NPR reports on a bizarre and unethical practice:
An epidural is a common type of regional anesthesia that eases the pain of labor. As she had done many times before, Sweeney followed hospital protocol and called the anesthesia department. But to her shock, they told her they could not help her young patient.
“They said that without parental consent, … she would not be able to sign for her own epidural,” Sweeney says.
In Ohio, people under 18 who are in labor cannot consent to their own health care. They can receive emergency services, but nothing considered to be elective. For the many Ohio minors who become pregnant, it’s a painful gap in coverage.
Who would deny pain relief to a teenager in excruciating pain?
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]An epidural for childbirth is a human right and no one, least of all state officials, should be allowed to pretend otherwise.[/pullquote]
Dr. Michael Cackovic, an obstetrician at The Ohio State University Wexner Medical Center, says every couple of months he sees a teenage mom who, under Ohio law, is unable to receive elective treatment, like an epidural. He says it’s frustrating to see patients in unnecessary pain.
… Cackovic … report[s] that, just as frequently, [he’s] had cases where the mothers intentionally denied their teenage daughters an epidural – as a sort of punishment for getting pregnant.
This is both cruel and bizarre. The same teen who is unable to consent to pain relief for herself, is able to consent to pain relief for the baby after its birth. It ought to be illegal for a very simple reason: pain relief is not considered elective for any other person in pain.
Were the same teen to be brought to the emergency room suffering abdominal injuries and requiring emergency surgery after a car accident, no one would deny her anesthesia claiming is it “elective.” Were a teen male brought to the emergency room with a fracture of his leg, no one would deny him pain relief while setting it.
In the paper Pain Management: A Fundamental Human Right, Brennan et al review the ethics of pain relief:
The importance of pain relief as the core of the medical ethic is clear. The relief of pain is a classic example of the bioethical principle of beneficence. Central to the good actions of doctors is the relief of pain and suffering. As Post et al. state, “the ethical duty of beneficence is sufficient justification for providers to relieve the pain of those in their care …” The principle of nonmaleficence prohibits the infliction of harm. Clearly, failing to reasonably treat a patient in pain causes harm; persistent inadequately treated pain has both physical and psychologic effects on the patient. Failing to act is a form of abandonment…
Childbirth is the only setting in which pain relief is wrongly viewed as elective and the reasons are religious, not medical.
In the case of analgesia for childbirth, there was bitter resistance on religious grounds. Fundamentalists cited the Bible as ordaining that childbirth was a necessarily painful process. Opposing both the church and powerful obstetricians, Queen Victoria requested that James Simpson administer chloroform analgesia for the delivery of her son, thus overcoming powerful negative attitudes that discouraged relief of the pain associated with childbirth…
In other words, many religious leaders believed, and some continue to believe, that women should be punished for having sex, and sex outside of marriage should be punished all the more. Abrogating that “punishment” with pain relief is therefore “elective.”
Lest you think that the idea that women deserve pain in childbirth is merely a relic of stodgy religious views, the belief has been secularized by the natural childbirth movement that deems epidurals in labor an “intervention,” but wouldn’t dream of labeling any other form of pain relief elective. Midwives and doulas are the only providers I am aware of that refuse to consult with anesthesiologists and condemn pain relief for ideological reasons.
What about the fact that epidurals have side effects? ALL methods of pain relief have side effects. Opioids administered into vein, muscle or by mouth have far more side effects — respiratory depression, addiction, death — than epidurals, yet no one claims that opioids for relief of severe pain are elective.
The relief of pain is NEVER elective, it is always emergent and ethically mandated. The only time that pain relief can be ethically withheld is if the patient refuses it.
What about the right of parents to determine appropriate medical care for children? If a parent brought a child to the emergency room with a severe burn from playing with matches, absolutely no one would honor that parent’s request to deny the child pain relief to “teach him a lesson.” They’d ignore the parent altogether and possibly petition the court on the grounds of child abuse. There is nothing elective about treating a painful burn regardless of whether the child brought it on himself.
There is also nothing elective about treating the pain of labor no matter how much or how brutally a parent or society wishes to punish women who have sex out of wedlock.
An epidural for childbirth is a human right and no one, least of all state officials, should be allowed to pretend otherwise.
Back in the 90’s they were demanding cash up front for epidurals at some hospitals so they also like to punish poor women too. https://www.ahcmedia.com/articles/33574-epidural-denial-leaves-hospital-at-risk-for-lawsuits-bad-publicity
This is sick and sadistic.
About 25 years ago, Medicaid (in Florida, not sure about other states), decided that epidurals were elective, and would no longer pay for them. If a Medicaid patient wanted an epidural for delivery, she had to pay for it……..in advance. Many women did not have access to that much cash.
Labor is painful for anyone, but an especially large number of Medicaid patients were teen moms. Teenagers, amid the anxiety and pain of being in labor, are usually not able to benefit from non-pharmacological methods of support. It was heartbreaking to hear them scream and beg for pain relief. Since epidurals are considered necessary for C sections, I wonder how many girls ended up with C sections because they could not deal with the pain, could not progress in labor because they were terrified and hysterical with it. I am sure the C section rate ticked up during that time, and because of their terrible experience, I am sure that very few of them would even consider trying a VBAC for subsequent pregnancies, leading to more C sections.
Within a year, if I remember correctly, Medicaid changed their opinion, and started paying for epidurals again. I wonder how much money they actually saved in the long run, compared to what the experience cost the women.
As on Ohio OB, I can verify the truth to this. Happens frequently, fortunately, most of the time, we can talk to the guardian and get them to reconsider. But it wastes my time, nursing time, anesthesia’s time, and it prolongs the patient’s agony.
We also now need written consent to give opoids to a minor. Thanks Ohio State Legislators!
That’s just awful. Those poor women.
Ugh. Doesn’t help that they keep redistricting to condense us urban liberals, too.
I’m a rural liberal…my vote always goes to the loser!
My husband’s a moderate conservative and his usually goes to the loser, too. He did vote for HRC, though. (He’s blind and it was faster for me to fill out his than wait for them to boot up the blindy one. We’d just moved that year, too, so they weren’t expecting him)
Ugh, they are attempting to reduce all opioid scripts to only a 7 day supply, and in some states they are trying for three days, if it’s your first prescription for something. So say you broke a femur and had a rod inserted, you only get vicodin for three days after you’re discharged and you have to go back to the doctor for another three days. It’s so stupid.
CVS has started limiting how many pills you can get and what prescription strength you can get, which, btw, is them pretending to be doctors. There’s proof that only a very few people who get opioids for legitimate pain become addicted and the CDC guidelines (which the VA put into law for their pain patients) of how much pain medicine someone can get was created by anti-opioid people with no discussion with pain medicine or chronic pain patients. We now have people killing themselves because they were forced to reduce their pain meds for no medical reason whatsoever or were dropped by doctors not willing to treat pain patients any more.
Most of the pill mills were in one state and they have stopped the pill mills. We still prescribe twice as many narcotics as the UK does but our overdose rates are the same as the UK, and the overdose is either from street drugs which are generally tainted with illicit fentanyl from china or from mixes of opioids and benzos. It’s not from prescribed drugs anymore, but they are punishing people with chronic pain.
When you say you need written consent to give them to a minor, is that for a prescription? Or does that include treatment in a hospital in the ER or after surgery or during a hospital stay? None of those are situations which are likely to lead to addiction.
Chronic pain patients are starting to gain momentum about the denial of their human right to have their pain treated, it’s so awful right now to find a doctor who will treat and to find a pharmacy that will also dispense the medication.
This makes me feel angry. I didn’t end up needing epidurals just the way things worked out, but they were always my plan if I felt I wanted them at the time. To have them withheld when requested is wrong.
This is truly insane
This is effing insane. INSANE. OMG, what the… no, I can’t even think through the end of any sentence that would make sense.
My native language (Hungarian) is much more sophisticated in swearing, so I better go downstairs and just say it all aloud.
(Thanks for the post. Yet another snippet of the world that I would have never, ever believed existing.)
Haha, my grandmother grew up speaking German, Hungarian, and Czech (she then learned English) and she always said that Hungarian was the best swearing language. Those curses are actual curses!
I don’t have anything to contribute other than WTF. Seriously, W, T, F!
OT: latest homebirth death in Michigan (religious zealots who refused to get serious jaundice treated). Didn’t the midwife have an ethical obligation to call CPS if she thought the mother wasn’t going to get necessary treatment for her baby? (The call ended up being made by the uncle, but only after the baby had died)
I mean, if she’s just a CPM, there might not be any laid out ethical guidelines, let alone professional consequences for failing to meet an ethical standard.
That’s my home state, where lots of my family still live (the rest live just across the state line in Fort Wayne, Indiana, where I did the second half of my growing up). Way to be ridiculous, Buckeye State! Teen moms need SUPPORT, not sadistic punishment. They already know life didn’t turn out the way everyone had planned. They get to learn that lesson earlier than the rest of us. They don’t need some smug lawmaker rubbing it in their face.
This is shocking and horrifying.
This reminds me of a bit from (I think) Michael Crichton’s memoirs. He spent some time, after med school, at a maternity hospital that made a point of ignoring teen mothers during labor. There was a horrific twist, however. This was in a past era of maternity, when “anesthetic” was that horrible “twilight sleep” thing that didn’t kill pain, it just made women disoriented. He said that the unwed mother ward was unpleasant. The ward with richer, married women was like one of the circles of hell. Fortunately, times were changing and the doctors themselves were pleading with women to hold off on the twilight sleep medication and looking for better alternatives.
It’s depressing to see that the only thing that’s changed is the effectiveness of the medication being denied to teens.
I have never heard anyone who gave birth under twilight sleep describe it as horrible. I have, however, heard, “It’s too bad twilight sleep isn’t so safe because it’s the best thing ever.”
My mother thought it was pretty great.
I gather the whole experience in those days was pretty appalling-left alone for hours on end and no reliable way of knowing how things were going until baby was out and safe.
Funny that so many women who gave birth under such circumstances are all for the epidurals etc.
My grandmother’s birth story basically consists of being shaken awake and told something like “Mary, Mary, wake up, your son is here”.
That’s exactly what I want! I wish we could still have that.
Well that’s a new one to me. Those poor teens. Are we ever going to get past punishing women for having sex?
I saw a pregnant 16 year old in consultation with her mother a couple years ago, during which the mother asked if we could withhold pain medication during labour to “teach her a lesson.” I was so angry I couldn’t even speak. What mother wills the pain of labour on her terrified teenaged daughter?
Mothers who are also child abusers and see a legal way to get away with it, that’s who.
I would be tempted to say that if that’s the kind of lesson the mother teaches, then one day the mother likely be too old to care for herself, at which point the daughter could teach her a couple of lessons.
If that’s the kind of lesson the mother teaches, no wonder the child is ‘rebellious’.
See, once a teacher, always a teacher. I would be sorely tempted for the discussion to go as follows:
Me: And what lesson would that be?
Mom: That she shouldn’t have sex!
Me: And how would that teach her that lesson?
Mom: Because it would hurt!
Me: I see. So you advocate intentionally harming your child in an effort to teach life lessons. Interesting….
That’s not even the lesson to take from it, and I hope the kid doesn’t. I hope she takes the lesson that sex can be awesome if it’s your thing and if you’re careful, and childbirth doesn’t have to hurt – but that her mom doesn’t care about her well-being and wants to torture her. Ugh.
Seriously. “I didn’t let anyone buckle her in because I wanted to teach her the lesson that driving is bad.”
Well, of course it’s not the lesson to take from it, but the idea is to get the person to say something insane by drawing their own stupid ideas out of them. And as I’m a terrible dialogue writer, I’m quite certain practically anybody else could have come up with a better fake conversation than I.
Exactly. That’s the only lesson: “Your mother is a horrible person. Leave her in your rear-view mirror as soon as you can.”
To give her the most benefit of the doubt possible, I’m guessing her thought process was along the same lines as my dad’s. He’s told me the following story:
When my sister was a toddler, she seemed to be magnetically attracted to a dangerously hot object (can’t remember what it was, maybe the kettle, the hot tap, a radiator, whatever). No matter how many times she was told “NO!” and had her hand slapped away, she would go right back towards it the moment my dad’s attention was elsewhere.
Had she stumbled into this hot object when my dad was in another room, or had she tripped at the last second and landed on it face-first, the consequences could have been serious. So the next time he saw her toddling towards it, he grabbed her hand and held it against this object for a second or so. Long enough to cause a lot of pain, but not enough to cause any serious injuries. After that, she never went near it again.
But even if this woman was following this line of logic, it doesn’t really apply to giving birth. The time difference between the act of conception and the pain of childbirth is far too long to activate instinctive avoidance of the act which ultimately leads to the pain. I doubt our species would be here today if labour pains lead women to avoid sex in the same way as burn pains lead people to avoid touching hot objects.
Also, it’s impossible to adequately explain danger to toddlers in words alone. A teenager about to give birth generally doesn’t need additional pain to understand the consequences of her actions.
The same mother, that in 20+ years will be crying that her “ugrateful children” don’t want to take care of her.
You mean kind of like how my mother cries and complains that us ungrateful kids never talk to her anymore?
(Should have included: the pregnant woman/girl gets to decide in my jurisdiction and we have universal healthcare. The girl got an epidural and did just fine.)
I grew up Christian and am more convinced it’s a cult. This is terrible, but i am not shocked.
I hope those old priests and ministers don’t do anything for their arthritis. After all, God gave them that pain for a reason, right? _snort_
And their limp dick.
Bullshit bullshit bullshit! Unless something has changed, the law in all fifty states says a pregnant teen has the ability to consent to any and all care regarding her pregnancy. Once baby is born, she may or may not have the ability to make her own decisions or those regarding her child (I’m looking at you, North Carolina!). I see a large number of pregnant teens and am familiar with this (or so has been the law in all of the states I’ve practiced in).
If this is really true, SHAME on Ohio!
ACLU of Ohio has an online resource that says Ohio minors cannot consent to non-emergency treatment. AND (and this is the REAL problem) the insurance companies can refuse to pay if there is no parental consent.
It all comes down to the idea that unrelenting pain is not an emergency.
Again, the insurance company is the ultimate enforcer here. Legally the doctors could push the envelope and declare it an emergency (there is already a doctrine in some legal circles that the actively laboring patient is an ’emergency patient’) but the refusal of insurance companies to pay is a powerful dissuader.
Holy hell! WTF??? What a load of unadulterated horseshit!
Ohio minors cannot consent to non-emergency treatment. AND (and this is the REAL problem) the insurance companies can refuse to pay if there is no parental consent.
I’d be very tempted to “teach the parents a lesson” by giving the teenage mom the epidural and sticking her parents with an out-of-pocket bill. This is what you get for trying to torture your child, folks.
My mother did this to my sister when she was pregnant at age 16. It was horrifying. And then she had long lasting complications that prevented her from going back to school for months and my mother kept saying how it served her right for being a slut. My mother isn’t a nice person.
Curious: How many of your siblings ended up adopting your parents’ values? Her catechetical methods seem, er, less than effective.
That would be a big, fat, zero.
There are still two siblings who are minors, so speaking only of the four adult siblings; three are non-religious raging liberals and one is conservative, but switched to a more open, accepting protestant denomination rather than the fundamentalist Catholicism we were raised with. None of us have good relationships with her. I have zero contact and the other three have various levels of limited contact.
Beatrice-
Every time you share something about your mother I am both appalled and in awe.
Appalled that someone could parent in the way she did and actually have the state send her more children to parent (not that I’m giving your dad a free pass) , and in awe that you have managed both to get free and to raise your kids with the values you have.
Phillip Larkin had it right.
They fuck you up, your mom and dad? But didn’t Larkin conclude that it’s better not to have kids? I disagree with him there; just do the best you can and accept that you’ll make mistakes.
You know, my mother is actually really good with little babies. She’s the reason why I actually managed to succeed at breastfeeding my oldest, by convincing me it was okay to use a little formula while we were figuring out the whole breastfeeding thing, and that it was okay if I was finding it difficult, because hey, it was a new skill, and it wasn’t always easy. But the older kids get, the worse she gets. And as for the state giving her more kids, well, money hides a lot of sins, and they have a lot of money. As much as I wish it weren’t so, that’s the way the world works.
As for my own parenting, I’ve certainly made some mistakes, and some rather colossal ones at that, but I keep trying, and when I mess up, I admit it, try to figure out what went wrong, and move forward. Honestly, a lot of my parenting boils down to “what would my mother do? Ok, now do the opposite.” Getting away wasn’t easy. I regret that it took so long to do it. How much heartache could have been avoided if I’d managed it years before I did? But I did get away, and I’m so glad I did. All I can do is move forward and make the best of it, and that’s exactly what I plan on doing.
Your mother likes babies because they can’t talk or have opinions. When they start speaking & thinking for themselves, I bet that’s when she turns against them. They’re like puppets until then.
I have that problem with my mother. She outright said that she preferred the pre-verbal stage. (I’m just about the opposite. I think that babies are very adorable and snuggly but I like KIDS because they can do so much more.) According to her, I started getting difficult at 3 and never stopped. My experience with my own kids was that at 3 they started talking back and expressing opinions and requiring me to change how I approached them in order to connect and get results. If my mom did not make these changes and instead interpreted it as a problem with the kid, no wonder we had, and have, issues.
Merrie, I’m pretty sure this is EXACTLY what went wrong in my family. I was “such a good baby,” I’m told, right up to preschool. “I could just leave you in your playpen for hours, and get everything done. But then you became so DEMANDING and DIFFICULT. I could never just get you to go play alone.” You mean I became able to express my needs and opinions, and had the mobility to proximity seek my caretaker. Heaven forbid.
It’s like people who get puppies or kittens and then want to get rid of them when they become dogs and cats.
It might be cathartic to read here, I can’t remember if I’ve mentioned it before. It’s about crappy mothers and MILs and dealing with what the’ve done/what they do to their kids and grandkids. https://www.reddit.com/r/JUSTNOMIL/
If it wasn’t you, it was somebody else, either here or elsewhere. I’ve seen it linked. I don’t follow it, but yeah, it’s definitely a good thing to read when one is feeling like they’re the only one with terrible parents.
That’s hideous. 🙁
I’m going to go hug my mom again. Thirty years ago she left my decision making up to me when I got pregnant. She took me the 80 miles to get the abortion, getting a loan from a friend to pay for it until my boyfriend could pay her back. My dad, while not enchanted by the idea of abortion, was there too. Had I chosen to continue the pregnancy she would have made sure everything was the best we could manage. I can’t even begin to wrap my mind around that thinking. My kids have known I would always be behind them. Just… I can’t even. 🙁
I always swore that I would do anything in my power to help my kids and/or their girlfriends have the least traumatic experience should a teen pregnancy happen. I’ve assisted several teens in accessing reproductive care at this point, and don’t regret a single instance, whether or not their parents knew.
Beatrice,
As a former teen mom who got pregnant at 15 after i was unable to get my birth control pills nor access any other reproductive care (its a long story but mostly due to moving to a poor US “red” – Republican – state)…. thank you for helping teens access the reproductive care of their choosing.
It’s very upsetting – not to mention counterproductive – to not provide reproductive care (of any type) to the teens responsible enough to ask for it. No teen should be placed in this position – the end result for too many is an unplanned pregnancy or child that will affect the teen – and child – for life. And even worse, these teens are denied access based on their age… which is the very reason that reproductive care is so critical for them! An unplanned pregnancy is a very stressful situation for adults, and much more so for a teen. Thank you for being there for them.
That’s horrific.
Beatrice, I’m so sorry to hear about this experience. I am a reporter looking to talk to women who have been affected by legislation like this. Could you email me at kaila.white@arizonarepublic.com?
While I am glad the subject is getting media attention, beyond the vaguest of details I’ve supplied here, this story is not mine to tell. I would feel uncomfortable giving more private details about an extremely difficult time in her life. I no longer have contact with any of my family, so unfortunately I won’t even be able to pass a message along.
How is this not straight up gender discrimination? Is there some sort of lawsuit we can help fund?
I hope/bet those parents denying daughters their epidurals never get to see their grandchildren.
Holy smokes! Makes me glad I live in the state I am in sometimes (often, these days, I’m not glad, thanks to our “I am a best bud to the POTUS” governor). But a pregnant teen is considered (temporarily – during pregnancy only) an emancipated minor, able to sign consents for all her care that have to do with the pregnancy.
So, if she needs an epidural, she gets one. But, if she needs a broken leg repaired, she’ll need parental consent.
I’m rather surprised by some things with medicine and teens. Took daughter#1 to the pedi for birth control pills (to regulate her cycle, actually) and when they called her explicitly said to daughter and nurse “I’ll wait for you here in the waiting area”. The doctor called me in to approve, etc. WTF, she’s the age of consent, and I’d made it clear that she was in charge of this and I was NOT listening in to her conversation with the doctor. If she wants birth control as well as cycle regulation, she needs to be able to tell the doctor without a parent right there.
Why are they doing gynecology if they can’t afford the patient any privacy? She’d have been better off in some ways going to planned parenthood.
As it was, it took EXPLICITLY asking for birth control pills to regulate her cycle after bitching more than once that she was debilitated around 2 days a month. Not hospital level, but not able to function at school.
To be clear, she is over the sexual age of consent in our state, but under 18. So she can consent to intercourse that could get her pregnant, but not the most effective way to prevent pregnancy?!
(Yes, we’ve had talks about use a condom anyhow, pills don’t prevent STDs.)
No, she can consent to birth control pills (or any contraception) under Minor Consent laws. You were not brought in because the doc needed your permission, but rather because having a parent on board is so important to improving adherence rates. Doctor rule of thumb: Get the parent explicitly on board whenever possible.
The conversation sounded like asking for consent (is this okay with you), but I understand the reasoning now.
A lot of parents aren’t as practical as you are and would not allow their children the pill. I know mine would not have. Luckily being a huge dork was all the birth control I needed.
Right, but this is an example of more sexual morality and punishment in medicine. As far as I know, she’s NOT having sex or planning to. But I do know, very clearly, that her cycle is wacky, her periods are debilitating and her moods are insane a few days before her period. And I understand the best way to control all this is the pill.
I agree. The fallout from this sort of stupidity will hurt more than just pregnant girls. Ironically, it has probably led to a few abortions.
Yep. My very conservative Christian neighbors put their 13-year-old daughter on the pill for her irregular, debilitating periods. She did not have sex until she married. (No, she really didn’t; we were best friends and told each other everything.) It’s a bit weird to conflate health and morality in such a way.
I didn’t have sex until I was married. But I was put on the birth control pill at 18 to control extremely irregular, heavy, and debilitating periods. The doctor had to convince me it was okay by the Catholic Church if I took the pill for medical reasons. Turns out I had severe endometriosis, not diagnosed until I was 25. So I spent the time from 13 until 25 curled up in the fetal position, unable to function, every time I had my period. Even on BCPs. All the BCPs did was allow me to know when the debilitating pain was going to strike, instead of it being random. I’ve still only had two sexual partners in my life (husband 1 and husband 2). I had a lot of Catholic guilt, which is one of the reasons I was a virgin when married the first time. I’m 45 now, still married to husband 2, and still struggling with endometriosis (although hysterectomy is finally being considered as an option, despite the fact that husband 2 has had a vasectomy since we met in 1999).
That sucks. I’m sorry. If you do have a hysterectomy, I hope it’ll take care of the endometriosis.
My religious mum tried to dissuade me from taking even so much as ibuprofen to treat my debilitatingly painful periods. I finally got sick of trying her various ineffective home remedies and went to the GP. I was on Mefenamic acid at first, then switched to COCP when I became sexually active a few years later.
I don’t know what the ‘logic’ is for the latter, but there seems to be quite a large overlap between the ‘No pain relief for labour’ and the ‘Ditto for periods’ crowd. Luckily, my mum wasn’t a full-blown fundie, but I knew some girls in my (then) church whose parents had a ‘No tampons before marriage’ rule. The mind boggles …
I have four daughters (and one son), ages 2 to 8 right now. I joke about starting to dose them with BC around age 11, hidden in their morning apple juice and all the way up through adolescence. I’m actually quite serious but refer to it as a joke as not to look like a freak XD I’m a BIG fan of BC.
I have a different take on that appointment. I see a lot of teens for birth control, and when parents can be brought on board I always do. The reason is that in teens, medication adherence tends to be so poor that the effectiveness of the pill goes waaaay down (down to only ~80% for certain low income teens.) So when a teen comes in with a parent, even though I see the teen alone first and we come up with the plan together, I always ask her for permission to bring her parent in. I then say something to the parent like “I advise starting the pill, is that OK with you?” It always is (because otherwise the teen wouldn’t have consented to the parent coming in) but it gives me the chance to talk out any concerns with the parent. If I don’t do this, I find that parents will not infrequently end up convincing their teens to go off of the med due to some side effect myth or another. Or they don’t realize how much more effective the pill is if they help supervise it. Asking for a parent’s explicit buy-in is golden.
LARC seems made for teens – no pills to remember. Is it the cost that makes it a less appealing option?
LARCs are wonderful, and my first choice, but there are a number of barriers. Cost can be one of them, although my state has a lot of special subsidy programs so where I practice that’s not a big barrier. The biggest barrier is that teens are afraid. Nexplanon insertion involves 2 needles and the teen years are peak years for needle phobias. IUD insertion involves a pelvic exam, and a lot of teens are totally freaked by that idea. Many of them are too afraid to even use a tampon (why the penis doesn’t invoke the same amount of fear, I am not certain.) Nexplanon also involves the prospect of a lot of irregular spotting and teens tend to tolerate that poorly.
What about Depo Provera? I’ve never suffered from needle phobia so I wouldn’t know exactly what triggers it, but I’d guess having the injection in a place where you can’t see it going in would mitigate the fear somewhat? Also, (bonus!) no periods.
Depo Provera has weight gain, bone thinning and menstrual chaos as common side effects. Not appealing to teens.
LARC is great for those it works for, but it isn’t for everyone.
I love Mirena, but had to have both of mine inserted under GA and had one get lost and need removed under sedation- also I still ovulated with it and needed surgery for an ovarian cyst. My OBGyn vetoed me getting another.
Nexplanon was great when I was breast feeding, but as soon as I dropped the last feed I bled every day for MONTHS, and not just vaginally, because I have weird endometriosis deposits outside my pelvis. Once I had it out I also realised that I had been on edge and angry for months, and I suddenly wasn’t anymore.
If LARC agrees with you and you get infrequent, light bleeding it’s worth it. If you get an intolerable bleeding pattern or some other weird side effect, then the benefit of LARC over the pill quickly disappear.
Depo Provera can be great. Those who love it, love it. But there are some downsides: it does involve a needle, causes substantial weight gain in some, irregular bleeding for the first 3 months and then either no period (either you love that or you hate it) or continued irregular bleeding (everybody hates that), reputation in the community that it causes permanent sterility (totally untrue but the myth won’t die.)
That makes sense. I’m fortunate to have zero needle phobia and thought the little subcutaneous stick was cool – but it freaked my husband out, so I should have guessed it would do it to teen girls, too. :/
Agree.
Teen compliance with COC goes up if they can keep it beside their toothbrush, hairbrush or the kettle or toaster and mum can remind them to take it.
It goes way down if they have to keep it in a drawer and no one to help them to remember to take it.
I mean, heck. My use of fresh produce goes way down when I have to keep it in the drawer of the refrigerator, vs. keeping it in sight on the counter. It’s an obvious thing, and really a shame that women and girls sometimes have to hide their pills.
I have them set an alarm on their phone, like Mimi in Rent.
Yep. For every single one of them I have them set the alarm on their phones right there in front of me in the clinic. And then I contact them in 1 month to see how they are doing with remembering. Even with the alarm set, the majority of teens on follow-up have missed at least a couple of pills. Part of this is the population I see: low income, low literacy, very stressful chaotic living situations.
Okay, that makes sense. I withdraw my rant. 😉
And to answer Roadstergal, the doctor wants to evaluate the effectiveness before committing to LARC.
Ah, I see, thanks. Yeah, when I found out about it, I thought it was goddam magic; after Implanon and Skyla, I’m now convinced that it’s goddam magic. :p
I really think the only way to fix this is to specifically amend laws to not refer to labor/pregnancy at all. Either teens can consent to (some) medical procedures or they can’t. Either teens can get pain relief on their own or they can’t. And if a parent wants to deny someone with a broken bone, burn, kidney stone, or severe laceration pain relief, well, CPS does still consider teens to be children.
Either pain relief is part of emergency treatment or it isn’t, as Dr. Tuteur said. Make up your mind, Ohio!