Informed Consent?
I've been doing some reading about exactly how hormone based birth control works.
In summary, according to multiple references throughout The Physician's Desk Reference, which articulate the research findings of all the birth control pill manufacturers, there are not one but three mechanisms of birth control pills:
1. inhibiting ovulation (the primary mechanism),
2. thickening the cervical mucus, thereby making it more difficult for sperm to travel to the egg, and
3. thinning and shriveling the lining of the uterus to the point that it is unable or less able to facilitate the implantation of the newly fertilized egg.The first two mechanisms are contraceptive. The third is abortive.
When a woman taking the Pill discovers she is pregnant (according to The Physician's Desk Reference's efficacy rate tables, this is 3 percent of pill-takers each year), it means that all three of these mechanisms have failed. The third mechanism sometimes fails in its role as backup, just as the first and second mechanisms sometimes fail. Each and every time the third mechanism succeeds, however, it causes an abortion.
Does the Birth Control Pill Cause Abortions? by Randy Alcor (condensation)
I'm not trying to debate if abortion should be legal or not. I'm simply saying that there are those that would choose to have an abortion and there are those that would not. For those that would not, this is extremely troubling.
The other trouble is that many medical care providers do not use the same definition of "pregnancy" that is commonly understood by most people (and in most widely available dictionaries).
From a medical point of view, however, pregnancy does not occur at the moment of conception. It occurs, instead, when an embryo (a fertilized egg that has divided over the course of a few days) attaches itself to the woman's uterus, a stage known as implantation. It is at implantation that a woman's hormonal system begins to respond to her embryo, a response that initiates a cascade of dramatic physiological changes in her body. This means that if a sperm fertilizes an egg after a couple has intercourse, but the fertilized egg never implants inside the woman's uterus, then the woman - from a medical point of view - was never pregnant. Therefore, she can be described as having menstruated, rather than as having experienced a miscarriage or a spontaneous abortion.
Some forms of what we call birth-control implicate the distinction between the pro-life definition of pregnancy and the medical definition of the same. For example, the I.U.D. (or intra-uterine device) can operate by preventing a fertilized egg from implanting in the wearer's uterus (though it can also work by preventing conception in the first place). When it prevents implantation, an I.U.D. has - necessarily - not prevented conception (and, if I were a pro-life advocate, I might accordingly say that in such instances, it does not literally fit the definition of "contra-ception").
When Does Pregnancy Begin?: A Federal Appeals Court Decision Implicates a New Abortion Question by Sherry F. Colb
The view that pregnancy begins at implantation is the view held by the American College of Obstetricians and Gynecologists (ACOG). When your medical care adviser tells you that various birth control methods "do not disrupt an existing pregnancy" (as stated in the World Health Organization's "Family Planning: A Global Handbook for Providers") realize that you both may be using the same word, "pregnancy," but the definition is not the same.
How can patients be expected to give informed consent if a word with a the commonly understood definition is being used with a definition crucially different?
Neither ACOG definition has been consistently adopted by its members whose definitions are more consistent with lay and embryologist definitions. Potentially, the process of informed consent is jeopardized by these ambiguities. The ACOG is urged to reconsider its definitions.
Informed consent and the redefining of conception: a decision ill-conceived? by J.A. Spinnato (abstract)
People most likely ask the question "Will this method of birth control harm a pregnancy?" are most likely people who would consider pregnancy to begin at fertilization and would consider any post-fertilization effects, such as inhibiting implantation, to be harmful to a pregnancy. To dismiss the commonly understood definition of "pregnancy" and play a game of semantics does not allow for informed consent and is poor care indeed.
Comments
I was glad to have this information as well. I was already contemplating my current form of birth control for other reasons, but after reading the article you sent me, and discussing it with my husband, we have changed to BC without the hormones. Either he or I will probably opt for the permanent route soon, but in the meantime, I feel better about my choice to remove the artificial junk from my system. Because of my personal convictions, even the possibility of my BC working as abortive rather than solely contraceptive, disturbs me greatly. I now live with greater peace of mind.
Although this post references an article that mainly discusses the pill, I was using the IUD, and my doctor had assured me that it worked in the same manner as the pill, just without having to take a daily dose. When I went in to have it removed and discussed with him my reasons for it, although he was supportive, I gained the knowledge from him the he, too, considers pregnancy to begin at implantation, not conception. He is an excellent doctor, a compassionate man, and well educated. And I thought he had similar convictions with me as to the origins of life. I was surprised to learn otherwise. I was more surprised to learn how common this is.
Fertility awareness or Natural Family Planning are acceptable methods of spacing births for Catholics. Of course, it's never that simple. Since from a Catholic point of view your intent matters, the reason you practice an effective method of BC can't be a selfish one.
Since I'm married, I imagine I'll be finding out how effective NFP is pretty soon.
"Catholic Roulette" my brother calls it. Nyuk nyuk.
Anyway, I've been kind of neurotic for the past few years about what I'm putting into my body. I worry about my cell phone giving me a tumor, and about microwaved food. But it's never made sense to me that women will put a hormone cocktail into their bodies without a care for the possible health effects.
Regarding "Catholic Roulette": it's funny I find a lot of people (not necessarily your brother) think that NFP is ineffective because of the larger size of many Catholic families, but another thing the class really opened my eyes to is that it's not that NFP is ineffective, it's that Catholics, in general, have a more welcoming view of children and larger family sizes compared to society in general, which is very refreshing.