Category Archives: Pregnancy

A Short History of Birth Control in the United States

Human Rights March for Equality – Source Library of Congress

Overview

Our mother was born in 1916, the same year the first birth control clinic opened in New York. She was a human rights activist and voting advocate until she died at the age of 89.

We received advocacy genes from both of our caring intelligent parents who were self-educated strong individuals raised in poor loving families. They encouraged hard work, independence, and broad horizons. Being females was not a detriment in their eyes but through the years, we have found it a struggle in a man’s world and have personally faced discrimination.

A review of contraception history and factors related to women’s rights is important because so many young men and women today matured during a period when many rights were established. That time has changed. Women gained the right to vote one hundred years ago, a right more important today than ever.

Women, and men who care about them–not to control their bodies and lives but support their independence, have entered a new era of activism.

The Supreme Court actions that overturned Roe v. Wade forces all women into a negative economic and personal rights environment. Contraceptive rights have reverted to the 1800s with religious patriarchs even mandating a child-victim of incest, or victims of rape, carry a resulting conception to term.

Source Samantha-Sophia Unsplash

THEN

In 1848, a conference attracted three-hundred women and men who met to gain women the right to vote. It took seventy-two bitter years of activism, hunger strikes, arrests and fighting obstruction for women to prevail. Congress finally passed the Nineteenth Amendment to the U.S. Constitution giving women the right to vote in 1920.

While early activists fought for a woman’s right to vote, another group of feminists spent their lives helping women obtain sex education and access to birth control. One of those women, Margaret Sanger, grew up in a household of poverty with ten siblings. Her mother had eighteen pregnancies.

In 1902, Margaret began working as a nurse, and later a midwife. She cared for chronically pregnant poor women living in the tenements of New York who begged her for information to help stop unwanted pregnancies.

Sanger’s book, Motherhood in Bondage, contains hundreds of letters from hopeless women across the country imploring her to help them limit the number of children they bore. Most of them wrote of being married as teenagers and bearing a child each year. One 43-year-old woman with nineteen children had begged her doctor for contraceptive information, only to be told to be careful. Stories included child-mothers escaping poverty to marry, and having a child before their thirteenth birthday. One, married at age fourteen, had fourteen living children, many miscarriages, and failing health due to multiple pregnancies and poverty.

The women’s plight incited Margaret’s actions, but by talking about birth control she risked imprisonment under the Comstock Act of 1873. That draconian law made it illegal to discuss, produce, print or use the U.S. Postal Service to mail any literature or product pertaining to the body related to birth control and venereal disease, rampant before the age of antibiotics. Anatomy textbooks being sent to medical students were prohibited and confiscated. Doctors failed to educate women about ovulation and contraception because they could be jailed for discussing the topics.

Anthony Comstock, the influential politician and religious zealot who became a U. S. Postal Inspector, considered Sanger’s pamphlets on sex education and clinics providing contraception advice to be obscene and pornographic. His imposed religious views set medical education and U.S. public health back decades.

After her arrest for publishing and distributing contraceptive information, Margaret fled to Europe under an assumed name to avoid prosecution that could have carried up to a 45-year sentence. She studied methods of contraception in the Netherlands and returned to open the first U.S. birth control clinic in New York City in 1916. She and her sister Ethel Byre, also a nurse, provided contraceptive information and treated 486 patients in ten days, before the NYPD Comstock Vice Squad swept in to arrest the nurses and patients.

Ethel nearly died in jail during a hunger strike to raise awareness for their cause. Margaret was sentenced to the penitentiary for thirty days and upon release, reopened her clinic in protest. She founded the American Birth Control League in 1922 that eventually became Planned Parenthood of America.

Margaret Sanger’s desire to help women fueled her lifelong activism to teach contraceptive methods and advance sex education. The Catholic Church considered Margaret an enemy and opposed her work, but she had seen what continual pregnancies had done to her devout mother and others in poverty producing huge families.

Support and fortunes of philanthropic people like International Harvester heir Katherine McCormick, John D. Rockefeller, and Margaret’s second husband, oil magnate James Noah Slee, fueled her campaigns for birth control and research for an oral contraceptive. Sanger and McCormick both lived to see the success of their efforts when the FDA approved the first oral contraceptive, Enovid, in 1960.

In 1972, the Supreme Court finally struck down the last of the oppressive Comstock law that restricted doctors from prescribing oral contraceptives to unmarried women ending nearly one hundred years of Comstock tyranny.

Source Gayati-Malhotra Unsplash

NOW

More than sixty years after the epic moment in 1960 making birth control pills available, women are fighting the same old battle, the right to self-determination and contraception.

Some legislators at the national level have vowed to defund Planned Parenthood clinics across the United States. Those who fight to defund the clinics and legislate reduced contraceptive availability and education are antiabortionists. They vehemently attack clinics that provide abortions, leading to violence, bombings, and terrorist murders of healthcare personnel.

Planned Parenthood provides healthcare to both men and women, education, contraceptives, treatment of sexually transmitted diseases, and they offer fertility consultation.

Comprehensive sex education and free contraceptives reduce unplanned pregnancies and abortions. Why would those against abortion defund Planned Parenthood clinics limiting access to education and birth control, thus increasing the need for abortions?

Abortions have been a legal right under U.S. law since the Roe v. Wade Supreme Court decision in 1973. That decision deemed abortion a fundamental right under the U.S. Constitution. Roe, (a pseudonym to protect her privacy) was a single pregnant woman who brought a class action suit against the constitutionality of Texas laws that made abortion a crime except to save the life of the mother. District Attorney Wade provided the state’s defense. The historic decision overturned the Texas law and held that a woman and her doctor could choose abortion in earlier months of pregnancy without legal restriction, and with restrictions in later months based on right to privacy.

Any adult has the right to make personal decisions based on their religious views. However, our founding principle of separation of church and state in the U.S. means no one as the right to impose their religious views on others.

Broad availability of birth control education and contraception has been shown to reduce unplanned pregnancies and reduce the need for abortions. In spite of this fact and the desire of most citizens in the United States, the U.S. Supreme Court overturned Roe v. Wade in this month. Their 2022 sweeping judgement not only removed a woman’s right to make personal healthcare choices, it broadly affects autonomy in every sphere of existence. The partisan justices also tainted the Court and destroyed the established framework of the United States of separation of church and State.

The next blog will provide an overview of Reproductive Biology for men and women, then related topics from the booklet will follow. If you are interested in following the Lipstick Logic blog, please subscribe by providing your email.

Thanks for stopping by.

Betty and Bev, The Lipstick Logic Sisters

A WOMAN’S RIGHT TO CHOOSE

LIPSTICK LOGIC BLOG

Statement of Purpose

Lipstick Logic ™ LLC was founded in 2008 to provide education and health conferences for women. This blog was developed as a way to reach a larger female audience with a wide range of science-based health topics. With woman’s rights having been set back 50 years due to Roe v. Wade being overturned, our focus on women’s issues and health seems even more important.

A new day has dawned for women in America. Freedom of choice can no longer be taken for granted. The Supreme Court ruled against a woman’s right to have an abortion. Although some states will continue to provide education and abortion services, many states are pursuing legal changes to terminate women’s rights, criminalize their actions, imprison practitioners, and even track a woman who might leave her state to obtain needed healthcare elsewhere.

Several years ago, Dr. Betty, a specialist in internal medicine, wrote a primer on contraceptive issues and related biology. Over the next several weeks, this Lipstick Logic blog will provide updated information from that primer.

CONTRACEPTION is a broad topic. Even if you have had a child and have grown up in an age where options for women’s reproductive rights were rights, you may learn new information to share with other women, your daughters, granddaughters, and the men in your life.

ORAL MEDICATION FOR ABORTION will be our first topic. It is a safe option if chosen early in pregnancy. But, if you live in a state that has banned abortions, this medication will not be available to you. Always consult with your private physician regarding your situation and any medical concerns you have.

If you are interested in reading researched, science-based information regarding women’s health and human rights, please join us by subscribing to this blog.

Everyone woman of voting age must vote to protect her rights and freedom.

Betty and Bev, The Lipstick Logic Sisters

Author Note – Betty Kuffel, MD FACP

This science-based publication is a quick reference to understanding the natural processes of reproduction and contraceptive choices available today. Information related to sexual assault and sexually transmitted disease is also included.

My desire is to provide information for informed choices and make this publication widely available to all ages. Reproductive and contraceptive education is known to reduce unplanned pregnancies and the risk of sexually transmitted disease. The need for abortions can also be minimized.

The information is current at the time of publication. Individualized guidance must be obtained from your health practitioner or pharmacist.

Make informed choices. The effects of what you do today will be with you the rest of your life.

If men got pregnant, there would be safe, reliable methods of birth control.

They’d be inexpensive, too.

Anna Quindlen, Pulitzer Prize-winning columnist

 and bestselling novelist

ORAL MEDICATION

ABORTION OVERVIEW

The 1973 Supreme Court decision on Roe v. Wade legalized ending a pregnancy during the first twelve weeks following conception. Prior to the legalization, women were forced to go to untrained abortionists, or aborted themselves using all sorts of objects including knitting needles and rug hooks. Often, they died of hemorrhage and sepsis from infection.

In 2000, the Federal Drug Administration (FDA) approved the first oral medication to induce abortion, (RU-486).  A newer, lower dose drug, Mifeprex (mifepristone), is also available. The FDA lengthened the duration of time it can be used to 70 days (10 weeks) of gestation. The time is calculated from the first day of the woman’s last menstrual period.

  • Mifepristone blocks progesterone cell receptors, a hormone important in maintaining pregnancy. It is used in combination with misoprostol to complete the abortion.
  • Misoprostol softens and dilates the cervix and induces uterine contractions to expel the products of conception. There will be significant cramping and some bleeding when the abortion occurs. A follow-up visit with a practitioner is recommended.

Following the advent of birth control pills, improved education and more options for contraception, pregnancy rates fell, as did the number of abortions. There are still times when women decide to end a pregnancy, however, the current Supreme Court ruling makes it illegal to end any pregnancy even those resulting from violent rape or incest.

Procedure:

* Patient receives counseling, signs an agreement form, and is given a copy of the FDA Mifeprex (GENERIC- mefepristone) Medication Guide.

Note: Cost is markedly reduced from the approximate cost of $100/pill, to $14.00 using WebMDRx.

* A certified healthcare provider dispenses the medications.

* Mifepristone, 200 mg, is taken by mouth.

* 24-48 hours later, misoprostol, 800 mcg, is taken as directed.

This method is 98% effective. If the abortion is incomplete and some tissue is retained, such as remnants of the placenta, a procedure may be necessary to remove the tissue to stop bleeding and infection. See www.fda.gov/drugs/ for detailed information.

EMERGENCY CONTRACEPTION

THE MORNING AFTER PILL

Emergency Contraception (EC) can be used to reduce pregnancy risk following unprotected intercourse. When taken early and correctly, the medication is usually effective following a rape or unexpected situations such as a broken condom. EC must be used soon after intercourse and will not be effective if pregnancy has already occurred.

Rape

If you are raped, Emergency Contraception is recommended to prevent pregnancy. This medication is usually provided in the Emergency Room if the victim seeks medical assistance and a rape exam to collect forensic specimens. Medication to prevent sexually transmitted diseases is also given to victims.

Note: An emergency contraceptive prevents pregnancy. It does not cause an abortion. This treatment will be unavailable in many states under the new Supreme Court ruling that overturned the Roe v. Wade right to privacy and abortion.

Progestin

The “Morning After Pill” has many forms: Plan B, One-Step, My Way, and others. They are available over the counter, without a prescription. There were no point-of-sale restrictions prior to overturning Roe v. Wade. Many states still allow use of this medication.

Progestin is a hormone that stops or delays ovulation and is best taken within three days of unprotected intercourse. It will not end a pregnancy. Talk with a pharmacist for information and side effects. Cost: ~$40.

Ulipristal (Ella)

This prescription medication delays or prevents ovulation. It can be taken up to 5 days after unprotected intercourse. (It is thought to be more effective than either progestin-only or a combination hormone pill containing both estrogen and progestin.) Cost: ~$40-$60.

Combination pills

These pills contain both estrogen + progestin., taken in two doses and result in delayed ovulation. For dosage, consult with a physician or pharmacist. More information may be found at: https://www.mayoclinic.org/tests-procedures/morning-after-pill/about/pac-20394730 Cost ~$30

Copper Intrauterine Device (IUD)

If you are overweight or obese, effectiveness of EC pills is reduced. Insertion of a Copper IUD is effective and provides contraception for ten years. IUDs must be inserted by a health practitioner. More information will be provided later on IUDs. Cost is variable. Placement may be free at Planned Parenthood clinics.  

Baby Blues

Emotions run high following any birth. Especially with a first baby, in addition to joy, a new mother may feel anxious and fearful due to a lack of experience in caring for her newborn. No mother expects to be sad following the birth of a child, but about fifty percent of new mothers experience Baby Blues.

Worry, unexplained bouts of crying, a slow physical recovery and lack of sleep impact postpartum emotional states. Usually the rollercoaster emotions resolve within two to three weeks, but some women are left with prolonged unexplained sadness. Pregnant women often joyfully await the birth and are caught off guard by serious emotional changes ranging from the blues to prolonged depression and even psychosis.

Postpartum Depression

Emotional swings extending beyond a few weeks mean Postpartum Depression and require medical attention. This prolonged depression following delivery is associated with physiological, social and psychological changes. Symptoms may begin immediately following the birth and increase if untreated. About 1 in 10 new mothers experience postpartum depression. Once experienced, the percentage rises with each baby thereafter.

Intense mood changes and inability to bond with the baby can swing to fears she might harm herself or the newborn. Additional symptoms include loss of appetite, lost interest in being around others, hopelessness and inadequacy compounded with panic attacks and inability to make decisions. Seeking professional help is essential if these symptoms last longer than a month.

Antidepressants and counseling are very effective.

Postpartum Psychosis

A third more serious but less common condition affecting 1 in 1000 women is Postpartum Psychosis. Symptoms beginning within a week can include rapid speech, insomnia, manic behaviors, obsessive thoughts, agitation, paranoia, and hallucinations.  This condition requires immediate medical intervention for dangerous life-threatening behaviors including attempts to inflict self-harm or harm to the baby.

Call for Help

A phone call and follow-up care from your medical provider is important when depression persists, or in the case of psychosis, immediate care is needed. Prolonged depression of any nature is serious. If untreated, it can affect the entire family. Because of added financial and parenting responsibilities associated with a new baby, fathers can experience depression following a birth, too. Untreated depression in either parent impacts other children in the family.

More information is available on the Mayo Clinic and Cleveland Clinic websites.

 

Betty and Bev

free photo source

A Silent Change in Motherhood

Motherhood is a variable experience. Some women find the nine-month incubation of a pregnancy enjoyable. But when hormones surge and nausea sets in, exhaustion makes Free Pixabay Stocksnap pg womanthe date of delivery seem faraway.

Dramatic physical changes occur. Blood volume doubles. The placenta nourishes the fetus and provides a natural protective barrier.

As the fetus grows, maternal weight increases and endurance wanes. Nausea from day-one often ends at three months but can continue until the birth. The mother wonders when her life will return to normal and if her clothes will ever fit again.

Miscarriages are common, bringing physical and emotional adjustment, but even following an uncomplicated delivery, life doesn’t suddenly normalize. A usually joyous time getting to know the newborn is interrupted by sleepless nights and sometimes complicated by feelings of inadequacy and depression.

A new mother must juggle schedules and if breast feeding, may pump breast milk for months so she can return to work. To communicate with her baby, she may learn and teach the infant sign-language or find herself babbling baby-talk. After an unpredictable adjustment period, a new norm is reached.

Getting back into shape, eating right, sleeping and taking care of mothering tasks prevail, but during the pregnancy, silent changes evolved in the maternal body that may impact her health for life. Fetal and maternal blood circulation are separate except for a nutritional interface. No maternal-fetal blood is exchanged but fetal deoxygenated blood passes through umbilical cord arteries to the placenta. There maternal nutrients and oxygen are exchanged through the mesh of an arterio-capillary-venous system, much like oxygen/carbon dioxide transfer occurs in adult lungs.

Despite clear separation of fetal and maternal circulation, an article published by researchers at the University of Arizona reported some fetal blood cells migrate through the placenta and are carried in the mothers’ blood. The fetal cells lodge in various maternal locations where they exist for years. Foreign cells in maternal tissue turn mothers into chimeras. The term alludes to Greek mythology and creatures built from different animal parts, in this case: fetal microchimerism. Fetal cells are detectable in 90% of healthy women after a pregnancy.

Researchers found fetal cells migrated to damaged tissue following a C-section delivery where they were actively involved in healing. In other cases, fetal cells were swept through the bloodstream into maternal areas including the lungs, where they appeared to be inactive bystanders. Some of the escaped fetal cells were pluripotent, like stem cells, able to change into different cells and impact body processes in both positive and possibly negative ways.

Health issues including autoimmune diseases might be triggered by the foreign fetal cells. In these common diseases, the body’s immune system attacks normal cells. Of note, women are more likely to develop autoimmune disorders such as rheumatoid arthritis, MS and lupus than men.

Male fetal cells are found in women who have not given birth to a male child. How could that happen? This may occur when a male embryo fails to develop properly and aborts or is absorbed by maternal processes but some of the fetal cells live on.

Another field of research has shown a reverse transfer of cells, where maternal cells migrate to the fetus. This may explain autoimmune diseases in offspring, including inflammatory bowel disease and biliary cirrhosis.

Although effects of fetal microchimerism have been studied over decades, their impact remains incompletely understood and vigorously debated within the biological research community.

Betty Kuffel, MD