Monday, July 28, 2014

Mailbag: Do I Still Have to do NFP if My Life is at Risk?

I get a lot of emails from you swell readers. I answer them. I thought perhaps some of you might be interested in those answers. So I've decided to start a mailbag series featuring your questions and my answers. I'm going to do a few in a row here, then it will become an occasional series.

So here goes . . .

Question:

Hi Kendra,

I have seen your write about the joys of large families, and the trials of NFP. Fertility has not been a super simple journey for myself and as you wrote the other day it is not for many women. There is an issue that I have a lot of difficulty finding the Catholic response to. I have had repeat cesareans. I am - God willing- in a few months going to have my third cesarean (fourth baby). At a certain point repeat cesarean becomes not recommended. There can be issues with the placenta, early birth, ruptures etc. Of course all of these issues can happen without repeat cesareans, but the likelihood is much higher. So what is the Catholic thought on this? I have searched online for months now racking my brain as to what to do and how to proceed. I have considered talking with our priest as well, but wanted to ask a woman who seems to know stuff (like yourself). If I practice NFP I will end up with many babies, and many cesareans, putting myself and said babies at risk. I know this through trial and error as I do not have regular cycles at all. Some of the women I know have continued to have cesareans, one woman has even had 8, many of the other woman I know have stopped at three. I am so torn about this. I want to follow church teaching, but cannot seem to find it anywhere. 

Blessings,
Sarah.

Answer:

Sarah,

This is a good question, and you're right, it's not something that gets talked about much in Catholic circles.

There are a couple of angles to consider:

1. There isn't a "mother's life is at risk" exception to the Church's teaching on using artificial contraception. Our options as faithful Catholics are NFP or, if necessary, abstinence. As I've written about before, we had trouble figuring out NFP because of my long cycles and confusing symptoms. But, by being extra cautious and widening our window of abstinence days, we were able to successfully practice NFP for over a year, until we decided we were ready to be open to another baby.

If I were in a position of needing to practice NFP again, I would consider consulting a naPro doctor. I listened to a great talk at the Behold conference by a naPro doctor and I understand better now that we are not necessarily stuck with things like weird cycles and confusing symptoms. Sometimes those things can be successfully treated.

Simcha Fisher wrote a post about her success with topical progesterone for regulating her cycle:
Progesterone cream (prescription and OTC) improved my Creighton NFP charting of cycles and now NFP is tolerable instead of intolerable

So, don't give up on NFP for yourself. I think it could still be something you could practice successfully, even long term.

But . . .

2. It might not be as necessary as you've been told. The three c-section limit is the standard line of OBs these days. But, as with everything, that's just an assessment of the risks and not a guarantee of safety or danger.

One OB says on her blog: *
What jumps out at me is just how low the risks really are. The death rate for a non-emergent primary C-section is 8/100,000 as compared to a death rate for vaginal delivery of 6/100,000, for a difference of only 2/100,000. And that difference is likely to be a dramatic overestimate in the case of a truly elective (vs. non-emergent) C-section.
It is true that the risk rises with every subsequent C-section. For the 4th C-section, the death rate is 39/100,000 as compared to 12/100,000 for a 4th vaginal delivery, for a difference of 27/100,000. Once again this is likely to be a vast overestimate.
. . . . The bottom line is that even multiple C-sections may have modest risks.
So, a 4th c-section is 0.031% more dangerous than a first c-section, and 0.024% more dangerous than a third c-section. The "modest risk" part is just just one OB's opinion, of course, but, as you mentioned, most of us know someone who has had more than the acceptable number of c-sections, and it's been fine.

Update: Reader Mary has indicated on Facebook that I'm not interpreting this correctly. She says there is a difference between percentage and percentage points, and that, according to these statistics, the risk of maternal death in a 4th c-section vs. 1st c-section is 4.8 times greater.

She points out that having four children at all, let alone four children by c-section, is rare, so there are not many studies. Here are a couple more:

A 2006 study in the Journal of Obstetrics and Gynecology, entitled Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries looked at 378,063 births during the study period, including 83,754 cesarean deliveries.
Although repeat cesarean delivery was associated with increased maternal morbidity, outcomes were good in most women undergoing these procedures. Maternal death was rare, and in only 2 cases (in women having their second cesarean delivery) could it potentially be attributable to cesarean delivery morbidity. Thus, there does not appear to be an absolute threshold number of cesarean deliveries beyond which patients should be unequivocally counseled to forgo future pregnancies. Others also have not definitively delineated a threshold for number of cesarean deliveries.11,12 On the other hand, our study did not have enough power to adequately evaluate whether rare but serious events such as death were increased with increasing number of cesarean deliveries. Indeed, the rates for rare complications are estimates, especially in women with 4 or more cesarean deliveries. Nonetheless, there was a substantial increase in the risk for several morbidities, including placenta accreta, cystotomy, and need for hysterectomy or intensive care unit admission with the fourth or greater cesarean delivery. Women should be counseled regarding the progressive increase in the risk for meaningful morbidity with repeat cesarean deliveries.
Here is another study, reference in the study above, abstract found here:
Maternal morbidity after elective repeat caesarean section after two or more previous procedures.

OBJECTIVES: To determine the incidence of maternal morbidity following elective caesarean section in women with a history of at least two previous caesarean sections, and to determine if the incidence of morbidity correlates with the number of previous sections.
STUDY DESIGN: We conducted an individual chart review of all women who had an elective caesarean section because of a history of two previous sections from 1990 to 1999.
RESULTS: There were 67,097 deliveries of babies weighing 500 g or more. The total number of cases eligible for the study was 250. There were 12 cases (4.8%) of placenta praevia of which four required a transfusion and two a hysterectomy. The incidence of wound infection was 6.3% and urinary tract infection was 11.2%. There were no cases of thromboembolism recorded.
CONCLUSIONS: Maternal morbidity with elective repeat caesarean section is low. The major morbidity is associated with placenta praevia. We found no correlation between the incidence of maternal morbidity and the number of previous sections.
I'm not a doctor, nor am I a statistician, all I want to point out is that the facts don't SEEM to back up the blanket discouragement of c-sections after a certain number.


Even though it can be scary, I honestly believe that this is an opportunity to surrender a bit, and to trust. If your gut tells you that you should seek to avoid another pregnancy, pray and trust and get good advice from a good supportive doctor and practice NFP. If you have really serious extenuating circumstances, you may need to prayerfully consider prayerful abstinence.

But if you have a desire in your heart for more children, pray and trust and get good advice from a good supportive doctor and be open to another baby.

This really is one of those situations where you need to inform your conscience and follow it.


St. Gianna Molla, pray for us.

And congratulations and good luck on baby number four! Please keep me posted!

Cheers,
Kendra

* So, people in the comments on Facebook have pointed out that the first study I linked to is from an OB blogger who is very unsupportive of homebirth. Isn't a site/person I was familiar with, I was just looking for someone willing to discuss the statistics of maternal deaths associated with multiple c-section. Because of the (good, important, and well-intentioned) focus on discouraging elective/unnecessary c-sections, there are very VERY few people out there willing to discuss the numbers. Her opinions on homebirth don't change the statistics on repeat c-section, and that's all I wanted to reference. If you prefer to see the c-section study firsthand, it's available for free here.


Disclaimer: I am not a theologian, nor am I an official spokesperson for the Catholic Church. (You're thinking of this guy.) If you read anything on this blog that is contrary to Church teaching, please consider it my error (and let me know!). I'm not a doctor or an expert on anything in particular. I'm just one person with a lot of experience parenting little kids and a desire to share my joy in marriage, mothering, and my faith.

If you've got a question, please send it along to catholicallyear @ gmail . com . Please let me know if you prefer that I change your name if I use your question on the blog.





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35 comments:

  1. Great answer, Kendra! My aunt has had seven C-sections to date (she's in her early 40s but I wouldn't rule out an eighth). And Sarah, should you be reading this: I highly, highly recommending finding a pro-life Ob/Gyn. I found mine by Googling "pro-life Ob/Gyns" and my area. They can be few and far between but if you find one they're a wonderful resource for pointing you in the direction of the best teachers for the best kind of NFP for you. Plus they will always work with you to respect your fertility instead of suppressing it. Best of luck with your upcoming birth and with your future childbearing (or not!).

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    1. Aww man this won't let me edit. Please excuse any typos -- I've spotted at least one. :)

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  2. Sarah didn't say what the reason is for the repeat cesareans, but many mothers do well with vaginal birth after cesarean. I had one cesarean followed by six VBACs. The C/S baby was my smallest. I had to find some supportive midwives.

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  3. I agree with Colleen - finding a prolife/Catholic ob/gyn is a HUGE help with discerning difficult (and very personal) medical issues. Also, while I don't personally practice the Creighton model of NFP, I do know women that have successfully remedied severe issues with their cycles by working with NaPro doctors and technology. There are options out there that won't force you to compromise your faith - don't loose heart! :o)

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  4. Great answer. And I would also highly highly recommend looking into the risks of a vba2c (vaginal birth after 2 cesareans) vs. the risk of the repeat surgery. The numbers are way way closer than most OBs will lead you to believe and almost statistically insignificant with the surgery having another set of risks apart from the rupture argument. Of course, finding provider who will be okay with that can be an issue but they are out there.

    (This, by the way, is one of the reasons I believe that birth choices are actually very important to the life issue and Catholic discussion and should be incorporated into it. There are far too many women receiving cesareans who are then pressured into limiting their family size when they otherwise would not because of it. And too many women who don't realize that their choices before and during birth can affect their future fertility and family decisions.)

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    1. Yes, VBAC isn't for everyone depending on your reason for a C, but it's more of an option than some doctors admit.

      Also, your doctor might be dealing with outdated information and data. If I'm remembering correctly repeat C-section used to be more dangerous when the larger T incision was used, but modern C's are done with a small horizontal incision at the bottom of the abdomen which helps cut down the trauma done to the rest of the body, risk of infection, scar tissue on the uterus, healing time, etc.

      I also look at the data shared above in a particular way - if a women is having a third, fourth, etc. C-section she might have other health factors that play into the mortality rate therefore meaning that the death is not necessarily caused by the form of delivery or that particular health issues already gave her a higher risk of mortality and a C was chosen as the best way to insure the survival of the baby (so if that decision hadn't been made the loss of the mother would have still happened and been part of the vaginal mortality rate). So it's not necessarily a straight line of cause and effect.

      I am not a medical professional either, but I have had c myself and have looked into this issue as well.

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    2. I totally agree with Mary above. I, personally, will be attempting a VBA2C in the fall. It can be some work to find a supportive midwife and/or doctor, but I have found both and in an area where VBACs are "banned". God bless you, Sarah!

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  5. This is a great answer Kendra!

    I find that it also helps to take it baby by baby and try not to take on worries that may never arise.

    I'll be going in for my fourth C-section in October. I attempted at VBA2C last time, but with a transverse baby it just wasn't happening and I'm okay now with the fact that it's likely not in the cards for me. But I was also pretty excited last time when the doctor came back after the C-section and said that he thinks I have at least two more safe C-sections ahead of me based on how things look, and that we can reevaluate with each one.

    I think this is one case where having a doctor who is on board and isn't pushing either old practices (3 and done no matter how things individually look) and who doesn't have an agenda (like being unsupportive of large families) is definitely a must!

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  6. I always meet people who say what you're having your 5th c/section? I was told you could only have 2 or 3. When I had my 4th c/section the OB was saying I think this will be your last but he is an amazing surgeon and he cut out all the old scar tissue and gave me a new line of stitches and said I was right for one more. And I'm kind of hoping that after this one he'll tell me the same. I have easy pregnancies and heal well after each one and he's been there since my first pregnancy.
    I think if everything goes well for you and you heal well and have a supportive dr then you can do it. And I've met a few mums who have had 5 or 6 c/sections all thanks to the right OB.

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    1. I love this. It shows how individual each person is, and a real trust in the doctor you have chosen for your care. Is it weird that after my 3rd c-section when my doctor said I was in good shape for another, I was kind of proud? Like- Good work uterus! you rock :)

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  7. Great answers and Sarah, such a tough one will add you to my prayers.

    "It might not be as necessary as you've been told. The three c-section limit is the standard line of OBs these days."
    This is a large part of the equation, we had an Irish doctor working here in one of our major cities and he shared with a friend that he had a woman who had 11 Caesar and wasn't fazed by friend's 8th. For most doctors anyone having more than 3 let alone caesars is out of the norm.

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  8. Repeat c/sections of this order aren't the most dangerous thing in the world, but I would definitely recommend looking into V2BAC. Risks are fairly low for either (somewhere between 2% and 4% for really serious complications that would impair life or future fertility), but the issues with so many c/sections, such as placenta accreta and abruption, only rise with subsequent pregnancies, whereas if you are able to successfully have a VBAC, you pretty much return to the lower risk group when it comes to uterine rupture. Of course, it depends on why you had the first c-section and prior ones: if you had it because of a breech baby, your odds of a successful VBAC are almost as good as for a first-time mom. If you had a c for failure to progress or cephalopelvic disproportion, then odds of success are a bit lower, but still better than 60 percent. I'd find a VBAC friendly doctor and one who is supportive of your desire to potentially have more children. Its worth it in the end! Good luck!

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  9. I had a c-section with my first and then three successful VBACs. As far as placenta complications like placenta accreta, that is about 1:2,500 pregnancies, and even fewer go as far as placenta percreta. I have personal experience with this. My fourth baby was at risk for placental accreta/percreta. The placenta implanted right over my old c-section scar. I was considered high risk, and I needed extra ultrasounds to monitor the placenta to make a judgment call. The docs decided to go ahead with the VBAC and have a surgical team ready if I needed the OR. They reassured me that I would not die. You just need doctors who 1) know your situation and 2) are prepared for it. That's most of the battle right there.

    I was assured that my worst-case scenario would be a total hysterectomy after baby was born. Is that awful? Yes. It means my child-bearing days would have ended with my fourth baby. Was I going to die? Not any more likely to die than any other pregnant woman, because I had doctors ready to address a possible placental problem. So if the worst-case scenario was a total hysterectomy, then what did I have to lose? My fertility? If I stopped having babies over fear of that complication, then I would have effectively cut off my fertility all by myself anyway. At least an emergency total hysterectomy would have been out of my control, and I could leave it with God.

    I am happy to report that the VBAC went smoothly with no need for surgery, and I am more motivated than ever to have more kids. God spared my uterus, and I don't want to take that for granted :).

    My sister-in-law had five c-sections, and her OB actually fired her after three. She found another high-risk OB who safely delivered her last two babies. I know there are risks. I've had a miscarriage, and it is possible that miscarriage was a result of implantation into my old scar. We'll never know. But I do encourage women to trust God as much as possible with these things and seek out multiple medical opinions, especially from pro-life docs!

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  10. Great answer.

    I'm not a doctor or a miwife or a nurse or anything like that...but I do think that one think to keep in mind with the "multiple c-section" risk is the spacing between pregnancies. From what I've read, it's "riskier" to have many c-sections (or even vaginal births) very close together (like less than 12 months between pregnancies) as opposed to further apart (say at least 18 months between pregnancies).

    As Kendra said the risk isn't at great anyway, but if that's something you are worried about, keep in mind that the risk may be lessoned if you've allowed your body more time to heal between pregnancies. There may not be a neet to "stop" at 3 or 4 kids, but you may prudently discern and pray that waiting at lesat 18-24 months between pregnancies would help your body heal more and lesson risks. It's something to keep in mind and talk to your doctor about

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    1. That's such a good point Amelia. I've had 2 c-sections and going forward will always have c-sections so using NFP to help us space and give my body time to heal is a big part of the equation. Therefore, I fall into that "very grateful for NFP" camp, because I think it ultimately will allow us to be more open to life in the long run instead of putting enormous strain on my body in a short period of time. Also, I definitely echo what some of the ladies said above about having a good (ideally Catholic) ob, although I know that can be nearly impossible depending on where you live. My doctor would never say "I'm done" unless there was an actual serious health risk. She's extremely careful and precise with her repeat sections on women who would like larger families. My last section took more than 2 hours because she was so careful closing and using double sutures. It's not ideal and it's scary having c-sections but it shouldn't be a deal breaker when it comes to trying to have a bigger than normal family. Of course, all this goes back to Kendra's post from last week about family size being out of our control. I've stressed about this often before but I have to remind myself that God alone knows the ultimate size of our family and the story of how we get there. :)

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    2. That makes sense. Using NFP and being conservative in-between pregnancies to ensure a safer spacing seems like a prudent thing to do. It is a major surgery either way you look at it, and letting your body heal properly in-between seems like the right thing to do .

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    3. Two years later but yes, spacing is key. After my c-sec, I was told at least 2 years to allow for the scarring to heal properly.

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  11. It is important to remember that all contraception has a failure rate. The sympto thermal method which CCL teaches successfully shows impending ovulation at the highest level when used correctly. It would be foolish to use contraception during the fertile time since the failure rate is based on whole cycles, not just the fertile time, which would necessarily have a higher failure rate! In order to avoid pregnancy for the most pressing of concerns, it would be wise to abstain from day 1 until after the most conservative rules regarding ovulation.

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  12. I wanted to respond to this bit of the writer's question: "If I practice NFP I will end up with many babies." When I was in my 20s, I was told by multiple HCPs that I was a poor candidate for successful NFP use. I once called my NFP teacher with a question about my chart and there was a long silence on the other end of the line. She said, "In 15 years of teaching I've never seen anything like that." I would not have believed you for a second if you had told me that the crazy cycles of my teens and twenties would give way to textbook cycles after I hit my late 30s. I'm currently 44, and NFP has become very straightforward. I expect to see a return to craziness in a few years, when I get closer to menopause, but it will be short-term. I have serious reasons to avoid pregnancy right now, and it has never been easier to figure out how. You don't know how your body will change over time; you don't know what little gifts God has waiting for you in the future.

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  13. My oncologist has encouraged contraception for us.... We have resisted and NfP'd. Any one see a Catholic gyn in SoCal, love the name. My current Gyn is Jewish and my Onc is Hindi. Not much help ;)

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    1. If you are still looking for a catholic Gyn let me know. There are 3 in socal. I also know of Creighton practitioners as well. :)

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  14. These have been great posts, thanks! As someone who is not Catholic I wondered if you could answer to the question of someone who doesn't wish to have more than one kid or two and/or doesn't wish to ever have children. If you cannot financially afford or choose to not afford children what are your options. NFP still allows for the possibility of pregnancy. I'm sure there are plenty of Catholic's our there who aren't interested in having 7 children. NFP and abstaining as often as required would just cause a lot of stress in the couple who are actively trying to not get pregnant. Just curious. :)

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    1. Hi! This is not a comprehensive answer to your question, but a few things: With the exception of infertility and drastic surgery, all sex -- even "protected" sex -- allows for the possibility of pregnancy. Many of my Protestant family members who use contraception have had surprise pregnancies, and I know that is not unusual. My SIL has five kids, because two were surprises. My other SIL has two kids when they only wanted to have one, but they are thankful everyday for their surprises. And they actually wish they could have more now. I know that's not everyone, but time and experience tend to change people.

      Most people tend to have fewer children than they want, not more. That's true of Catholics using NFP and even the secular folks who struggle with infertility, which is far more common than super fertility.

      You are right -- There are Catholics who not want 7 children. But many of those Catholics are young and cannot fathom 7 all at once. To them, I would say take one baby/pregnancy at a time, and do not worry about the exact number in the end. Too often, we focus on the number of children we want as young adults and newlyweds and -- most of the time -- we don't get that exact number for a variety of reasons. Sometimes we get more, often we get less because of life circumstances. So do not angst over the exact number.

      And, finally, for everyone who falls outside those categories, any more advice would largely depend on individual circumstances. The individual circumstances almost always change the conversation a little. But, for Catholics, Kendra has listed all the options here -- NFP, nothing, or prayerful abstinence. I'm sure Kendra has other good things to add, and I apologize if I danced around your question a little :).

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    2. For us, it's not "we do or do not want x amount of children". It's a relationship and NFP promotes this relationship. What birth control requires both the husband and the wife to talk seriously about childbearing every month? Because the truth is, we change, circumstances change, life changes. So you get to go into every month prayerfully and talking, "can we add another baby? What's going on in our life that would make that difficult? What do you feel? Have you asked God about it?" Etc. One of us may be feeling something the other isn't, or have concerns the other one didn't see. To have the opportunity to look at my spouse every month we are not already pregnant, and get to talk about the tough, deep life questions is such a gift. Seriously. We don't practice NFP right now, as our kids are spaced well with my breastfeeding, but we do still converse about if it's something we need to consider and how we would feel about seeing that positive test. It is a great and natural way to nuture our marriage.

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    3. Hey Caron, thanks for your question. It's got a few aspects to consider.

      1. As far as wanting NO children, the Catholic Church would not consider a marriage valid if the spouses went in to the marriage intending to have no children. From the Catechism of the Catholic Church (the big book of rules): 1601 "The matrimonial covenant, by which a man and a woman establish between themselves a partnership of the whole of life, is by its nature ordered toward the good of the spouses and the procreation and education of offspring; this covenant between baptized persons has been raised by Christ the Lord to the dignity of a sacrament."

      That does NOT mean that if for some reason the spouses are not ABLE to welcome children that they would not have a valid marriage. But to be married in the Catholic Church, you must be open to having children.

      And 2. The ONLY way to guarantee you won't get pregnant is to not have sex. Failure rates for artificial contraception (according to the CDC) range from about 1% for an IUD (but I think that's misleading, because the IUD doesn't prevent pregnancy, just implantation, so PREGNANCY rate for an IUD would be very high), to 9% for the pill, to 18% for condoms. The CDC estimates a failure rate of 24% for NFP, which is maybe unfair, because plenty of people who "do NFP" aren't really diligent about it, because we are open to having more children.

      So I guess what I would say, is that if a couple open to having a kid or two, then discern that they have serious reasons to not have more, they can be diligent about NFP and have a very reasonable chance of not conceiving again. But the only foolproof contraception is complete abstinence. One of the reasons given by the Supreme Court in the Roe vs. Wade decision, was that because of widespread use of artificial contraception, there was an expectation that one could have sex without having babies, but because of the high failure rates of contraception, women needed to have recourse to abortion.

      No matter what method of family planning people choose, sex can always end in babies. I hope that helps a little.

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    4. Keep in mind that pregnancy is established only at the conclusion of implantation of a fertilized egg. This scientific definition of pregnancy is also the legal definition of pregnancy, accepted by governmental agencies and all major U.S. medical organizations. So when some IUD's prevent implantation, they do actually prevent pregnancy. In addition, the copper IUD's create a toxic environment for the sperm,so that they never make it to fertilize the egg- they do actually prevent the fertilization.

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  15. I think this is a great answer. I am ac section mama 5 times over. However, i am one of the few who has experienced complications. My baby and I almost died from them during my birth so my husband and I prayfully decided no more biological children.
    So what do we do? Well, nfp has always worked for us, and my doctor is confident that he can deliver me safely if we do have a sixth child. So while we are saying we shouldn't have more, we are following God's rules and trusting in him. Just giving some more insight....God bless!

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  16. Great advice! My SIL had five C-sections. Her OB actually fired her after her third, because the OB considered her such a high risk. She had two more surprise babies with a different OB and then had her tubes tied. (She is not Catholic, but she is pro-life. She would never consider ending a pregnancy even when her doc pressured her). She is in her early 40's and, just the other day, she was telling me that she wished she could have more children. She is such a great mom! Ultimately, everyone's story will be a little different, and I don't mean to suggest that her story should be yours, especially the part about a tubal. But I want to encourage you to seek God's will for your life in this and, as JPII loved to say, "Be not afraid". :)

    I know that's easier said than done -- I had a c-section and three VBACs. I am often anxious about these things too. My most recent pregnancy was high risk, because the placenta implanted over my old scar, and we had to be closely monitored. We all turned out fine, but the risks are always in the back of my head. So I truly understand, and I must also remind myself to pray and not be afraid. We have spaced our kids further apart thus far with NFP just to give our family extra time to adjust and to prepare for the next pregnancy and baby. God Bless you!

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    1. And as a side note, we also use NaPro. We have found that it is the most comprehensive method for more complicated medical situations. Hope that helps a little. I know people love to make NFP suggestions, and I don't mean to impose my way on anyone. Just an FYI :).

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  17. So, I wrote a comment and it got deleted (silly smart phone) so I thought I'd try round two...
    I had 3 c-sections in 3.5 years. We are currently expecting our fourth who will be delivered via c-section. There are few things that annoy me more than when someone tells me about their sister's mother's uncle's cousin who had 8 c-section and was perfectly fine... Here's my two cents.

    I choose my doctor because I trust her. After my third c-section she said we would be able to have a fourth after evaluating my uterus and my scar tissue. She has strongly suggested after this child we not have any more- the risks based on her medical knowledge and my uterus would be too great, and I have three (almost four!) small children to tend to. She is a doctor, and I'm gonna go ahead and trust her background, education, and recommendations. I choose her because I trust her.

    I find that often, well meaning Catholics, who have never been inside my uterus, suggest that perhaps my doctor doesn't know what she is talking about, and I could have more children if I want (I am NOT saying Kendra did that, I am AM implying some of the comments have)- or, oh my gosh, the suggestion that I try to vbac this fourth- I.can't.even.

    My husband and I plan on using NFP strictly for the next ten years after this child (unless my doctor feels a fifth could be possible)- I am sure it will be very hard, and we understand that even with NFP there is a slight chance we could conceive again, and we know that if we do...there will be risks and we will trust God. However, because of the medical advice of my DOCTOR, coupled with what I think is the best decision for my family (regarding my health) Imma go ahead and avoid pregnancy if possible. And I think that's the smart and prudent thing to do.

    A couple more things... while I'm going.
    I love that someone said even with artificial birth control, there are no guarantees. I think when we have a sound medical reason for avoid pregnancy (and multiple c-sections are a very sound reason, make no mistake about that) we want guarantees... but that is where the trust in God comes in. Not a blind trust that doesn't work with God, but entrusting God your fertility (NFP can help do that) and knowing He has a much greater love than any of us can imagine.

    Lastly (long winded, I know)... after my second c-section I felt so much guilt about seeing a 'non pro-life' obgyn from Catholic circles- that for my third, I went into the phone book/websites and found a pro-life doctor in our area. We (my husband and I) hated our experience with her. She was incredibly lax in her understanding of situation, had zero concerns or questions about our third pregnancy in 2 years with 2 c-sections under our belt. We felt SO uncomfortable with her, we left and never went back. We returned to our 'gasp' secular obgyn who was super diligent in our pregnancy. At the end with my third, I had massive blood issues and ended up with a clotting/hemorrhaging situation- I had iron infusions as recommended by my diligent doctors, which helped me deal with an incredible blood loss. I think my husband and I are a tremendous witness to our secular doctor and we trust her and are so thankful for her guidance through each of our pregnancies.

    If you (reader with question) ever want to talk to someone who has been in a very similar situation and shares very similar concerns... please feel to email me! marywilkersonym@gmail.com

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    1. Thanks so much Mary. This is all really, really helpful.

      I had a similar situation with a Catholic, pro-life OB that I tried switching to for baby number five. I found her office to be generally unprofessional and her bedside (exam table-side?) manner was horrifying.

      I went running back to my non-Catholic, contraception-prescribing OB, who I trust and who has been very supportive of our big family, and who'll be delivering me of baby number eight any day now. Trying to give birth with a doctor you don't really, really trust to make the hard calls just isn't a tenable situation. The process is intense enough as it is.

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    2. Oh my gosh, yes that was my experience. Although she wasn't Catholic, but identified as Christian. In her office she had all sorts of pamphlets on the sin of fornication and premarital sex- and lots on satan. It just gave us such a bad vibe. Like you, my obgyn is super open to our bigger family. She/her partner/ ask a lot of questions about our religious background and our refusal of artificial birth control, and NOT in a condescending way, but out of real curiosity. Two months ago, I had to bring the whole crew to an appointment, and she asked to take a pic to show her husband our little family (I am assuming it's very unusual for her to see a family with children so close together). She took it with such pride. It was a really cool moment.

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  18. I have seven children, and just had my 6th C-Section - everything went swimmingly. While my own doctor said he would treat me if I got pregnant again, he would be reluctant due to the risks involved. However, when I spoke to his partner, he said the only time he counsels against pregnancy are in cases of renal or heart failure. Apparently a lot of data with high numbers of repeat multiple C-sections comes from Israel (oddly? I have not looked any of this up!), and to him the risks are manageable. He left me with a merry, "See you when you're pregnant!" I'm in my early forties, so who knows if we will conceive another child. But his thoughts were very comforting to me.

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  19. My friend had eight c sections with no complications.

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  20. My first was a vaginal birth, my second was a c-section due to his size. I bounced right back after my first delivery. Recovering from the c-sec sucked.

    I'd be lying if I said this number 3 wasn't scaring me a little; I'm hoping that 1) I can have a v-bac and 2) it will be much more of a normal sized baby.

    It's one baby at a time around these parts. We'll see how this delivery goes, but if it resembles #2, as much as I want to put my faith that God will provide and all that, I'd be really scared to try for #4, kwim? In French, we have a saying "Aide-toi et le ciel va t'aider." It's one thing to trust in God, but you have to do your part too. Which for us, would mean being super serious about NFP, which helped us space #2 and #3 as much as we did.

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