Louisiana-based primary care physician Dr. Susan Caldwell is a NaProTECHNOLOGY medical consultant and mother of three. In an April 2022 episode of The FAbM Base podcast, Dr. Caldwell shared the story of her evolution from prescribing hormonal contraception (and taking it herself) to eschewing artificial birth control in pursuit of women’s health care that respects the female body and addresses the root causes of reproductive health issues. Dr. Caldwell transparently and eloquently shared some key reasons why many doctors, be they primary care or OB/GYNs, don’t know about or are uninterested in fertility awareness, and offer their patients birth control instead.
Dr. Caldwell’s personal and professional experience of shifting her perspective on hormonal birth control is enlightening for women who feel disappointed, annoyed, frustrated, or even angry when their doctors continue to offer the Pill as a panacea for whatever reproductive problem ails them.
Dr. Caldwell’s journey, in her own words
Connecting the dots about birth control’s risks
Dr. Caldwell told FAbM Base podcast co-hosts Mary Bruno and Emily Frase that when she graduated from med school and began practicing medicine, she was fully on board with prescribing birth control for a host of problems, from “terrible PMS” to “really irregular” cycles. But over time, she connected the dots between birth control use and TIAs (transient ischemic attacks, or mini-strokes), heart attacks, and blood clots in her patients.
And there were other less well-known effects. Dr. Caldwell recalled a 35-year-old patient who came into her office bald because of chemotherapy for liver cancer connected to her birth control. Another patient came to her for a NuvaRing insertion and returned 6 months later with “a devastating outbreak of genital herpes” she’d contracted from her boyfriend. The Pill “protected” her from pregnancy but not from an STD or a broken heart.
On her blog, Dr. Caldwell also remembered a high school-aged girl whose mom brought her to get a prescription for birth control because she was “moody and irritable.” “Our conversation revealed a very broken girl who was secretly engaging in self-harming behaviors, who desperately needed mental health support, not birth control,” said Dr. Caldwell. Time and time again, Dr. Caldwell realized, the Pill and other forms of contraception couldn’t fix what was truly wrong– and sometimes broke what was healthy.
As she grew increasingly uneasy with what she was seeing happen to her patients on birth control, Dr. Caldwell began questioning whether she wanted to continue prescribing it. But when she approached a respected colleague with concerns about what she’d learned of the connection between hormonal birth control and breast cancer, Dr. Caldwell was immediately dismissed. “She put her hand on my shoulder and said ‘Oh, honey. Don’t worry about that. It’s not really connected that much. Don’t worry about it. You just keep prescribing it. You’re fine.” Fortunately, Dr. Caldwell couldn’t unlearn what she’d seen in her practice and read in the medical literature about the pitfalls of birth control. Gradually, she stopped prescribing it altogether.
This may be the main reason your doctor prefers prescribing hormonal birth control instead of encouraging fertility awareness
Dr. Caldwell offered this key insight that speaks into why many doctors (like her aforementioned colleague) may be reluctant to put away the birth control script pad: “I’ve had to mature a lot in my own ability to sit with [some] really tough emotions and situations and disappointments.”
Infertility, recurrent miscarriage, and other reproductive issues may be treatable with restorative reproductive medicine (like the NaProTechnology protocols Dr. Caldwell is now trained to administer) but sometimes a woman still doesn’t conceive or carry to term. Dr. Caldwell commented, “Not all women are mature enough, are ready enough, to chart, to be honest [with themselves]. It’s an act of bravery for a woman to begin to chart her cycles. And then for me to encounter whatever comes up as a woman [‘s cycle] is scrutinized… [She] comes into my office with her chart and I’m the one who’s telling her ‘this is what I think it means,’ for better or for worse.”
Dr. Caldwell said candidly, “I love it, but I don’t think I could have handled it at the beginning of my career. And I know that’s why a lot of doctors don’t [look into fertility awareness]. They can’t do what I’m doing. It’s hard at times.” “But that’s the fullness of life,” she says. “We can’t just have all the fun things in life without also holding in tension all the disappointments and all the pain and all the suffering.”
FAbM Base podcast co-host Mary Bruno, who shared her own story of eleven surgeries to treat her endometriosis and a twelfth surgery for a hysterectomy in the book Twelve Stripes Deep, added, “I don’t know if you [Dr. Caldwell] remember me crying in your office this one particular day. Exactly what you’re describing, and I had my chart, and I’m not a crier but I burst into tears in front of you. But you were so kind and so patient. And you were able to give me the advice that I needed and you were able to connect those pieces for me right there—the understanding that my expectations [needed to change]. I was expecting my chart to change and it didn’t do what I wanted it to do, and I needed to accept myself and my body, exactly where I was.”
Bruno affirmed, “Your position is so valuable and your ability to recognize that, I think, is really beautiful.”
Hormonal birth control is often an attractive alternative to having to sit with patients during tough emotional moments
Dr. Caldwell noted, “When you’re sitting in front of somebody who’s really struggling with the deep, dark places in themselves— if the doctor in front of them or the person in front of them is not comfortable in those spaces within themselves that that is connecting with— there’s going to be a temptation for me as the ‘fixer’ to say ‘okay, what can I do to fix her to get her out of here quickly so that I’m not dealing with this anymore?’”
She acknowledged, “The Pill works” to Band-Aid the symptoms of many reproductive problems, including problems that may be complex and take a long time to treat. Whereas fertility awareness charting may point to a need for further testing, extensive work-ups, and many more visits, hormonal birth control gets a woman in and out quickly and the doctor can move on to the next patient.
Dr. Caldwell continued, “And so I get it. I get why doctors cling to their birth control prescriptions. Totally get it. I sympathize. Because if you’re not willing to be comfortable with that pain, then you’re just going to want to get rid of that pain in the person who is sitting across from you. But what you’re doing is dismissing the woman and helping her to dismiss herself, which we really just should not do. We can’t do that anymore. We’ve got to stop.”
Here’s why it’s so important for doctors to incorporate fertility awareness into their practice of medicine
Dr. Caldwell believes, “When you know your fertility, you know yourself. Your fertility is really a vital sign. If you’re ovulating—and of course there’s a spectrum of variations of healthy ovulation—as you ovulate and understand your ovulation, you’re unleashing these powerful hormones that give us life. Every single physiologic process that a woman undergoes in her body needs these hormones. It is so important… that we understand our hormones so that we can be the best versions of ourselves, be kind to ourselves and be gifts to the world.”
Dr. Caldwell empathizes with the reasons doctors don’t know about or are uninterested in fertility awareness, but she underlined, “We are called, those of us who are at the service of women and their health, to help them to venture forth and be not afraid.” Women who are interested in or already using fertility awareness can learn more about how to encourage their doctors to look into fertility awareness methods here and here.
Additional Reading:
Misconceptions your doctor might have about NFP and fertility awareness, and how to respond to them
