This placement in Obstetrics and Gynaecology has afforded me very little time, and the so-called ‘free-time‘ and ‘me time’ has really been at a premium. Quite unexpected given the horror of my A&E rota but Surgical Dad has been quick to remind me this one is worse. And he’s right. The sweetener to all of this is that it is now 2013 – Happy New Year! Come February 6th I will be leaving work after my last night-shift, ever, and my last shift in a hospital. It will be what I can only describe as ‘a wrap’! Maths has never been my forte but the 23 shifts between now and then is so ludicrously small in number that Bella is well-versed in my count-down.
What this job has allowed me to do is my sexual health diploma; interesting, eye-opening, frightening….this has been many things so far, and not least useful to my future career and patients.
What, perhaps, is the scariest thing gleaned from this, and confirmed many times over on the ward, is that no contraceptive is fool-proof! I am guilty of giving the hard-sell to the implant and mirena coil; long-acting, reversible contraceptives that are more effective than sterilisation. Yes, that’s right, more effective than sterilisation. If you’re ok to use hormonal contraceptives and not wanting to have babies in the near future then these get a huge thumbs up from me. Or they did…..now there will be an addendum to my pitch…
My pager goes off, a 2am referral from A&E, a 20 year old with a positive pregnancy test. Most ladies who are pregnant are referred to maternity, albeit usually via their community midwife, in working hours. What made this referral different was the patient had the implant inserted 18 months previously. Having just finished working a late shift herself, plagued with urinary frequency and vomiting she swung by the emergency department. Having suffered with recurrent urinary infections for many years she knew the signs and it being the early hours of Saturday morning couldn’t really wait. So imagine her horror on being told instead of leucocytes showing in her urine specimen it was beta-hCG. She was pregnant! And no idea how far as she had the most reliable of contraceptives palpable in her arm and no periods since it’s insertion 18 months ago. And that is how I came to be involved. And before you ask it really was in her arm. I know this for a fact because I took it out.
“How did this happen?”, it was her voice asking this question but could so easily have been mine. A damn good question, how did this happen? Most documented cases of pregnancy whilst using the implant are because the implant isn’t actually in the arm due to insertion failure. In fact, so rare is this occurrence, I have been asked to write it up. But this offers little consolation to this particular 20 year old, alone in the early hours of the morning, being told she is pregnant against the odds. And the only answer I can offer is it’s “bad luck”. Which it is, extraordinarily so, but what recompense does this offer?
So, as chance would have it, another surprise comes several days later. Almost to add insult to injury; a 40 year old self refers in the early stages of pregnancy for consideration of termination. This was an unplanned pregnancy, her family long complete. She assumed her symptoms may have been ‘the change’ coming early. Never did she consider pregnancy as a viable option, after all she had the coil in…..
No! This isn’t right! I obviously don’t decide to share these thoughts, not straight off anyhow. Surely the coil has migrated, been expelled, is past it’s date to be changed? This 99% effective form of contraception, deemed to be more effective than sterilisation. Not only does it claim to prevent fertilisation but it claims to have a back-up mechanism. The belts and braces approach. It prevents implantation too. This is designed to be fool-proof. Surely this hasn’t failed her.
Again, for the sceptic in you, I am the one to remove this very much in-date and correctly placed coil. So there go all my hypotheses of how this could have happened. And so all I have as way of explanation, again, is the somewhat self-fulfilling prophecy of it’s “bad luck”. Not the most deftly delivered line but the most frank, and if we’re being honest what else is there?
So when discussing contraceptive options the long-acting implant and coil will still be my party line. They’re the best we’ve got, but it will do well for me to remember they are not absolute. While both of these conceptions were very much against the odds they are both on-going after a fair amount of agonising. And so I’ll leave you with this thought, “never say never, because limits, like fears, are often just an illusion”.