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Unplanned Pregnancy

You are not alone

A new parent with her babyUnplanned pregnancy – a term that makes many women tremble with trepidation and anxiety. According to the Office on Women’s Health, half of pregnancies in America are unplanned.

The only 100% effective way to avoid unplanned pregnancy is not having sex until you’re ready to be pregnant. I have spoken to hundreds of pregnant women, and for many, it wasn’t their first pregnancy. Yet many times I have been asked the question: how could I have possibly gotten pregnant? Not that they didn’t understand that it was sexual intercourse that resulted in a pregnancy. What drove this question were assumptions about birth control coupled with a lack of understanding of the more subtle details of the reproductive process. I will address some of these below.

I have found along the years that a vast majority of the women I have interacted with weren’t aware that the egg released by a woman’s ovaries during her menstrual cycle only survives for 24hrs. The implication of this is that pregnancy only has the potential to happen one day per month! Does this mean that a woman must have sex on ovulation day in order to become pregnant? Most definitely not – because sperm can survive for 3 to 5 days in a woman’s fallopian tubes, after intercourse. This means that even if a woman had sex 4-5 days before ovulating, she can still become pregnant. One may deduce that as long as a woman figures out the day she ovulates, she can prevent or improve the chances of a pregnancy happening. That would be correct. Unfortunately, telling the exact day of ovulation is elusive. There are tools that a woman can use to give her some indications of ovulation, but they are not exact. An example is measuring basal body temperature before getting out of bed every morning and looking for a slight increase in temperature (less than 0.5 of a degree). In order to avoid pregnancy, a woman has to avoid sex from the beginning of her period till 3-4 days after she has noticed the rise in temperature. Examining the amount and consistency of one’s cervical mucus can be another helpful clue that ovulation is about to take place. When this discharge increases and feels more like egg white, it is a clue that the woman is in her fertile window (aka ovulation is taking place). Another tool to assist in identifying when the egg is released from the ovary, is an ovulation predictor kit. These tests track the level of luteinizing hormone in a woman’s urine. This hormone will increase before ovulation, thus providing a woman a better idea of when she is likelier to become pregnant. In case you thought using an ovulation kit is fail-proof, there are instances when it can be hard to interpret, and they can’t predict an exact day when ovulation occurs. Some women will ovulate one or two days after the surge, and then there are women who have a couple of smaller surges before a larger one… In order for any (or all) of these tools to be most helpful, the woman should use them for multiple cycles, learning to recognize the patterns of her cycle and how her body feels/functions.

Contributing Factors to Unplanned Pregnancy

Other factors contributing to unplanned pregnancy center around birth control, such as: being sexually active without using any, failure rates, inaccurate assumptions, and experiencing unwanted side effects. Many women who use birth control are not aware of how strictly they have to follow the instructions in order for the method to work. Many neglect to take their pills at the same time every day. Several don’t know that there are sperm in the pre-ejaculate fluid and this can result in pregnancy. Some women assume that any form of birth control is 100% effective, but even when used perfectly, all birth control methods (other than not having sex) fail. According to the FDA, the birth control methods that have the least failure rate are: sterilization surgery (aka. having one’s tubes tied), IUD, and having an implant put in. For each of those three methods, the expected pregnancy rate is less than 1 out of 100 women. Depo-Provera shots have an expected pregnancy rate of 6 out of 100 women, if taken every 3 months. Oral contraceptives (the pill), the patch and the vaginal ring, each have an expected pregnancy rate of 9 out of 100 women, if used as directed. The diaphragm with spermicide has an expected pregnancy rate of 12 out of 100 women, while the use of a sponge with spermicide has an expected pregnancy rate of 12-24 women out of 100. 17-23 women out of 100 are expected to become pregnant when using a cervical cap with spermicide for birth control, and 18 out of 100 women are expected to become pregnant if the male partner is using a condom. If the female partner is using a female condom for birth control, the expected pregnancy rate is 21 women out of 100. Use of spermicide alone carries an expected pregnancy rate of 28 women out of 100. Fertility awareness based methods have a 2-23% failure rate (2-23 out of 100 women are expected to become pregnant).

The Effects of Birth Control

The effect of birth control methods on their body is the main reason some women quote as the reason they have stopped using hormonal birth control. Here’s a list of possible complications and less common risks associated with birth control methods according to the FDA.

  • Copper IUDs can cause cramping and heavier, longer periods, or spotting between periods. Some less common risks with having an IUD include developing pelvic inflammatory disease, ectopic pregnancy, uterine perforation, and the IUD “falling or coming out” and therefore there is no pregnancy protection.
  • IUD with progestin, may experience irregular bleeding or no menstrual bleeding at all, and abdominal/pelvic pain. The less common risks associated with IUD with progesterone include all the ones mentioned for the copper IUD, as well as ovarian cysts.
  • Implant (contains progesterone). The side effects associated with it are changes in menstrual bleeding patterns, weight gain, headache, and acne. Some less common risks associated with implants are: complication of insertion and removing including pain, bleeding, scarring, infection, movement of the implant to another part of the body (very rare), ectopic pregnancy, ovarian cysts, and in very rare instances women with an implant experience blood clots, heart attacks or strokes.
  • Depo-Provera injections. Side effects may include loss of bone density, irregular bleeding or bleeding between periods, headaches, weight gain, nervousness, dizziness, and abdominal discomfort. Some less common risks are ectopic pregnancy and, in rare cases, blood clots.
  • Birth control pills (estrogen & progestin or progestin only). Side effects may include spotting or bleeding between periods, nausea, breast tenderness, and headache. In rare instances, women on this method have developed high blood pressure, blood clots, heart attacks or stroke.
  • Patch (estrogen & progestin). Side effects may include spotting or bleeding between periods, nausea, stomach pain, breast tenderness, headache, and skin irritation. The patch exposes users to higher levels of estrogen compared to most combined oral contraceptives, and there may be an increased risk of developing blood clots.
  • Vaginal contraceptive ring (estrogen & progestin). Side effects may include vaginal discharge, discomfort in the vagina, and mild irritation, headache, mood changes, nausea, and breast tenderness. Rare risks with the ring are high blood pressure, and blood clots, heart attacks, or strokes

Experts who have written on fertility and pregnancy have stated that the probability of one random sexual act ending in pregnancy is about 1 in 20.

While this sounds comforting for someone who is not trying to become pregnant, the following has also been shown: 85% of women who have sex without any form of birth control become pregnant after a year of being sexually active, even if the sexual activity is sporadic. I don’t know about you, but those two statistics just don’t seem to jive: how is it possible for 85% of women to become pregnant in a year when a random sexual act only carries a 1-in-20 (5%) chance of pregnancy? Maybe this is happening by design? According to a 2004 study, a “random” sexual encounter may not be random at all. It seems that woman’s sexual activity tends to peak during her fertile window, even though she has no idea that she’s in her fertile window. Wow! I don’t know about you, but when I first learned that, I started to pay attention. It helps to explain why both of the two statistics above can be true.

What am I driving at? While educating women in these lesser-known facts will not eradicate unplanned pregnancies, it would be in a woman’s best interest to understand the wonder of her body. As humans we know that we do not always make choices based on reason. This is particularly true when it comes to sex. There’s been research done that shows that when an individual experiences sexual arousal, the areas of their brain that regulate rational behavior are turned off. All that to say: it seems like unplanned pregnancies will continue to be around.

If you find yourself having an unplanned pregnancy, know that it doesn’t mean your life is ruined. Life as you know it now will be changed regardless of your choice about carrying or terminating the pregnancy. Some changes will be outwardly visible, and others will not. Regardless of whether others will be aware of these changes, you will. We are here to help. We care about you and the life that has begun within you. We have listened and helped many women who have traveled this road, just like you. If you’re looking for help navigating this moment in your life, please know that we are here and ready to step beside you for a stretch. You are not alone.