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CONTRACEPTION AFTER CHILDBIRTH – CONCLUSION

After childbirth a contraceptive choice must be made as few women will want to risk another pregnancy immediately. As always, that choice will rest on the balance between what is medically appropriate and the emotional factors involved.

The experience of childbirth exerts profound changes, both physically and mentally. The doctor providing contraceptive care is in a unique position to observe these changes, which in most cases will be part of a healthy maturational process but which may have an important effect on the choice of contraceptive method and its efficient use.

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THE STEREOTYPES – ‘MEN NEED TO BE IN CONTROL’ (WITHDRAWAL)

Can withdrawal be considered the ultimate test of control for the man? It involves fully potent sex up to a point that only he can recognize. Most men have tried it at some time, and talked excitedly about the experience until it came to describing the difficult bit. In addition to recognizing the importance of his own control, several said it was impossible if, at the last moment, the woman grabbed hold with her arms or legs and held him in. These men were describing risky sex, and the group must contain a number whose enjoyment is particularly connected with the risk of conception.

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INFERTILITY AND THE CONTRACEPTIVE CONSULTATION – INSTANCE

Mrs H. had hidden the nonconsummation of their marriage for eight years. She had requested repeat prescriptions for the Pill, avoided examinations by having a period or a pressing engagement, and had also moved house and general practitioner (GP) on several occasions. Eventually she plucked up courage to approach her new female doctor, saying that she wanted to have a baby and thought it sensible to have a smear before stopping the Pill. She did not mention the lack of intercourse.

The doctor noticed the hesitancy in her preparation to get on to the couch and remove her underwear for the examination. She looked like a young girl, despite her 28 years, rather like a china doll with neatly parted and waved hair, no make-up and wearing a summer dress with puffed sleeves. She sat up on the couch with her arms clutching her knees and to the doctor’s comment about her apparent reluctance to be examined she began to talk about the lack of penetration in their sex life. Nobody had asked her about sex before and if they had the answer would have been ‘it is all right’, for they did enjoy a degree of intimacy when she achieved an orgasm with manual stimulation. It was only now that they wanted a baby that the situation had become a problem.

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THE DOCTOR AND THE UNPLANNED PREGNANCY

Greater social and medical sophistication in our society has also meant greater involvement between the medical profession and pregnant women. Doctors have become increasingly responsible for the health of the pregnant woman and her unborn child. Laws designed to liberalize abortion have also made doctors more involved with unwanted pregnancies. Throughout the ages and in all societies women have sought to control their own fertility using methods ranging from trying to abort themselves and obtaining an illegal abortion, to infanticide. Although the consequences were sometimes disastrous, it did mean either that women took measures themselves or sought the help of other women. Doctors now have the legal power to terminate a pregnancy and the knowledge to do so safely. If there had been another method of procuring abortion, not requiring medical skill, it is doubtful that doctors would have been so involved. The abortion pill has proved to be a disappointment to women in this way as it still involves medical input. Many women feel that the decision as to what happens to their own body and their own pregnancy should be theirs alone and resent the need to ask doctors for permission to terminate their pregnancies.

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WHAT ABOUT THE MESS? – USING CONTRACEPTION (INSTANCE)

Silence. In the background, the practice nurse looked at her watch. ‘My husband and I are no longer together.’ Mrs A. looked quickly at the doctor, and then back at her watch. ‘I’ve got a new bloke . . . don’t know why . . . just felt I ought to have a check-up . . .’ Suddenly, the defences were lower, and Mrs A. was able to talk about the new man in her life. ‘He’s smashing, really nice

. . . [another anxious sideways look] but . . . well . . . he don’t really get on with the sheath, says he never had to use it with his ‘ex’. But, there’s no way I am going back on those Pills!’ ‘Why don’t we get on with the check-up,’ said the doctor. ‘We can talk about it then.’

Behind the screen, although the examination continued as requested, the talk was all of contraception. She had hated the Pill, well, to be fair, her ‘ex’ was an alcoholic, had wanted sex when fairly drunk, incapable of it later. ‘Every time I took that Pill, I felt sick.’ The oral contraceptive pill had equalled anger and humiliation. ‘When I left him, I said, never, never again.’ The doctor commented that the anger at the husband had turned into anger at the Pill, and wondered if it was only the new partner who did not like the sheath. Was sex OK now? Mrs A. blushed. ‘Smashing,’ she said, in an embarrassed way. ‘But it is true, neither of us like the sheath. It seems … a bit cold, really.’ (The pelvic examination was normal, and Mrs A. had been completely relaxed. It was warm and intimate behind the screen.) Had she thought of the cap? ‘It had been discussed, originally, but . . . wasn’t it too messy?’ ‘Well,’ said the doctor, ‘so was sex, come to that.’ Both laughed. A cap was fitted, she took it out, put it in again, ‘It’s perfect,’ she said. ‘I like to be able to do it, and I know he will be pleased. Who would have believed it? Fancy that!’

A cheerful, sexy lady left the room. The doctor looked back at her old notes: ‘Cap discussed. Positively rejected.’

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