Parent Savers
Contraception After Having a Baby

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Please be advised, this transcription was performed by a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[Theme Music]

DR. RAY KAMALI: To say that having a baby is life-altering will be an understatement. You may have just had a baby or are on the verge of having one or perhaps some time has passed since you brought your little one home and you're suddenly struck with the reality that unless some measures are taken you might find yourself in the family way again. I’m Dr. Ray Kamali, OB-GYN, and today on Parent Savers we’re talking about contraception after having a baby.

[Theme Music/Intro]

JOHNER RIEHL: Welcome everybody to Parent Savers broadcasting from the birth education center of San Diego. Parent Savers is your weekly online on-the-go support group for parents from the newborn years through kindergarten. I’m your host Johner Riehl. Thanks again to all of our loyal listeners who join us week in and week out and thanks also to those of you who’s listening for the first time.

As you may know, you can join our Parent Savers club and receive access to special bonus content after each new show plus special giveaways and discounts from time to time. And if you haven’t already please make sure to download the free Parent Savers app available in the Android and iTunes marketplace and for Windows phones so you can automatically have access to all the great parenting advice and conversation we have on Parent Savers every week.

Let’s start this conversation by meeting everyone who’s in the room today to talk about contraception after having a baby and I will start with myself. My name is Johner and I am 40 years old. I’m the host of Parent Savers. I’m also a PR Guy. And I have three boys, a 7, a 5, and a 3-year-old. And we actually I often joke that I actually had a fourth kid and done and it’s my favorite.

SUNNY GAULT: And done.

JOHNER RIEHL: And done. I have three boys and done.

ERIN ESTEVES: I’m Erin Esteves otherwise known as OG Mamamsita and I have one boy his name is Cash and he’s about 2 ½ and oh by the way I wanted to talk about virtual panelists our virtual panelist program. If you have some questions or comments and would like to participate but aren’t in the area or aren’t able to make it. You too can be a panelist virtually by hashtagging #vp@parentsavers. Shoot us a question. Give us a comment.

SUNNY GAULT: Alrighty. So I’m Sunny. I am the owner of the New Mommy Media which produces this show as well as Preggie Pals, The Boob Group, and Twin Talks. And I have four children and so we are done. The last two were a surprise because they came at the same time. My husband went oh my gosh what are we going to do and scheduled his vasectomy immediately following but we will reserve all that information for the actual episode.

JOHNER RIEHL: Right. Dr. Kamali tell us about yourself.

DR. RAY KAMALI: Absolutely. My name is Ray Kamali. I’m an OB-GYN practicing down at South Bay San Diego and the Western region. I’ve been on practice for about 9 years. I’m also a father of two and a father of three now that I’ve learned the yeah and done.

JOHNER RIEHL: And sometimes that last one is my favorite.

DR. RAY KAMALI: Absolutely.

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JOHNER RIEHL: Before we begin on today’s topic, we’re going to check out an app today. From time to time we check out apps that we think would be of interest to parents and today we’re looking on an app called “Retail Recall” from a company called TangoSquared. It’s a free download and it’s available from IOS and what it is basically for you to log products that you own whether it ranges from toys or infant carriers or really anything with the UPC code.

So that’s the thing when you scan it those black lines. It’s kind of like when you check out the grocery store. And what you do is you can scan the UPC Code or you can manually enter a product it look it’s a little more difficult to manually enter a product but you can and they got some list. You scan the UPC code and then it kind of registers that you have that device. When you sign up, you can sign up for an account with your email address or you can link it to your Facebook. That’s your decision on how you want to do it.

From there it will tell you if there are any recalls or now that it’s in your logbook whether or not any recalls do come up it will give you a notification that something has been recalled. So we have a chance to play around with it just a little bit for a couple of weeks and one thing I notice when I started I was getting a little bit frustrated when I started because there are some products that we have that you wouldn’t find the UPC code like it wouldn’t even scan.

Others it would scan and then it would say it was private. But then once I did start finding things that we did have that I could register, it became actually really kind of fun to log all the things that we have. It reminded me of like we are doing the baby registry and you start realizing or even registering for marriage that you like beep beep oh it is.

ERIN ESTEVES: Peep

SUNNY GAULT: I want that and that and that.

JOHNER RIEHL: And actually those…

ERIN ESTEVES: Peep...Peep

JOHNER RIEHL: Lightning fast once you find the UPC if the UPC code then the system it goes super fast and then It thinks about it and then it puts it in and it’s pretty amazing that it gets the product in there. And so it’s pretty neat for you to have a way to get notified. It does take a little bit of work to get everything there but obviously, they can’t just automatically know what you do have. But once you do get everything log and the process itself it was kind of fun.

SUNNY GAULT: You know what I really like about this is I feel like it puts the power back in your hands as a parent because whenever we get like a new baby product you know it comes with that little card that you’re supposed to like. Fill out your information…

JOHNER RIEHL: Yeah.

SUNNY GAULT: Send it back in. I’m always like concern that it’s not going to make it back there or the company is going to lose it or something is going to happen where if there is a recall I’m never going to find out about it. Right?

JOHNER RIEHL: Right.

SUNNY GAULT: And so that’s always a weird time for me and I know that some companies allow you to register online but it’s been my experience that that’s kind of be kind of tricky too. I don’t know why they make that so difficult but that is my go-to option as opposed to blindly mailing something in. But what I like about this is that again if I’m keeping track of it, I know it’s good. Right?

JOHNER RIEHL: Yeah.

SUNNY GAULT: And I guess you could argue too that know it’s up to this third party company to notify me…

JOHNER RIEHL: Right.

SUNNY GAULT: If there are recalls that match it. But I do feel like it puts it a little bit more in your hands at least for me so I don’t feel like I’m just blindly sending something and I don’t even know where is it going.

JOHNER RIEHL: Yeah and I think building the list is the hardest part but once you kind of get into the habit of having it build up, you buy a new product then you can just pretty easily scan when you’re opening it. When you have to pull out the scissors to open the package…

SUNNY GAULT: Yeah.

ERIN ESTEVES: Yeah I’m in love with this because flipping the coin to what you said for me it’s a relief because I feel like I don’t have so much responsibility.

SUNNY GAULT: Oh I get yah.

ERIN ESTEVES: Because it stands now every time that’s ever any blip on the radar that there’s a recall, I feel this incredible responsibility to go and find out exactly what’s been recalled.

JOHNER RIEHL: Right.

ERIN ESTEVES: Why it’s been recalled? Do I have it? Do I know someone that has it? Oh my god who’s going to get hurt? You know and this way I have a sense of relief because I know that everything I have is registered and somebody is going to shoot me some email and say hey yo recall.

JOHNER RIEHL: And then you can get up on your watchtower or your Facebook watch tower…

ERIN ESTEVES: Yes.

JOHNER RIEHL: And yell from the roof.

ERIN ESTEVES: And can then light the signal fires.

JOHNER RIEHL: Everybody…

SUNNY GAULT: I was actually amazed recently you know they had that big Graco recall of the car seats…

ERIN ESTEVES: Yeah.

SUNNY GAULT: And affected all this children's car seats and of course both of my car seats are Graco car seats and so that the process actually works. I think we were actually automatically sent some stuff on the mail and it’s just like to replace the buckle with it like got a whole new car seat or whatever. And I actually remember being kind of amazed that the process work because again I’m always just like I’m just blindly sending this off…

JOHNER RIEHL: Right.

SUNNY GAULT: Nothing is going to happen. And so yeah I like this a lot.

DR. RAY KAMALI: Interesting.

JOHNER RIEHL: Yeah.

ERIN ESTEVES: You sounded like Julia Child.

JOHNER RIEHL: So Retail Recall it’s from TangoSquared. It’s free to download on it you can get it on IOS store so like gets a thumbs up for Parent Savers.

SUNNY GAULT: Yes absolutely.

ERIN ESTEVES: Yoohoo!

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JOHNER RIEHL: Today’s topic is contraception after having a baby. We’re talking with Dr. Kamali. He’s the chairman of the department of obstetrics and gynecology at Sharp Chula Vista Medical Center and the father of two. Thanks for joining us.

DR. RAY KAMALI: Thanks for having me.

JOHNER RIEHL: So there are many types of birth control both temporary and permanent. How is it the people choose what’s best for them and how deeply did you think people should research the topic. Will do they often just take whatever you say as the answer or how do you see people approaching this topic?

DR. RAY KAMALI: Absolutely. Yeah, it’s very important. It’s important for patients to choose the birth control option that best suits their lifestyle and depends on what they want to do as far as when they want to have the next child and also it depends on their medical and clinical scenarios. So it is tested on…

JOHNER RIEHL: Right.

DR. RAY KAMALI: By having a conversation with their physician.

JOHNER RIEHL: Because definitely there are different needs. Right? There is temporary like we cannot have another one as far like at least a couple of years and there is permanent like done.

DR. RAY KAMALI: Done for sure.

JOHNER RIEHL: Like you definitely don’t want anymore.

DR. RAY KAMALI: Absolutely. With that permanent option, I always encourage the couple to have a conversation.

JOHNER RIEHL: Yup.

DR. RAY KAMALI: And definitely be sure that they are done because in literature they quote somewhere around 3-25% regret factor. Meaning that the couple you know ties their tubes or has a vasectomy and then you know a few years down the line they have said you know it would be nice to have another one and you know they regret the decision. And as you know it’s difficult to reverse it and so it should be considered as an irreversible method and also it doesn’t always work and insurance just don’t cover it. So once you tied it…

JOHNER RIEHL: They don’t cover the reverse.

DR. RAY KAMALI: The reversal exactly.

JOHNER RIEHL: Yeah.

DR. RAY KAMALI: So it’s if someone or having a permanent procedure, you should kind of consider that permanent and really…

JOHNER RIEHL: But in the literature that you go that something the regret factor like that something that’s going on in literature.

DR. RAY KAMALI: Absolutely. Yeah. Absolutely.

JOHNER RIEHL: And so it’s pretty much the way to get people to think.

DR. RAY KAMALI: To think yeah absolutely and I say if there is even 1% you know thought…

JOHNER RIEHL: Yeah.

DR. RAY KAMALI: That you may want to have another one, I always encourage you to get another method that’s reversible but also you know pretty effective.

JOHNER RIEHL: Yeah. Do you a lot of times talk to the husband and wife or both partners or the couple at the same time or is it usually just one?

DR. RAY KAMALI: It’s usually just one for whatever reason men just want out of the contraception conversation.

ERIN ESTEVES: No.

DR. RAY KAMALI: It just yeah for whatever reason it’s just I don’t know it’s just not something that men really you know think about. I mean if you ask us to use condoms we don’t do it. Right? So…

JOHNER RIEHL: Right.

DR. RAY KAMALI: We’re just not very good at it. So…

JOHNER RIEHL: Yeah.

DR. RAY KAMALI: But it’s just for whatever reason you’re right I mean you know men do not come to the, you know to these visits or to you know the prenatal visits they’re always there but the contraception visits, not so much. We do try to have a conversation with the patient in their last you know trimester about contraception so they kind of start having them to think about what they wanted…

JOHNER RIEHL: Yeah.

DR. RAY KAMALI: You know to use but yeah so and that’s when the husband is there. Sometimes we do try to kind of introduce that kind of topic.

JOHNER RIEHL: Speaking as a husband, I think that there is also a factor of so what is it that you want? I want you to like what do you want? And know we do that probably way too much and it’s not fair like but we also want them to be happy but yeah it is something that both parties need to be involved in the decision. And maybe if it is you giving as much information as you can then she takes it home to her partner.

DR. RAY KAMALI: Absolutely.

JOHNER RIEHL: Let’s start talking about some of the specific options and I think that we’ll have more time to go through this and also in our second segment as well. But so there’s temporary and there’s permanent.

DR. RAY KAMALI: Absolutely.

JOHNER RIEHL: So let’s talk temporary, temporary ideas. And so the first I have on the list is hormonal or non-hormonal. So what does that mean?

DR. RAY KAMALI: So under the temporary or reversible options, the non-hormonal means that the method that you’re using does not have any hormones. It doesn’t introduce any hormones. For instance birth control pills have estrogen and progesterone which is so you’re taking a hormone that basically helps out helps with the contraception.

JOHNER RIEHL: Right.

DR. RAY KAMALI: But also does affect you know a little bit of your body’s hormonal environment. So when we’re talking about…

JOHNER RIEHL: It’s like the birth control pill is like changing the body’s chemistry to make sure [inaudible]

DR. RAY KAMALI: Just like it absolutely. Yeah.

ERIN ESTEVES: Did should it trick it into thinking?

DR. RAY KAMALI: Well yeah to trick it into not ovulating basically as one of the ways that birth control pills work is by preventing your ovary from making an egg every month. And also you know when your ovary is making that egg it produces that estrogen and progesterone to help the uterus get ready for pregnancy. So the birth control pills try to simulate that same type of hormonal environment but they tell the ovary not to make any eggs, not to make any hormones and you’re taking it by mouth instead and so you’re basically just telling your body not to ovulate.

JOHNER RIEHL: Is it common for women to go back on pills after having babies or do they usually go with other methods? Because I think that’s a really common pre-pregnancy. Before you start a family, it’s pretty common the pill for at least for my experience so what I’ve heard.

DR. RAY KAMALI: So well yeah and so to answer the question it is common but actually we’re trying to change it a little bit to try to encourage patients to use more effective lower failure rate contraception options. So we try to encourage long-acting reversible contraceptives and we’ll talk about that in a second.

JOHNER RIEHL: Right.

DR. RAY KAMALI: But going back to the whole non-hormonal methods basically so you know one of the non-hormonal methods if you’re talking about immediately after your delivery is actually breastfeeding. You know obviously, there is a, you know it’s not very, very effective and we always encourage the patients to use something as a backup to just breastfeeding.

But if you have a patient that’s exclusively breastfeeding, meaning no formula and you know and they’re not having their periods yet and it’s been less than six months since their delivery, you know breastfeeding by itself and sometimes with a little bit of spermicide is effective non-hormonal you know the way of basically preventing pregnancies. Again we try to you know encourage patients to use something more than that but . . .

SUNNY GAULT: I was going to say I can see that going wrong so many ways.

JOHNER RIEHL: I can vouch for the fact that after six months that’s not . . .

ERIN ESTEVES: Yeah.

DR. RAY KAMALI: There you go.

SUNNY GAULT: Why is it the six-month mark then? I mean let’s assume like for me I’m still exclusively breastfeeding my twins and my period hasn’t returned TMI I’m sure. But you know my husband also has a vasectomy so it’s somewhat irrelevant in our case but you know why the six-month mark if I’m still exclusively breastfeeding…

DR. RAY KAMALI: Sure.

SUNNY GAULT: Will it change then?

DR. RAY KAMALI: When you start introducing solids in your baby’s diet and sometimes the baby is still breastfeeding and still you know stimulating the whole hormonal prolactin and everything but it still not the same as before the six months so your ovulation sometimes returns and also I think our the human body is also kind of programmed to you know kind of return back to you know ovulation within six months to a year after your delivery.

SUNNY GAULT: Back in the seventh day.

DR. RAY KAMALI: Exactly! Exactly! Absolutely!

ERIN ESTEVES: I have an anecdote for that because a couple of weeks ago I’ve met a woman at the park who at the time was like 6 or 7 months pregnant with twins and she had a six-year-old, a four-year-old and like an 18-month-old. Something crazy like that and she was actually going to her doctors to get her tubes tied and her period hadn’t started back and they found out she was pregnant.

JOHNER RIEHL: Oh wow.

SUNNY GAULT: Oh my gosh.

DR. RAY KAMALI: Yeah. So that’s the idea. Like I said I don’t encourage it but it is an option. So and then the non-hormonal methods also you know condoms is you know so when we’re talking about the effectiveness of a contraceptive option there’s a theoretical and there’s actual effectiveness meaning that if you were to use it 100% the way it’s recommended and you know to do it right versus the way most people actually do it.

And there’s a huge difference you know with condoms because people sometimes don’t do it right or they use it sometimes but not always. So condoms are also non-hormonal methods but they have a higher failure rate or lower effectiveness. As far as the more effective measure…

JOHNER RIEHL: Can I ask you a question?

DR. RAY KAMALI: Sure.

JOHNER RIEHL: What’s spermicide? I know you’ve mentioned…

DR. RAY KAMALI: Sure.

JOHNER RIEHL: I’ve heard that word but I don’t really understand what it is.

DR. RAY KAMALI: It’s basically a gel or a chemical that you can put in the vagina and basically kills sperm with that.

JOHNER RIEHL: Basically it just kills the sperm.

DR. RAY KAMALI: Exactly and prevents them from being able to get up to where they needed to get to.

SUNNY GAULT: Does it matter what kind of condom you use with that to [inaudible 00:16:13] some spermicide can that reduced the effectiveness of the condom?

DR. RAY KAMALI: Of the condom itself exactly. Yeah. You know some condoms have spermicide also in them so you can actually see that.

SUNNY GAULT: Okay.

DR. RAY KAMALI: But spermicides usually be used with the diaphragms and the cervical cap and all those things. You know honestly, we don’t really use anymore as much but again they’re not really effective. They require you, a woman, to you know put them in before sex. Keep them in there sometimes for as long as 48 hours. It just requires a lot of timing.

SUNNY GAULT: Sounds messy.

ERIN ESTEVES: Yeah I should I can say that yeah.

DR. RAY KAMALI: Yeah.

SUNNY GAULT: It’s already a messy process there’s no need to get anymore.

DR. RAY KAMALI: Yeah. So we don’t yeah we don’t really encourage that by I mean it’s available and the sponge and all those things. But and the most effective non-hormonal contraceptive option is the Paragard IUD. So IUD stands for Inter Uterine Device and there are other names for it, Inter Uterine Contraceptive, IUC or IUS, Inter Uterine System. There are all these different names but anyway it’s just basically a device or a thing that you can put inside the uterus that has a copper releases copper. It can be in there for as long as 10 years but can be removed, you know whenever she is ready to conceive and…

JOHNER RIEHL: We needed to take a break but I think you just said it releases copper?

ERIN ESTEVES: I know I’m stuck on that too.

JOHNER RIEHL: I don’t think I okay let me take a quick, let’s take a quick break and then we’ll come back. I want to hear more because I, all I know is the IUD is like the magic savior of our and done?

DR. RAY KAMALI: Sure.

JOHNER RIEHL: Right now and so I need to hear more of this…

DR. RAY KAMALI: Absolutely.

JOHNER RIEHL: Chemical method.

DR. RAY KAMALI: Sure.

JOHNER RIEHL: Alright.

DR. RAY KAMALI: Absolutely.

JOHNER RIEHL: We’ll be right back.

[Theme Music]¬¬¬

JOHNER RIEHL: Welcome back everybody to Parent Savers. Today we’re talking about Contraception after having a baby. We’re talking with Dr. Kamali, so thanks for joining us.

DR. RAY KAMALI: Sure.

JOHNER RIEHL: Alright let’s talk about IUDs again.

DR. RAY KAMALI: Absolutely.

JOHNER RIEHL: Because that is I mean there’s a lot of magic that happens like down in that area and some of the magic that happens is that’s the whole point of like why we have kids in the first place right?

DR. RAY KAMALI: Exactly.

JOHNER RIEHL: But some of the magic is that the IUD is keeping us from having more kids and I actually don’t really understand how it works.

DR. RAY KAMALI: Okay.

JOHNER RIEHL: You just said that it releases copper.

DR. RAY KAMALI: What is . . .

JOHNER RIEHL: And now I’m like what?

DR. RAY KAMALI: What.

JOHNER RIEHL: What is going on?

DR. RAY KAMALI: So there’s different yeah…

ERIN ESTEVES: Does it sets off a metal detector?

DR. RAY KAMALI: Yeah.

JOHNER RIEHL: Right.

DR. RAY KAMALI: Yeah. Exactly! It actually is. So there’re different types of IUDs.

JOHNER RIEHL: Okay.

DR. RAY KAMALI: There are the non-hormonal IUDs..

JOHNER RIEHL: Okay.

DR. RAY KAMALI: Which we were you know initially talk about.

JOHNER RIEHL: Yeah.

DR. RAY KAMALI: Exactly was the Paragard that’s commercially available in the United States. It’s a copper T or a Paragard or the copper IUD and…

JOHNER RIEHL: And so it has like a 10 year supply of copper in it.

DR. RAY KAMALI: Exactly. It’s just basically kind of coated with copper. We’re not talking about a tremendous amount…

JOHNER RIEHL: Okay.

DR. RAY KAMALI: Of copper but just you know a little bit of copper you know…

JOHNER RIEHL: And so copper is it kill sperm?

DR. RAY KAMALI: Well so IUDs work in a number of different ways. The actual having a foreign object inside the uterus and you know back in the days Egyptians actually use to put a rock or a stone inside the uterus after you know a woman had a baby and they use that as a contraceptive you know the method. So any foreign object inside the uterus and I discourage my…

JOHNER RIEHL: Yes.

DR. RAY KAMALI: The viewers to put any foreign object, please.

SUNNY GAULT: It’s so weird.

DR. RAY KAMALI: Exactly. No but it’s just you know having the, you know the actual device in the uterus itself will discourage the . . . or decrease the transport of sperm up to where it needs to work.

JOHNER RIEHL: Okay.

DR. RAY KAMALI: It also interrupts the transport or the movement of the egg you know through the fallopian tube and also prevents ovulation and basically interrupts ovulation. One of the misconceptions, when a lot of patients ask me, is that they think that IUDs interrupt the pregnancy implantation. Meaning that it causes an abortion every month and they don’t want that. And that you know that’s not the case.

JOHNER RIEHL: Right.

DR. RAY KAMALI: It doesn’t do that.

JOHNER RIEHL: Prevents.

DR. RAY KAMALI: It prevents pregnancy from happening.

JOHNER RIEHL: I don’t think they use of the word misconception was an accident.

ERIN ESTEVES: I know.

JOHNER RIEHL: It’s a turn of a phrase.

SUNNY GAULT: I have a question.

DR. RAY KAMALI: Sure.

SUNNY GAULT: When it comes to how is it inserted? What is the procedure like? That’s my first part of the question so go ahead.

DR. RAY KAMALI: Absolutely. So it’s inserted in the physician’s office or doctor’s office. It’s a little bit more uncomfortable than having a pap smear. And again every patient has different pain tolerance and pain threshold. And so you know the speculum is placed then the cervix was visualized and then you basically use some sort of solution to make sure you get rid of bacteria whether that’s betadine or another sort of solution.

And then you open up or dilate the mouth of the cervix just a little bit. Enough to be able to introduce the actual device and the device is basically comes from the manufacturer in their sterile package. So it’s all done under sterile conditions and the whole thing takes you to know about 3 to 4 minutes. That was pretty quick.

But again patients have asked me how painful is it you know and most of the time it’s a little bit uncomfortable than a pap smear but I’ve had that occasional patient that just you know is just extremely uncomfortable.

ERIN ESTEVES: The worst.

DR. RAY KAMALI: Exactly. And it’s just the same as you know childbirth the experience you know sometimes you know some people you know have a lot of different experience than others.

SUNNY GAULT: Sure.

JOHNER RIEHL: Just for a guy’s perspective how uncomfortable is a pap smear?

SUNNY GAULT: It can . . . well yeah because they got a kind of clamp to iy. That’s what I thought.

JOHNER RIEHL: Yeah

SUNNY GAULT: It’s pressure.

JOHNER RIEHL: Right.

SUNNY GAULT: It’s pressure.

JOHNER RIEHL: Okay.

SUNNY GAULT: It’s not like giving birth.

ERIN ESTEVES: Right. Well you know my husband says that he imagined it’s kind of like to say as uncomfortable as a prostate exam?

SUNNY GAULT: Yeah.

JOHNER RIEHL: Yeah.

SUNNY GAULT: I would have imagined. My second part of the question was regarding possible scarring on the uterus? On Preggie Pals we just did an episode about cervical scar tissue and how that can cause unnecessary C-sections. So I’m wondering if we have any information on how often does it automatically cause some type of scarring…

DR. RAY KAMALI: Absolutely.

SUNNY GAULT: When removed or….

DR. RAY KAMALI: You know and that is a question that patients ask and you know we’ve looked it up in the literature and the studies and I mean it’s different to it’s difficult to quantify or document how a cervix scarred and whether it’s from the IUD or was it from a patient’s previous abnormal pap smear…

SUNNY GAULT: Right.

DR. RAY KAMALI: Or from various different experiences as childbirth itself. So it’s hard to but we do know is what the return to fertility or basically once we remove the IUD, how quickly a patient was able to get conceive or pregnant and with the IUD it’s no different than birth control pills or any other contraceptive methods.

So the IUD itself from what we know doesn’t cause any sort of scarring that prevents you from getting pregnant and also the C-section rate on patients that have used the IUD versus contraceptive options is not significantly higher or different. So for what we know, we don’t think the IUD is causing sort of…

SUNNY GAULT: Okay.

DR. RAY KAMALI: Effect on the cervix itself.

JOHNER RIEHL: So to tie up the IUD conversation is there are non-hormonal IUDs and there are also hormonal IUDs…

DR. RAY KAMALI: That’s correct.

JOHNER RIEHL: And so that’s . . . just because the one we are talking about really is copper that’s not they all do.

DR. RAY KAMALI: Not. Exactly. So the hormonal contraceptives the one that is available in the United States they’re [inaudible] that’s the amount of progesterone that the IUD so instead of having copper it just has that [inaudible] so every you know so it just basically releases that hormone into your body that actually that IUD is actually indicative for helping patients to have heavy bleeding or regular bleeding so even if you don’t want to use it as contraception, you can use it for heavy bleeding. So it actually helps you know significantly decrease your period for sure.

JOHNER RIEHL: Alright let’s talk about let’s. . . and Erin you can chime in with Facebook question as well but birth control patches and birth control rings, what are does?

DR. RAY KAMALI: Okay. So classically birth control pills most birth control pills have estrogen and progesterone in the pill but sometimes people forget to take them so you take a pill and you forget the next day and that’s where you know the compliance and the effectiveness basically that’s where you know unattended pregnancies happen. So with the patches and the ring basically it takes a little bit of you know the remembering and the guesswork out of it because you know with the ring you put it in, the patient’s put it in on the beginning of the month…

JOHNER RIEHL: Right.

DR. RAY KAMALI: And remove at the third week and they have their period that week and the fourth week they put a new one in so three weeks in and one week out. They don’t feel it during intercourse. It’s easy to put in and remove and the partner doesn’t feel it so it’s easier to basically comply or just be able to use the medication but it’s exact same you know similar formulation of estrogen and progesterone and it basically cost a little bit amount of money.

JOHNER RIEHL: Where does the patch go?

DR. RAY KAMALI: The patch can go anywhere. Most people put it in in their inguinal area or you know the abdominal area. One of the side effects that we see sometimes with the patient is that they get irritation on their skin when they use the patch.

JOHNER RIEHL: Got it.

DR. RAY KAMALI: And also there’s a weight you know restriction or limitation because the effect you see decreases on patients over 185 and over 200 pounds.

JOHNER RIEHL: What are implants?

DR. RAY KAMALI: Okay. So there is an Etonogestrel which is another progesterone formulation implant.

JOHNER RIEHL: Okay.

DR. RAY KAMALI: It’s the brand name is Explanon or Implanon and it’s just basically a small implant that is placed on the patient's arm basically and so the patient the good thing with that is the patient can feel you know where the implant is at all times. They know it’s there.

JOHNER RIEHL: Yeah.

DR. RAY KAMALI: It’s you know to the general public I mean people wouldn’t be able to see that you have it unless somebody came in and touch it.

JOHNER RIEHL: And it’s kind of like where you would get it’s just like…

DR. RAY KAMALI: IV basically.

JOHNER RIEHL: Kind of like the IV fall. . . Where the IV would go.

DR. RAY KAMALI: Exactly.

JOHNER RIEHL: Yeah.

DR. RAY KAMALI: And it can last up to 3 years but it can be removed obviously before then if the patient wants to conceive or is not happy with that method.

SUNNY GAULT: That’s crazy to me?

JOHNER RIEHL: I haven’t heard that.

SUNNY GAULT: No. I know me either.

DR. RAY KAMALI: Yeah it’s a little bit newer. There was a previous system of five implants that we use to put it. Now the problem with that was that it was placed a little bit deeper and it was hard to fish out at the end of you know the…

JOHNER RIEHL: There were five of them?

ERIN ESTEVES: Yeah.

DR. RAY KAMALI: So it would scar in and it would be a little bit deeper in the tissue.

SUNNY GAULT: Yeah.

DR. RAY KAMALI: So now you. . . this one is just under the skin so you can actually kind of feel it. You can you know it's right there. So it’s very easy to remove.

SUNNY GAULT: Yer.

ERIN ESTEVES: Yeah.

JOHNER RIEHL: That is a new one to me.

DR. RAY KAMALI: It’s fairly effective and it actually has the highest effectiveness…

JOHNER RIEHL: Really?

DR. RAY KAMALI: Yeah so it’s you know so the failure rate is very low.

JOHNER RIEHL: What are they called? Like are they just called an implant or is it like an arm implant? What do you…

DR. RAY KAMALI: It’s called yeah the brand name for it is Nexplanon…

JOHNER RIEHL: Okay.

DR. RAY KAMALI: But yeah it’s basically just an implant in the arm yeah.

JOHNER RIEHL: Okay. And talk a little about diaphragm and sponges and those are kind of like temporary solutions and messy cervical caps. That’s what we talk about.

SUNNY GAULT: I know.

JOHNER RIEHL: And they are like…

SUNNY GAULT: They are messy.

JOHNER RIEHL: They are?

SUNNY GAULT: They are.

JOHNER RIEHL: Cervical caps?

DR. RAY KAMALI: You know the same thing basically just you know not very effective and like you said messy and you know we just you know require a lot of planning previously and post we see most of the time people don’t do have of course a lot of time spontaneous and takes that out of it because you have to plan it out and everything. One of the things I wanted to mention I’m sure the listeners know about this but all these are contraceptive options…

JOHNER RIEHL: Right.

DR. RAY KAMALI: You know for STD prevention. We always you know encourage using condoms in conjunction with contraception.

JOHNER RIEHL: And then the last temporary method we have down here before we enter the permanent stuff...

DR. RAY KAMALI: Sure.

JOHNER RIEHL: Is the rhythm method.

DR. RAY KAMALI: Okay.

JOHNER RIEHL: And as I’m looking on this list I’m thinking non-hormonal equals not effective. Because I can tell you the rhythm method does not work.

ERIN ESTEVES: I think the rhythm method goes hand in hand with the withdrawal method.

DR. RAY KAMALI: Right.

ERIN ESTEVES: Right?

DR. RAY KAMALI: Yeah so they’re sort of yeah they’re sort of different but yeah they’re people a lot of times use them together. So the withdrawal basically you know is that in the shortcoming is that well some fluid is released prior to actual ejaculation is called pre-ejaculatory fluid and there’s a lot of sperm in that fluid so and then the other part is sometimes you know the male is not able to withdraw in time so the failure increases.

And then the rhythm method basically and sometimes you know also in conjunction with the calendar method just kind of requires you to look on the calendar and then see when you are ovulating and prevent doing that. Again same thing spontaneity and you know and it just requires a lot of thinking but the patient really doesn’t want to use hormones you know again I discourage it but I see patients doing this.

JOHNER RIEHL: Alright so let’s talk about the more permanent options and we can start with the man and the vasectomy?

SUNNY GAULT: Thank god!

ERIN ESTEVES: Finally.

SUNNY GAULT: Some things you guys can do.

JOHNER RIEHL: It’s something. Exactly! So that is something that men can do is the vasectomy and I actually heard that men were scheduling that there’s a spike in vasectomy schedules like around March madness because they want their recovery time on Thursday and Friday where all the college were [inaudible].

SUNNY GAULT: Are you kidding me.

JOHNER RIEHL: Well take it away okay.

SUNNY GAULT: Wow.

JOHNER RIEHL: It makes sense right?

SUNNY GAULT: They’re assuming a lot.

DR. RAY KAMALI: So the process is basically it has to be a consultation with the neurologist and they you know obviously the neurologist will go through the risk and benefits and the consent will be signed and then most of the time it’s done in-office setting under local anesthesia with small incisions made in the scrotum and basically as the procedure is done it’s you know it’s fairly straight forward for most parts again pain is you know subjective but for the most part is not that . . .

JOHNER RIEHL: It’s basically they cut the tubes the vas deferens.

DR. RAY KAMALI: Exactly

JOHNER RIEHL: Cut and then like cauterize.

DR. RAY KAMALI: Exactly.

JOHNER RIEHL: And so then if you had to reverse one that you’ve mentioned before that there aren’t there sort of this thing in the back of the head like when you hear about vasectomy like to be well I guess in the worst case it could be reversed because we hear about reverse vasectomy.

DR. RAY KAMALI: Yeah.

SUNNY GAULT: We do.

DR. RAY KAMALI: Absolutely.

JOHNER RIEHL: But’s really it’s not a given.

DR. RAY KAMALI: It’s not a given but I mean it can be reversed and you know with some success we may get about 15-30% you know success…

JOHNER RIEHL: Okay.

DR. RAY KAMALI: With that reversal but and some people you know quote higher rates than that but again yeah it should be always considered as a permanent thing.

JOHNER RIEHL: Yeah.

DR. RAY KAMALI: So that stays the same and then you know there are neurologist or sometimes do it in the operating room because you know men are you know when we get sick or we’re chicken so if that’s the deal-breaker and you want it done under more anesthesia you know some neurologist is willing to do it in a surgery center with subsidization or anesthesia so you know there’s definitely ways to get it done if you know if that’s an issue.

ERIN ESTEVES: Oh we’ll know you out. We’ll knock you out if you need it. There are multiple ways to knock you out.

DR. RAY KAMALI: Absolutely.

SUNNY GAULT: You know this was something that my husband and I just went through and I do say we both went through it and I’m one of those who would say that we were pregnant. And so but it was you know it was a tough kind of decision to come to and it was something my husband was really pushing for more than me and I just wasn’t sure when we should quit having kids and he made it clear that after four we were done.

But the process you know I was very pleased that at least through our medical care provider, my husband had to go through training like a day of like a full day but it was like an hour and a half but yeah he had to attend the class to talk about listen this is a permanent option are you really okay with it? And the process that was very you know I went with my husband and it was an outpatient procedure they had multiple you know it’s like we go there are only certain days they do it. Right?

So we go into like the waiting room and you can see all these men because you got to bring a little kit with you, you got to bring like ice, you’ve got to bring a jockstrap, you got to bring so you can definitely tell who’s there to get a vasectomy. Right? And so it’s like all these men with their wives or whatever and one of the mistakes and this was something that you know we should have done we really didn’t do is just keep in mind it is a medical procedure and you know similar to you know if you have a C-section you’ve got something going on, you need to give your body some time to recuperate from that.

And I’m not just talking about intercourse stuff. I’m just talking about you know my husband was supposed to kind of just relax for a couple of days and he didn’t and it got infected. It was a whole other and he’s fine now and everything is cool but it was a little more involved than It was going to be and just you know just because it’s outpatient it doesn’t mean it’s not you know important to you know…

JOHNER RIEHL: Recovering.

SUNNY GAULT: Just follow up and they ask me you know when I was about to deliver the girls via C-section then they give me one last opportunity they are like are you sure you don’t want to have your tubes tied because we’re down here anyways we can do and I said you know what I said my husband needs to get involved in this whole thing. You know if I’ve given birth to all these babies he can have that can have the procedure…

ERIN ESTEVES: Yes.

SUNNY GAULT: To finalize everything.

JOHNER RIEHL: But let’s talk about that the tubes tied though.

SUNNY GAULT: Oh yeah.

JOHNER RIEHL: So then that is I know it’s an option. It feels like almost with every birth that we had like you want to do it? Yeah. You want to do it? Yeah. Almost like the hospital is like we’ve got too much business. So what happens with that?

DR. RAY KAMALI: So one of the things that impartially I guess the reason they ask you in during your pregnancy is because it constantly needs to sign on a certain period of time before your actual procedure and same thing with vasectomy and also a tubal ligation or sterilization. If it’s if you have you know government-funded insurance it has to be 30 days before your procedure and if you have private insurance you can actually waive to 72 hours.

So you know I have had patients that sometimes right after delivery like can you tie my tubes? And I say no I can’t because you know I talk to you about this and you didn’t sign the consent and there needs to be consent. So we always ask the patient so that you know they know that they have that option and you know but so once so there’s a few different other choices. If the patient wants it to be done before they leave the hospital after delivery is called a postpartum tubal ligation.

So the advantage to that is if the patient did use an epidural we can actually keep the epidural and catheter in place and then you know after delivery or the next morning just dose setup. Give her a little bit more medication through that catheter and then do the procedure. And it sort of you know prevents the patient from you know to change your mind or if you know or just or not doing it or if their insurance gets canceled or something and so while in the hospital basically, they could get it done, they walk out you know having their tubes tied.

The sort of disadvantage is that because the uterus is still kind of large, there’s not as much you know space for us to do it but you know through the smaller instrument and everything we actually still have to use our fingers to actually do the surgery. So you have to make a big enough incision to be able to sneak in and you know our fingers and do stuff so it’s about you know not that I try to make it as small as possible because [inaudible] are important for patients. So we did it under the belly button. It’s about like 2 ½ cm incision. It’s called a mini-laparotomy and we basically kind of tied the tubes that way.

JOHNER RIEHL: And so are you literally with your fingers tying the tubes in a knot?

DR. RAY KAMALI: Well no we put a suture or a basically a kind of string basically.

JOHNER RIEHL: Yeah.

DR. RAY KAMALI: And, you know basically make a little loop and then kind of…

JOHNER RIEHL: Is it like kind of lasso kind of?

DR. RAY KAMALI: Exactly. Yeah, kind of like a pigtail. You make that?

JOHNER RIEHL: Yeah something like that. Yup.

DR. RAY KAMALI: And then you cut with the postpartum procedure we and then we cut that little extra loop and then we cauterize the ends and everything in.

JOHNER RIEHL: Okay.

DR. RAY KAMALI: And basically we turn into the other side. There’s an option also to use a clip you know but we don’t do that but I mean some people do put a clip-on.

JOHNER RIEHL: So the tubes aren’t physically tied.

DR. RAY KAMALI: No. Exactly.

JOHNER RIEHL: Barely.

DR. RAY KAMALI: Yeah they’re [inaudible]

SUNNY GAULT: They probably are at one point that’s why we came up with [inaudible].

JOHNER RIEHL: Yeah.

DR. RAY KAMALI: Yeah somebody did that. So that’s the postpartum procedure and then basically patients don’t have to stay an extra day in the hospital so they basically can go home two hours after the procedure. So they have the surgery and then they can go home I know.

And then breastfeeding they can still resume and all of that stuff. Again some patients don’t really love that because they were breastfeeding and they do want to kind of not to be separated with their baby and have surgery right after delivered and working through labor and all that stuff but again that’s an option.

The other options are laparoscopic tubal ligation which is basically done through a tiny camera through a belly button that can be done six weeks after delivery or any time basically and more than six weeks after delivery. And the last option is called hysteroscopic tubal ligation which we do it through a little camera through the cervix, no incisions and significant lower complications. So that’s another method.

SUNNY GAULT: Wow gosh there are so many options out there.

JOHNER RIEHL: A ton of stuff and we covered a ton of ground.

SUNNY GAULT: Yeah.

JOHNER RIEHL: So thanks Dr. Kamali for kind of sharing over that stuff. I know there are maybe some more questions after the show so feel free to post on Facebook. Put it in the comments of our first five video on YouTube and definitely thank you so much for joining us. We’ll have a ton of info and site to for more information go to our website parentsavers.com but stick around if you were a member of Parent Savers club. After the show Dr. Kamali will tell us more about we’re going to continue the conversation and we’ll do a little bit of bonus content.

[Theme Music]¬

ROBIN KAPLAN: Hi Parent Savers. I’m Robin Kaplan an International Board Certified Lactation Consultant, owner of the San Diego breastfeeding center, and the host and producer of Parent Savers sister show The Boob Group. I’m here to offer some advice on different breastfeeding remedies such as how can I get over my fear of breastfeeding in public.

I remember the first time I’ve breastfed my son Ben in public. He was six weeks old. My husband Jason and I were driving to his sister Kim’s wedding in northern California. We have stop in Los Angeles for lunch and it was brutally hot like 95 degrees in the parking lot. And I actually contemplated nursing Ben in the car but I was sweating so profusely I figured I got to go in the restaurant.

So into the restaurant, we went. I sat down at the table and got a larger sitting blanket. I distinctively remember asking Jason to stand behind me to pull down the blanket so I can hide my six weeks postpartum back fat. To me, covering my back was actually more important than possibly flashing a boob. Up until now, I’ve been helping Ben get a comfortable latch by compressing my breast into that breast sandwich. I wondered how was I going to do this without the blanket slipping off of my shoulder.

I slowly lowered Ben under the blanket, lifted up my shirt, and bam that kiddo latch without my help whatsoever. Clearly, he was a very capable participant. I just had no idea. So from then on, breastfeeding in public was a breeze. Sure he made extremely loud gulping noise while eating which often attracted some onlookers, but now I was comfortable feeding him anywhere. And I began to feel an incredible sense of freedom. So hear my top tips for breastfeeding in public. First practice at home so that you are comfortable latching your baby while sitting in different chairs and wearing different shirts.

If you were uncomfortable breastfeeding in public without a cover, practice using that cover or a blanket in front of a mirror so you can actually see what you are doing. Next, find stress-free places to breastfeed in public such as the northern nursing rooms or breastfeeding support groups. It’s no big deal if you flash a boob in front of other moms and you can also ask them what tricks they’ve tried to become comfortable nursing in public. Another trick is to practice breastfeeding in a carrier wrap or sling.

I remember my sister-in-law walking around the San Diego Zoo while nursing her daughter in a movie wrap. It was super discrete and she didn’t have to stop and sit down. Lastly, go to lunch with a few other breastfeeding moms and practice in their company. You will most likely feel less stress if you were surrounded by other women plus you can learn some valuable tricks from them.

For more great information about different breastfeeding remedies, check out my blog at www.sandigeobreastfeedingcenter.com/blog, and be sure to listen to Parent Savers and The Boob Group for fantastic conversations about breastfeeding and breastfeeding support.

[Theme Music]

JOHNER RIEHL: That wraps up today’s show. Thank you so much for listening to Parent Savers.

Don’t forget to check out our sister shows:
• Preggie Pals for expecting parents
• The Boob Group for moms who breastfeed and
• Twin Talks for parents of multiple kids.

This is Parent Savers empowering new parents.

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical, or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

SUNNY GAULT: New Mommy Media is expanding our line up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or organization interested in joining our network of shows through a co-branded podcast, visit www.NewMommyMedia.com .

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