I was barely out of college and looking to change birth control methods. I had been on the ring for a year and thought a long acting reversable contraception (LARC) method would be an easier, practical method of birth control. I had my mind set on an intrauterine device (IUD) but didn’t know much about it and assumed my provider would educate me about my options and let me know what was important. And you know what they say about assumptions.
After making the initial appointment and telling my provider that I wanted to get an IUD, the conversation went something like this, “I think an IUD is a great idea - get the one that stops your periods and make sure we have that particular brand in stock and that it’s covered by your insurance.” These morsels of wisdom were the only insight my provider bothered to share. I guess that for the rest I was on a need-to-know basis.
On the day of the procedure my provider let me know that I would be getting an anesthesia shot in my cervix. To say I was surprised is an understatement. I was already on the stirrups staring at the ceiling when my provider showed me the needle that would soon be inserted in the last place you want a needled inserted. Sadly, this would not be the only surprise of my IUD experience. The insertion was excruciating and since my provider never shared how I could manage the pain or explained what I could expect, I was also confused and scared.
The insertion was excruciating and since my provider never shared how I could manage the pain or explained what I could expect, I was also confused and scared.
The second surprise came in the form of a $450 bill from my medical provider three months after the procedure. Unfortunately, the anesthesia shot was not considered essential and not covered by insurance. It’s not just baffling to me how anesthesia for a procedure that requires a clamp to hold the cervix can be considered non-essential, but also how I was already in such a vulnerable position when I was even made aware of the shot.
The third surprise came when I had my follow up visit. My provider was unable to locate the string because it had been cut too short. Because the string on my IUD is too short, I needed a transvaginal ultrasound – which was painful, invasive, and uncomfortable – to ensure that the IUD was placed correctly and that I was protected from an unplanned pregnancy. The ultrasound was another unexpected expense as it too was not covered by my insurance. I’ll have to get another should I ever want to check on my IUD’s status. Also, once I am ready to replace or remove my IUD there is a chance I will have to general anesthesia to remove the IUD if they are not able to remove it in the office. Even if they are able to remove it in the office, it’s likely to be painful and require another shot of anesthesia in my cervix.
From beginning to end, it feels like everything that could have gone wrong with getting my IUD went wrong. But, despite all the unpleasantries, painful discomfort and weeks of worrying about how I would pay a $450 bill, I love my IUD and would recommend it to anyone looking to get on birth control. I just wish that getting to this side of the mountain had included less surprises. What should have been an empowering experience turned out to be a lesson in just how much I had more to learn about the real world.
Self-reflection questions:
- In my practice, what information to I discuss with patients about their chosen birth control methods? Are they on a need to know basis?
- Do I find myself defending the providers in this article? Do I see myself in these providers?
- Do I know how much my patients are paying for the services they receive? Is that a part of the counseling process?
- What is my guidance for patients about what to expect during an IUD insertion, including feelings of pain and anxiety?
- How can I ensure that I am practicing radical consent during pelvic exams?
