Conference turris::womannotes-v1

    Okay.  Some clinics that handle abortions do pre and post counselling.
    Some do individual counselling sessions, some do group.  Individual
    sessions are clearly better, since you've got the time to yourself.
    You need to talk with someone who talks to women about abortions;
    a woman might even be best since sometimes there's this nagging
    feeling like you're being judged for goofing up, no?  Even though
    you didn't at all goof up.  
    (I think I've got some Boston area recommendations, we can handle 
    this anonymously through the moderator?)
    
    It's okay to be upset.  I mean, look: you did everything you know
    to be right, and somebody with authority blew it, and because you
    relied on it, you get to suffer through the consequences.  It's
    crummy because you really ought to be in control of birth control,
    and when you were, everything was fine.  So, you'll do fine again.
    
    If it's any help, I heard once that a stable couple using a form
    of contraception can expect, on the average, one unwanted pregnancy 
    in five years.  Now, this may include the folks who aren't 
    consistently careful in using birth control.  Still, it's an indication
    that things can go wrong.  Many women have abortions, many even
    have more than one.  But not so many talk about it.
    
    And since nobody talks about it, you always feel isolated.  Well,
    you're not.  There's this vast, silent <ah heck> sisterhood of women
    who have.  Yeah, they won't speak up to you, but then, you haven't
    identified yourself either--now, don't!--they might feel pressured
    to speak up too.  Sure, it might be better if women did, but there's
    still this feeling of scandal attached to it.
    
    You've got company, you did your best, you're angry but that fades.
    Sometimes slowly, like any anger.
    
    At any rate, I'm no pro at this.  I think you should talk to someone
    who counsels about abortions because it really seems that your anger
    is centered around this, yes?  And your counselling should be centered
    around this, and not dredge through other areas unnecessarily at
    this time.  Talking to someone who might also be in such a position,
    and to someone who isn't going to freak if you cry is also different.
                                     
    This may not be the appropriate time for it, but I really liked
    John Irving's novel, _The_Cider_House_Rules_.  Despite warnings
    of the graphic descriptions in the operating room (they aren't,
    really all that graphic), I thought them extremely tame, especially
    compared to Irving's taut plotting.  It has a couple of very strong
    women in it.  I can't get out of my head the image he paints of all 
    those women taking the train up to Maine and walking up the hill to
    the orphanage; you want to hope it was really there and they really
    had that choice.  It might be cathartic for you.  I cried a bunch,
    but then I cry when I read any Irving.  [Well, I even cry reading
    notes and mail (but rarely when reading code! :-) ).]  I laughed
    a bunch too.
    
    

     >Ovral with a 99% effectivity rate.
     >... another brand that would be 97% effective, but not as harmful 
     > ...She assured me that if taken every single day
     >I would not have the situation of an un-wanted pregnancy.  
     >I found myself to be pregnant before the month of April had ended!!

In 1968, when I first started taking the pill, I read bunches of research
on the pill and this fact stuck in my head.  In the trials of the pill, no
pill earned a 100% effectiveness rating altho a bunch were rated 95-99. The
researchers said the "98% and 99%" pills were BELIEVED to be 100% effective
and the pregnancies actually resulted from people who genuinely FORGOT to
take their pill because clinical experience showed that people get absent
minded yadda yadda yadda. The studies were based on several hundred
thousand women.  

So we are left with this question: did the women REALLY forget to take
their pill, or did/does the 99% pill FAIL for 1000 of every 100,000 users? 
(I would guess it was the researches "clinical experience" that prompted
the GNY's question, "Well, are you sure that you took your pill everyday?" 
Even tho this "clinical experience" cited was based on all kinds of medicine, 
including high-blood pressure and anti-biotics.)

I believe the GYN acted as she believed best.  There are now a few million
women included in the pill studies, and I'd guess she was weighing the
pregnancy vs stroke statistics. 

Alas, I don't have any thoughts about how to let go the anger and grief you
feel.  Except don't blame the doctor overmuch.  There are many currents
behind this failure:  the willingness of researchers to explain the
majority of those who become pregnant as "forgetful," the lack of funding
for exact studies, and the people who actually did forget their pill and
thus confused the statistics.

My sympathy to you and your husband.  You certainly did your best to avoid 
the very thing that has happened. (The next paragrph does not apply to 
you.)

ONE GRIM NOTE OF CAUTION. About drugs in general.  It is wise to read the
pharmaceutical insert that describes the purpose and side effects of any
drug and weigh what it says. I tested positive for TB exposure (not TB, just
exposure!) when I was 28 and newly married, my prime years for pregnancy.
Some jackass gave me pills to inhibit the already inactive TB bacillus. THE 
BILLS CAUSED BIRTH DEFECTS.  IT WAS RIGHT THERE IN THE 4PT TYPE, PAGE 4, 
OF THE INSERT THAT THE DOCTOR HAD NOT BOTHERED TO READ. 

    Back in 1972, I also became pregnant while on the pill, and miscarried
    after 6 weeks.  I didn't even know I was pregnant.  The doctor insisted
    that I had forgotten to take it, which made me furious!  It's not
    the kind of thing I would forget under any circumstances, and I
    always keyed the pills to the calendar so I would have a system
    of double checking.
    
    I was so upset about it, and felt so helpless, that I stopped sleeping
    with my husband for over a year.  That may have been a contributing
    factor to the breakup of our marriage, but at age 20, I didn't know
    that.  And finishing college was my absolute highest priority at
    the time.
    
    

Just some added information (as if facts could ease emotions): My female
gyn also suggested a lower dosage pill recently. From what she said,
I gathered she had been reading up on the latest doctor-studies on the
pill and dosages. She had also put herself on a lower dosage. So, there
must be some pretty well-publisized studies going on.

Statistics are OK, but for any sample of one (you or me), they're
meaningless. 
	Mez

    I don't blame you for being angry.  I would be angry too.  When
    you KNOW yourself, your body and your situation so well and yet
    (understandably) allow an "experts" opinion to override your own
    judgement it creates an extremely frustrating experience.  
    
    Having an abortion is the most difficult thing any woman ever has
    to do.  Some people never realize that no woman would get an abortion
    unless she truly felt she had to.  Please remember that (in this
    life) we all do what we feel we have to do AT THE TIME THE DECISION
    IS MADE.  We learn from our mistakes and experiences, we grow stronger.
    We leave the past behind us and we never allow ourselves to be put
    in that situation again.  Allow yourself some time for regrets,
    grief and recriminations and then pack it all away in a little place
    deep inside your lower brain and close the door.  Tomorrow you will
    be a much stronger person and....  better days are coming.  Take
    care.

Re: .1

    Effectiveness rates  for contraceptives are given as percentage of
    women pregnant after 1 year using the technique. The one pregnancy
    every  5  years corresponds to an 80% effectiveness rate, which is
    what  you  get  with  condoms alone (no foam) in practice (meaning
    including  pregnancies  from  putting the condom on too late or in
    such a way that it tears...  

Re: .0
    
    Your doctor  was trying to reduce a real risk. Taking the pill and
    smoking  is  a  bad combination, perhaps you should use some other
    form of contraception (or quit smoking).

--David

    Re .6
    
    >                                              Taking the pill and
    > smoking  is  a  bad combination, perhaps you should use some other
    > form of contraception (or quit smoking).
    
    <flame on/sarcasm=heavy>
    
    And just what would you suggest, pray tell?  I recognize that there
    is always condom+foam, or for those who are _not_ prone to chronic
    cystitis [unlike me] the diaphragm.  Some people still have their
    cervical caps, but they can be dreadful, too.
    
    Telling someone to quit smoking so they can take the birth control
    pill without increasing their chance of stroke is like telling a
    Kamikaze pilot to tie his shoes so he won't fall down and break
    his neck!!!  We KNOW smoking is bad for us; if quitting were
    easy/possible at this time, we wouldn't be doing it!!!
    
    Now my IUD was scheduled to come out this summer.  What the heck
    am I supposed to do now, quit smoking so I can go on the Pill???
    
    <sarcasm off>
    
    With the IUD gone, there is practically no alternative to the Pill for
    a WHOLE LOT of us [there was a note about this a long while back] -- in
    many/most cases, the risk of stroke remains smaller than the risks
    associated with pregnancy/miscarriage, and is next to nothing compared
    with the risk of lung cancer/heart disease/adnauseum that we are
    running already. 
    
    All this (plus previous replies) simply goes to shw how much the
    state of birth control today SUCKS THE BIG WAZOO!!!
    
    Lee

    Don't get all flamed up, Lee.  All of us are doing our best with
    what we have available to us.
    
    As for .0, I'm sure your doctor was doing the best she knew how,
    but I would be angry also.  However, now is the time to move on.
    First of all, if you haven't already had the abortion, I would check
    to see if you really want it.  Since you have already had a miscarriage
    and since you have stated that you want children in the future,
    you may want to check whether an abortion would lessen your chances
    of carrying a child to term in the future.  If you decide to give
    birth, then you run the risk of birth defects, but you may have
    an amniocentesis also.  Never forget that you don't have to keep
    the child; you can adopt it out.
    
    For the future I would recommend that you don't stop at only one
    level of birth control.  You have indicated that you are very fertile,
    and your experience seems to prove you out.  I would suggest that you
    supplement the Pill with other method(s).
    
    Above all, good luck, and take care of yourself.
    
                       Carol

    I disagree with the statement "I'm sure your doctor was doing the
    best she knew how".  
    
    As the saying goes "If it works, don't fix it".  By giving a woman
    a complete physical, a doctor knows what type of BC to prescribe.
    If the stronger ones gave no side affect and was working, why change?
    
    Some woman's bodies cannot handle the lesser dosage of BC (i.e.
    weight gain or loss etc.).  If a complete physical was not given
    before the new perscription of BC, then the Dr. is at fault here.
    
    

    This all points out that medical science doesn't know everything, no
    matter how much they like to pretend they do. 
    
    I went to school with a woman who was for various reasons was switching
    from an IUD to the pill.  Her doctor had her establish her level of
    dosage etc. before she removed the IUD. 
    
    She became pregnant with the IUD still in place while taking a fairly
    high dosage of a strong form of birth control pill.

    The doctor agreed that this woman had done none of the known causes for
    birth-control failure -- no allergies, no weight changes, no flu or
    other illnesses, no forgetfulness -- said she'd never seen anything
    like it in some 20 years of medical practice.  Probably she hasn't
    seen anything like it since.  

    It's easy to say that by giving you a complete physical (presumably
    including an honest evaluation of your lifestyle), a doctor knows the
    best form of birth control to prescribe for a particular woman, but
    that 'best form' depends on present knowledge.  The best forms of
    birth control have an effectiveness rate of about 98-99%.
    
    A 1% failure rate means that out of 100 women using that particular
    method correctly, one woman will get pregnant every year. The doctors
    doing research *PRESUME* that most of those failures are caused by
    either neglect or by physiological changes, but they *DON'T KNOW WHY*
    that 1% to 2%  of pregnancies happen. 
    
    --bonnie 

    about birth control pills:
    
    o Some antibiotics (Tetracycline, Deoxycyline, maybe others) and
      other medications can make BCPs less effective.  Please check
      the Physician's Desk Reference (PDR) for *any and all* medication
      you take re: side effects, interactions, etc.
    
    o Illness (ie; flu and friends) which involves vomiting or diarrhea
      can make BCPs significantly less effective.  Be aware!
    
    o BCPs can significantly increase your risk of sunburn.  If you
      are a new user of BCPs, be careful and use a higher spf sunscreen
      than usual.
    
    These are just some of the side effects your doctor may not have
    mentioned!  (Besides the more commone; ie; weight gain, increased
    cardiovascular risk, etc.)
    
    Rita
    

    I can understand your anger and sympathize with it a lot...I would
    probably be ready to sue.
    
    You have been forced to make a real difficult decision, as a woman
    I support you 100% in whatever decision you should make.  
    
    But, please consider all options, get lots of counseling, hear all
    viewpoints and consider all possibilities.
    
    When I was in my childbearing years, I didn't have the options and/or
    they were just becoming available.  I had two pregnancies that I
    didn't want nor could afford but it worked out.  
    
    If there is anything I can do to help please feel free to contact
    me.  My thoughts are with you and I will think of you in the days
    ahead and wish you well.
    
    Joyce

    A properly performed first trimester abortion without any of the 
    bizarrer consequence will not lessen your chances of later carrying 
    a child to term.
    (The bizarrer consequences would have resulted in a hysterectomy
    having happened a few days after the abortion: so don't panic.)
                                                               
    ----------------
    
    It is probably time to stop even thinking about what might have
    been.  It's a downer, about any topic.  And don't let even any nice
    person, even a wonderful husband, ever bring it up again.  
    
    Forward.

        My reactions to this note come on two levels. First the personal
        level. Like many who have replied here, let me express my
        sympathy, concern and support for the annonymous author of the
        base note. Life can be hard and at times unfair, and we will
        each get through it better if we can support and help each
        other. If listening has helped, I am glad I can have helped. If
        there are other things we can do, I am sure that the vast number
        of WomanNoters each wish, to the extent of their abilities,
        to do what we can for each other.
        
        On a more detached level, I think we need to understand that
        even highly effective forms of birth control are not all that
        reliable. The last time I read up on the pill, the effectiveness
        ranged from 95% to 99% with most in the 97% to 99% range. That
        means that of each 100 women who use the pill, 1, 3 or 5 women
        will become pregnant each year.
        
        What we often overlook is what the effectiveness over a 10 to 20
        year period. If my quick calculations are correct the 10 and 20
        year effectiveness derived from .99%, .97%, and .95% annual
        rates is:
        
         1 year		99%		97%		95%
        		---		---		---
        10 year		90%		74%		60%
        20 year		82%		54%		36%
        
        With a 95% effective method, over 20 years only 36% will never
        become pregnant! Not good odds.
        
        The bottom line is that birth control is in no way a guarantee.
        If you are a fertile human and you have regular sex with a
        fertile member of the opposite sex, there is a very real chance
        that you will have 1 or more unplanned children or abortions.
        The choice is to accept that that's the way the world is, to
        cease to be a fertile person, or to have little or no sexual
        intercourse with the opposite sex.
        
        That's a very hard fact and hard choice to live with. It can
        easily result in frustration, stress, fear and anger, EVEN IF
        YOU NEVER GET PREGNANT. For those who do face unwanted
        pregnancy, or who undergo abortions, the stresses are even
        higher. The anger of the author of the base note is very
        understandable, in this situation, but it is important, I feel
        to related it to the basic realities of sex and reproduction in
        modern medicine. It affects all of us, and not just those who
        get caught or who make the difficult choice of abortion. 
        
        JimB.

    First of all, to .0, my sympathies.  It's not only a hell of a position
    to be in, but dealing with the understable anger is the pits.  The
    worst type of anger is the kind that has no real object to be angry
    at.  
    
    Whichever noter said that whatever decision you make, it is the
    right decision of the moment, is correct.  When dealing with an
    unwanted pregnancy, you don't have a whole lot of time to make a
    decision.  Plus at that time, your mind, body, and emotions are
    all in turmoil.  You may regret your decision later on;  BUT AT
    THAT TIME you must do the right thing for YOU.
    
    I made the decision 13 years ago.  It was totally right for me then,
    and I have regretted it every year since.  Now that I am older,
    and think more positively about having a child, it's almost too
    late for many reasons.  
    
    All I can tell you is to be honest with yourself, and with your
    husband.  It sounds like you both have hashed out everything.  You
    don't need me to tell you that it is hard to decide.  As for your
    anger, here's what always works for me:  we have a heavy bag down
    in the cellar where we work out.  When I am absolutely frustrated
    with something that there is no solution for, I just go down there
    and whale on the bag until I am exhauted.  Talk about a cathartic
    experience!!  THEN I can be civilized about anything.  You'd be
    surprised at how free you feel afterwards--as we women are programmed
    from birth to be gentle, unassertive, and endlessly forgiving, it
    is hard to "go against the grain" by actually striking out at
    something;  even a heavy bag.  But when there is no one around,
    and you can beat on it (GOOD IDEA:  Wear gloves when you do this
    :-)!) and yell to your heart's content.  You will feel amazingly
    better afterwards.  It isn't a solution, but it helps.
    
    It is also a good idea to get yourself a good consellor.  Therapy
    is a wonderful and healthy way to work through your anger and pain
    in a safe environment.  It is a lifetime investment in good mental
    health and attitude.  
    
    Good luck to you and your husband, and you are in my prayers,
    
    Jane

    a while ago I was exploring the options myself.  After being told
    there is no perfect preventive measure except abstinence, I asked
    what the options were for sterilization.  I'm not definitely going
    to get it done, I'm just considering all the options.  My SO and
    I have discussed it, and we don't think we'd like to bear any children.
     But when I asked, they said there was basically no possibility
    for me getting one, because I am only 23, and I might somehow "succumb
    to my biological clock and regret my hasty decision".  I asked what
    age they'd consider it.  They said 30.  Pfeh.  Birth control methods
    can damage the body, and cause it to have unnatural reactions to
    the various chemicals.  Abortions are painful and expensive.  And,
    at this point, for me, kids are out of th question.   When
    will doctors begin to trust that we know our bodies and our minds?
     Since the publication of "Our Bodies, Ourselves" I think women
    have grown a lot better informed of what's going on with them, body
    and mind, and how to cope with it.  

    Without all the options there is no freedom of choice.
    I will listen to what the experts have to say, but in some cases
    it is in my best interest to listen to my own valid opinions.

    -Jody
    

    Jody, don't take their refusal as gospel, keep looking.  There are any
    number of physicians who will, with perfectly straight face and immense
    arrogance, tell you that whatever you want is "impossible".  That, of
    course, is a crock:  if it ain't illegal, it's negotiable.  (And
    sometimes even if it is illegal :') 
    
    I would check with female gyns...I think women tend to be less invested
    in other women remaining baby-factories longer than they want to.
    
    						=maggie

    re .16,.17
    
    I have yet to get a good gyn who is male.  When I was lactating
    [fairly heavily] at age 17, one of 'em poked around my beasts and
    said, no sweat, no big deal.  As I had never heard of a noever-pregnant
    woman my age with this, I went to a woman gyn at a huge [out-of-state]
    clinic who also had never seen such a thing [at a huge clinic, they
    have a bit more experience...].  Went through horomone testing changed
    the Pill I was on then etc, etc, and it went away.  _He_ was cold
    and impersonal, acted as if I were a hypochondriac.  She was obviously
    concerned, asked about my history, looked into what Pill I was taking,
    and was generally wonderful.
    
    When I went to get an IUD, a male doctor told me I couldn't get
    one at my age.  Went back to the clinic, they recxommended against
    it, I explained my situation, that most of the serious problems
    with the device were only serious if other things got out of hand,
    if I could tell I had cystitis or a vaginal infection within hours
    of getting it, I would certainly not run into most of those problems.
     Upshot is that I signed some release forms, and got the thing.
    
    Find a doctor, let them know you are not some ignorant twit who
    is ignoring the advice you are hearing, but rather someone who is
    willing to sacrifice your fertility in exchange for a more healthy
    form of birth control.  If that doc denies you, go to another. 
    I recommend clinics: they are very warm, concerned, and have seen
    most everything under the sun.  They could also use clients who
    are able to pay for the services, as many of them are really short
    of money due to treating less financially-able women.
    
    Lee
    
    

    re .0:
    
    The only way to avoid pregnancy is to avoid sex altogether.  
    
    Barring that, you take your chances.  
    
    Have you considered having the baby and putting it out for adoption?
    
    Marge

    Your anger and your situation really hit home with me.  Some years
    ago I had an unwanted pregnancy that resulted from a failure of
    my birth control method.  I had an abortion.  For a long time after
    that I harbored incredible anger toward the doctor who had performed
    the abortion (sure, he was a jerk, but that wasn't the point!).
     It was only when I got counselling to deal with my grief and with
    my anger toward myself that the unreasonable anger toward the doctor
    vanished.

    I hear your anger, grief and saddness.  Losing a child, whether by
    choice or not, is tragic.  It sounds like you're grieving for the
    child, and rightly so.  In situations like this I think it is 
    very common to feel guilty.  We feel as if somehow we really don't
    have the right to make a decision about what is best for ourselves
    and the child (or we may feel that it is wrong for us to abort a
    pregnancy for any reason other than health related ones).  
    
    I would like to support you in knowing that you made the right decision
    based on the fact that *you* know what is best for you and the child.
    And, I strongly believe, it is still your right to grieve the loss
    of your child.  
    
    It also sounds as if your doctor was trying to protect you from 
    the physical side effects of a dangerous drug.  Even if you are not
    having symptoms presently, these drugs can be dangerous.  No one really
    knows what the long term effects will be.  And no form of birth
    control is fool proof.  
    
    Unfortunately, these are some of the risks we take today.  The 
    decision we make about the form of birth control we use can have a 
    major impact on our lives.  There are no right answers.  We make 
    our decisions based on what we think will be right for us.  And then 
    live with the consequences, understanding that we can do only that.
    
    Melanie
    

    Jody--
    
    A friend of mine in the south was able to be sterilized in her
    mid-20's.  She got the doctor to agree after she had a lawyer draw
    up a contract which she presented to the doctor.  It basically said
    that she absolutely understood what she was doing, and that she
    forever relinquished all rights to sue him if she later regretted
    her decision.  It takes a lawyer to come up with the right jargon,
    but it's amazing how differently doctors feel when you remove the
    possibility of lawsuit.  (understandably so in some cases...)
                                    
    Good luck.
    

    Even sterilization is not 100%.  The only real guarantee is abstinence
    as has been mentioned before.
    
    If you want to be sterilized and a docter refused on some arbitrary
    decision that he/she made I would sue and site discrimination. What
    is the big fear...the operation could be reversed...in vitro could
    be an option.
    
    This makes me think of another note and another subject that we
    should discuss.

    Re: .14
    
    Sorry Jim but the concept of "percent effectiveness" for birth control
    is a vast oversimplification. The effectiveness of birth control is
    measured in "pregnancies per 100 woman years", that is if 100 women use
    this method for one year, how many get pregnant. In your percentage
    figures you ignore the time base. Thus if a birth control method has 5
    pregnancies per 100 woman years (commonly reported as 95% effective)
    then over twenty years, a woman is likely to get pregnant *once* using
    the method. 1-2 (some say as high as 5) pregnancies per 100 woman years
    is about the rate for "The Pill". This doesn't make the situation any
    easier or better of course. Bonnie touched on all this in .10 but it
    apparently wasn't clear.
    
    Given the rate of effectiveness of most forms of birth control,
    *everyone* who is sexually active should be prepared to deal with an
    unexpected pregnancy sometime during their fertile years!
    
    [*This* is effective birth control?!]
    
    Re: .0
    
    As for anectodal "evidence", I have had friends get pregnant using the
    pill, IUD, diaphram, condom and foam, "modern" rythym (basal
    temperature and cervical mucous), and one got pregnant after a tubal
    ligation (!). As far as I know I don't have any friends who practice
    abstinence :-) I'm *NOT* saying that your anger is unjustified, on the
    contrary, you have every right to be angry, furious in fact. But I also
    have sympathy for your doctor. I believe (at third hand and
    electronically removed) that she was trying to do as best she knew.
    With your health and well being as her primary concern. Imagine how she
    feels. Surely not as angry as you, or as sorry, but angry and sorry
    none the less.
    
    One very close friend of mine became pregnant (by me) while using the
    IUD. Since she was in college, and working, and living away from home,
    and for lots of other, personal reasons, she decided (after we talked
    about it for a *long* time) to have an abortion. It didn't take long,
    but was not painless, either in the short term, or long term. I was
    there, and am still there for her. It's not an easy decision, either to
    make, or to live with. I don't *ever* bring it up, but if she wants to
    talk about it, I listen, and support, and share my feelings too.
    
    	-- Charles

        Sorry Charles, but I stand by my admittedly quick calacualtions.
        As is often the case with statistics we're both right. You only
        appear to contradict me. 
        
        Lets look at the 95%, 20 year case which I reported as a
        cumulative 36% chance that an individual woman will never get
        pregnant. 5 pregnancies per 100 woman years means that among 100
        women over 20 years there will be (100 * 20) = 2000 woman years,
        which means (2000 / 100) * 5 = 100 pregnancies. Thus the number
        of pregancies will equal the number of women. It is therefore
        reasonable to say that that a woman is likely to get pregnant
        once. But it is not certain. 
        
        While you are right that over a period of 20 years using a 95%
        effective birth control method, the number of pregnancies will
        be equal to the number of women using it, you are over-looking
        the fact that some of the women will get pregnant multiple
        times. On the whole 36% of the women will manage to never get
        caught. This number is is obtained by raising .95 to the
        twentieth power. 
        
        Thus although it is tempting to say that since in twenty years
        of 95% effective birth control there is likely to be one
        pregnancy for a given woman, it is still true that there is a
        36% chance of none, an N% (I'm lazy) chance of 2 and so-on and
        so-on down to a .05 to the 20th chance of 20 pregnancies
        (assuming outrageous constitution). 
        
        Beyond this, since some women *are* more fertile than others,
        and some women are more sexually active than others, and women
        are less fertile later in life and so on, and thus membership in
        each year's 5% pregnant women is not independant, the 36% figure
        is actually a bit low. Trying to model this and arrive at a more
        accurate assesment is sufficiently awe-inspiring to cause people
        to use statistics like pregnancies per 100 woman years. As you
        say this "a vast oversimplification".
        
        I do agree with you quite strongly on one point though:
        
            Given the rate of effectiveness of most forms of birth
            control, *everyone* who is sexually active should be
            prepared to deal with an unexpected pregnancy sometime
            during their fertile years! 
        
        or as I said:
        
            If you are a fertile human and you have regular sex with
            a fertile member of the opposite sex, there is a very
            real chance that you will have 1 or more unplanned
            children or abortions.
        
        In personal terms, the pill that my wife takes has a 98% to 99%
        effectiveness, and we're 36 so she'll be fertile for on the
        order 5 to 10 more years. This means that we have about a 5% to
        20% chance of having a fourth child, a very real probability
        which is all the more real to us because she miscarried an
        unexpected pregnancy just a few months ago, and event that had a
        less than 5% chance of happening. We know that 5%-20% is a very
        real probability, and not to be sneezed at.
        
        Oh, by the way, I went off and looked up the percentage
        effectiveness numbers from the pamphlet that came with my wife's
        pills and the range that the cite is 97% - 99+% and not the 95%
        - 99+% that I remembered. Of course they have a vested interest
        in optimistic figures, but also can't afford in this litigious
        age to be caught lying. The figures they give are:
        
            Pill >= .050 mg estrogen		99+%
            Pill .020 - .035 mg estrogen	98% - 99+%
            "Mini-Pill" progestogen only	97%
            IUD					94% - 99+%
            Diaphram + spermicide		80% - 98%
            Condom				64% - 97%
            Foams				71% - 98%
            Jellies + creams			64% - 96%
            Rhythm 				53% - 99%
                Calendar			53% - 86%
                Temperature			80% - 99%
                Temp (postovulaory only)	93% - 99%
                Mucus				75% - 99%
            None				20% - 40%
            
        The figures vary depending on the precise dosages of the pills,
        how faithfully and correctly you use the method, and how
        sexually active you are. Please note that for many women one or
        more of these methods aren't available. (My wife can't use a
        diaphram, and we've demonstrated that sponges aren't a very
        effective for her either.) 
        
        As Charles, Lee, and I have all said at some time during this
        discussion, no form of birth control other than abstanence is
        terribly effective over the sexually active life-span of your
        average human being. A major effect of this fact of life is a
        high level of anxiety, frustration, anger, fear, or stress at
        least for a number of us. 
        
        My own resolution of this is to accept that a large and
        important part of my life is not within my control, and to
        decide to live within that framework. This isn't acceptable to
        many. The feeling of powerlessness can be very difficult. 
        
        JimB.

    How is it that I am the only one who has mentioned using more than
    one form of birth control (together)?  It seems to me that if you
    are on the Pill, and 97% is not a large enough percentage for you,
    that you could also use a condom or some other b.c., and have a
    much lesser chance of having an unexpected child.
    
                  Carol

    re: .0 --
    
    I called my gynecologist last week and asked him about getting birth
    control pills; in the interest of comparing his advice with your
    doctor's advice, I told him I smoked.
    
    He flatly refused to prescribe birth control pills until I had stopped
    smoking for six months.  He feels it's just too dangerous at my age
    (33).
    
    Since you're only 25, it's probably less of a factor for you, but
    it seems that doctors are more concerned about the combination of
    hormones and smoking than they were in the past. 
    
    Is there some more recent evidence or surveys about smoking and
    pill usage?
    
    --bonnie

        From the pamphlet that came with my wife's birth control
        pills:
        
               Estimated annual number of deaths associated with
                control of fertility and no control per 100,000
            nonsterile women, by regim of control and age of women
        
        		15-19	20-24	25-29	30-34	35-39	40-44
        
        No method	<6	>6	7	<14	21	>22
        Abortion only	>1	<2	<2	<2	<2	>1
        Pill only/
          nonsmokers	>1	1	1	<3	5	7
        Pill only/
          smokers	<2	<2	1	>10	<14	59
        IUDs only	1	1	1	>1	<2	2
        Trad. contr.
         (Diaphrm or
          condom) only	1	>1	2	3	5	<5
        Trad. + abortion<1	<1	<1	<1	<1	<1
        
        This is my transcription of a bar chart. I have tried to show
        roughly where the bar comes for each of these statistics.
        
        As you can see the risks for smokers and non-smokers using the
        pill is quite dramatic. It is also true, however, that the risk
        of being sexually active without birth control is higher.
        
        JimB.
        
        PS: I make no claim that this data is extremely accurate, but it
        is the kind of information available from the companies
        manufacturing and distributing the pill, and doctors see it
        readily. 

    The Massachusetts Surgeon General states that a first trimester
    abortion is less dangerous than carrying to term.
    
    A tubal ligation is almost certainly going to be more painful than
    an abortion since it is a much more invasive procedure: first trimester
    abortions are performed normally by dilating the cervix and scraping
    the uterus; getting your tubes tied involves surgery (read: cutting 
    skin and all that) and I don't believe it is an outpatient procedure,
    unlike first trimester abortions.
    
    For that matter, for most women, an abortion is going to be less
    painful than giving birth.  (Yes, I've had friends who never felt
    a thing during childbirth.  Amazing women.)
    
    Vasectomies appear to be a chancy form of birth control, since from
    what I've been told one needs to have checkups for sperm count
    regularly.
    
    About two forms of birth control: well, only condoms have any
    effectiveness against AIDS, and they're the most effective against
    veneral disease.  So, some birth control counsellors are urging
    condoms in addition to other methods, but for other reasons.
    
    But, hey, .0: how is the anger doing?  Is any of our stuff any helping,
    do you think?  I know, this takes time, but if you can, let us know
    how you're doing--it might help us out, if we're ever angry like
    that too.  And, as the statistics given show, it's not unlikely
    that will happen, sometime.
    
    Take care

    >About two forms of birth control: well, only condoms have any
    >effectiveness against AIDS, and they're the most effective against
    >veneral disease.  So, some birth control counsellors are urging
    >condoms in addition to other methods, but for other reasons.
    
    It is my understanding that condoms and a spermicide are even more
    effective against AIDS than a condom alone.  Also, a condom and
    spermicide *used correctly* in combination are almost as effective
    (95-97%?) as the pill.
    
    

    I think this is off the track, too, but re: .29, discomfort associated
    with different procedures.
    
    A tubal ligation is (or can be) an outpatient procedure, even if
    the patient chooses general anethesia.  I had an abortion about
    12 years ago in a military hospital in Mississippi.  It was a 
    first trimester abortion, done very early in the first trimester.  
    At that time, and in that place, it was an in-patient procedure 
    and I experienced severe cramping for a few days afterwards.  I
    had my tubal occlusion done about 5 years ago.  It was an 
    out-patient procedure, done under general anethesia (my choice) 
    and I was uncomfortable for about a week.  (Not unbearably so -- 
    I felt bloated and had the very weird feeling that my inside parts 
    were "loose" and moving around.  I wore bib overalls for the week 
    and the discomfort lessened everyday.  The discomfort was probably 
    due to extra work being done in the area -- the doctor found a cyst 
    on one of my ovaries and decided there was no time like the present 
    to take care of it, so there was extra pulling and probing going on.)
    
    CQ

    RE .29:
    
    As .-1 says, a tubal ligation can be an outpatient procedure if
    the patient is otherwise healthy and the doctor expects no problems.
    
    As for vasectomies, it is true that the man has to have a couple
    of sperm count checks for a few months after having the vasectomy
    - and he will be fertile for the next few weeks - continuing the
    previous birth control method is recommended during this period.
    However, after this period is over, vasectomies are about the surest
    method of birth control available, unless you start having sex with
    another man.
    
    And BTW, I agree with Carol, that if the prevention rate of your
    form of birth control is not good enough for you, stack methods
    up.  Pill + foam + diaphragm + condom =  .05 * .10 * .10 * .10 =.00005
    chance of getting pregnant in one year - still there are no guarantees
    - even abstinence didn't help Mary :^).
    
    Elizabeth
    

    This note is really getting off the track of the original note
    which involved dealing with the pain of an abortion and the 
    anger at the doctor's decision. There was a good long note
    about 10 months ago on contraception # 102, can we move that
    part of the discussion there and leave this note to the original
    topic?
    
    thanks to you all, wonderful people
    
    Bonnie J

Dear anonymous:

I apologize for dropping an off-the-topic reply into your note without 
first replying seriously to you.  This seems rude to me, now.

I'm not the best when it comes to dealing with anger.  It wasn't displayed 
very often in my childhood home, and I think living with it unacknowledged 
but all around me has given me a sensitivity to it.  To me, a cross word 
or a "look that could kill" carries a lot of weight.  I always thought that
I had no anger in me until I stumbled into it about 10 years ago.  I think 
I have a lot more to be found.  So, I very often _think_ about what makes 
me mad.  I hope you've got a counsellor you can work with.

    Here is a capsule of your 		And here is what I think is
    story, edited from your 		happening:
    note:
    -------------------------------     -------------------------------
    
    I found a new gynecologist.  	You feel confident with this
    I am immediatly comfortable - 	doctor.
    to my pleasant surprise, this 
    Dr. is a woman!!

    I tell her what brand of birth 	You tell her about yourself	
    control I have been taking...	and your experiences.
    for over three years and give 
    her my medical history.

    I...explain (as she inquired)...	She makes a strong recommendation
    why I was taking such a strong 	based on factors outside of your
    dosage.   She assured me that 	history that goes contrary to the
    if taken every single day...I 	one which your judgement and common
    would not have the situation of 	sense dictates.  She does not put a
    an un-wanted pregnancy.  		positive value on your experience.

    I found myself to be pregnant 	She was wrong.
    before the month of April had 
    ended!!

    I went through home pregnancy 	They question your honesty
    test (3 times) and called my 	and responsibility.
    GYN.  Of course, "Well, are you 
    sure that you took your pill 
    everyday?"  

    "Those home tests can be 		They were wrong.
    inaccurate - come into the 
    office for a blood test."  Yes 
    after test #4 at the Dr's. 
    office I am pregnant.

    "I have expressed my anger to my 	You express your anger but
    gynecologist.  I know that things 	it hasn't helped.
    can not be changed at this point, 
    but "I'm sorry that you feel that 
    way" does not make me feel any 
    better.


Now, I cued in immediately to your doctor's response.  To me there is a 
big difference between saying "I'm sorry" and saying "I'm sorry THAT YOU 
FEEL THAT WAY".  One is an apology.  An apology admits of some assumption 
of responsibility.  The other is -- what?  I wouldn't know how to make 
sense of what she was saying.  It doesn't feel satisfying.  I would 
probably think: 'She wasn't saying that she was sorry it had happened.  I 
think she was saying she was sorry I'm mad at her.'  It would feel to me as
if she was ducking her contribution to your predicament.  She doesn't 
really address the problem, she addresses your reaction to it.  To me, the 
phrase "I'm sorry that you feel that way" is a dismissal and is used when 
an emotion (usually one I'm feeling very strongly) has been judged to be 
invalid, or of no consequence.  So, I'd analyze the heck out of it.  

You say that you don't want to bring suit.  Maybe you just wanted her to be
aware of her responsibility as an influencial member of the decision making
partnership you and she have as doctor and patient, and to acknowledge it 
by offering an apology for this time when a decision she'd recommended was 
followed with such unfortunate results.  Maybe that would've helped you 
feel less angry at her.

I think that would take care of the anger for me.  But, you still have 
the grief to get through.  I can't say that I feel grief for my 
baby-that-never-was, but even though that was almost 12 years ago, I still 
haven't forgotten it.  I had absolutely no doubt in my mind about what I 
was doing and though I was aware of the seriousness of the decision, I felt
no grief.  But, it's still a part of my story.  It's a part of my life.  
This past weekend I went to a party and saw a slender, dark skinned, brown 
haired, serious looking, 4 year old girl and I thought 'If I had a baby, 
she might very well look like that little girl.'  That gets expanded to 
'If I'd not had the abortion, if I'd had that baby and it was a girl, she 
might have looked like that.'  It's a sad feeling.

I think that when your doctor seemed to shrug off her own responsibility, 
you then gave it all to her (she went against the knowledge you have of your
own body and your experience).  If she had not done that, would you have felt
she was so much to blame?  If she had shared it with you, maybe you would 
feel differently now.

CQ

    I agree that the doctor's "I'm sorry you feel that way" was way
    off base.  I think that would have made me as mad as the decision
    she made.  Either way, I would definitely be furious.
    
    I was wondering if you could be misdirecting some grief as anger.
    I'm not trying to pyschoanalyze, but I can imagine how I would feel
    if I were in your position.  If I felt tremendous grief--which is
    NORMAL; your body and mind have been through much more than the
    simple procedure this seems on the surface--I think I would be
    reluctant to show it for fear that my husband, who made the decision
    with me, would feel guilty or frightened or betrayed (if your emotions
    now seem "mixed.")  However, I think he needs to see all the things
    and realize what you've been through.
    
    I think counseling by someone who specializes in this, or a support
    group of women who've been through similar situations, may be a
    good idea.
    
                                                     ]
    

    How interesting.  I come to the same analysis as .34.  I also keep 
    wondering if the doctor didn't apologize because she didn't feel
    partly responsible or because she was afraid that by admitting any 
    responsibility, the chances of her losing a malpractice suit were
    greater.  I know that my parents taught me that in a car accident,
    never say "I'm sorry", since it might infer guilt and can be used
    against you, whether or not you are at fault.  I think that if I were 
    the patient, and my doctor actually apologized, that I would not be as 
    angry, and maybe the next step from the doctor would be "how can we work
    together to fix this?"
    
    Having an unwanted pregnancy and then an abortion is a terribly
    emotional experience, but at least if the doctor had been more human
    and loving then it might have seemed like you had another ally,
    not an adversary.
                             Carol

    Although I am sympathetic with the writer and her problem I do not
    think we have fully explored the doctor's point of view.  
    
    What if the doctor had prescribed the higher dosage and the patient
    had one of the adverse reactions that occur in patients who smoke?

    re:.37  The writer states that she had been taking Ovral for (at
    least) 3 years (I think she said "over three years) with no side
    effects.  I think the doctor could have prescribed the higher
    dosage pill maybe for 6 months instead of a year, and then they 
    could have talked about other forms of birth control, a more 
    frequent check up cycle to watch for whatever problems are 
    expected with patients who smoke, or a stop smoking program
    (even though, in my opninion, there really aren't any of these).  
    The doctor could have said "It seems as though you need this high 
    dose pill, but I cannot, in good conscience prescribe it because 
    of the complications likely because you smoke.  I'm concerned for 
    your health; how can we work this out?"  etc... 
    
    CQ

     Hello Everyone.

     A month has passed since the abortion and I'm really feeling alot
     better about myself.  Taking "one day at a time" really helps.
     I wanted to let all of you know that I am now seeing a wonderful
     counsellor (female) in my area which has helped me tremendously,
     as all of you have.  My husband and I both are seeing another
     councellor together every two weeks.  We are learing alot more
     about each other because of this experience, and that is 
     wonderful also.

     My gratitude is extended to each and every one of you.  You are a
     great group of people to know and am looking foward to becoming a
     non-R.O.N.'er in the near future.

     I would also like to extend my "THANKS" to Bonnie Reinke for 
     submitting the base note for me.

     I have come to realize that my Dr. was considering my best interests.
     Yes, I will be finding another Dr. soon as I really don't feel that
     her and I can have a good Dr./Patient relationship.  I DO believe that
     "I'm sorry" would have been much more beneficial to me than "I'm sorry
     you feel that way".

     Thanks again.  God Bless You All!!!!!!!!!!

     Anonymous

     PS:  Also wanted to let you know that I believe I have succesfully
          "Kicked the habbit".  One year ago I was a 3 pack per day smoker.
          At the time of my "predicament" I was smoking at a rate of 1
          pack lasting me 3 days.  It has now been 3 and 1/2 weeks (3 
          days after the abortion since I have smoked at all).  Yes 
          I'm proud of that too!!!

The following note is being entered annonymously    
    
This note has addressed some of the emotional parts of abortion,
but I see nowhere that shows the other parts.  A lot of people
have preconceptions (no pun intended) about what abortion is, or
what it is like, or how it can impact your life, but how many
people really know what is involved. 

In tactful terms this is the story, and the method I describe is
the one they used at Planned Parenthood.  I'd rather not go into
how I got pregnant, if that's okay. 










I was 6 weeks overdue for my period.  I was gaining weight.  I
felt nauseous all the time.  I KNEW something was up.  So I
called up, and the Planned Parenthood lady told me how to collect
and where/when to bring in a urine specimen. They issued me a
five digit number, and when I called later they identified my
test results with that number (for privacy sake).  Positive.
First wave of panic strikes, and I'm facing something I've never
had to face before.  A big decision.  I weighed it all out, and I
really felt an abortion would be the right thing.  I have no
religious problem with it, and I know it is not the answer for
everyone, but it was at that point the answer for me. 

Then, they scheduled me for two weeks later to have an abortion,
as I had decided it was not the time for me to have a child, and
physically I had never felt worse in my life.  They gave me a
flier with some information on what to do the day before (and
what not to do) and I was to show up at 8 a.m. on Saturday. 

So I did.  And as usual outside many of these places, there were
pro-lifers (or, rather, anti-pro-choicers) picketing with
disgusting signs depicting dissected remains of aborted fetuses.
Made me feel real good, but I felt I was doing the right thing
and that fortified me.  My boyfriend came with me, as he felt
really awful about this and wanted to help in any way he could. 

I brought another urine sample, so they could double-check the
results (although false-negatives are much more likely than
false-positives, especially before the 12-week point).  It was
positive again.  The waiting room had several other couples
there.  we were all pretty quiet.  The counselor called me in
(alone, without my boyfriend) and talked with me. She asked me if
I was sure I wanted an abortion, and presented me with other
alternatives.  We talked about birth control and also about the
method they'd be using to perform the abortion.  It was kinda
scary, but she was really nice and supportive.  She also told me
about the options for sedation/anesthesia prior to the operation. 
Throughout it all, the staff was wonderful and sympathetic.  They
didn't pressure me or anything, and I'd hate to see clinics like
this closed down because the alternative is a horror show in a
back alley with some lunatic butcher with a coat hanger (or a
very expensive trip to another country to have the abortion).

The sedative alternatives were a local anesthetic to the cervix, or a
general anesthetic that would leave me groggy for a day or so but
I wouldn't feel any pain.  I told her I didn't want to be groggy
but I was really nervous, so she suggested a valium.  First time
in  my life I ever took one, but it worked just like she said it
would.  It helped me relax and cope.  Then they called me in.  I
got in a little changing booth, and they had flannel nighties to
change into (I only got to leave on my socks).  Then I went to
sit down with 4 other women in a waiting room. 

We kind of talked.  We were all nervous.  None of the people who
had accompanied us was allowed to visit us in this "inner
sanctum".  One girl said she was afraid her mother would find
out, and that her boyfriend couldn't make it to be there with
her, but a friend did.  One other woman had chosen the general
anesthetic and they wheeled her into the "operating" room in a
wheelchair...boy was she out of it.  Another woman seemed really
happy to be ending her pregnancy.  She said she was going to
drive home at 80 miles an hour with the top of her convertible
down screaming, "Guess what!  I'm not pregnant!" at the top of
her lungs. I read some of the magazines they had, but I was still
a little worried. 

Then they called my name.  I went in and lay down on a table
(feet in stirrups, a really ridiculous position).  The only man I
saw in the whole establishment was the doctor, all of the
counselors and nurses and helpers and stuff were women.  He was
really nice, and kept asking me if it hurt, or was I doing okay,
and explaining what he was doing every step.  A woman "nurse"
(whatever) helped me through it and held my hand throughout the
whole thing.  They wouldn't let my boyfriend out of the waiting
room, but I told them to make sure to tell him when I was done an
that I was okay and everything. The doctor first felt around
inside me to make sure I was, indeed, pregnant, and to figure out
how pregnant (how long I had been pregnant) to decide which
method to use to terminate it (sounds like Arnold
Schwarzenegger).  First he put in a speculum of some sort, to
keep things accessible inside.  Then he inserted metal rods of
continually wider diameters, to open up the cervix (OUCH!).  Then
he used a suction tube and basically suctioned out the inner
lining of the uterus (including the fetus) (kind of a tugging
sensation and a DOUBLE OUCH!). During this process the woman
holding my hand told me to look at the ceiling and count slowly
to 40.  It got my mind off of what was going on, which I suppose
is what it was meant to do.  I cried a little, part pain, part
fear, part relief. 

Afterwards, they wheeled my table into a "recovery" room, and I
was told to put on my underwear under the nightie, and a
super-duper-absorbent maxipad that I had been asked to bring
along.  So I did.  They put blankets over us (I saw the women I
had met before in the waiting room here in the recovery room) to
keep us from the chill brought on by the mild shock caused by the
minor surgery we had been through.  I read for a while, and then
a nurse came over to talk to me.  She prescribed penicillin to
keep me from getting any infections over the next two weeks
(which could interfere with the healing process), and she also
prescribed methergine, which is used to collapse the uterus and
expel the remaining blood left over from its lining after the
abortion.  I had to take the methergine exactly every 8 hours for
three days. 

I was driven home, after waiting an hour or two before leaving.
My boyfriend was very helpful, and they gave me a pamphlet on
what to expect during the next month, and they gave him a
pamphlet on what to expect from ME.  Basically, I had to change
my maxipad every hour for a week.  And every few hours for a week
after that.  After the surface of my uterus healed (sometime the
first week), the clotted blood came out in unbelievable
quantities (not exaggerating or being sensationalistic about
this, either). The methergine contractions hurt.  I hurt.  I felt
tired and sore and just wanted to sleep for a month so I wouldn't
have to deal with it.  Tylenol is a girl's best friend.  They
told me to stay off my feet as much as possible for the next
week, and no sex for a month (although other people I know who
have gone to other places for abortions have been told anywhere
between 2 weeks and 2 months before sex).  The no sex bit was no
problem, because after an abortion I was kind of scared about
having sex again, afraid of getting pregnant and stuff.  That was
one thing they warned my boyfriend about, and we talked about it
a lot before we started it again.  He was terrific through the
whole thing and I was glad he was there for me.  I felt sorry for
the woman I met in the waiting room whose boyfriend didn't want
to help her once he'd helped her get in trouble. 

Cost of the procedure: $320.

An expensive mistake.  One I don't want to repeat.  And sometimes
when I look around (or listen around, or read around) about
people and their babies, I wonder what would have happened if I
had kept mine.  I really have no regrets about what I did.  But
it was an ordeal.  And when I hear people talk (in this file and
elsewhere) about people getting pregnant and having abortions
just to sell the fetus tissue for surgical use, or I read about
people saying, "well, no birth control method is fool proof, and
you should either learn to live with the consequences or
abstain..." I wonder if they know what they're talking about.
Now YOU know.  It's not only a difficult decision to make, it's
difficult to go through, and for some it is difficult to live
with.   I suppose one of the reasons I'm telling you is that
you'll know what someone else is going through if they ever turn
to you for support in a time of crisis like this.  One friend of
mine who had two abortions says she still cries some nights
wondering if she'll ever be pregnant again, and wondering if she
really did "kill" her children.  It's a very charged topic, but
maybe this note here has taken some of the mystery out of it.  Again,
abortion is by no means the answer for everyone, and I am not
sanctioning vast and popular use of it as a birth control
technique or anything, but if anyone was curious, or is facing it
yourself (or your girlfriend/wife/whatever is facing it), now you
know.

sincerly,
				sadder but wiser

    re: Sadder but Wiser:
    
    Thank you for sharing your experience.  
    
                 big hug,
    
                             Carol