Finding a doctor you like can sometimes feel like entering the dating scene. You might find them online or through a friend’s recommendation, you arrange to meet one-on-one, and then you try to decide if you’re willing to meet again or not. Hopefully, you already have a friendly, trusting relationship with your healthcare provider, but if you’re still looking for “the one” in terms of an OB/GYN, you may find yourself having to say no to birth control again, and again, and again with every “first date.”
Even outside the OB/GYN’s office, you may find yourself feeling harassed about birth control by every medical professional you visit, regardless of their specialty. Two years ago, I went to a doctor’s office to have some stitches removed from my hand (remember to always be careful when cutting avocados) and the medical assistant asked if I was on birth control. I answered “no,” she left, and then no one ever came back for me! After an hour, I started wandering the halls and convinced a nurse practitioner to remove the sutures so I could go home. Maybe there was just some sort of mistake where I got lost in the shuffle, but at the time I was very convinced that I was being unjustly discriminated against for refusing to comply with the status quo.
Why do some doctors feel so strongly about birth control?
“You’re pregnant.” “There’s something we need to discuss.” “I’m so sorry.” “Congratulations!” What might be one of the best or worst conversations in your life may just be one appointment among many for your doctor. Your doctor may have treated young pregnant teens, mothers pregnant again just weeks after giving birth, or women who feel scared, overwhelmed, or distressed to learn that they are expecting. Many doctors entered the medical field in the first place because they want to help people, and they want to be able to protect women as much as possible from the stress that comes along with an unexpected pregnancy.
While fertility awareness takes time and dedication to learn, doctors can send women away with a prescription to start birth control immediately. It’s a simple way for doctors to protect patients against unexpected pregnancy while “regulating” their hormones and (maybe) helping other issues like acne or dysmenorrhea. The difficulty for patients comes when doctors become so certain that birth control is necessary for women to lead a happy and healthy life, that they are resistant to patients wanting a different option (like fertility awareness methods, or methods of natural family planning). It could also be difficult for a doctor to consider the idea that birth control might cause more harm than good for someone when they have advised so many other people to start birth control.
But sometimes the situation isn’t so dire as all that: while some doctors may be unsupportive of fertility awareness no matter what you do, other doctor/patient relationships may just need a little work upfront. If you are willing and able to explain your choice to use fertility awareness to your doctor using these four tips below, you might be surprised by her response.
Four practical tips for saying “no” to birth control
1. Be specific: what your doctor hears when you say no to birth control
After the birth of my first child, I was talking to a physician for my 6-week follow up visit and informed her of my plan to use fertility awareness to space births. She sighed and settled in to explain that I wouldn’t be able to use NFP in the midst of fluctuating postpartum hormones. I quickly clarified that I had taken both FEMM and SymptoThermal classes and that my husband and I were happy to abstain until we felt confident with our charts. Her response was something along the lines of “Oh, wow! You actually know what you’re doing!”
My big takeaway from the conversation was that when this provider hears the words “NFP” or “FAM,” what she actually hears is “I’m just going to wing it and hope for the best!” Letting your doctor know that you have invested time, energy, and dedication into making an informed decision on your health can help them understand that you are taking your health seriously.
2. Build trust: why your doctor might be assuming the worst
If you feel like your doctor doesn’t believe some of the things you say, I’m here to tell you: you’re probably right. Back when I was considering med school, shadowing doctors gave me a lot more perspective on what it’s like to talk with patients. One thing I found was that it’s not uncommon for patients to bend the truth. There were lots of potential reasons: negative past experiences, shame, lack of trust, fear of a diagnosis, fear of not having a treatment approved… but even with just shadowing once a week I saw plenty of contradictions, changing stories, and question-avoiding.
From the perspective of trying to catch or prevent as many problems as possible, it makes sense to assume the worst. That’s why a doctor might run a chlamydia and gonorrhea screen even when you say you’ve never had sex, or try to talk you into birth control after you’ve said you take fertility awareness very seriously.
3. Provide evidence for your “no” to birth control
Some things that might help if you think your doctor is skeptical that you really do track changes in your cervical mucus every day and abstain for nine or so days a month when trying to avoid pregnancy, are: offering to show her your charts, giving an overview of your preferred method, and asking if she has any questions. Hopefully, this allows for a better patient/doctor relationship around your health, especially if you where you live or what insurance you have prevents you from finding a doctor that is enthusiastic about fertility awareness. If your doctor is still dismissive of your values regarding your reproductive health after this conversation, then it may be a good time to try again with a new provider, perhaps one available through telemedicine.
4. Ask for a note to be made in your chart
A friend of mine who was working for a respiratory specialist told me that it was office protocol to red-flag patient charts for additional counseling for any women who were not on birth control. Note that this wasn’t an OBGYN office, but a respiratory specialist. Since some medical providers consider birth control to be an essential part of women’s health care, your provider may have made a note in your chart to make sure you aren’t missing out on something important. Explaining your situation and requesting a note be made saying that you’re unwilling to consider contraception could save you time and seemingly endless conversations about your decisions.
You and your healthcare provider have a common goal
“Women’s health” includes topics that are deeply personal and intimate: sex, fertility, pregnancy, and birth, and it can be difficult to feel like you have to fight for what you value in these areas. However, what feels like a confrontation at the time is usually really two parties who want the same thing (your health and wellbeing) but aren’t seeing eye to eye about how to get there. When five different people are sent in to give you the “it’s really important to use birth control” talk before discharging you after giving birth, they just want to make sure that you won’t become pregnant again before you’re ready. Having an open and candid conversation with your healthcare provider about the research, time, and commitment that’s gone into your decision to use fertility awareness can help them to understand that you’re both ultimately working towards the same goal.
Need resources to share with your doctor? Click here!
Additional Reading:
Tired of the critical comments about your NFP use and pregnancy and parenting choices? Boundaries can help
Is your doctor not listening to you? What to do when you experience medical gaslighting
