Family Planning Post #6: Barrier Methods

I started in Post #5 to discuss various methods of birth control. This is a continuation of that effort. After I've finished discussing all the major categories, I will attempt to discuss how we should think about these things and make good decisions. On with the barrier methods and spermicides....

Male Condom

Basically, the male condom places a layer of latex rubber between the male and female to keep the sperm from getting to the egg. It is a contraceptive method.

In his chapter on contraception in Evangelical Ethics, John Jefferson Davis writes, "When consistently used, the condom can be an effective contraceptive device, having a pregnancy rate as low as three per 100 woman-years [this means that three in every one hundred women will get pregnant within one year of use]. It has the advantages of simplicity, low cost, and partial protection against venereal diseases. Its disadvantages include psychological distraction, dulling of sensation, and occasional breakage or leaking. There are no known health hazards associated with its use." (p. 34)

It seems like almost everything he writes is widely accepted. In my research, I have read some things (mostly published by the Couple to Couple League) suggesting that it's possible that, when there is long-term consistent use of condoms, and the female body is not used to her husband's semen at all, her body may end up having a harsher reaction to the semen when it is present. Basically, if you use condoms all the time and then stop using them because you want to get pregnant, you may experience problems for a period of time while the female body gets used to this "foreign substance".

Additionally, in The Art of Natural Family Planning, Kippley and Kippley cite a Washington Post article from 1989, which reads, "'Women who rely on birth control methods, such as condoms and diaphragms, that prevent semen from reaching the uterus are more than twice as likely to develop one of the most serious complications of pregnancy as are their counterparts who had been repeatedly exposed to sperm from the prospective father.'34 The complication is called preeclampsia or 'toxemia of pregnancy' and 'is the third-ranking cause of pregnancy-related death, following infection and hemmorhage.'" (p. 12)

Clearly, there are many virgins who enter marriage never having experienced the invasion of sperm in their bodies, their bodies don't end up putting up an all-out protest, and they get pregnant right away and maintain their pregnancies. However, these are things we should be aware of. It is one of the reasons that, while Chet and I were trying to prevent pregnancy for a short period of time after the birth of each of our boys, we used a combination of the fertility awareness method and condoms. When I was clearly infertile based on my charting, we didn't use anything, but during my more fertile times, we used condoms.

Female Condom

Basically, they line the vagina instead of having to be worn by the man. They are contraceptive in function. They can be inserted up to 8 hours in advance, so there's less interruption. However, they are not used very often because they tend to be more difficult to use than male condoms, they seem to have a higher failure rate (maybe because you have to learn how to insert them properly), they tend to cover the clitoris which obstructs female climax, and they are certainly much more expensive than male condoms. Some people appreciate the idea that the female can share in the wearing of the condom, but it seems clear that this is not enough to motivate large numbers of people to overcome the other obstacles related to using these devices.

Cervical Cap and Diaphragm

The cervical cap and diaphragm are both dome-shaped rubber devices inserted over the cervix to prevent sperm from entering the uterus. Both are generally used in combination with spermicides to optimize effectiveness.

The cervical cap is not widely used or recommended because of its many disadvantages and risks. I'm not going to spend a lot of time on it for these reasons, but if you're interested in learning more, please read an overview here.

The diaphragm, which is much more commonly recommended and used, is a dome-shaped barrier made of soft rubber that is inserted to cover the cervix in order to prevent sperm from entering the uterus. The woman must be fitted for the diaphragm, and because the shape of the cervix changes so dramatically throughout the cycle, it is important to be fitted at the time that she is most likely to be ovulating. The diaphragm is generally used in combination with a spermicidal agent. With a proper fitting and when used with a spermicide, the diaphragm is ineffective about 5% of the time (which means that 5 out of 100 women will get pregnant within one year of use). When improper fittings, improper use, or absence of spermicidal agents are factored in, the failure rate tends to be upwards of 20%.

Additional disadvantages include a greater risk of urinary tract infections and the need to be refitted and replace the diaphragm after pregnancy, surgery, weight changes, etc. Also, see the last three paragraphs at the end of the section on the male condom, as they apply here as well.

Many people enjoy the diaphragm because it can be put in place early in the day and left there so that there is no interruption in intimacy. Additionally, it seems that there is no noticeable diminishing in sensation for either the man or woman.

The diaphragm itself is contraceptive in nature, so it would appear that there is no inherent moral issue with its use as a rule. However, it tends to require the use of accompanying spermicidal agents to optimize its effectiveness....

Spermicides

Spermicides come in various forms, but they are chemicals that are used to kill the sperm cells before they can reach the egg to fertilize it. They are considered a barrier method, because they present an obstacle for the sperm to overcome on their quest to reach the egg.

In Evangelical Ethics, John Jefferson Davis writes,

Devices such as condoms and diaphragms are frequently used in conjunction with foams, creams, suppositories, and jellies, which contain spermicidal chemicals. Until the early 1980s there was little or no concern about possible harmful side effects of these chemicals. But then a study, conducted under the auspices of Dr. Herschel Jick and the Boston Collaborative Drug Surveillance Program raised the possibility of a link between the use of such vaginal spermicides and a higher than normal incidence of birth defects. Researchers studied the children born to a group of 4,772 women in Seattle, Washington during an 18-month period. The incidence of severe birth defects, including Down's syndrome, malignant brain tumors, and limb deformities, was twice the rate of those born to nonusers.35 While the total rate of serious defects was low--2.2 percent for babies of spermicide users versus 1 percent for nonusers--the results were still a matter for concern. Animal experiments have shown that the spermicidal chemicals can be rapidly absorbed through the vaginal wall into the bloodstream and then carried to the ovaries and uterus. Dr. Jick noted, "It would be prudent to give up spermicides at least two months before getting pregnant, and to stop using them immediately if you suspect you might have already conceived."36 (p. 35)

In The Art of Natural Family Planning, Kippley and Kippley write:

"The most serious problem with barrier methods is an increased risk of miscarriage if pregnancy occurs. 'Women who inadvertently become pregnant while using spermicidal contraceptives suffer about twice the rate of miscarriages in the first three months of pregnancy as other women, according to researchers at Temple University and the New Jersey School of Osteopathic Medicine.'30

Another serious problem: spermicidal foams and jellies may cause birth defects. This allegation was made in the medical literature in 1981, challenged, and reaffirmed by those who made it.31 In January 1985, 'U.S. District Courth Judge Marvin Shoob said Ortho Pharmaceutical Corp., which makes Ortho-Gynol Contraceptive Jelly, knew its product could cause birth defects and was negligent for not warning its users.' The court awarded a judgment of $5,100,000 to the parents of an unplanned pregnancy child born with birth defects.32" (p. 12)

Further links regarding spermicides:

"Birth Defects Tentatively Linked to Spermicide Use," New York Times, 1981

"Spermicide: Vaginal Route," Mayo Clinic. This article includes the following statement: "Many studies have shown that the use of vaginal spermicides does not increase the risk of birth defects or miscarriage."

In the end, there are quite a few studies that suggest that there is no link between spermicide use and birth defects or miscarriage. However, in my mind, it would seem reasonable, based on some of the research provided, to take the safer route and avoid spermicides if possible. I'm not a person who lives in great fear of things going wrong, so I don't think this is an opinion I've formed out of paranoia. Instead, I kind of see it like the Atkins diet... there are people who did lots of studies that showed that there was no link between heart disease and the Atkins diet. However, there is an uncanny number of people on the Atkins diet who develop heart disease and die. I'm not on the Atkins diet because I'm taking the safer route. It seems like I'd take risks to another person's life even more seriously.

Family Planning Post #5: Natural Family Planning, Fertility Awareness, Sympto-Thermal Methods

In an effort to provide you with more specific information regarding family planning methods available, I am going to try to address them more individually. So here goes...

Natural Family Planning, Fertility Awareness Method, Sympto-Thermal Method

Basically, all three titles above are used in reference to the same thing--a method of noticing and keeping track of various signs your body provides to demonstrate whether or not you're fertile. In general, there are three things to check:

• your basal body temperature (your temperature early in the morning before any activity or other things have had a chance to impact your system)
• the amount of cervical fluid/mucus that your body is producing (this is generally checked externally and internally)
• the height, softness, opening, and wetness of your cervix (this is checked internally)

When you are experiencing signs of greater fertility, you basically either abstain from intercourse or you use another method (realizing that the other method may or may not be as effective as abstaining. and you have to be careful about the other method you choose). When done properly and if you abstain during your most fertile time, this method has the same effectiveness as something like the pill (greater than 99%).

The advantages (when additional methods are not introduced) include:

• 100% medical safety
• no physical side effects
• no requirement of surgery, chemicals, drugs, or mechanical devices
• complete reversibility
• no cost
• increased ability to detect other problems if your cycle is abnormal (i.e. nutritional deficiencies, cysts, cancer, etc.)
• increased awareness of when to try to get pregnant if you end up having difficulty, as well as an opportunity to detect the problem and find remedies
• increased communication between husband and wife

Possibile disadvantages include:

• difficulty in abstaining during the fertile time, especially since this is the time that the female is generally most interested in intimacy
• difficulty in reading the signs if your body is not giving super-clear indications
• since most medical schools don't educate their doctors and nurses well in this area, you may have difficulty finding a medical doctor near you who can help if your body is doing weird stuff (one way to take care of this if there really is no one in your community is to sign up for a Couple to Couple League class, because with the membership comes a year of free medical advice from their staff of doctors if you have trouble understanding your charts or what your body is doing)

Further reading/research opportunities:

• Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health by Toni Weschler. This is a great book to start with, and it will probably provide enough information for most couples. Keep in mind that she is not writing from a Christian perspective... which in my mind is helpful, because she is very quick to remind us of the health risks of many of the methods we're so apt to use because of their immediate convenience. I see this kind of book as a common grace to people who would not otherwise be motivated by things of the Lord. I would just suggest that you never recommend the book to a friend without also pointing out that you don't agree with MANY of her statements and conclusions. For example, at the back of the book, she refers to the morning after pill as a form of emergency contraception and gives a reference to where to get it. She also regularly refers to your "partner" as opposed to "husband" throughout the book. Basically, she doesn't focus on any moral issue other than the fact that the female is the one who has to inject her body with stuff while the male does nothing--women's rights stuff. Despite these problems, I still think the book is very helpful for many reasons, including the fact that it actually shows color photos of the various types of cervical fluid so you can determine what they actually mean when they use terms to describe it.
• The Couple to Couple League (a ministry of the Catholic Church) offers classes all over the country as well as loads of resources regarding Natural Family Planning. (NOTE: Keep in mind that the Catholic Church has a fundamentally different view of the purpose of sex in marriage than most Evangelical Christians in that the Catholic Church teaches that EVERY act of sexual intercourse must be EQUALLY open to the gift of children, whereas most Evangelicals would argue that every MARRIAGE should be open to the gift of children but that it's not necessarily true that every act of INTERCOURSE be equally open to the gift of children (that's when you test your motives). Basically, the Catholic Church teaches that if you think you have a valid reason for preventing pregnancy, then you shouldn't have sex at all while you're fertile. We'll get to that more later, but I just wanted to point out that, while I think the Catholic Church offers a TON of helpful information and help to us, I don't fundamentally agree with everything they say.)
• The Art of Natural Family Planning by John and Sheila Kippley. This a book published by the Couple to Couple League and was the text for the class Chet and I took at the Catholic Church. My cycles tended to be a bit strange, and this book offers a bit more detail about how to read weird cycles than Taking Charge of Your Fertility offered.
• Fertility, Nutrition and Cycles by Marilyn Shannon is a great book to help you figure out how to naturally remedy some of the weirdness if your cycle is abnormal or if your signs aren't as clear as you need them to be. She makes a lot of helpful dietary suggestions and focuses in general on lifestyle choices (i.e. if your body produces very little mucus, she recommends adding a good fish or flax oil supplement to your diet so that you produce enough fluid to make it easier to determine when you're fertile). Further, if you have problems with your actual menstrual cycles, PMS, or other issues, she offers some helpful dietary suggestions.
• Your BIBLE is always something you should keep beside your other reading materials, making sure that you are testing things against the Word of God.

Our Tiny Little Man

I took Gabe to the doctor today for his 18-month check-up, and he is so TINY! I knew he was, but when he weighed in at only 20 lbs. 0.8 ounces, I was a little bit surprised. He's actually lost a little bit of weight in the last month or so. That puts him WAY below the 3rd percentile for his weight. He's down to about the 25th percentile for his height, so that's not super-great either. We're basically in the same place we were with Ladan at this age.

He's starting to eat less and less all the time, probably because of his teeth (they take forever to come in, and he has a really hard time with them). It's also entirely possible that he's a little bit anemic (he was a few months ago). He doesn't eat much meat at all and doesn't eat as many green veggies as he should, especially if he's going to boycott meat in any valuable quantity. We'll have his iron level checked in another couple of weeks at another appointment, so they didn't check it today. If he's still anemic, we'll go from there.

I absolutely love that my kids will eat fruits and veggies until the cows come home, but they really do need some of the proteins, fats and vitamins found in meat. Once Gabe gets a full set of molars fully through his gums, I think he'll start eating more and more. He doesn't seem to have the same aversion to meat that Ladan had (Ladan could pick tiny pieces of ground meat out of spaghetti in his mouth, eat around it, and spit the meat out)... he just doesn't want to eat more than a couple bites at a time. Ha! I just had a random thought. Maybe Ladan's early meat-extraction and spitting practices will help him when he's eating sunflower seeds on the baseball field in the future. I still cannot figure out how to put multiple seeds in my mouth at the same time, find the seeds, and spit out just the shells.

While the nurse was giving Gabe his shots, Ladan noticed that his brother was in distress (to put it mildly). A look of grave concern took over his face, and he started speaking very firmly to the nurse, "Hey! You keep hurting my brother!" and "STOP HURTING MY BROTHER!" I thanked him for protecting Gabe and explained that, even though it was hurting Gabe, she was being kind to him and was trying to help him. Then I made a mental note to prepare him in advance the next time.

Oh, and in the middle of all the chaos, I realized that I had to go to the bathroom really badly and I couldn't wait. Gabe had his shirt on, but since we were waiting for his shots, he had no pants, socks or shoes on. I was NOT going to let him down on the floor with bare feet in the pediatrician's bathroom.... Can you say DISGUSTING? I had to carry him in one arm, use the other arm to take care of myself, and try to go with a squirming toddler in my lap. Ladan kept dropping his car on the floor of the bathroom, and naturally he had to pick it up again, which required that he squat down, tip over a bit, and use his hands to steady himself... even worse than bare feet on the pediatrician's bathroom floor is pre-schooler hands on said floor. I finished up in a jiffy, we rushed back to the exam room, and I busted out the hand sanitizer for all three of us and the car... all with Gabe still dangling over my forearm.

You can see now that the Lord is gracious to reveal the sunny side of an otherwise irritating situation. I loved the fact that Gabe is a little man before we went to the doctor. I could have taken his weight measurement as a clue that I should be completely dissatisfied with his size and that I should rush home to shove his face full of every fatty thing under the sun just to make him grow right away. Then the Lord made me have to go to the bathroom so badly I couldn't wait (which hardly ever happens unless I am just now remembering that I had to go to the bathroom 4 hours ago and didn't do it). This rare emergency trip to the potty forced me to throw my squirming toddler over my arm and hold him the entire time I went to the bathroom, cleaned our extremities, and made it back to the exam room... long enough to remind me why it was that at first I loved having a 20-pound 18-month old!

For the rest of the night, I reminded myself that we do need him to eat more and I do need to figure that out, but at the same time, I really do think he's one of the cutest things I've ever seen! He has tiny hands, tiny feet, a little head, a perfectly little round belly, just the right amount of squish on his thighs, and the biggest eyes, smile, and dimples you ever did see! I love our tiny little man!

Boogers and Bubbles

Quick break from the Family Planning series to provide an update and a few photos...

We had a whirlwind of a weekend! Chet's mom got married in his hometown on Saturday. He had to work Friday night and got off at 3:15 on Saturday morning. I slept for a little under two hours. He came back from work, loaded up the van, and we took off. It took us a little over 9 hours to get to NE Missouri, which was the best time we've made with kids in the car since we moved here (and we weren't speeding). The boys took a quick nap when we arrived, and we got ready for the wedding.

All the townspeople came out for the event, so that was really neat. Okay, I can't seriously pull off that word without laughing. Chet's mom actually used the word "townspeople" in reference to the folks from Novinger, and I cracked up! That's totally what they are, but we had the best time laughing at her word choice. I didn't realize that there were "townspeople" in existence past sometime in the mid-1940's, but I guess I was mistaken. Ha!

Anyway, the wedding and reception were Saturday night. This is the best picture we got of me(standing with our brother-in-law, Mike) the whole night...

On Sunday morning, we woke up and went to church at Pure Air Baptist Church. It's a really great old country church that is made up of about three extended families and a few extras. They sing "Happy Birthday" to you right in the service if it's your birthday. And if you decide to give a birthday offering or anniversary offering, then you get a pencil. The children there were SO KIND to my kids! They were very welcoming and shared a good chunk of the Easter treats that they had just received. A couple of the older ladies came up to me after the service and said, "It was so nice to have you here today! I just loved hearing the sound of little children in the service. We haven't had little ones here for quite some time." And they totally meant it, even though Gabe had to be removed because he was teething and exhausted and was having a really rough time. I've been to church there three or four times now, and there's definitely something really fun about it. I'm not saying I'd trade Clifton for it, but it's a really fun change of pace sometimes.

After church, we went on to Grandpa Kermit's for the annual Easter gathering (which we haven't been to in about 5 years). We had the Easter egg hunt outside, and the guys roasted hotdogs, grilled hamburgers, and toasted/burned marshmallows according to their preference. Gabe pretty much slept through the entire thing, he was so tired.

Then we went on to Chet's dad's house for the evening. He cooked us a big meal and wrestled with the boys most of the night. They had a great time playing with him! He had Easter treats for them, including a Mater and Ramone (from Cars) that talk and drive when they're shaken. The boys think they're pretty awesome!

After that was all over, we went back to Chet's mom's house, and the boys were able to open more fun gifts and candy. Ladan's favorite is "candy beans" (aka jelly beans... the Starburst variety are the best). They got a bathketball game (for the bathtub), a velcro bunny toss, and some fun little popper toys from Aunt Megan and Uncle Mike. Ladan was playing with the bunny toss game and wanted to throw it fast. He said, "I like fast cars, and fast bunnies!" Chet's mom and Danny gave them a basket full of goodies and a bubble machine. They played for a few minutes and went to bed late. We woke up on Monday morning, ate breakfast in town, and then hit the road again, arriving in Louisville in enough time to unload most of the van and sit down for just a few minutes before Chet had to go to work. It was a wild 40 hours, that's for sure!

The boys were finally able to play with the bubble machine outside today, but the wind was so strong, they didn't actually get to catch the bubbles. It was more like being pelted with them. Either way, they had a blast, and a couple of the neighbor girls we hadn't met yet came over to play too. Here are some photos...

If the bubble had been about one inch lower, this would have been the BEST picture!

Ladan does not go easy on the drama factor these days. There were about five bubbles coming his way, and he thought it was hilarious to act like they were brutally attacking him! He's great!

Finally, we got some really exciting news this weekend! Our good friend, Kyle Parrish, got engaged this weekend! We haven't lived in the same city as Kyle for nearly three years, but I feel like he's my little brother. We spent a lot of time with him throughout his college years, and we were so thankful to have a transparent relationship with him that went way beyond just the surface stuff. We heard his heart, and he heard ours. It was like he was part of our family. He's the source of Gabe's middle name, so it's clear that we think he's pretty awesome. Anyway, he's apparently found an amazing girl, and we're really excited for him! They're getting married in August, and we're going to make the trip. He told us that they might come to visit us here in Louisville sometime during the summer, and it was almost more than I could take. To see him more than once in the same year is going to be AMAZING! For those of you who don't know Kyle, sorry for the long discourse on a guy you don't know. For those of you who know Kyle, then you know what I'm talking about and might be a little bit jealous!

Well, I'm working on my next Family Planning post, and Amber's working on her "What If" post, so look forward to those in the near future!

(Note: There are some weird line breaks in this post! I kept fixing them, but they kept "fixing" themselves back. Whatever. I'm not going to waste any more time on it right now as long as you don't think that I don't know how to hit the "Enter" button the appropriate number of times to designate a paragraph break.)

Family Planning Post #4: Concerning Ectopic Pregnancy

(For those of you visiting from Amber's blog, thanks for stopping in! You'll want to read Post #3 below before you read this one. #3 is the foundation for so much that we believe, and you won't likely get the full meaning of this post without reading it first.)

There was a question raised regarding ectopic pregnancy as a result of the last post. I will admit that I have no personal experience and very little knowledge regarding ectopic pregnancy, though I have known friends who have gone through them (it was AWFUL). With that in mind, I did some limited reading. One article I found to be helpful is written by the American Academy of Family Physicians. It provides some detail about rates of ectopic pregnancies, where they land, how they are resolved, etc. You can read it yourself at http://www.aafp.org/afp/20000215/1080.html if you're interested.

I deduced/reasoned several things from this article, but I'm up for correction if any of you know more or have other experiences...

1. There is a good percentage of ectopic pregnancies that resolve themselves without treatment (and sometimes without the mother even knowing they existed).
2. It seems like ectopic pregnancies are difficult to diagnose clearly, which is why a woman can so easily find herself in an emergency situation.
3. When they are diagnosed early, if there is no immediate danger to the mother, it seems as though there are many doctors who monitor the situation VERY closely to see if it resolves itself... either by re-implanting itself (which is VERY uncommon, but may be possible) or by dying and being removed naturally. If it's resolved, then no action is necessary.
4. There are some cases where the location of implantation and size of the life (and apparent impossibility of re-implantation) cause the doctors to make decisions to recommend removal of the life. There are also some cases in which the organ where the life has implanted begins to rupture or tear, making it impossible for the life to continue and creating an emergency situation for the mother.

Another helpful story to make things even more complicated... One of my friends just told me about a woman who had an ectopic pregnancy where the life had implanted in her fallopian tube and then moved and re-implanted in her intestine. Because there was significant blood-flow in the intestine, the baby was able to survive, be delivered, and was just fine. The pregnancy was very high-risk, but both mother and baby survived.

My thoughts in response to all of this... I would say that, because there is significant evidence stating that many ectopic pregnancies resolve themselves (either by being naturally removed or, in the rare case, by re-implanting), one should not necessarily jump to remove the pregnancy automatically. AND AT THE SAME TIME, the mother should be closely monitored to see if things are digressing.

If a mother has a motivation to do everything to preserve her pregnancy, is closely monitored, and her doctor comes to the conclusion that it is really, truly impossible for the life to continue and that she is in grave and immediate danger... or if she begins to rupture (thereby making it impossible that the life will continue)... it would seem like it's not imprudent to take the advice of her doctor. Maybe???

And yet, if a baby was developing in the uterus, and a doctor determined that the baby and the mother were in grave danger, I would not suggest that the life of the child be terminated. In fact, I would suggest that it should NOT be terminated. Instead, I would recommend that the mother and baby be closely monitored so that if rupture or something else happened, the doctors were nearby to help preserve both the life of the child and the mother if possible.

I'm not sure if there is a discrepancy here (between my thoughts on the ectopic or correctly implanted pregnancy), so I'm totally open for help on this one. I don't think there's an easy answer from a human perspective, and yet I know that there's a right (as in acceptable and without error) answer according to the Lord. I just don't know what it is. Help me out here, those of you who have expertise or thinking minds. I'd also like to know if any of you have thoughts about how all of this plays out in less-developed countries where they lack the same technology we have.

Additional Thoughts

One way to help filter through whether or not your doctor is giving you advice that is out to preserve life at every stage is to interview him/her at the outset--as in, before you decide to employ this person as your physician--to determine these things. Then, if and when a tragic situation like an ectopic pregnancy occurs, you will still need to think for yourself, but will be able to trust your doctor's recommendation with a bit more confidence, even if he/she says that medical intervention is necessary.

I read several articles discussing the details of ectopic pregnancy. Here are a few of them (in addition to the one listed above):
KidsHealth: Ectopic Pregnancy
American Pregnancy Association: Ectopic Pregnancy
Mayo Clinic: Ectopic Pregnancy

If you read these articles, you'll notice that in each article, there is a list of things that contribute to an increase in the chance for ectopic pregnancy. These lists have inevitably included a set of information regarding birth control methods (temporary and permanent) that increase the risk for ectopic pregnancy (you can deduce this information from the paragraphs in the KidsHealth article even though specific methods aren't listed).

You'll also notice that the APA and Mayo Clinic articles list the IUD as one method of birth control that increases the risk of ectopic pregnancy. However, the American Association of Family Physicians article describes that the IUD does not likely contribute to an "increased risk" of ectopic pregnancy simply because, when a woman has an IUD in place, IUDs are more effective at preventing the life from implanting in the uterus, and because of this, the life is more likely to implant in another (ectopic... "out of place") location or not at all. I think that this is a helpful thing to think about, because it demonstrates to us the complexities of the issues at hand. Basically, what they're saying is that the rate of ectopic pregnancies as compared to successful intrauterine implantations is higher, not because the rate of actual ectopic pregnancy goes up in IUD users as compared to non-IUD users... but because the rate of successful intrauterine implantations goes down in IUD users as compared to non-IUD users.

It seems to me that this is just one more confirmation that there are a good number of "breakthrough" fertilizations with the IUD, and it gives us a good picture that, when the IUD is functioning properly, it does indeed create a hostile environment for implantation in the case of breakthrough fertilization. If it did not create a hostile environment for implantation, then it would not be nearly as effective at "preventing" pregnancy. Why? If the first function of the IUD--which is supposed to be that it prevents fertilization by making it harder for the sperm to reach the egg--were effective, then it would seem that the number of ectopic pregnancies would actually DECREASE among IUD users... because there would be fewer breakthrough fertilizations of any kind that needed a place to implant. The fact that there are at least as many ectopic pregnancies among IUD users than there are among non-IUD users should be a helpful piece of information in helping us decide that there is serious cause for alarm when it comes to this method of birth control. I hope I just made sense there.

Further, I have been convicted during the research for this series that, if a choice I'm making regarding family planning increases the chance for ectopic pregnancy, then that method should be excluded from my list of options. After all, in the end, doing something to my body to cause an increase in the chance that a life would implant in the WRONG place is not different than doing something that would cause the life to fail to implant at all... because it's my job to do everything I can to prevent myself from adding to the chance that my child would not survive. I told Amber and Chet the other day that this was a new aspect to my line of thinking that I hadn't really thought about before... and when the ectopic pregnancy question was raised in comment to my last post, I realized even more that this is a very important ethical issue. Basically, I had not really considered the risk of ectopic pregnancy as an issue related to birth control methods prior to about a week ago even though it makes total sense... it's just evidence that I didn't know a lot about some things and needed to research in order to find out that there is indeed a significant connection.

One more thing just came to mind... I think that the story above about the woman whose baby implanted in the fallopian tube and then re-implanted itself in her intestine and went on to survive is a demonstration of my point that it doesn't necessarily take implantation in the uterus to deem this a human life that we're talking about.

These are certainly weighty issues we're discussing, and we should not handle them flippantly without due consideration. After all, this ectopic pregnancy discussion could help us to think through so many aspects of family planning that we might not have otherwise considered. I know it has done just that for me. I haven't obviously come to any clear conclusions about what should be done in all the various situations regarding an existing ectopic pregnancy, but I have concluded that I do not want to do anything that would increase the risk of being put in that situation or increase the chance that it would be impossible for my child to survive. This topic will come up again when I finally get around to posting about where I am right now with this whole issue as it applies to our family.

On that note, I would LOVE to hear some of your thoughts, experiences, etc. on this issue. Have any of you had ectopic pregnancies that you feel comfortable discussing? If so, did your doctors give you any information about the process of deciding when it was time to remove the baby from its incorrect location? Or did they resolve themselves either by re-implantation or natural miscarriage? Are any of you actual doctors who can speak to any of these issues? I realize that these are VERY sensitive subjects, so I want to emphasize that I am humbly asking for your thoughts because I just don't know exactly how it all works.

Family Planning Post #3: When Is "It" a Human Life?

As a result of the first few posts we've written, a couple of very good questions have been raised. One of these questions is, "How do you determine that the fertilized egg is a baby at the time of fertilization as opposed to after it implants in the uterus (or sometime later)?"

What a timely question! As most of you know, there is a raging debate going surrounding this very issue. We asserted that we believe that a cell group is a human life that is to be protected from the moment of fertilization. Many people believe that it is not until implantation or sometime later that this group of cells becomes a human being with a right to life, which is how they can justify the "morning after" pill even if they believe that surgical abortion is wrong. Still others assert that the right to life doesn't develop until a normal child is up to two years old and can engage in complex social interactions--a position held by Dr. Peter Singer, professor of bioethics at Princeton... who also believes that infanticide and euthanasia are viable options and even obligations in many cases if the individual cannot contribute in a "meaningful way" to society. I don't think there are a whole lot of people who adopt the views of Dr. Singer, but just in case you didn't know, they're out there teaching in our Ivy League schools.

Obviously, there is a wide range of opinion regarding the moment of imparted personhood. How do we tear it apart? When exactly does the "mass" or "tissue" or "cell group" become a real human life? Some say it's when implantation occurs, some when the heart starts beating, some when the baby develops feelings, some at birth, and so on. Addressing these in reverse order, here are my thoughts...

Premature babies are still babies even if they come out at 18 weeks and are no more developed than their counterparts who are still stuck in the womb, so experiencing birth is not the indicator of when it becomes a real human.

As for the argument that feeling indicates personhood, I'd simply respond by saying that there are adults who become completely paralyzed, and simply because they couldn't feel us cutting off their limbs doesn't mean that it's acceptable.--they are people, so we treat their bodies with respect (not to mention that babies can probably feel a lot more a lot sooner than we think, as is evidenced in the movie Silent Scream).

In answer to the heartbeat argument, I would say that all of the genetic information necessary for a heart to beat is present from the beginning, and so simply because it's not beating yet doesn't mean that it's not going to beat or that somehow we're not talking about a baby until we hear or see the heartbeat. Sure, the heart is necessary for life, but so are the lungs, and we don't tend to say that lack of lung function means that it's not a real person. I guess I'm just saying that it's a pretty random and arbitrary thing to say that the heartbeat indicates personhood. Not to mention that if a person's heart stops beating, forcing that person to have a transplant, we still consider it to be a "person" lying on the operating table even during the point in time when there is no heart present in the body, and the blood is flowing through a machine. The functionality of a particular organ or lack thereof does not indicate personhood or lack thereof.

Regarding the issue of fertilization vs. implantation as the point of imparted personhood, I don't think we need a ton of medical statistics to think wisely and correctly about this issue. Thank goodness! However, in order to come to a right conclusion, I think we do need to have a basic understanding of the process of human reproduction. So here goes... You start with "the act" (quoting the grandmother of one of our good friends). The sperm travel from the man, through the vagina, through the cervix, through the uterus, and into the fallopian tubes. There is generally one egg sitting in one fallopian tube. Some of the sperm make it through the treacherous obstacle course, get all the way to the egg, and attempt to break through the wall of the egg. One gets in, and the two cells (egg and sperm) mesh all their information and become one cell. Their DNA links pair up to form the complete chromosomal make-up of the baby.

The new cell immediately starts multiplying as one unit. It's a life with all the information necessary to develop throughout pregnancy, childhood, adulthood, and right up through death. The group of cells continues to multiply as it moves out of the fallopian tube and into the uterus, where it finds a nice place to implant and acquire necessary nutrients for continued growth (FYI--the placenta grows as an organ of the baby--with the baby's genetic makeup and not the mother's--and begins to function on its own over the course of the next two weeks).

The implantation into the uterus prompts the mother's body to produce a hormone called hCG, which basically tells the mother's brain to continue producing progesterone and estrogen in proportions that will not prompt the sluffing off of the uterine lining (and the baby). So you have a blessed 9 months without periods (or if you're like me, more like 21 months if you include the post-birth period-free time)!

These are all amazing functions of implantation in the uterus, but neither the nourishment nor the signal to the mother's hormones do anything to change the make-up of the "group of cells" that already existed. That, to me, is the profound truth that we need to understand. Basically, the cells implant in order to be nourished to keep growing and developing. They are not changed in any way. They were already living, completely-human cells and a sole entity before they implanted. The uterus imparts no humanity on the group of cells since they are completely-human cells on their own before they get to the uterus.

One way to look at it is this... I can make it a while without food and water, but if I go more than a few days with no nourishment or hydration at all, I will die. Once the egg is fertilized by the sperm, the two mesh together to form the complete genetic make-up of a human being, the "cell group" begins to multiply, and then travels through the fallopian tube into the uterus, it's just fresh out of juice! It needs nourishment, or else it will die. This is a common problem for humans at all stages, and it begins at fertilization.

The egg and sperm combo is a developing life right from the very beginning. It is a complete unit that simply needs nourishment to keep going. If we do things to alter the lining of the uterus so as to prevent implantation, all we are doing is preventing the nourishment of the already-existing life... so it dies. This is why we see any process, procedure, device, or chemical that contributes to the death of this life as abortifacient. It's either directly causing the already-living, completely and fully human life to die or removing its provision for survival. When we consider born humans, we see that there are ways to directly extinguish them (pushing them out of moving cars, shooting, etc.), and there are ways to prevent the provision of sustaining nutrition for them, so they end up dying on their own (i.e. locking them in a room without food and water). Either way, the end result is that the person is not alive anymore.

Wow! That's a lot to think about. What exactly does it mean in practical terms? Basically, it all boils down to this. Since there is no point beyond fertilization that adds anything to the complete human genetic make-up of the child, and the cells have all they need except nourishment and protection, I see this as the point at which the baby is a baby with a life to protect. It's "on its own", so to speak, at the moment of fertilization. Just like I go to the refrigerator to get food, it goes to the uterus for nourishment... to promote growth of the complete (though not fully-developed) being that already exists.

Things like the "morning after" pill introduce a high dose of chemicals into the body to attack and kill the living cells even before they have a chance to implant and receive needed nutrition... they end the life of the child and are a form of abortion.

There are many other chemicals and technologies which may work to render the uterine lining so hostile that implantation is impossible or very difficult. In these cases, there is nothing directly attacking the new life. Instead, the provision for sustenance is removed, thereby "starving" the life to death. If the uterine lining is altered in this way by something that we have introduced to our bodies, then we have, in effect, caused the same end result as the person who introduced attacking chemicals into her body.

This type of clarity is an incredible help to us as we determine which types of birth control are abortifacient and become unacceptable to the Christian (and hopefully to the common) conscience. There are some forms of birth control that are clearly designed to make the uterine lining hostile to implantation. And there are others that list this alteration of the uterine lining and prevention of implantation as a "back-up" function in case the other functions fail. In general, the other two functions of these treatments include one or more of the following: 1) altering the hormones of the woman in such a way that her body does not ovulate and release an egg, and 2) altering the vaginal fluid of the female in such a way that it is more hostile to the sperm, rendering the sperm incapacitated and unable to complete their march to the egg. Then, the "back-up" function in case the others fail, is to alter the lining of the uterus to make implantation more difficult. Many medical professionals and others say that it's just a theory that the change in the uterine lining causes difficulty in implantation (though they don't refute the actual change in the uterine lining). In my mind, I can't see why this third function would need to exist or be listed as part of the functionality if it never came down to it actually working that way. I'm at least convinced that there's a chance that it works this way, and that's enough for me to make a decision about a lot of available options.

So, in the end, I think I've answered the question of why I believe that fertilization is the point at which the baby is a human life to be protected... and then gone on to describe some of the implications of this clarification as we consider acceptable forms of birth control. This is, by no means, a complete thought regarding specific forms of birth control, but it does provide a foundation for why these discussions are so important.

Amber is preparing a post to introduce some "What-if" questions (for example, "What if my husband is not on board with my convictions?"), so that will be coming very soon. I have really been researching and thinking more about my current situation with the c-section business as it relates to sterilization and other methods of birth control, etc., so I'll post on that soon. I think I'm also coming to the conclusion that it would be helpful to include a post on each form of birth control, including research, external links, and opportunities for discussion about them individually. Would this be helpful, or are you finding all the information you need yourselves?

I feel like I need to conclude this post by saying that the Lord is so gracious to me! I am so thankful for a sister-in-law who has great ideas and wants to co-labor with me to think through the hard stuff (we had a GREAT conversation just this afternoon about our individual situations and how we might think about them). And now that we've opened the discussion to the rest of the reading world, I have been so blessed to hear some of your experiences and thoughts! Please keep sharing either by posting comments or by e-mailing directly. And feel free to ask anything you want, even if it's more personal.

For instance, one of my friends e-mailed and asked me exactly what barrier methods I was referring to in the post outlining my story. I was able to fill in the blanks and let her know that we used condoms of the male variety during the 2-3 months that we were preventing after my return to fertility each time. I have a friend who has a diaphragm and loves it, but I don't have one myself. I've never tried the female condom, so I can't speak to that at all. One thing I will say is that it seems like there's sufficient evidence to say that it's important that we pay attention to whether or not we're using spermicides (in sponges, condoms, gel/liquid form, etc.), as these chemicals can lead to an increased possibility of birth defects in babies conceived within up to two months of spermicide use, but more on that later...

Oh, and one more thing... Almost all of the supporting information for this post is included in the links Amber provided. And more detailed support for specific methods and issues will be included in the posts when we address those methods more thoroughly.

(NOTE: I changed the title of this post from “When Is 'It' a Baby?” to “When Is 'It' a Human Life?” It seems to me that people get hung up on the definition of a baby instead of placing appropriate focus on the nature of the human life, which is to be protected at all stages. I hope that this will bring an important point of clarity to my argument.)

Family Planning Post #2: Our Story

As you can see, this is a series of posts on family planning. It would be helpful if you could read them in order, so if you haven't read Amber's Story below, it would be good to start there.

And one last time, if you're a teen or younger, please make sure you have your parents read the posts in this series first and get their permission to read them yourself.

Our Story

Before I get started, I'll let you know that this will likely be a little bit long, but it's been a long road with a lot of questions. My attempt is to give an accurate picture of what it's actually been like to walk through this whole thing... not just to give you a quick 30-second overview so you can move on with your day and say "that's nice". These are really tough issues, and I do not want to pretend in any way that we have had an easy time coming to any single conclusion regarding family planning and birth control methods. Likewise, I do not want anyone to think that it's strange to have lots of questions and not know what to do with them or how to begin to answer them. It's tough, especially when most couples often have very little information and don't know what's reliable. With that in mind, here goes...

About two years before I was married (at approximately age 19), I went to the doctor to discuss my irregular cycles. I would have three periods in one month and then go three months before having another one. This had gone on for about two years, so I figured there was something wrong. After about 10 minutes of discussion, the doctor prescribed the birth control pill to regulate my cycles. It remedied the situation, so I kept taking it.

In 2000, Chet and I got married, and I just kept taking the pill. We were both in college, and since we weren't ready to start "trying" to have kids, I proceeded to refill my prescription every month. I didn't have a lot of side effects that I noticed, so I never saw any problem with it. There was just one issue that came up after I was on the pill for about a year. My doctor in our college town was asking me questions about my family's medical history and began to ask me if anyone in our family has ever had problems with clotting (since this is a common risk associated with taking the pill, she didn't want to make a problem worse if it already existed). I told her that MANY people in my family have had clotting issues. Before she would refill my prescription, she ordered some clotting tests. They all came back negative (saying that I didn't have an unusual problem with clotting), so she refilled the prescription. That was the end of that.

Fast forward about 2 1/2 more years. I had graduated from college and was gainfully employed. Chet, however, was raising support to pay his salary as a part-time associate pastor at a church plant in town. He had two other jobs in addition. Oh, and he was part of a band that traveled quite often, especially on the weekends. We were busy, didn't really have "all that much money", and were working to pay off Chet's undergrad student loans. So we still weren't ready to start "trying" to have kids. Our mindset was that, if we're not ready to start trying, then we're preventing and there's no reason to go off the pill. We didn't discuss it much. It was just part of the normal routine, and if I forgot to take it one day, we just made sure we were careful. Pretty simple.

At this time, I was hanging out a lot with a good friend of mine named Angie. We would walk at a nearby park after work quite frequently. She too was on the pill and hadn't thought twice about it, especially since her cycles were strange (this is why it was initially prescribed to her). Her husband heard some stuff about how it was possible that the pill could be an abortifacient (it could cause abortions of fertilized eggs... aka babies). So he started researching. He came to the conclusion that Angie should stop taking the pill immediately. She nearly freaked out! They still weren't ready to have kids because of some circumstances in their lives, so they enrolled in a Natural Family Planning class at the local Catholic church. I basically watched Angie walk through all of this, but I was still a little bit skeptical of what her husband was saying.

That's when I started researching for myself. Any of you who know me well are aware of the fact that I love to learn, and if there's something I don't know much about, it kind of (or REALLY) bothers me. Realizing that this could possibly be a moral issue, I researched with gusto. Angie shared some things with me that they had come across. I forgot to mention that, in the process of all the aforementioned stuff in their lives, they were converting from Protestantism to Catholicism. As a result of this and the fact that they took the class at the Catholic church, most of the resources were produced by the Catholic church. In my mind, there was no inherent problem with the Catholic church producing useful resources that I could learn from even though I wasn't Catholic. The problem I was running into is that, in the things I was reading, most of the reasons why a person shouldn't use the pill were based on what the Pope said and not on what the Bible said.

I continued my research. I basically got online and typed "Oral Contraceptives as Abortifacient" in my search engine window. Immediately, all kinds of articles popped up, and many of them were written by Protestant authors. Wow! Can I just say that this whole time I never knew this was even a question I should be asking! It was just something everyone did. I had NEVER heard this discussion brought up in any of the Protestant churches I had been part of (and for that matter, I had never even heard it as a discussion among my Catholic friends, who were admittedly nominal Catholics, but still... shouldn't I have heard this SOMEWHERE?).

Actually, it was this shocking moment 5 years ago that has prompted countless hours of research, interviewing, praying, thinking, etc. and that has produced in me a great desire to make it known that there is indeed a moral aspect of decisions regarding family planning and birth control methods, and people need to be able to make INFORMED decisions. Further, there have been many people who have come to us asking us to discuss our journey and our findings in the past, and we assume that there are many others that would ask about if they knew it was something to be discussed. Hence the blog series.

Okay, back to my story. I researched a lot. I read the articles from both sides. I read the Physician's Desk Reference listings for all the types of hormonal birth control that were on the market as well as devices like the IUD. After HOURS of reading from both sides of the issue and tossing these things around in my mind throughout a lot of sleepless nights, and after a lot of talking and praying with Chet, we came to a conclusion... finally. We determined that because it seemed very clear that there is at least a possibility that the birth control pill (of any kind) renders the uterine lining so hostile that it could make it impossible for the already-fertilized egg to implant (thereby aborting the baby), we could not in good conscience continue taking the pill. We recognized the IUD as abortifacient right away because one of its main functions is to irritate and thicken the lining of the uterus to "sluff off" the fertilized egg (which is a baby because it's already fertilized even if it's not implanted). That meant that the IUD and other such devices were also out of the question.

So what would we do? Barrier methods don't always have the best track record. We learned that Natural Family Planning (aka, the Fertility Awareness Method or Sympto-thermal method), when done properly, has a much higher rate of success at preventing pregnancy than barrier methods. We looked into family planning classes, and the only ones that were offered were at the Catholic church. They did seem well-researched medically, so we enrolled in the same class that our friends took. While we see Scripture as the ultimate authority and not the Pope, we did learn some very helpful facts regarding various forms of birth control. We also learned a TON about my body and the way it works naturally, including the fact that it was probably stress and nutritional deficiencies that were originally causing my cycles to be so irregular... and that if I had only known more about my body, there would likely be many things I could do without introducing hormones to regulate my cycles.

Can I just say that this was one point of instant relief for me?! Unlike Amber, who had to go off the pill because of what it was doing to her body, I was afraid to go off it for fear of what my body would do without it. I learned that I could find out a lot about my body just by watching for and charting a few easy signs.

All of these things were helpful, but I think that Chet and I would both agree that the most helpful aspect of the class was the call to consider whether or not we were really trusting the Lord. We had to ask ourselves all the same questions that Amber and my brother had to ask. The instructors of our class did not teach that anyone who wanted to use any method of family planning was automatically lacking trust, but we realized as we looked at our own lives that we were indeed failing to trust the Lord. We're both the oldest children in our families and have had some fairly out-of-control experiences in our lives (who doesn't?), so we had learned to be independent go-getters who had to have things in line and all figured out. Of course, the Lord had grown us each in some ways regarding our need for control, but I think this was really the culmination point of that for both of us.

Chet had three random rather low-paying jobs. I had the 8-5 job with the insurance (which by the way I loved). My job didn't pay a whole lot, and we figured out that I would earn about a dollar an hour after we paid for child care, formula, disposable diapers, extra transportation to and from work, work clothes, and the bump up in tax bracket. So could we trust the Lord to provide for our family if I had to quit my job? This was HUGE! We are not people who spontaneously enter into things without thinking through them first, so it was a tough one... for about a month or two.

We realized that part of our problem was that we were overestimating what it REALLY took to take care of a family. Essentially, we weren't frivolous people, but the Lord revealed to us that there were a lot of wants that we could forego in order to take care of real needs. The Lord doesn't call us to provide for all our family's wants... just their needs. Wow! Talk about a paradigm shift when you already thought you had a pretty minimalist perspective. So we stopped freaking out about it so much. We followed the "rules" of Natural Family Planning for two months with the mind that we were preventing pregnancy. And by the third month, we continued to chart for the sake of awareness, but our hearts had adopted an attitude of trust and willingness (and even a bit of a desire) to accept the gift of children. It was that same cycle (the third one) when I got pregnant with Ladan.

I need to stop here and say that going through these stages of the process helped us both to see how gracious and patient our Heavenly Father is. I mean, seriously, we were so ignorant of so many things, and then when we researched and found out, we just didn't want to accept it... and then when we accepted part of it, we didn't want to be totally humble before the Lord fully seeking what He wanted (because we had a lot of ideas about what we wanted). And through it all, He loved us and was merciful to even reveal these things to us in the first place. We could have gone on for quite some time before He softened our hearts to the penetrating truth of his sovereignty, but He chose that time and place to help us. He gave us the gift of Ladan, that's for sure, but He also gave us the gift of understanding what it really meant to trust Him with our lives.

Fast forward to 13 months after Ladan's birth, which was almost 4 years after we were married. We had just moved to Louisville so Chet could start seminary. My cycles finally returned at this point, and I suddenly realized that I was pretty petrified again of the idea of having another kid--and mainly another possible c-section--so soon. After all, I finally got back to feeling like myself when Ladan was a year old, just one month before. Additionally, I was scheduled to travel to Sudan for a couple of weeks the following month, and I didn't want to be going through the early stages of pregnancy while I was there. I resumed charting so I was aware of what was going on in my body, but I was a little bit unsure of what I thought about using even barrier methods. Was I lacking trust as some said? Was I introducing complications as others suggest? Should we just abstain during my most fertile days as our class recommended?

Here was my thought process on that.... I was all about being "self-controlled" and "disciplined", but God designed my body so that I am most interested in even being intimate with my husband on the same days that I'm most fertile. Chet's system is designed to be ready to go almost all of the time. But mine is designed to be particularly ready at the time when I'm most fertile. Clearly, this is one aspect of the female biological make-up that promotes the population of the earth, and He has a reason for making it this way. He also says in His Word that we're only to abstain from intimacy with one another (as husband and wife) for a time of mutual prayer and fasting. Let me just say that I'm not exactly thinking about praying and fasting when I want to be with my husband. I just want to be with my husband, for Pete's sake. So I had to question whether or not it was indeed immoral for me to want to be with my husband and act on it and AT THE SAME TIME come to the conclusion that we could postpone pregnancy for a time and for a specific reason. This is a tough one for me, and it still kind of is sometimes. My reasoning on it at this time is as follows: It does my husband a lot of good if I initiate things because I desire him, and our marriage is boosted as a result. It also does me a lot of good, not just because it's fun, but because it draws me closer to him and our hearts are more unified (this is the purpose of sex, right?). Keeping that in mind, but also realizing that there were seemingly biblical reasons for us to postpone pregnancy for a time, we decided to begin using barrier methods during my most fertile times (fully accepting that they don't have the same success rate of perfect pill use). And it was helpful to us and our relationship.

So we continued to prevent pregnancy using a combination of charting and barrier methods until we knew more about the trip. A few months passed by, and we decided not to worry about getting pregnant for the sake of the trip. But I still had to get used to the idea that I might possibly have another c-section... and another kid to take care of. Add to this the facts that our insurance didn't cover pregnancy or delivery (which is about $20,000 for a c-section) and that Chet only made about $8 per hour at his part-time job, and it was a recipe for a bit of internal freaking out!

Wait a second! I thought I had conquered the trust issue, and I thought I had decided how I was going to handle myself in the future. Nice how the Lord gives us additional opportunities to apply what we've learned, isn't it? (It really is amazing, but it doesn't feel like it at the time.) Anyway, we decided not to worry about it again and determined that there were many ways that the Lord could provide (including a job change for Chet), so we didn't feel like we were reckless even though we didn't have all the answers. We ceased the use of barrier methods and continued charting for the sake of awareness. Two cycles later, I was pregnant with Gabe who was born when Ladan was 27 months old.

Fast forward one more time to when Gabe was 12 months old and my cycles returned again. I had to have another c-section with him despite my great desire to attempt a VBAC. While we had resolved that we would use a combination of charting and barrier methods for at least a few months, we had a new set of things to consider regarding family planning. How many c-sections can my body handle, and what will we do when we've reached that point? Is it wrong to reach a point where we say enough is enough? We know that we will not use the pill or IUD, that barrier methods may not be effective enough, and that I don't know that it's a good idea for me to abstain during the time when I find my husband most desirable... every single month... for another 15-25 years. In light of all this, is it appropriate to consider either tubal ligation or vasectomy? We know that we wouldn't recommend these procedures to most people our age who have so much of their fertility ahead of them, but what if your body is really done? How do you determine if your body is actually "done"? Is there a point in time when it becomes a stewardship issue and we need to realize that we have x-number of kids at home that we are caring for and that the risks associated with further c-sections are too great? What about our friends who've had upwards of 5 or 6 c-sections and are ready for more? If we don't approach it in the same way that they do, are they trusting more than we are? Are their doctors right when they say people over-react to the dangers of multiple c-sections? Are we failing to understand something?

These are all questions that have gone through our minds. Since Gabe was born, we realized the weight of these questions and began reading, praying and interviewing others (medical experts, theologians, friends who have had a wide variety of experiences, etc.). My next post will attempt to outline some of our recent questions, thoughts, and findings. Stay tuned for that.

In the meantime, there is a relatively short article by Dr. Albert Mohler (the president of Southern Baptist Theological Seminary) that I'd like to recommend. Dr. Mohler can pack a ton of stuff to think about into just a few words, so it will be well worth your read. Here it is:

Can Christians Use Birth Control by Albert Mohler

In his conclusion, he writes, "For evangelicals, much work remains to be done. We must build and nurture a new tradition of moral theology, drawn from Holy Scripture and enriched by the theological heritage of the church. Until we do, many evangelical couples will not even know where to begin the process of thinking about birth control in a fully Christian frame. It is high time evangelicals answered this call." Amen to that! May this blog series attempt to help us all begin the process of thinking in a "fully Christian frame" regarding birth control, and may we end up more educated, more unified, and more Christ-like as a result!

Family Planning Post #1: Amber's Story

As I mentioned in my most recent post, my sister-in-law, Amber, and I are working together to do a blog series on family planning issues. She has kicked it off by providing a look into the journey she and my brother traveled with regard to birth control along with some links to some of the articles she found helpful when researching.

Once again, if you're a teen or younger, please make sure you have your parents read the posts in this series first. They will all have the words "Family Planning" in the title. Since these are topics that parents need to be in charge of sharing with their kids, I don't want to get in the way of that. However, if your parents read the entries and feel like it's appropriate for you to read them as a resource, then I'm all for that.

The rest of this is Amber's post (the only thing I changed from what you'll see on her blog is that I listed the article and sermon titles and linked them to the URLs instead of listing the URL directly, mostly because it helps me to know which article I'm clicking on)...

BC Part One:From A Chemical Decision to a Morality Issue
Post by Amber Burger

As of lately, I have had so many people interested in talking to me about Birth Control and why our family chooses to do things the way we do. I have been wanting to write this series of blogs for a long while now, but have waited for the right timing...it tends to be such a sensitive subject. I love talking about this issue because of the incredible impact that it has made on our life and marriage, but I do realize it is not the easiest thing to discuss. It has taken us on a five year journey with the Lord that has lead us to a much deeper love and trust in Him.

I thought that the best way to start this series is to give our personal testimony on the issue and link some of our favorite articles and sermons on the issue. As you read, please know that this is what the Lord has done in our life...seek Him on the issue and He will resolve in your heart what is right for your family. I know it looks long, but please do endure.

OUR STORY
A couple months before Vernon and I got married, I went to my very first OBGYN appointment. At this, I got prescribed 'the pill' so as to regulate my cycle before our wedding day. This was totally not thought through or anything. I just went in because I thought that is "just what you do." For two months I had these episodes of crashing blood-sugar and light headedness. I would go through surges of emotions and just crash into sleep....it was crazy and completely not like me. The second month I went a week with no problems....and then it dawned on me that that was the week I was taking the placebo pill. So I noted that in my mind and continued taking the pill as directed. The next week it got so much worse that I was crashing HARD, virtually passing out...but conscience. One night this episode happened at my aunts house and Vernon came running into the room, I was crying in the midst of my semi-conscieness and somehow I muttered to him that I thought the Pill was causing this. Vernon decided that we should figure out another way of birth control and I agreed. This was only a month away from our wedding night, so this was not far out to be deciding on our future! What we walked through together that last month brought us so close to each other but even more importantly it built our Love and Trust in the Lord. We were faced with the Truth of His word and had to decide if we REALLY believed it. Did we really believe that God had numbered our days and therefore numbered our children's days? Did we believe that God would not give us more than we could handle? Did we believe that He was our ultimate satisfaction, not time with each other before children? Did I really believe that the Scripture calls children an reward/ blessing of the Lord? Did we believe that He was Sovereign over the affairs of man? Or were all of these truths and many more just ideologies we claimed when it made us feel better?

So at that point we concluded that God gave us wisdom and abilities to make decisions but ultimately it was His Sovereign hand that fashioned and formed our family. Now this did not mean just haphazardly going about our intimate life and not paying attention to the situation we were in financially or just assuming we were mature enough for children. It did mean however, that we relinquished control over the size and timing of our family. It meant we asked the Lord to reveal to us His good timing, in whatever way He liked.

So this issue for us started as a chemical issue and then made its way to a Trust issue and a Control issue.

After the Trust issue was resolved I began looking into alternative ways of contraceptive and what I found was astounding. I had no idea that birth control was in anyway a morality issue. I had not idea that OBGYNs are divided across the board on certain birth controls being abortive. Being extremely pro-life and in complete fear of facing the Lord and Him saying we had had a fertilized egg that was not able to implant in the womb because of a chemical I ingested, I immediately began to read anything and listen to anything I could get my hands on....I wanted to know both sides and what each side said in full. And basically my conclusion was to opt to side on the safe side and avoid any potentially abortive birth control methods.

Yes, we did get pregnant three months into our marriage, but it was not a surprise to us, we knew we were probably going to be. Many people who do not do "natural family planning" give it a hard time and tease about how many kids NFP people have. But to them I will say, we are just now pregnant after 3 1/2 years of an awesome intimate marriage...and we knew about this one too. So there are ways to control that are not potentially hazardous to you or your babies....but in the end, God has numbered the days of your sweet children, they are a reward from Him and He will give you the grace to carry them! amen.

THE LINKS
My favorite sermon so far that I have heard on this topic is by Marc Driscoll and here is the link for that: Religion Saves + 9 Other Misconceptions, Question 9: Birth Control

The first link is my over all favorite article but the rest are great as well:
Does the Birth Control Pill Cause Abortions? a booklet by Randy Alcorn

Readers' Responses to Does the Birth Control Pill Cause Abortions?

Hormone Contraceptives Controversies and Clarifications by the American Association of Pro Life Obstetricians and Gynecologists (AAPLOG)

Birth Control Pill: Abortifacient and Contraceptive by AAPLOG

AAPLOG Response to the ACOG Ethics Committee Opinion #385, Titled "The Limits of Conscientious Refusal in Reproductive Medicine" by AAPLOG

Which Methods Cause Abortion? by Abort 73

Life Is But a Dream

Just about two minutes ago, this happened...

Ladan (singing): "Row, row, row your boat, gently down the street. Merrily, merrily, merrily, merrily, life falls a dream."

Me: "Life is but a dream. That's how it goes."

Ladan: "No, Mom, Life FALLS a dream. It's not a butt dream." The funny thing is that we don't use the word "butt" in our house, so it made me laugh when he appeared so concerned that I would suggest singing a song including such profanity! :)

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And last week, he was singing the song about the house built on the rock. It went something like this...

"The rains came down, and the fuzzes came up. The rains came down, and the fuzzes came up. The rains came down, and the fuzzes came up, and the house on the rock stood firm! Yea!!"

Oh, gracious! I guess we need to do some instruction about floods again! :)

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And, on a fairly unrelated note, my sister-in-law, Amber, has started a series on family planning issues on her blog. She has asked me to work with her to share some of the research we've done over the last 5 years. We have both had a lot of people asking us about it, and we know a lot of people that we wish knew more about it before they make decisions... so we're using this forum to share what we've found and to begin discussions. Our hope is that this can be a resource for people in the future, including ourselves. I'll be posting the entries here on my blog as well, so stay tuned. On that note, if there are specific things you've found or specific questions you have, feel free to let me know in advance.

And, if you're a teen or younger, please make sure you have your parents read those entries first. They will all have the words "Family Planning" in the title. Since these are topics that parents need to be in charge of sharing with their kids, I don't want to get in the way of that. However, if your parents read the entries and feel like it's appropriate for you to read them as a supplemental resource, then I'm all for that.

Haircuts, Glasses and Snowmen

Friday night I cut Chet's and Ladan's hair. It was the first time I used the clippers on Ladan's head, and he was petrified at first. He was pretty much screaming bloody murder. I had to tell him to get control and listen to me while I explained what was happening. Then I showed him on his arm that it just tickled. After a bit more screaming about how he still didn't want it on his head, he got used to it and had a good time. I can see that one of our jobs as his parents will be to help him branch out a bit and get over his fears, sometimes by just making him try something and then getting really excited when he's done it. Anyway, here are a couple of photos of his new haircut... just like Daddy.

Ladan is gearing up for the Cardinals baseball season, that's for sure! He's getting really good at throwing the ball up and hitting it by himself. He doesn't have the happiest face in this second picture, but I like it because it shows how much taller he is than Gabe. I told Chet that I wonder if I thought Ladan was such a little peanut at Gabe's age or if I thought he was big. I really can't remember. I think I thought Ladan was small, just because he was so much smaller than his friends and he still wasn't walking at the same age. Either way, Gabe is a little man, and Ladan's practically a giant, and this is the proof...

Doesn't every kid have to take an opportunity to wear the Mr. Potato Head glasses? What a cute-face kid!

Over the course of Friday and Saturday we got about 12 inches of snow here in Louisville. As a result, the Casting Crowns concert was postponed, not because the roads were too bad, but apparently the bands had some trouble with cancellations at the airports they were flying through. Bummer. They've rescheduled it for May 4, which isn't exactly great timing for us. It's a small group Sunday, and it's right at the beginning of Chet's finals week. Pretty much, the only way it could be worse timing is if they had rescheduled it for a time when I was going to be out of town. In any case, it's better off that everyone is safe. At least we can think ahead how to pull it off.

The snow outside was so deep that I knew Gabe wouldn't be able to walk in it, and I wasn't ready to hold him the entire time (call me a whimp if you want to, but that kid is like a wet noodle whenever he has a snowsuit on). So Chet took Ladan out to build a snowman on Saturday while Gabe took a nap. (Lest you think that Gabe was deprived of an opportunity to enjoy the snow, I'll let you know that Ladan, Gabe and I had a snowball fight outside last night when we got home from church. It was good fun, and the boys were both drenched when we came inside.) Here are Saturday's photos...

Recently, Ladan has been saying he "can't" do quite a few things that we know he can do. We've reminded him that he can do them (sometimes going back and forth a couple of times with him), but he's still been saying it a lot as a bit of an excuse. Today, I started explaining to him that God has given him the ability to do these things, and one way he can show thankfulness to God is by using his abilities and doing the things he knows he can do. This seems to make sense to him, and he's been a lot quicker to snap out of it when I've described it to him this way. Why I didn't step back and think of this myself a couple of weeks ago when it started is beyond me... actually, I'm realizing that it's the Lord's demonstration to me that I would do a terrible job as a parent without His help! Thankfully, He's gracious to reveal better ways to do things to me, and as a result I can be a better help to Ladan.

Update on... Me!

Every once in a while people ask what I do outside of taking care of the boys and making sure our home is running efficiently (or running at all even if not efficiently). To answer that, I thought I'd give a little update on what and how I've been doing lately.

For starters, I've finished three books in the last couple of weeks (I started two of them a while ago and have been working on them simultaneously).

• Holiness By Grace by Bryan Chapell
• The Cross Centered Life by CJ Mahaney
• When Sinners Say "I Do" by Dave Harvey

All three were EXCELLENT books, and I highly recommend them, the first two to every person for sure, and the third to any person who is married, or thinks it's a possibility, or knows anyone who's married and ever gives that person advice or a listening ear (pretty much every person, I'd say).

I've also made/constructed a few things in the last couple of months:

• Shelves for Ladan's wall... we rearranged his room and took his actual shelf out to make more floor space, but we still needed some place to put the books. It was a one-day project that required a trip to Lowe's and the use of a drill and hammer, so it was fun for me!
• Neck pillows for the boys when they ride on long road trips. While completing this project, I sewed in something other than a straight line and installed a zipper, both for the first time. I've never had a sewing lesson, but thanks to Robyne (my stepmom), I have a machine and had some instruction about how to thread it and turn it on! :) She also provided an instruction book and lots of little accessories, which have made it pretty easy to figure things out. Anyway, when I made the pillows, I used a light yellow base fabric and stuffed the pillows. Then I made zip-on covers that can be removed and washed or switched out if girlier fabric is required in the future. The entire pillow is machine-washable, so it should be pretty easy to keep them clean. I'm excited to test them when we drive to MO in a couple weeks. Oh, wait! I just remembered that I did actually have a sewing lesson in eighth grade, but I didn't remember a thing except what the tools are used for in general.
• A squash book. This is a little fold-out book that Beth Schakat (our youth pastor's wife) showed us how to make one night when we were hanging out with the teen girls. It was super-easy and super-fun... and a great gift idea. If I think about it, I'll try to find instructions online and post a link. Here is a link to instructions for several types (I did Book 3).

This Saturday, I get to go to the Casting Crowns concert for the second time in less than 4 months! And I'm going with 7 really fun people... Gretchen and the three oldest Wright boys as well as Michele, Caitlin and Chelsea Murray. The Wright boys have decided that we're eating at McAllister's first, which will make it an all-around good night.

Tomorrow will be my last session of SWI (Seminary Wives Institute) class. After class, I have to write a quick 1-2 page review of the course, and I will have completed all the requirements for the SWI certificate. I have learned so much from my classes and feel like I am much better equipped for ministry and to fulfill my roles as wife and mother. I learned a lot about how to divide the Word rightly, how to practically carry out what it says... and I've met some really amazing women who will be fabulous resources even when we're gone from here. I know there are many seminaries that have basic programs for the wives, but this was much more in-depth, intentional, and helpful than any program I've heard of so far. That's not to brag, but rather, to demonstrate a heart of gratitude to the Lord for a husband who saw this as a priority when he chose a school for himself and for the seminary professors and their wives who invest so much time and energy into preparing us.

Right before that class tomorrow, I'm going to hear Elyse Fitzpatrick (author of Idols of the Heart and Love to Eat, Hate to Eat among other things) speak on campus. The title of her talk is Because He Loves Me: How God's Love Transforms Our Identity and Life. I can't wait!

I'm still in the Continuing in Christ (CIC) discipleship group at Clifton. We're finishing our discussion of Holiness by Grace and getting ready to start discussion of Instruments in the Redeemer's Hands by Paul Tripp. I read that book last year, and it was excellent, so I'm really looking forward to the discussion. As part of CIC, I've memorized some really great scriptures: Colossians 1:15-20, 2:6-14, and 3:1-2 (we'll add chapter 3 verses 3-5 throughout the rest of the semester). That's 20 verses total, which is pretty exciting for me.

Scripture memory is NOT easy for me, but I think I'm finally finding some strategies that are working to help me really store the Word in my heart. I've found it helpful to listen to a sermon or two on each passage to solidify the information, and I also rigged up a fancy scripture-memory holder system in my shower so I could see ALL the verses at once instead of just 1-3 at a time. It's actually not fancy; it's just a couple rows of Ziploc snack bags threaded together and held up with suction cup hooks on the ends. I just insert my 3x5 cards--each one with three verses typed on it--right into the snack bags. I'm excited because I didn't have to spend money to laminate them, and I can switch them around when I move on to other scriptures. I'll just hole-punch these and put them in my little 3x5 inch scripture memory binder so I can easily review them.

I'm about half-way through the Seeking Him study by Tim Grissom and Nancy Leigh DeMoss. I'm just working on this in my personal time and chatting with Amber, my SIL, every once in a while about it. For the first couple of weeks, I wasn't too sure how it would be, but it's getting deeper and deeper every week. It's a study about how to seek personal and corporate revival, so it makes sense that they wouldn't have started out with super-intense study times right from the get-go. If people are struggling to even designate a few minutes per day toward things of the Lord, you don't want to discourage them from the outset. It will be an excellent resource for the future, I think.

I've really been having a great time with the high school girls! Tonight we started our discussion of Lies Young Women Believe and the Truth That Sets Them Free by Nancy Leigh DeMoss and Dannah Gresh. We had some very good discussion tonight! There are 8 girls total and the two of us adults, so it's really the perfect number for a small group. I've also been able to spend some extra time with one of the girls in particular, which has been a blast for me. Sometimes we have an agenda when we meet, and sometimes we just hang out (like this afternoon when we ran errands and then went to eat a snack at her favorite place). I'm looking forward to the possibility of spending time with more of them individually, especially once SWI and CIC wrap up.

We started the adult small group that's meeting at our house. Our first meeting was this last Sunday. We absolutely LOVED being in the Murrays' small group, so while we were pumped about the idea of opening up another small group, we weren't excited to leave the group we were in. We were praying that the Lord would put together a group of people who would have a variety of experiences but would be able to really open up and share life together, joys and struggles. So far as I can tell, I don't think He could have answered our prayer more thoroughly! We have one single woman, two couples a couple years younger than us, one couple exactly our age, and one couple with kids in college. There are 11 adults in total. Ladan was nearly beside himself when we told him that one of those adults was Mr. Job (Mr. Jove if I say it like Ladan)! So far we haven't started going through material. Our normal schedule will be to eat dinner, then move into our more formal discussion time, then divide into guys/gals groups for prayer. Here at the beginning, we're just sharing our stories with one another so we can be better acquainted. Once we finish that, we'll start going through The Pursuit of Holiness by Jerry Bridges. I'm sure Chet will do a great job facilitating discussion as we go through the book!

Sorry that was totally out of order, but that's kind of the way it works around here! Hopefully that answers the question about what I do "outside" of taking care of the boys. It might also explain why I don't really have a concept of how it could possibly be boring to be a "stay-at-home" mom. While there's no clear delineation between family time and "other" time for me, I do get to do lots of things that aren't directly centered around my kids.... But, in the end, I'd like to hope that the Lord will use ALL of these things to make me a better mom, wife, family member, and friend.