have it once a month. They know exactly when it's going to be. So, that's individualized, but improving menstrual cycles or the pain, or the amount of bleeding with the cycle can be a very positive benefit of birth control.

Host: Oh, absolutely. And how can a patient know what the best contraceptive is for them?

Dr. Beickman: Sure. Again, I think it's very individualized. However, when patients come in, one of the questions I'll often ask, are you somebody that really wants to know when that period is going to be and is that the most important thing knowing exactly when or is the amount of bleeding that you're going to have more important. It may be, you have a little bit of less certainty on the exact day. You may have some spotting, et cetera, but the overall amount of bleeding may be much less. Is there an idea that you may want to get pregnant in three months or six months versus five years or 10 years or never again. So, all of those things come into play when we're looking at birth control options, whether this is something that's on the shorter term, maybe pregnancy in six months, or on a longer term basis.

Host: What are some questions you should never be ashamed to ask your OB-GYN?

Dr. Beickman: I think that when you come in to see the OB-GYN, you should feel comfortable that you can ask anything related to your concerns, whether it's pregnancy, whether it's about your cycle, whether it's about safe sexual practices, whether it's about concerns for infections, you know, this is a very confidential space and most questions, even though an individual may feel like they may be embarrassed or that this is something that the doctor's going to find offensive; that's never the case. Most of the time we've heard this question before and therefore there's no feeling of being embarrassed or ashamed, et cetera. The goal is to make sure that you're safe and that you're healthy. And that if you have a concern, we should be able to address that and make you feel comfortable that we can get your questions answered and so forth. And if we don't, that question should be readdressed maybe differently so that we make sure we answer you so that when you leave the office, you feel like you've been given the education that you need about that topic.

Host: And as always with your doctor, everything is confidential. So, it's a safe space.

Dr. Beickman: Correct.

Host: And Dr. Beickman, do you have any words of hope for your patients?

Dr. Beickman: Well I think now, as we are exiting this pandemic and hopefully this is going to be behind us in the near future, our goal in this office is to provide a welcoming environment. We try and practice the standards of care and try to bring the top of the line care to our patients that we can and we enjoy having patients come in and help them achieve whatever it is they want to achieve; the next pregnancy, or maybe it's the last pregnancy and we're moving on after that. But the goal is, that we provide them an environment here that they want to come to and they want to tell their friends to come to as well.

Host: Love it. And Dr. O’Nan, I’ll give you the final word. Any final thoughts?

Dr. O'Nan: Yeah. Just to reiterate what Dr. Beickman said, you know, we are here as a resource to help you and there's really nothing that's off the table that you should be embarrassed to ask us about. So, yeah, we're an open book. Let us know if sex hurts. If you're peeing on yourself, if you have a smell, we're here for all of it.

Host: Again, a safe space, but thank you so much, Dr. O'Nan and Dr. Beickman for shedding some light on all the good options out there to help your patients plan their families. It's been great to have you both on the podcast.

Dr. Beickman: Thank you.

Deborah Howell (Host): And that wraps up this episode of the podcast series from Deaconess, The Women's Hospital, A Place For All Your Life. For more information, or to set up an appointment with one of our providers, please call 270- 827-4000. And for more health tips and updates, follow us on your social channels. I'm Deborah Howell. Thanks for listening and have yourself a great day.