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September is National Sexual Health Awareness Month, which makes it the perfect time to talk about birth control options at Fika Midwifery. Our birth control options have never been more diverse or more accessible than they are today. At Fika, our midwife can help you figure out the best method to fit your individual needs and values.

When most people think about birth control, they think about The Pill (anyone else a superfan of Loretta Lynn?). There are many birth control pills available today, and the midwife can help you figure out the best fit for your needs. Also called oral contraceptives, most birth control pills come in a pack with 21 or 28 pills. They work by releasing either a combination of the hormones progestin and estrogen or just progestin to block ovulation. Some pills also make your cervical mucus thicker, which makes it harder for sperm to reach an egg in the first place. They are a very good method of preventing pregnancy. With perfect use birth control pills are 99.7% effective and with typical use they are 93% effective.

You’ll want to consider the discipline birth control pills require before choosing them as your contraception. To use the pill effectively, you’ll need to take it at the same time everyday. Setting a phone alarm is one easy way to get into this routine. Your period on the pill can vary by which brand you use – some give you a period every month, some every 3 months, and some skip your period altogether. Skipping your period is completely safe, but it’s not for everyone. Many people are reassured by a monthly menses, so make sure to take your period preference into account when selecting a pill option. The most common side effects of oral contraceptives are sore breasts, nausea, spotting, and decreased sex drive, but everyone’s body responds to the pill in its own way.

The birth control ring works with hormones the same way as birth control pills to prevent pregnancy. It is a small, bendable ring that is inserted into the vagina once a month. It’s left in place for 3 weeks, then on the 4th week it is removed. Most people do not feel the ring at all, even during intercourse. Before you select this option, think about whether or not you feel comfortable putting your fingers in your vagina. If you can put in a tampon, you can probably use the ring without an issue. Another option is the birth control patch, which uses the same mechanism as the pill and ring to prevent pregnancy. The patch looks like a square bandaid which you stick to your skin and replace weekly.

The birth control pill, ring, and patch all require a prescription, but you don’t have to pick it up every month. New York State passed the Comprehensive Contraceptive Coverage Act in 2019, which means you can pick up a whole year of birth control at once. To get more information on how to get 12 months of birth control at one time, watch this brief video from the NY Birth Control Access Project.

Condoms are another form of birth control that most people are familiar with. Condoms are slipped over the penis prior to intercourse and are the only contraceptive method that protects against both unplanned pregnancy and sexually transmitted infections. They work by keeping sperm inside of the condom and out of the vagina. Condoms come in hundreds of different shapes, sizes, and colors. You can choose smooth or ribbed, lubed or unlubed, and even glow-in-the-dark. They don’t usually have any side effects. If you are sensitive or allergic to latex, just make sure to select a latex-free option. There are also internal condoms, which you insert into the vagina. They work the same way that other condoms do, except that they’re worn on the inside, rather than slipped onto a penis, and offer more control to people with vaginas.

Condoms are readily accessible and inexpensive at drug stores and supermarkets. No prescription is required. You can also find them for free at many clinics, like the awesome condom bar at Evergreen Health. The downside of condoms is that they require effort and commitment. If this is your preferred birth control method, you need to use one every time you have intercourse. You can easily incorporate condom use into foreplay though to keep the mood intimate, and they can even make sex last longer if you or your partner have trouble with premature ejaculation. With perfect use, condoms are 98% effective in preventing pregnancy, and with typical use they are 87% effective in preventing pregnancy.

Intrauterine Devices, or IUDs, are one of the most common birth control methods used by our clients (and our staff). These small, T-shaped, pieces of plastic are inserted by the midwife into your uterus during an office visit. IUDs interfere with the way sperm move, preventing them from fertilizing an egg. The insertion process can cause spotting and cramps for the first 24 hours, but is usually well-tolerated with the help of Ibuprofen, a heating pad, or whatever else you usually use for menstrual discomfort. What makes IUDs such a popular option is that they’re super effective, long-lasting, and require little maintenance. In fact, they’re over 99% effective at preventing pregnancy and can last up to 12 years.

If the idea of an IUD appeals to you, there are hormonal and non-hormonal options. We provide both Kyleena and Mirena IUDs at the Coit House, which use the hormone progestin to prevent pregnancy. Kyleena prevents pregnancy for up to 5 years, while Mirena lasts for up to 7 years. Both of these hormonal options may decrease menstrual bleeding, and for some people they stop periods altogether. We also offer the Paragard, which uses a small amount of natural, safe copper to prevent pregnancy. It is the only non-hormonal IUD available in the U.S., and lasts for up to 12 years. With Paragard, you will still get a monthly period, and your bleeding and cramping may increase. You can have your IUD removed at any point with a simple office visit. So even though they’ll last for many years, if you decide you want to get pregnant, an IUD will not interfere with your fertility.

Attached to the T-shaped IUD, are strings that hang into the vagina (only inside, unlike a tampon). It’s a good idea to check that you can feel the strings of your IUD each month to ensure the device is in the right place. If you’re unable to feel the strings, don’t panic. They soften over time and can become harder to detect on your own. Reach out to our office anytime to schedule an appointment for the midwife to check.

The Caya diaphragm is another non-hormonal option that we offer at the Coit House. The Caya is a light purple dome-shaped disk made of silicone. It is inserted into the vagina before sex to cover the cervix so that sperm cannot reach the uterus. When thinking about this option, make sure you’re comfortable sticking your fingers in your vagina. Diaphragms are most effective when used with spermicide, which we stock at the Coit House and is readily available at drug stores. Just put a teaspoon of spermicide inside the cup of the diaphragm (the side that faces your cervix) and put it in place with your finger tips. You can insert a diaphragm up to a few hours before sex if you want to be more spontaneous, and you need to keep it in for at least 6 hours after intercourse. Both diaphragms and spermicide have expiration dates, so don’t forget to check! This method is 84% effective, so it’s not ideal if you need maximum protection against unplanned pregnancy.

Withdrawal, also known as the pull out method, is the oldest birth control method humans have used. This is when the penis is pulled out of the vagina before ejaculation. Withdrawal requires perfect use and A LOT of discipline from the penis-owner. If an unplanned pregnancy is something that cannot happen in your life right now, it might be best to consider more reliable methods of birth control. The failure rate for withdrawal is about 20%.

In addition, fertility awareness is a birth control method that doesn’t use any hormones, devices, or have any side effects. Instead, you’ll closely track your menstrual cycle to determine the days when you can get pregnant and avoid sex or use another birth control method on those fertile days. In addition to recording when you get your period each month, most people who use the fertility awareness method also monitor the color and consistency of their cervical mucus and their body temperature every day. There are apps that can help you track these elements, like the FDA-cleared Natural Cycles. This method requires education, discipline, and commitment. With perfect use, it is 95-99% effective, and with typical use, it is 78-98% effective.

We would be remiss not to mention vasectomy, even though this is something outside of the midwifery scope of practice. A vasectomy blocks the tubes that carry sperm, so the penis-haver’s ejaculate can no longer cause pregnancy. This is an excellent option for those looking for a permanent birth control solution. A vasectomy usually involves a brief office procedure and heals quickly. If you’re interested, reach out to a urologist to set up a consultation. We recommend Western New York Urology Associates.

If you’ve had unprotected sex or your birth control failed, call or message the midwife right away. There are a few different forms of emergency contraception available, which can stop a fertilized egg from implanting in the uterus. There are two types of emergency contraception pills: Ella and Plan B. Ella is only available by prescription, but Plan B is available over-the-counter at most drug stores and supermarkets (although having a prescription may save you any out-of-pocket costs, usually about $40). Ella can be used up to 5 days after unprotected sex or birth control failure with no decrease in efficacy. Plan B can also be used up to 5 days after unprotected sex or birth control failure, but the efficacy decreases with each day so you’ll want to take it as soon as possible. It may be a good idea to have Plan B in your medicine cabinet, just in case you ever need it. The most common side effects from emergency contraception pills are nausea and vomiting. If you don’t get a period within 3 weeks of using the pills, take a pregnancy test to rule this out. Paragard can also be used as emergency contraception up to 5 days after unprotected sex or birth control failure. Having a Paragard inserted is the most effective form of emergency contraception and will decrease your chance of pregnancy by 99.9%.

Emergency contraception is not an abortion. It will not stop a pregnancy that has already implanted from continuing to grow. If you do become pregnant and don’t want to be, reach out and we can discuss your local options for abortion care and what to expect.

If you want to learn even more about your birth control options, check out the awesome online resources at Bedsider. Don’t hesitate to call or message our office with any questions or if you want to make an appointment to talk about contraception with the midwife!

Author Mary Badame is the Quality Assurance Manager at Fika Midwifery and is a passionate advocate for midwife-led care, increased birth options, and better reproductive healthcare for everyone.