Contraception Options

Women use contraception for many reasons, but the primary reason is to prevent pregnancy.  There are many options for contraception and some options are more effective than others.  Choosing the right method for YOU can be confusing at first, but a conversation with your midwife or provider can help.


Natural Family Planning/Fertility Awareness:

1 in 4 women will be pregnant within a year using this method.  The sad, tired, worn out joke goes:  What do you call couples that practice Natural Family Planning?  Answer: Parents.


Natural Family Planning involves a commitment to learning about your cycle, reading your body signals daily, and a commitment by both partners to practice abstinence during your fertile periods.  This method can be highly successful for motivated partners.


Barrier Methods: 1 in 4 women will be pregnant within a year using this method, but you can purchase these over the counter without a prescription from a provider.


Diaphragm:  The only diaphragm on the market currently is the Caya.  It is a one-size fits all diaphragm that can be purchased over the counter at pharmacies.  Coupled with a spermicide, it can be effective if used properly.  This is a great option if you do not wish to become pregnant, do not want an implant inside your body, and are willing to use the Caya every time you have sex.


Condoms:  This method has the benefit of protecting against sexually transmitted infections.  Your partner must be willing to use the condom every time you have sex.  The downside is that they can break, leak, slip, or just not be used.


Hormonal contraception options: About 1 in 15 women will become pregnant within a year using these methods.  All of these methods require a prescription by a provider, but there is legislation in some states to make some of these methods available in the pharmacy without a provider visit.


Pills:  The tradition birth control pills contain two hormones, estrogen and progesterone.  The Mini Pill contains only progesterone.  They do have a slight increased risk of blood clots, so your provider will investigate your medical history and ask questions related to migraines, heart disease, blood clotting disorders, seizures, and other medical complications.  The pills are very effective if taken every day, but missing even one pill can cause you to ovulate and place you at risk of pregnancy.


Patch: If you choose the patch, you place a new patch on your skin every week for three weeks.  The fourth week you do not wear a patch and you get your period.  The hormones in the patch are both estrogen and progesterone.  If you are overweight, the hormones might not work as effectively for you due to absorption issues through the skin.


Ring:  The NuvaRing is a soft plastic ring that you can place in the vagina for three weeks.  The hormones estrogen and progesterone slowly absorb into your body.  The fourth week, you remove it and have your period.  Some women love the convenience and some women report being able to feel the ring in the vagina.


Depo Shot:  The hormonal method of birth control that has the greatest documented side effects is the Depo shot.  It is an injection of high dose progesterone that you get every 3 months.  For the first 3-6 months you can have very irregular spotting and bleeding, but usually after the 2nd or 3rd dose, your periods go away.  It can take 18-24 months for your fertility to return after you stop the Depo shots.  Major side effects include depression and weight gain.


Long Acting Reversible Contraception (LARC): <1 in 100 will get pregnant using these methods.  They are as effective as tying your tubes but completely reversible.

Nexplanon:  The Nexplanon is a small plastic rod that is inserted into your arm.  It stays there for 3 years, slowly releasing progesterone every day to keep you from ovulating.  The side effects can include unpredictable spotting, headaches, increase appetite, and depression.  After about one year, many women report that their periods have stopped, but they will return when the Nexplanon is removed.


IUD:  There are two forms of IntraUterine Devices: the Mirena and the Paragard.  Both are inserted into the uterus and act primarily against sperm to prevent pregnancy.  The Mirena lasts for 5 years, releases a small amount of progesterone to thin the lining of the uterus, and many women report lighter or no periods while using the Mirena.  The Paragard lasts for 10 years, contains no hormone, but your periods might be heavier with heavier cramping.  Both of these must be placed by a trained provider.

Gestational Diabetes: Do I HAVE to drink that?


Short Answer:  Yes.

Long Answer:  You actually don’t HAVE to do anything you don’t want to do.  We won’t MAKE you do anything you don’t want to do.  This concept supports your autonomy as a patient.

However, you trust us to be the lifeguard of your pregnancy.  Throughout your pregnancy, we will monitor your blood work, vital signs, and the baby’s growth and development by using ultrasound, drawing your blood, listening to your baby’s heartbeat, and measuring the size of the uterus.  Trust us when we say that the second trimester glucose screen is very important to the health of both you and your baby.  We might even recommend it earlier in the first trimester if we are concerned about impaired glucose tolerance.

One complication of pregnancy that we screen for and treat is called gestational diabetes.  Gestational diabetes can occur in women of any size, even without a personal history of family history of diabetes.  Insulin is a hormone produced by the pancreas, and the body uses insulin to help transport blood glucose (sugar) from the bloodstream into the cells of the body.  The hormones of pregnancy can cause you to be resistant to insulin.  If you become resistant to insulin, your blood glucose levels become elevated and the glucose easily transports across the placenta to your baby.  This can cause the baby to grow very large, and at the same time it impairs the development of the baby’s lungs.  You can end up with a very large baby who, at the same time, has very immature lungs and needs help breathing after birth.

Maternal Complications of Gestational Diabetes:

  • You have a 70% chance of developing Type 2 Diabetes within 10 years
  • You are at a higher risk of high blood pressure or preeclampsia in pregnancy
  • You might require medication to help manage your blood glucose
  • You are at higher risk of miscarriage or stillbirth


Fetal Complications of Gestational Diabetes:

  • Your baby can grow very large
  • Your baby might experience a shoulder dystocia at delivery, which is an emergency situation where the head delivers but the large body is stuck behind your pelvic bones.  We might have to break the baby’s collar bone to help your baby deliver.
  • Your baby might require assistance breathing at delivery or in the first few days
  • Your baby might need to be observed or treated in the special care nursery for low blood glucose.

What happens if your one hour glucose screen comes back elevated? 

We will ask you to take a three hour glucose screen.  If the three hour glucose screen comes back elevated, you will have the diagnosis of Gestational Diabetes.  At that time, we will send you for a consultation with a Maternal Fetal Medicine physician called a Perinatologist.  These physicians are specially trained in high-risk pregnancy and obstetric ultrasound.  They can help us monitor the growth of your baby.  In addition, a diabetic educator will teach you how to test your blood glucose daily.  They will also teach you how to eat well to keep your blood glucose as stable as possible.  You will also be asked to increase your daily exercise, which will help your body be more sensitive to insulin and help you regular your blood glucose.


The glucose screen is usually done at the 24-28 week visit.  We ask that you eat normally that day, with good protein and not a heavy carbohydrate load.  Plan for the visit to take at least an hour because we have to draw your blood one hour after you finish drinking the liquid.  Pack a healthy snack with protein for the ride home.


So… yes.  Your midwives are aware that the glucose screen can cause nausea and discomfort.  You may not like the taste of the drink.  However, it is an important screening test that can help us provide the very best care for you and your baby.


For more information:

By: Kirsten Johnson | Certified Nurse Midwife

Birth Plans!

Should I write a Birth Plan?

Many women want to write out a birth plan to clarify the care they hope to receive while they are in labor.  A birth plan can be a short wish list or a long explanation of your circumstance, such as if you are adopting the child out or if there are known anomalies incompatible with life.

Is a Birth Plan required?  No.  The nurses, midwives, and physicians are highly trained professionals who will take care of you to the best of their abilities.  We have not performed routine shaves, enemas, or episiotomies for over 25 years, so you do not need to request that we refrain from these procedures.  We have many tools in our bag of tricks to help your labor progress well and hopefully avoid complications.

In addition, every woman and every labor is different.  It is a good idea for you to relax, let go, and accept the labor that comes to you.  There really is no other choice but to deal with the reality of the moment.  Your care providers will help you.  Honest.  That’s what we have chosen to do for our career.  We want the best outcome for you and your family.

I do recommend that my mammas write up a short, one-page wish list that gives the labor team a frame of reference of what experience you are hoping for in labor and delivery.  It is a good idea to designate one person to speak for you if you are unable to speak for yourself due to an intense labor.  It tells us if you have specific requests, such as dad cutting the umbilical cord or your desire to avoid an epidural or even GIVE ME THE EPIDURAL THE MOMENT I WALK IN THE DOOR!

Bring your birth plan to one of your prenatal visits to discuss with your midwife or physician.  Then when you have a final draft, bring a printed copy for the nurse caring for you in labor and delivery.  That way, your entire team is on board with the plan and works with you!  Remember to keep it short and flexible.

Some ideas of what women specify in a birth plan:

  • Who will be present for the birth?
  • Are you bringing a doula?
  • Will there be siblings present?
  • Do you want mobility or do you want to stay in bed?
  • What activities or positions do you plan to use (walking, birthing ball, standing, tub, squatting, etc)?
  • What is your plan for pain relief (massage, hot packs, position changes, hypnobirthing, Lamaze breathing, jacousi tub, medication)?
  • How do you feel about fetal monitoring?
  • Who will care for the baby?
  • What is your plan to feed your baby?
  • Do you want to wear your own clothing and listen to music?


You can always google “birth plans” on the internet for more ideas, remembering to keep your wish list to one page!

-Kirstin Johnson, Certified Nurse Midwife




The Climacteric, The Change of Life, or my favorite:

MANopause.  That’s right, fella’s, back away slowly…

Throughout a woman’s life, hormones are constantly shifting and changing, rising, and falling, performing an intricate dance.  When the ovaries reach the end of their lifespan, on average around the age of 50, they no longer produce the hormones estrogen and progesterone.  For some women this happens suddenly and they are thrust into distressing symptoms such as irregular periods, heavy  bleeding, hot flashes, night sweats, vaginal dryness and pain with sex, low sex drive, anxiety, irritability, and even depression.  Perimenopause, the years before the official diagnosis of menopause, can last 10 years or more.  When you have not had a period for an entire year, we can officially say you are in menopause.

One of the most common distressing symptoms are called “hot flashes”. Hot flashes begin as a sudden sensation of heat centered on the upper chest and face that rapidly becomes generalized.  The sensation of heat lasts from two to four minutes, is often associated with profuse perspiration and occasionally palpitations, and is sometimes followed by chills, shivering, and a feeling of anxiety.  Hot flashes may range from less than one each day to as many as one per hour during the day and night.  On average, symptoms last 5 years but 30% of women have symptoms for 10 years and 9% of women have symptoms for 20 years

Modern medicine can offer relief from distressing symptoms, but there is no “cure” for this very natural life process.  As with any medication, there are risks and benefits.  A discussion with your provider can help you decide if medication or hormone replacement therapy is right for you.

Thankfully, there are many things you can do to manage symptoms at home.  These suggestions are basic recommendations for self-care:

For the management of hot flashes and night sweats:

  1. Lower the room temperature
  2. Use fans
  3. Dress in layers that can be easily shed
  4. Wear a base layer that wicks moisture away from your skin.
  5. Avoid spicy food, hot drinks, alcohol, stress
  6. Weight Loss

To keep your mood and emotions steady:

  1. Daily Exercise
  2. Daily Yoga or other mindful meditation and relaxation

For vaginal dryness and pain with sex:

  1. Use a vaginal moisturizer three times a week.
  2. Use lubrication for sex.
  3. Sorry, we have no great medical solution for libido


To protect your bones, support your immune system, and promote sleep:

  1. 1200mg of Calcium
  2. 400mg Magnesium
  3. 2000IU Vitamin D daily.

Calcium is only absorbed 500mg at a time so taking a supplement twice a day with meals, in addition to at least one serving of dairy or other calcium fortified food daily will supply what you need. The Vitamin D helps your body absorb the calcium and it activates it in your muscle and bone cells so it can work for you.  Magnesium and Vitamin D help with mood and a healthy immune system, too.

For more information on perimenopause and menopause, you can explore the following:

The Wisdom of Menopause, by Christiane Northrup, M.D.

-Kirstin Johnson, Certified Nurse Midwife