Can I use birth control pills as EC? Can I get an Ella prescription early? and other things you always wanted to know about emergency contraception

It was 2004 and a Women’s March had just concluded. Yet there I remained, standing on a crowded corner in Washington, D.C., my prescription pad firmly in hand. My goal? To write as many scripts for emergency contraception as I could get out before my hand cramped – up to 12 refills for  some of the women and teens coming up to me on the street.

It’s now 15 years later and most EC is available easily to people of all ages, without a person needing to access a doctors office (or worse, a doctor on the street corner) in order to get the medication. That’s a huge and essential development, too. With abortion bans passing in states throughout the U.S. and the President determined to cater to anti-abortion activists in order to win another term in the White House, there may be no act more important to a person’s future than to be sure they are able to prevent unintended pregnancies.

But with blatant misinformation being spread purposefully by opponents of reproductive rights and health, emergency contraception is still surrounded in a cloak of mystery that continues to make it difficult to access and use effectively. Here are a few lingering questions that people still ask about what is now a process that’s been around for more than two decades in a variety of forms.

Is emergency contraception an abortifacient? 

Obviously there are entire political campaigns, court cases and “religious liberty” virtue signaling around the obsession that emergency contraception could cause a fertilized egg not to implant. This belief has led a small (but extraordinarily noisy and disproportionately politically connected) minority of people to argue that any form of emergency contraception is in actuality a potential abortion. The fact is that almost all medical professionals believe pregnancy does not begin until an egg implants, making the argument pointless. But even if that were not the case and a fertilized egg was the beginning of a pregnancy, emergency contraceptives like Plan B or Ella do not alter the lining of the uterus – they only prevent ovulation for a few days in order to give live sperm enough time to die off before an egg is released. If Plan B did alter the lining fewer people would still get pregnant despite taking the medicine – currently Plan B and its generic counterparts have a success rate of only about 90 percent when taken within 72 hours of unprotected sex, and that rate drops quickly as you add days on (Ella is more effective, working for up to a week, but requires a prescription). Even IUDs, which antis claim prevent implantation, aren’t actually abortifacient and are more likely to make a womb hostile to sperm than irritate a lining. They can be the most effective EC out there, but be sure you were interested in long acting birth control if you do get one – don’t just do it because you had unprotected sex once.

Can you use birth control pills as EC?

There are a lot of questions going around about whether or not a person can make their own EC out of an existing pack of hormonal birth control pills. The answer is yes – but with caveats. People often used pill packs to prevent pregnancy after unprotected sex prior to EC being available over the counter, especially in the 1990’s and early 2000s when access to a health clinic for birth control pills could be the only way a person has a shot at preventing pregnancy once sex already occurred. Today EC is so much easier to access and the types available for purchase are more fine tuned especially for preventing ovulation, making them much preferable to the old method of navigating multiple pills from a pill pack. Unlike full birth control pills, Plan B and other emergency contraceptives are less likely to cause nausea since they don’t contain estrogen. It’s also just one pill, one dose, rather than needing to navigate the correct number of pills at the correct intervals in order to be protected after sex (usually doses need to be taken 12 hours apart to be effective). In other words, true emergency contraception is always going to be easier and gentler on your body. But there may be circumstances where you just can’t get to a place that has EC in time – maybe your store doesn’t stock it, or the clinic you’d go to is closed for the weekend, or you don’t have the $40 it might cost to buy OTC without going through a doctor. In those cases, yes, if you have pills available that is far better than putting yourself at risk for an unwanted pregnancy. If you find yourself in that situation consider reaching out to friends that you know are on the pill who may have extra packs in their possession (many prescription programs send them months or even a year at a time now), and use this resource to figure out how to do the right dosage. Also, be aware that like Plan B, birth control pills are less likely to be effective as EC if a person has a higher BMI (Body Mass Index).

Speaking of higher BMI, should I take twice as much Plan B if I’m overweight?

NO! Don’t do it! Plan B does lose its efficacy if a person has a BMI of 26 or more, but taking more of the medicine is not going to make it more effective. If a person has unprotected sex and wants to try to prevent pregnancy, then just one dose of Plan B should be taken – not multiple – and you should try to take it as quickly as possible in order to have a better chance at preventing ovulation. There is at this time no indication that a double dose will do anything more than just give you more hormones that you don’t really need, and won’t change the likelihood of getting pregnant at all. If at all possible, to be truly safe try to use Ella instead, or look at getting an IUD placed as quickly as possible if long acting reversible contraception was already a path you wanted to pursue.

Can you “stock up” on EC if you want Ella?

Everyone recommends that a person capable of getting pregnant should have at least one dose of EC on hand for emergencies. Unfortunately Ella, considered the most effective due to its longer window of usability and success with physically larger patients, is sadly prescription only. But just because you need a prescription doesn’t mean you can’t still get a dose (or more!) to have on hand. Ask your doctor to write you a prescription now so you can get it filled on your own timeline and have it ready in case you (or a friend, or a family member, or a partner) need it down the road. In fact, ask for multiple doses – some doctors can write refills for anywhere from six to even 12 doses.

Also, if you are currently getting your birth control pills via mail order, check in to see if your clinic or doctor can add an EC dose into the delivery. While obviously it is less likely you’ll need EC when you are already on birth control, accidents do happen and pills do get lost or forgotten. Plus, it’s always good to have one on hand to share.

No, We Aren’t ‘Murderers’ – We Are Your Doctors

The far right is now on its second month of claiming that unless new laws are put into place, abortion providers will willfully and eagerly murder newborn infants while the patient silently and complicitly watches. The utter mistrust and suspicion that anti-choice politicians have towards medical professionals who offer legal abortion care (and, frankly, to the people who seek it out) is no longer shocking. What is surprising, however, is how much the public is falling for this mistaken concept that the doctor providing abortions is somehow a completely different entity from the doctor checking your paps, inserting your IUDs and yes, even delivering your baby into the world.

One of the hardest parts of being an abortion provider is the isolation in our medical profession that is  thrust upon us by anti-choice factions. They’ve forced medical schools to outsource full-scale Ob/Gyn care that includes learning miscarriage management and abortions at all levels of gestation. They’ve made medical students opt in, rather than opt out, of learning these completely legal and necessary medical procedures, and travel off campus and further if they want to get enough training to be proficient. And they’ve removed elective abortions from hospitals and private family medical clinics and corralled them into abortion clinics and reproductive health clinics alone, as if they were an infectious disease that must be contained.

Providing an abortion is just one part of what an Ob/Gyn, or even many family doctors can and should be able to do, and an important part of the medical services spectrum that allows one doctor to see a patient through every level of that person’s medical needs at any given point in their life. Yet the right has siloed abortion into one “shameful” medical concept and annexed it from the full continuum of care, as if there are “abortion doctors” and “real doctors” rather than them being one and the same.

That same doctor that gives one pregnant person an ultrasound to see if she is early enough to use medication abortion for a termination is likely to be found a day later with another patient checking her dilation to see if she’s  in labor. Yet the right is adamant that the first one is a monster, and the second a trusted part of the medical team, despite the fact that each is the same person in a different setting.

No, we aren’t committing infanticide, or murder, or doing harm. We took oaths to protect our patients, and there are already laws to be certain that we uphold them. We are all  physicians and we are all governed by the same boards and bodies,  yet anti-choice activists have convinced you that we are different simply because of the clinic in which we provide our care.

Of course there are bad abortion providers out there, that is inescapable. There are also bad cardiologists, bad oncologists, bad surgeons and more. Yet in those specialties a rogue doctor is treated as an anomaly, and isn’t seen as tarnishing an entire profession. Yet because an abortion doctor’s specialty is relieving a patient of a pregnancy they do not want to continue, every rare instance of poor care or doctor violation is seen as the rule, not the exception.

Abortion providers, like all doctors, do what they need to do to best meet the needs of their patients. Just as you would trust a doctor to provide the best end of life care that a patient and their family requests, you can trust us as well to put the needs of the pregnant patient first and do what they want and is necessary as they deal with an unwanted pregnancy, or a pregnancy that is medically compromised.

As a doctor, I am no more likely to harm or dispose of a viable, full term fetus than any other doctor would be to murder an elderly patient simply because they are bedridden or too frail to walk. But just as most doctors will honor end of life decisions and work with a family to offer hospice when there is no hope for recovery, I too work with my own patients to make the best medical decisions for themselves and their families, too.

No one is murdering Grandma, and no one is committing infanticide, despite what anti-choice activists say. But those same activists who want to end abortion – not just later abortion, but all abortion at any point and for any reason – want to also take away your right to make end of life decisions, too. Today they are arguing to force resuscitation on fetuses on the very edge of viability against the wishes of a parent. Tomorrow, they will be focused on keeping bodies with no brain activity on life support against the wishes of the family, too. We already saw this in Texas when the state kept a brain-dead pregnant woman on life support to try to get her fetus to viability, despite her family asking them to stop. When you are legislating “life” as “conception to natural death” a family’s wishes could easily be against the law.

I am not a murder, or a monster. I am a doctor. I once delivered your babies and still do your paps, IUD’s, physical exams and STI checks, and yes, I terminate pregnancies, too. Trust me to do my  job and look out for your medical best interests at every point in your life.

After all, I trust you to make the best decisions for yourself, too.

It’s doctors – not the FDA – standing between miscarrying mothers and medical best practices

Like so many people who encountered the recent NPR piece on mothers suffering through miscarriage, my heart broke for the patients forced through the agony of waiting after using a less effective drug to end the pregnancy when there was a far quicker and more successful option available. However, that sorrow was overshadowed by the furious anger I felt for the doctors managing their care – because it is them, not the FDA – who are standing in the way of patients getting the mifepristone that would end their suffering faster.

As NPR reported, mifepristone is highly regulated, meaning a doctor does need to go through additional protocols in order to have it stocked in their office. But the actual requirements aren’t onerous at all, especially not for an OB-Gyn or other doctor doing pregnancy related or reproductive healthcare. All that is needed is for the provider to have a medical license, as well as the medical knowledge and ability to refer a miscarrying patient for a D&C should the medication fail.

Not even perform a D&C. Just refer.

Just like having Rhogam shots in the office to provide for a patient who is RH negative, or methotrexate if a patient has an ectopic pregnancy, mifepristone could easily be stocked in offices to have a supply on hand. The cost of mifepristone is the same as a Rhogam shot- nothing exorbitant! Unlike these other medications, though, mifepristone carries the stigma of being thought of as an “abortion drug,” and the added issue of drawing the attention of rabid anti-abortion activists who would rather watch women suffer and put their health in jeopardy through a drawn out miscarriage than risk the possibility that even one unwanted pregnancy might be ended with secretly in the process.

There is absolutely no reason for a hospital or doctor not to be stocking mifepristone other than complacency and cowardice in our profession. Mifepristone has been used to accelerate the process of pregnancy loss in non-viable pregnancies for two decades, with repeated studies showing that the process is both safer and more efficient. Yet every month I see patients coming in to have D&Cs after weeks of undergoing multiple rounds of misoprostol-only miscarriage management from doctors who simply don’t understand how the process works, or care enough about the physical and emotional well being of a patient who is suffering a drawn out loss of a wanted pregnancy. Patients who after waiting for a failing pregnancy to end eventually end up in a hospital surgical center with huge deductibles due for a D&C when she could have already been done and potentially trying once more to get pregnant again.

Make no mistake about it – doctors, led by abortion opponents, are letting miscarrying mothers suffer in order to punish abortion patients.

It doesn’t have to be this way. Doctors, whose first responsibility is to help their patients and provide the best care possible, could easily stock mifepristone and help any current and future mother undergoing a miscarriage – but only if they are brave enough to break the stigma around this safe, legal, efficient medication regime and stock it in their practices all across the nation. Instead, they’ve refused and tried to pin the blame on the FDA and NPR let them pass the buck.

The question is, are you going to let them pass the buck, too?

Arizona Reporting Rules: Ending Abortion Through a Thousand Paper Cuts

For the last decade the right has chipped away at abortion access by making it more expensive, closing clinics, increasing waiting periods and decreasing gestational limits. But for 2019 Arizona abortion opponents are literally enacting a “death by a thousand paper cuts” agenda against legal abortion through their new paperwork and reporting requirements for doctors performing abortions. None of them are medically necessary, not a single question will provide any benefit to public health, and each one will dramatically raise the amount of resources a clinic uses per patient.

What these rules will do, on the other hand, is systematically aid anti-abortion activists in their quest to harass their way to the end of accessible legal abortion.

The Arizona legislature has instituted a full range of new reporting requirements that are only applicable to those who perform abortions, all of which just went into effect.. The state wants to see any complication from an abortion no matter how insignificant that issue may be, even including each instance where a medication abortion does not completely terminate the pregnancy (ironic, since under other circumstances they consider this not only not an abortion complication, but a potential “reversed abortion” and a win for their side). Since abortion – early abortion in particular – has so few medical incidents, their goal is to try to amplify any small complication to booster their vendetta of proving abortion is actually “dangerous” despite its longstanding history of safety, especially compared to all other medical procedures. Could you imagine if the state required reporting on each incidence of induced labor or every time an episiotomy is used during a vaginal delivery? Live births are frequently one medical intervention after another, and OB/Gyns would protest en mass if similar reporting requirements were demanded, knowing they had no bearing on public safety and would cripple them with extra burden.

These reports will slow us down, hurting providers financially as we are forced to hire people to deal with the onslaught of new forms and questions. But they will hurt other medical professionals just as much. The requirement that we list those doctors who refer patients to us has no sound medical reasoning behind it. Instead, it is obviously meant to create a catalog of those who are open to the idea of helping their patients access care when they choose to end their pregnancies, a listing of doctors and other caregivers who could be harassed if their names every were accidentally or intentionally made public. The new rule that we must cite the specialty of each medical provider on staff is clearly meant to offer ammunition for future TRAP (Targeted Regulation of Abortion Providers) laws, like ridiculous demands that only board certified OBs be allowed to dispense abortion pills.

And of course these rules will also hurt patients. While we can all cheer for the small victory that abortion providers will no longer be mandated to report a crime to the police anytime a patient asks for an abortion and says she was impregnated due to sexual assault, that does little to address the root issue of asking any pregnant person why they want to end the pregnancy. There is no more or less valid reason for seeking an abortion – the only answer that matters is that the patient, for whatever reason, does not wish to remain pregnant or give birth. To force that person to explain their reasoning is an attempt to undermine the professional relationship between doctor and patient, and adds no value to the medical process or to public health.

The new law reporting requirements – which were crafted in part by the anti-abortion Center for Arizona Policy, not even the Health Department – have clearly been created simply to harass patients and clinics. Do men get questioned by the state about why they want ANY medical care? Or women for any procedures other than an abortion?

If Obstetricians had to ask every pregnant patient why they wanted to have a baby, or every patient seeking contraception why they wanted birth control, and had to figure out a way to gather this information, record it, then enter the mass of data on the health dept website, or even hire staff to do this – heads would roll. Imagine any doctor or office tolerating this invasion into personal decision making? It would never stand.

Despite reports that show the number of abortions is decreasing across the country, in clinics like my own we are seeing an opposite trend. Regardless of continuing abortion restrictions across the state the number of people seeking out our services continues to grow, with as many as 20 percent more people coming to us in 2018 than in the year before. It is not unheard of to have as many as 25 unscheduled walk-ins arrive on a given day, wanting to complete the first day of their 24 hour mandatory wait prior to a termination. We are already overextended as we try to meet this growing need for our services. And now the state wants to double our paperwork over each and every patient, overburdening our resources not out of medical necessity but for political gains.

The Arizona legislature is quite literally trying to end abortion access though one thousand paper cuts, and while it may not have the media glamor of a full abortion ban or mass clinic closures, it very well may be the one attack that succeeds.