Family Planning Post #12: Where We Are Now

I'm posting two entries in a row, so if you missed the Helpful Bible Study in post 11, you'll want to go back to it. I didn't write it, but there's no sense reinventing the wheel if someone else has already done a great job. Check it out.

I want to take a minute now to let you know where we are with regard to our current situation....

As I mentioned in an earlier post, I have had two c-sections and may come to a point at which we decide enough is enough based on medical recommendations. So, what will we do? Here are my thoughts regarding each method of birth control mentioned:

Natural Family Planning--It can be highly effective at preventing pregnancy if I understand my charts and cycles well enough. The major downside for me is considering abstaining during my possible fertile times (for me, it seems like this is about 10-15 days of each cycle) every month for another 15-20 years. Since the time I'm most interested in intimacy falls during my most fertile time, this is even more challenging, but I'd be willing to do it if this was our best option. I'm doing a lot of research to determine what I can do nutritionally to help concentrate this fertile period of time and cause my cycles to be more regular.

Overall, there is nothing sinful about NFP, unless I use my charting (or lack of diligence in charting) as a way to manipulate my husband into getting what I want at a given point in time. This is most likely to happen if I were to want a baby and he wasn't ready. Husbands, it is possible for you to manipulate your wives one way or the other as well or to put undue pressure on her to "figure it out" accurately as she's trying to interpret her charts. That's why NFP is best done with both spouses cooperating and learning TOGETHER along the way.

Withdrawal--I do not believe that withdrawal is inherently sinful, though it's not always super-effective.

Barrier Methods--Since spermicides are out of the question for Chet and I based on their potential to cause birth defects, it seems like condoms without spermicides are the only reasonable method of birth control in this category (the others might be fine if used without spermicides, but they're not nearly as effective as condoms, so we probably wouldn't use them).

Hormonal Technologies (pill, shot, patch, implant)--I just cannot come to the conclusion that these things are ever okay, unless a person is not married and is taking them to remedy some kind of health problem. Even in that case, while you're not risking the abortion of a child, it seems like these hormones tend to mask problems rather than fixing them. Additionally, there are so many side effects that I would definitely chart (using NFP guidelines) and explore every possibility to take care of problems nutritionally. Surprisingly, there is a LOT you can do to help with symptoms of endometriosis, polycystic ovarian syndrome, etc. just by changing your diet and adding various nutritional supplements. Sometimes the dietary changes are dramatic, but it beats pumping your body with hormones and risking the side effects or the possibility of aborting a child.

IUD--No.

Sterilization--Sterilization is a very big deal. It's permanent. It changes the way the body was designed to operate. And it's employed all too often in my opinion. Chet and I still have not decided whether or not this is an acceptable option for us. Because of the increased risk of ectopic pregnancy and all of the awful personal side effects caused by tubal ligation, Chet and I have ruled this out as a possibility, even if I'm already lying open on the operating table during a future c-section. As for vasectomy, there are all manner of conflicting thoughts that go through our minds...

• 100 years ago, I wouldn't have been sitting here having experienced two c-sections and wondering what to do if my body is done. I'd be dead, and so would Ladan (our oldest). With the improvement in medical options to help us survive the first childbirth (and then the second), we're now sitting in a much more complicated situation as we try to figure out what to do with our future medical situations.
• What if I die, and Chet gets remarried to a woman who wants to have her own children? My body is the "defective" one, so is it a good idea for him to be sterilized even though nothing is wrong with his body?
• There is a list of possible side effects that go along with vasectomy (some very serious), and there is also a long list of side effects associated with having many c-sections. I'm only 29, which means I could quite possibly have a long period of fertility ahead of me. Are we in a position to determine (with our doctors' help) the point at which one set of medical side effects becomes worse than the other and consider vasectomy if it seems like the risks of c-sections become too great?

It seems to me that there are not all that many circumstances that would justify permanent sterilization as a method that Christian couples should employ. However, I'm also not ready to say that it is altogether unacceptable without any exception. As I've mentioned, it does seem like there might be a more concrete moral issue associated with tubal ligation since it carries the increased risk of ectopic pregnancy with it.

Honestly, I don't know the answers to our questions regarding sterilization right now. Until we're settled, I'm spending my time researching as much as I can about how to "read" my body and how to use nutritional means to bring my body to a more consistent cycle. If I can get my more fertile time concentrated down to 5-7 days, we might just be better off to use NFP as long as possible to prevent pregnancy after I've had "enough" c-sections. In the meantime, we'll keep in mind that, since we're not guaranteed any additional pregnancies, we may never have to make this decision... and if I do find myself having another c-section, the doctor will let me know at that time how I'm healing and what the risk of having another would be.

Either way, I will likely ALWAYS chart my cycles. There are so many benefits to charting in addition to family planning--earlier detection of problems (cysts, cancers, thyroid problems, etc.), detection of nutritional deficiencies or poor habits (not enough sleep), and more. I really value the vast array of information I can gather just by taking 45 seconds each day to notice how my body is working. One benefit in particular is that I can know whether or not I'm pregnant without wasting a bunch of money on pregnancy tests--for a girl with irregular cycles, this is VERY helpful for my peace of mind and our budget!

If you're a single woman, I think it's really great to learn about this stuff (charting, etc.). It can be so helpful to you as an indicator of health. Should you be blessed with marriage, you will already know what's going on with your body. And if you have the gift of singleness for your entire life, it can be super-helpful at helping you detect all manner of issues that you might not otherwise notice.

In the end, it boils down to four possible options for us: Natural Family Planning, condoms WITHOUT spermicides, withdrawal, or MAYBE vasectomy... but we're not ready for that yet. The Lord has been merciful to reveal so much to us already. I don't know all the answers today, but He will be faithful to provide wisdom.

I do have regrets about choices that we made in the past regarding birth control, but I am not weighed down with guilt. I cannot change them, and the Lord has forgiven me. I can, however, use the information I've learned along with the story of our journey to help others avoid the same pitfalls.

If you too are a believer who is using a method of birth control that you have been convicted is sinful, my recommendation is that you confess that to the Lord, don't do it anymore, and accept his forgiveness. If it was a lack of information that caused you to make poor decisions, get educated and humbly pass the information along to other people you know. If you knew the risks of a certain method and were simply in rebellion, this too can be a powerful testimony to those around you. Don't let shame prevent you from being a light to others.

And if you are in a place like we are where you just don't know what the Lord would have you do, all I can recommend is that you keep studying the facts and the Word of God; pray for wisdom; talk things over with at least one person/couple who can give you wise counsel; and, until you have clarity, stick with the method that doesn't cause either you or your spouse to have a stained conscience.

Along the way, we've received some really helpful advice, some of which I'd like to compile into a list of random tidbits in my next post.

Are there other questions you have that have not been addressed so far? I would be so grateful to hear them, as there may be aspects of this issue that I haven't addressed yet.

Family Planning Post #11: Helpful Bible Study

We've taken time to describe our experiences with birth control methods, established why we believe that conception (as opposed to implantation or some later point) is the moment of imparted personhood, and discussed in greater detail the various methods of birth control that are commonly used in our society today. So, what do we do with all of this information? How can we make wise and biblically sound decisions regarding birth control? What is ultimately acceptable, and what is not?

To help you think through this, I'm going to include a helpful Bible study that was written by Jonathan Anderson, the brother of one of my very best friends here in Louisville. Jonathan wrote this Bible Study as part of the culmination of lots of research on the issue of family planning. I hope it's a blessing to you! You'll want to print it off and write your answers in a different space, because I didn't leave enough room between lines in this post. Here it is...

FAMILY PLANNING: A BIBLICAL UNDERSTANDING

Laying the Foundation
While the Bible does not speak directly to the issues of family planning and contraceptive use as we know them today, it does contain principles regarding family and planning that allow us to form a biblical understanding of these issues.

Understanding Marriage
What purposes for marriage does God lay out in the following passages:

• Genesis 1:26-31
• Genesis 2:18-25
• Malachi 2:15
• Ephesians 5:22-32

Understanding Children
How do the following passages teach that children are to be viewed in marriage:

• Genesis 1:28
• Genesis 33:5
• Psalm 113:9
• Psalm 127
• Psalm 128

In what ways are children a blessing?

In what ways does our culture manifest a different view of children?


Understanding Planning
Read the following verses. Summarize what they teach about planning.

• Proverbs 15:22
• Proverbs 20:18
• Proverbs 21:5
• Proverbs 16:9
• Proverbs 19:21
• James 4:13-17

How should these principles affect your attitudes in family planning?



Examining the Issue – Birth Control

Is it prohibited? The most commonly cited text as a prohibition against birth control is
Genesis 38:8-10. Read it and Deuteronomy 25:5-6. Was God angry about the “birth control” or was there a deeper issue? If so what?

Is every use of it acceptable?
Nearly all evangelical scholars agree that there is no biblical prohibition against birth control in principle, but that it is an area in which God gives freedom to make a wise, biblically grounded decision. However, as with any freedom, there are biblical principles that limit it (Consider doing a Bible Study on Decision Making if you are unfamiliar with the biblical process for making decisions). Think back to the passages you have already read. List the principles from them that should “regulate” your use of birth control (Consider what method you will use, when you will use it, and the attitude with which you are to have when using it.)
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What other principles should regulate your use of birth control based on the following:

• Hebrews 13:4
• Psalm 139:13-16
• 1 Timothy 5:8

Your Family Planning:
What are God’s purposes for your marriage?

What is your view of having children? Is it the same as God’s view?

Who is ultimately in control of the size of your family? Do you trust Him in this area?

Do you desire to prevent or limit having children? Why?

Are these godly desires or selfish desires?

Are you planning on using birth control?

What methods are you considering?

Are these biblically acceptable methods? If you don’t know, do some more research about the methods (your pastor or counselor can recommend appropriate resources).

Summarize your plan for family planning – include what you will use, when you will use it, how long you plan to use it, and the attitudes you will seek to maintain while you use it.

Look back over the biblical principles you identified in this study. Does your plan fit with all of these principles? If not, how do you need to change it?

Who is at least one other godly person you can seek counsel from before making a final decision on this issue?

Family Planning Post #10: Sterilization

This is the last of the posts set out to discuss particular methods of birth control. I will focus on the two main methods of elective sterilization--tubal ligation and vasectomy. After this post, I will move into a discussion of how we can put all this information together and think through it in a God-honoring fashion.

Quick note: Hysterectomy is another form of surgery that results in sterilization, but it does not tend to be something people choose right off--it is usually something that is deemed "medically necessary" for reasons other than birth control. I will briefly say that, because of the dramatic side effects associated with this operation, hysterectomy is something that a woman should try to avoid if at all possible.

Tubal Ligation

Tubal ligation or occlusion is a surgical procedure in which the fallopian tubes are cut, clamped, stitched, cauterized (burned), or blocked so that sperm are prevented from reaching the egg. The patient, the circumstances, and the physician's preference will determine the type of incision created. Some procedures are much more invasive than others. Please see the following links for more information on the variety of possibilities.

Web MD: Tubal Ligation and Tubal Implants
Baby Center: Tubal Ligation
About.com: Women's Health--Permanent Methods of Sterilization: Tubal Ligation Vs. Vasectomy

If you read these articles and/or do additional research, you'll see that tubal ligation is EXTREMELY popular worldwide and tends to be about 99% effective for the first few years. The failure rate increases over time, especially for women who have the operation at a younger age. Nevertheless, the operation should be considered PERMANENT. Reversals can be attempted but are most often unsuccessful.

There are a variety of side effects associated with tubal ligation, most of which are labeled "mild" by the majority of the medical community (see articles above for lists). However, there are some other "major" side effects which may be less common percentage-wise, so women tend to be ill-informed about them.

Post-Tubal Ligation Syndrome

Lumped under the title "post-tubal ligation syndrome" are long-term symptoms such as dysfunctional uterine bleeding (which is likely to result in hysterectomy), painful periods, excessive bloodflow during menstruation, increased mood swings and PMS, pain during intercourse, severe pelvic pain, and sudden premature menopause. (Info taken from Kippley and Kippley, The Art of Natural Family Planning, pp. 13-14 AND John Jefferson Davis, Evangelical Ethics, p. 38)

In reference to a study done on the menstrual problems women displayed after a tubal ligation, Davis goes on to write,

"The causes of these irregularities were not clear, but at least one investigator suggested that the sterilization procedure, by disturbing the normal blood circulation between the uterus and the ovaries, might have contributed to the menstrual disturbances suffered by the women," (p. 38).

Kippley and Kippley write in The Art of Natural Family Planning,

"If your friend or relative has recently had a tubal ligation and is telling you that everything is just fine, wish her good luck. There is good evidence that many of the women who will suffer from the post-tubal-ligation syndrome may not experience the bad effects until two years or more after being sterilized. 'At follow-up intervals longer than 2 years, the tubal sterilization group had significantly increased risks of abnormal menstrual cycles and combinations of two or more adverse menstrual outcomes.'45 The longer the follow-up on sterilized women, the higher the rates of problems. M.V. Muldoon reported that of 374 patients who were followed for at least 10 years after tubal ligation, 43% needed further gynecological treatments and 25% had major gynecological surgery [read hysterectomy].46" (p. 15)

The "funny" thing is that many women have their tubes tied after c-sections to avoid an increased risk of hysterectomy. However, it seems as though I've found quite a few sources who suggest that there is also an increased risk of hysterectomy with the tubal ligation.

Ectopic Pregnancy

The increased risk of hysterectomy and the long-term side effects of tubal ligation are bothersome to me, for sure, but right up there alongside them is the increased risk of ectopic pregnancy. While there is debate surrounding validity of claims that there is such a thing as post-tubal ligation syndrome (in that some people insist that there are no long-term side effects of tubal ligation), there is no debate about whether or not the rate of ectopic pregnancy increases with tubal ligation. Because the rate of tubal ligation failure increases over time, the risk of ectopic pregnancy goes up over time.

Kippley and Kippley describe well how this happens:

"A woman who has a tubal ligation and later becomes pregnant has a much higher chance of having an ectopic pregnancy than if she had not been sterilized. Why? The microscopic-sized sperm manage to get by the place where the fallopian tube was blocked, but the much larger conceptus cannot do so." (The Art of Natural Family Planning, pp. 14-15)

Why does this matter? We have established already that conception is the point at which human life begins and should be protected. Throughout my research, I have found this ectopic pregnancy issue to be most disturbing. When I carry it through to its logical conclusion, I cannot say that it is somehow different to create a situation where there is an increased risk--because of my CHOICE--that the human life would implant in the wrong place than it is to create a situation where there is an increased chance that it would not implant at all (as with the IUD or hormonal technologies).

The general consensus is that it is nearly impossible (some even say it is impossible) for a human life implanted in the wrong place to survive. Stewardship of my own body is a huge issue, so medical side effects that I will suffer are a problem. However, as I consider the possibility that I would be making a choice to decrease the chance that my baby would be able to survive, it makes it even more difficult for me to conclude that tubal ligation is a good way to go.

Just a few months ago, we had come to the less-than-settled conclusion that this would probably be the way that we would go when we find that enough is enough of the c-sections. While we had determined that this might be the best option based on a comparison of medical side effects associated with numerous c-sections vs. tubal ligation, I was still uneasy and not finished researching. Now that we have learned more, we have determined that this is not a good option.

So, what about...

Vasectomy

According to WebMD,

"During a vasectomy, the vas deferens from each testicle is clamped, cut, or otherwise sealed. This prevents sperm from mixing with the semen that is ejaculated from the penis. An egg cannot be fertilized when there are no sperm in the semen. The testicles continue to produce sperm, but the sperm are reabsorbed by the body. (This also happens to sperm that are not ejaculated after a while, regardless of whether you have had a vasectomy.) Because the tubes are blocked before the seminal vesicles and prostate, you still ejaculate about the same amount of fluid.It usually takes several months after a vasectomy for all remaining sperm to be ejaculated or reabsorbed. You must use another method of birth control until you have a semen sample tested and it shows a zero sperm count. Otherwise, you can still get your partner pregnant."

The operation should be considered PERMANENT. Reversals can be attempted but are most often unsuccessful.

John Jefferson Davis provides a helpful synopsis of vasectomy and related issues in Evangelical Ethics. Here are a few excerpts from his book:

"An increasingly common method of male contraception, vasectomy is undergone by some 750,000 American men each year.55 This represents a dramatic incrase since 1969, when 212,000 men underwent this sterilizing procedure.56

A vasectomy procedure, which can be done in a doctor's office or clinic, takes about 20 minutes and typically costs around $200.

... The vasectomy procedure involves the surgical excision of the vas deferens, the sperm-carrying duct. Due to the presence of residual sperm, a sterile condition does not result immediately. According to a study published in The Journal of the American Medical Association, vasectomy cannot be relied upon to provide 100 percent protection against pregnancy for at least six months after the operation. Researchers found that eight of 400 postvasectomy patients had transient reappearance of sperm in the semen from one to four months after the operation. All the patients studied became sterile seven weeks to six months after the operation.58" (p. 39)

Davis goes on to write,

"The general opinion in medical circles is that vasectomy is a safe and effective means of contraception with no significant harmful side effects. There have been a few physicians and medical researchers, however, who have raised questions about the effects of the prodedure. Dr. H.J. Roberts, who practices internal medicine in West Palm Beach, Florida, has expressed concern about evidence that men who have vasectomies can develop immune reactions to their own sperm. 'I know of no other operation performed on normal individuals that evokes immunologic responses of such magnitude,' Roberts observed.62

... This immune response to vasectomy is part of the body's effort to eliminate some of the 50,000 sperm that are produced each minute. According to Dr. John B. Henry, professor of pathology at the State University of New York Medical Center, the antibodies produced in reaction to the man's own sperm after vasectomy could prove to be 'an important compoenent in the evolution of autoimmune diesease,' though such a connection has not been definitely established.64 Some studies, but not all, have indicated a possible link between vasectomy and the risk of prostate cancer. While this possible link has not been firmly established, there is certainly cause for 'discussion ... and further research,' according to Dr. Stuart Howards at the American Urological Association.65" (pp. 40-41)

... and ...

"There are possible psychological as well as medical side effects to be considered in relation to vasectomy....

Men who have had problems with sexual dysfunction or histories of emotional instability before the operation are likely to find these conditions exacerbated afterward....71

While men with healthy egos and self-confidence can apparently accept the condition of sterility without psychological damage, that is not necessarily the case for men with marital or emotional problems. ...[S]ocial workers around the country report cases in which vasectomies have compounded sexual difficulties, increased anxieties and tensions, and helped to break up marriages." (pp. 41-42)

Here are a few more links that might help you learn more about possible side effects of vasectomy, which range from bleeding, swelling, continued fertility until the vas deferens is completely emptied, prolonged dull pain, immune reactions and even intense long-lasting pain.

WebMD: Vasectomy

National Institute of Child Health and Human Development (NICHD): Facts About Vasectomy Safety

NICHD: New Study Finds Vasectomy Does Not Increase Prostate Cancer Risk

VasectomyMedical.com: Post Vasectomy Pain Syndrome

Vasectomy.com: Vasectomy Risks and Complications

If It Works, Don't Fix It!--A Downloadable Book About the Risks of Vasectomy

National Cancer Institute: Vasectomy and Cancer Risk

There seem to be quite a few medical side effects that should DEFINITELY be considered seriously. You'll notice that there are varying opinions on the risk of various side effects (i.e. prostate cancer), but I think it's important that we at least read the information from both sides before making decisions.

Because vasectomy prevents sperm from being released from the male, it is seen as completely contraceptive in nature. Even if it fails, it has no opportunity to abort a human life.

Additionally, according to Vasectomy.com, "Tubal ligation is a more complicated sterilization procedure compared to vasectomy, which is safer, easier and just as effective." This statement is affirmed by everything else I've read.

BUT keep in mind that just because it's safer, easier, and just as effective as tubal ligation doesn't necessarily mean that it's totally safe, a total breeze, or without complications... or that it's necessarily biblically acceptable in any and every situation.

Biblical Considerations Regarding Sterilization

I could sit here and try to write out a helpful conclusion for you, but Andreas Kostenberger has done such a fabulous job in his book God, Marriage, and Family: Rebuilding the Biblical Foundation that I think I'm just going to quote him directly. It may be a long quote, but every sentence is key, so hang in there. The bold and underlined parts are my emphasis. Here goes...

"There are several important considerations with sterilization that may caution us against its use. For instance, it is an elective procedure that involves the intentional and permanent setting aside or inactivation of a bodily function. The permanence of the procedure makes it a different case from the use of a condom or other temporary measures. In addition, we might ask whether it is ever right to remove a part of one's body (cf. Lev. 21:20; Deut. 23:1; 1 Cor. 6:19) simply for convenience's sake,20 and whether this is the proper way to treat the body as the 'temple of the Holy Spirit' (1 Cor. 6:19).

In both Old and New Testaments, Scripture indicates that while care for the physical body is not to be of primary concern, it should be treated with honor and respect (cf., e.g., Gen. 2:7; Ex. 21:22-25; 1 Cor. 6:12-20). As ethicist John Jefferson Davis contends,

The apostle's point is that the believer does not have the right to exercise unlimited dominion over his or her body but should view the body as a trust from the Lord, to be cared for in ways that are glorifying to God. And surgical operation--such as sterilization--is not merely a personal "choice," but a decision that needs to be seen within the biblical framework of stewardship of the human body. Given the fact that our human bodies are a trust from God, and in light of the positive valuation placed on human procreative powers and large families in the Old Testament, these powers should not be rejected or surgically destroyed without compelling justification.21

While the subject has yet to receive adequate attention among evangelicals,22 some might respond that the same reasoning adduced above regarding the appropriateness of using certain forms of contraception applies here as well. God has given us intelligence and powers of judgment to fulfill his command to 'be fruitful and multiply' in our individual personal circumstances in keeping with scriptural commands and principles (such as the sacredness of human life). In light of our conclusion that it is fallacious to interpret this command to mean that every act of marital sexual intercourse must be open to procreation, it would seem appropriate that a given couple could determine that they have reached the point where they believe God would not have them conceive any more children. The question, then, becomes whether or not sterilization is a legitimate means of ensuring that no additional children are conceived. Indeed, while not every Christian would agree that sterilization involves an improper violation of one's body as the temple of the Holy Spirit,23 it is vital that believers submit their personal desires to a prayerful consideration of what is scripturally permissible.

While arguments can be made both against and in favor of sterilization as a form of birth control for Christians, therefore, since Scripture does not directly address the various forms of modern sterilization practices, it seems appropriate to refrain from dogmatism in this area. Where Scripture does not directly address a given matter, biblically informed principles must be applied to specific issues with wisdom and care. We have known godly couples who assured us that they pursued sterilization in an attitude of prayer and trusting the Lord. We have also known other, equally godly, couples who later regretted having followed through with this procedure and sought to reverse it in order to have more children. Both cases suggest that it is imperative that a couple who would use a given method honestly search their hearts and motives during the process of making such a decision and be certain that pragmatic considerations and personal desires do not override scriptural principles or unduly shape what they perceive to be the leading of the Holy Spirit.

... [W]ith regard to sterilization it is important to reiterate the need to take great care in avoiding dogmatism on matters that Scripture either does not prohibit or does not directly address. It is the principle of honoring 'the temple of the Holy Spirit' that one must seriously consider before deciding whether or not to employ such a method. ... [H]owever, it would seem that the consideration of scriptural principles ought to lead one away from employing sterilization... as a means of family planning." (pp. 136-8, 141-2)

Kostenberger's entire book is very helpful. If you're looking for further information on hormonal technologies, he provides several pages of information that might be helpful to you as well. The book is on sale at Amazon.com. If you invest in it, I'm sure it will be a blessing to many aspects of your own marriage and will be a great help to you as you walk through life with other married people (even if you're not married yourself). He spends several chapters laying a foundation for biblical marriage and family relationships. Based on this foundation, in addition to discussions of contraceptives, he also discusses fertility treatments, homosexuality, singleness, divorce and remarriage, qualifications for biblical leadership, etc. Check it out if you don't already own it!

So, then these questions remain... What is considered "compelling justification" for something as serious as permanent sterilization? And, if there is compelling justification, is it appropriate to choose either of the methods of sterilization available?

My plan is to write a post to summarize and discuss the possibilities for Christian couples seeking to employ some method of birth control.

In the meantime, what do you all think? What IS compelling justification for sterilization? If you see sterilization as a viable option for Christians, do you see a difference between tubal ligation and vasectomy?

Gabe's Surgery

I'm taking a quick break from the Family Planning series to give you an update on Gabe's surgery today. We took him in for an inguinal hernia repair and a circumcision revision. He was scheduled at 8:30am, so we had to arrive at 7:00. Cali (one of the high school girls I get to hang out with often) arrived at our door at 6:10am--even earlier than I asked her to be here--and she looked GREAT! How does this happen, anyway? I hadn't slept nearly enough, and in contrast to Cali, I did not have it all together.

This started a series of opportunities for Chet to laugh at me. For example,

• I forgot Gabe's shoes and had to turn around and get them.
• On the way to the hospital, I made a series of wrong turns (but thankfully ended up in the right place).
• When we arrived in the parking garage, I failed to put our vehicle in park and almost ran into the wall. So I put it in park and started to get Gabe out of the van... without turning it off or taking the keys out!
• We arrived in the pre-op waiting room, and I was asked for my cell phone number. I promptly provided it in the following order: first three digits, area code, and last four digits. The woman asked, "So, is that local?" Nice. I got that corrected.
• We waited a few minutes and got Gabe back into his little pre-op room and started getting him ready. It was at this point that I realized I had forgotten my cell phone outside... the same cell phone connected to the number I gave the waiting room attendant to use in case they needed to reach us while we were in the hospital. Whatever.

All I can say is that this is why I do not wake up before 9:00am except for Sundays when I wake up at 7:45 to go to church. I do not EVER wake up at 6 am, and it is for the good of everyone else around me.

Back to Gabe... We met all the people that would be helping him throughout the process. He screamed at every single one of them. Thankfully, he's cute even when he's crying, and they're used to it, so it was actually a source of amusement for everyone in the room (which probably wasn't all that amusing for Gabe himself). He was able to go to the play room to hang out for a few minutes. His surgeon came to talk to us and marked the site where he'd operate. We got him dressed in the tiny little gown they had set out for us. Then I gave Gabe his "happy juice". Basically, he just became friendlier to people but didn't act crazy or anything. I was prepared for something much more dramatic. When Ladan had surgery at the age of 28 months, he acted totally drunk as a result of the happy juice. Additionally, there was a preschool-aged boy across the way from us this morning, and his happy juice caused him to make a bunch of pig noises and then laugh hysterically. I was ready for worse, but it is a bit unnerving to see your toddler acting drunk. I was thankful I didn't have to watch Gabe act that way. After he was good and glassy-eyed, they took him down the hall. He cried for 3 seconds or less and was in good shape.

The surgery took about 45 minutes. The surgeon came out and told us how it all went. Apparently, the circumcision revision was a little bit worse than normal in that Gabe's skin was fused all around his private part, so they had to do a little bit more work to get it off, which caused more bleeding than normal. He was unable to find a hernia when he went in. He said this happens to him about 2-3 times per year (because it's very difficult to diagnose a hernia until you actually get in there) and described what he did find. There was a fat pocket in there that was possibly causing the appearance of swelling. So he removed that. He also drew a nice diagram of Gabe's inner anatomy on his scrub pants to help show us that it's possible that Gabe's floor (similar to a female pelvic floor, but I'm not sure if it's called a pelvic floor or just a floor in boys) was weak even if there was no hole in it. This weakness could have made it feel like there were organs popping through even if they weren't actually coming through the layer of tissue. So he pulled a bit of muscle down and stitched it across the floor. This will serve to make the normal hole where hernias develop smaller and will also strengthen his floor so that hopefully we won't see a hernia pop up in the future.

We waited about 40 more minutes while Gabe was in the recovery room, and then we were able to meet him in the post-op room. He was SO CUTE when he rounded the corner in that tiny little stretcher and soft green toddler-sized gown with his little blonde curls poking out from behind his ears! I was able to pick him up right away, and he was asleep on my shoulder again within 7 or 8 minutes. As long as no one tried to take him from me, the only fussing he seemed to do when he was waking up was when they checked his vital signs. It was lots easier than when Ladan woke up from his surgery. Ladan insisted on trying to walk even though he couldn't support his weight at all on his legs, and he did a lot more screaming than Gabe. I guess that extra 10 months of age made a difference.

We waited with him in the post-op room about an hour. The nurse showed us his incision sites. The hernia incision was closed up with internal stitches and has a clear plastic protective coating over the top. It looks a little bit yucky, but that clear plastic layer makes all the difference. His circumcision site, on the other hand, looks DISGUSTING! He has a tiny ring of little black stitches all around, it's swollen, and it's bloody. I had to walk to get a glass of water after that, because I was pretty sure I was going to pass out or throw up. I can handle pain, but stitches are another story. More on that in a minute.

His surgeon came to see him one more time and verified that everything looked good. Chet was reading some of his ethics materials, and the doctor asked him what he was studying. When he said he was reading about euthanasia, we branced into a discussion about how science has outpaced ethics and how it's crazy to think about the implications of so many things that are being done right now or that are coming up in the near future. Can I just say that this is one more reason that I think we have an awesome surgeon?!?

On the way home, I made at least two wrong turns... just so I didn't let Chet down, of course. :)We arrived at home at about 11:30. Ladan had just woken up at 11:15, so Cali was bummed that she didn't get to hang out with him longer. Another day.

I went to get Gabe's prescription filled while Chet fed him and put him down for a nap. He slept for a few hours. Chet went to bed as well since he hadn't gotten much sleep between work and the surgery. When Gabe woke up, his diaper was totally full, and his clothing and sheets were soaked... and Chet was still planning to sleep for another hour! Great! That means I have to do the diaper change. I sucked it up and forced my way through it. All the while, I made sure I spent as little time looking at the stitches as possible. However, you kind of have to watch what you're doing when you're applying ointment to the wound. Let's just say I worked as quickly as possible without hurting him and had to IMMEDIATELY sit down before I passed out. (I've done that enough times that I know what it feels like when it's coming). Whew! Narrow miss! Chet was gracious and did the rest of the diaper changes until he had to go to work. I've had one since then during which I made sure the lights were dim, and it was lots better. Maybe I'll be a pro at stitches by the time this is all over! I'm just praying that handling stitches is NOT one of the things that the Lord is preparing me for more of in the future!

Gabe got better and better throughout the rest of the evening. He sat in my lap for a while. Then we went for a stroller ride outside just so he could be still for a while longer. By the end of the night he was laughing, running a bit, and I had to try to keep him from dancing around too much. Can you even imagine bouncing back like that?

It seems like all our experiences with surgery have proven that day 3 is the worst, so we'll see how it goes on Sunday. We're off to a good start though.

When Ladan was saying his prayers before bed tonight, he said, "Thank you, God, for Gabe not burning up!" Amen to that! He said this because, when Gabe woke up from his nap, I said he was "burning up". Ladan and I had to take him outside and walk him around in the breeze in order to cool him off until his medicine kicked in again. Ladan was just thankful that Gabe wasn't on fire, I guess. He was so great all day with Gabe. He brought him toys and tried to help him. There was only one occasion where he forgot that he couldn't roll around on the floor with Gabe. Gabe is certainly blessed to have a big brother who loves him so much! And we are blessed to have two amazing kids!

In the end, the possibility of the hernia is what helped us to go ahead with the circumcision revision, and I'm so thankful that we decided to go for it. I think that if we hadn't done the circumcision revision now, it would have caused him lots of problems later. Better to do the operation when he won't remember it. So his circumcision is fixed, and hopefully he won't develop a hernia anyway! There is One who knows better than I do!

Family Planning Post #9: Hormonal Technologies

In this post, I will describe and discuss the various hormonal technologies that are employed as methods of birth control.

Birth Control Pill

There are several forms of the birth control pill. The two main categories are the combination pill, which uses a combination of estrogen and progestin (a man-made form of progesterone) to prevent successful pregnancy, and the progestin-only pill, which simply uses progestin to prevent successful pregnancy.

According to the American Pregnancy Association:

"Oral contraceptives are designed to prevent pregnancy in one of three ways:

• Prevent ovulation each month.
• The cervix produces less and thicker mucus so that sperm cannot easily enter the uterus.
• The lining of the uterus becomes thinner, making it more difficult for a fertilized egg to attach to the uterus should ovulation occur and fertilization take place. Ethical Consideration."

The link to the "Ethical Consideration" is exactly the same link that they include in the information on IUDs, and it reads as follows:

"It is possible that you may not have been aware that any ethical questions existed concerning contraception. The contraceptive methods that involve the changing of the lining of the uterus to prevent implantation from occurring create an ethical or moral consideration for some people.

Some people believe that life begins at conception whereas others believe it begins at implantation. The ethical consideration develops for individuals who believe that life begins at conception.

When contraceptive methods fail to prevent ovulation or fertilization, the changing of the uterine lining is used to prevent the fertilized egg or “life” from implanting in the uterine wall. It is this action that leaves people believing they have crossed an ethical boundary."

KidsHealth provides further information on the progestin-only pill (aka "mini-pill"):

"Another kind of pill that may change the number of monthly periods is the low-dose progesterone pill, sometimes called the mini-pill. This type of birth control pill differs from the other pills in that it only contains one type of hormone — progesterone — rather than a combination of estrogen and progesterone. It works by changing the cervical mucus and the lining of the uterus, and sometimes by affecting ovulation as well. The mini-pill can be slightly less effective at preventing pregnancy." [emphasis mine]

Other links to check out to determine the function of "the pill":

The Center for Young Women's Health at Children's Hospital Boston

KidsHealth by Nemours Foundation

Depo-Provera, Birth Control Patch, and Vaginal Ring

Depo-Provera is administered by a health care professional once every three months. It contains a chemical called depo-medroxyprogesterone acetate (DMPA), which is designed to mimic the natural function of progesterone.

The Birth Control Patch (aka Ortho-Evra) is a small sticky patch that is applied to the skin. Hormones contained in the patch are absorbed through the skin into the system of the woman. The patch is replaced once a week for three weeks and is left off the skin for one week to allow for menstruation.

The Vaginal Ring (aka NuvaRing) is a small piece of flexible plastic that is inserted into the vagina for three weeks at a time. Estrogen and progestin in the ring are absorbed into the system to affect the way the body works. The ring is removed for one week to allow for menstruation, and then a new ring is inserted.

According to the American Pregnancy Association:

Depo-Provera (the shot), OrthoEvra Patch (birth control patch), and NuvaRing (the vaginal ring) all operate with the same three mechanisms:

• "First, it prevents the ovaries from releasing an egg, which is also known as ovulation.
• Second, it thickens the cervical mucus which acts as a barrier preventing the sperm from reaching the egg.
• Third, it changes the lining of the uterus preventing implantation. Ethical Consideration."

As you can see, they all also come with the same "Ethical Consideration" warning associated with the birth control pill (of both types) as well as the IUD.

There are a host of side-effects associated with all of the hormonal technologies listed above, which remind us that there are issues we need to consider related to stewardship of our bodies. However, for the sake of space, I will let you read about the physical side effects of these hormonal technologies on your own.

I will focus now on providing you with resources to help you determine how to evaluate the morality of using these methods of birth control...

Conclusions

All of the hormonal technologies described above operate with the same three basic mechanisms. If you were to read the Physician's Desk Reference at your neighborhood library--or if you were to check out the insert in the packaging of your prescription if you are currently taking any of these medications or using these devices--you would notice that all three of these mechanisms are listed for each brand/medication/device. If the manufacturers are listing these as the mechanisms, then it's safe to say that they probably really are the mechanisms/functions of these technologies.

As Amber mentioned in her first post, there are varying opinions, even among Christian obstetricians, regarding whether or not hormonal technologies are acceptable methods of birth control. After all our reading and research, it comes down to two basic systems of thought:

• One the one hand, there are some doctors who would say that there is not enough proof that there is a high enough risk that the uterus would be altered in such a way as to make implantation of a fertilized egg impossible. These doctors feel comfortable prescribing the combination pill and some other hormonal technologies to their patients because there is not enough proof to them that there is a significant rate of the third mechanism working.
• On the other side, there are doctors who would say that there is significant evidence that this third mechanism of hormonal technologies exists for a reason--it is there because the first two mechanisms may fail, and this third function is there to help prevent successful pregnancy. Their conclusion is that the mechanism exists for a purpose, and even if the first two mechanisms USUALLY work, these doctors do not feel comfortable prescribing these hormonal forms of birth control because there is even the slightest chance (if not a really good chance) that they would be causing the abortion of a fertilized egg (aka newly-formed human life, a baby).

I previously quoted Dr. Albert Mohler, president of The Southern Baptist Theological Seminary, when he wrote, "Christian couples must exercise due care in choosing a form of birth control that is unquestionably contraceptive, rather than abortifacient." (Can Christians Use Birth Control?) [emphasis mine]

It is this very same conclusion that has shaped my conscience regarding the issue of hormonal birth control methods--long before I even heard of Dr. Mohler. I cannot shake it off and pretend like it's not there. (I also tend to see all the various physical side effects of these technologies as a common grace to those who may not be motivated by things of the Lord, as these side effects could be a way to steer us away from the use of abortifacient technologies even if we don't know about or are not motivated by their moral implications.)

Randy Alcorn has written a very thorough booklet called Does the Birth Control Pill Cause Abortions? outlining the evidence that supports his conclusions. You can find it at http://www.epm.org/pdf/bcpill.pdf.

Also, you may refer to Amber's first post for additional articles discussing the various positions taken on this issue.

Next up... sterilization. In the meantime, please let us know what your experiences have been with hormonal technologies. Do you have any additional questions/comments/resources?

Family Planning Post #8: IUDs

Intrauterine Devices

The intrauterine device (IUD) is a small t-shaped plastic device that contains either copper or synthetic progesterone and is inserted into the uterus by a physician. It tends to be very effective with a less than 1% failure rate.

According to the American Pregnancy Association, it works in this way:

The progesterone intrauterine device releases a constant low dose of a synthetic hormone continually throughout the day. Both the progesterone IUD and copper IUD prevent pregnancy in one of two ways:

• The released progesterone or copper creates changes in the cervical mucus and inside the uterus that kills sperm or makes them immobile.
• Changes the lining of the uterus, preventing implantation should fertilization occur. Ethical Considerations.

The link to the "Ethical Considerations" reads this way:

"It is possible that you may not have been aware that any ethical questions existed concerning contraception. The contraceptive methods that involve the changing of the lining of the uterus to prevent implantation from occurring create an ethical or moral consideration for some people.

Some people believe that life begins at conception whereas others believe it begins at implantation. The ethical consideration develops for individuals who believe that life begins at conception.

When contraceptive methods fail to prevent ovulation or fertilization, the changing of the uterine lining is used to prevent the fertilized egg or “life” from implanting in the uterine wall. It is this action that leaves people believing they have crossed an ethical boundary."

First of all, can I just say I am SO THANKFUL for a mainstream medical website that even mentions that there is an ethical issue to be considered? The American Pregnancy Association is not taking a stance on the issue, but it is actually providing helpful information for people who are deciding how they're going to think about this stuff by letting them know that there is a question to be asked.

In an earlier post, I spent a good deal of time developing a foundation for why I believe that the point of fertilization is the point at which the life has begun and personhood is imparted. This ethical consideration helps us see exactly why that foundation is necessary.

For Catholics and Evangelicals alike, the question regarding whether or not IUDs are acceptable seems to be a no-brainer... if you are informed. I am not suggesting here that people who use IUDs necessarily have no brains. The problem is that so many people are not informed. Once you know how it works, it seems to clear up any ethical dilemma you may have. Basically, the IUD is abortifacient (because it works to prevent the fertilized egg--human life--from implanting in the uterus) and should not be used. Here are a bunch of quotes in support of this reasoning:

"For many years the exact nature of the contraceptive action of the IUD was not known. It is now well-established, however, that the primary action of these devices is to produce an inflammation of the uterine wall, which prevents the implantation of a fertilized ovum. According to Dr. Thomas W. Hilgers of the Mayo Graduate School of Medicine in Rochester, Minnesota, 'It is evident that the IUD exerts its birth-preventative effects primarily through the destruction, at a uterine level, of the preimplantation blastocyst.' Consequently, 'the primary action of the IUD must be classed as an abortifacient,' according to Dr. Hilgers.23" --John Jefferson Davis, Evangelical Ethics, p. 33

"The IUD is quite effective but I don't recommend it. The IUD is merely a formed piece of plastic placed within the uterus. It apparently works this way: Conception occurs in the fallopian tube, just as if one were using no contraception. Yet when the so-called pre-embryo--the tiny developing baby--reaches the uterus, it is unable to implant (attach to the wall of the uterus). Thus, it aborts without the woman ever knowing it. The abortion risk, coupled with a risk of infection within the uterus that can lead to infertility, renders this method unacceptable, in my view. Some research has suggested that the IUD may work in some other way than I have described, and that it actually prevents pregnancy rather than terminating it. However, until we have more data, I would recommend erring on the side of caution." --William Cutrer, M.D. [OBGYN] and Sandra Glahn, Sexual Intimacy in Marriage, p. 255

"Unacceptable forms of family planning include all forms of induced abortion. Thus, the intrauterine device or 'IUD' is an unacceptable method, because its primary function is to create an unstable environment for the fertilized egg to implant in the uterine wall by depleting the endometrial lining, making it incapable of supporting the life of the child." --Andreas J. Kostenberger, God, Marriage and Family: Rebuilding the Biblical Foundation, p. 136.

"Since the mid-1970s, there has been general agreement that the primary action of the IUD is to prevent a newly conceived human life from implanting in the uterus.25 When a drug or device prevents the implantation of a newly conceived human life, it has to be classified as an abortifacient, something causing an abortion." --Kippley and Kippley, The Art of Natural Family Planning, p. 11

"Christian couples must ensure that the methods chosen are really contraceptive in effect, and not abortifacient. Not all birth control is contraception, for some technologies and methods do not prevent the sperm from fertilizing the egg, but instead prevent the fertilized egg from successfully implanting itself in the lining of the womb. Such methods involve nothing less than an early abortion. This is true of all IUDs and some hormonal technologies. A raging debate now surrounds the question of whether at least some forms of the Pill may also work through abortifacient effect, rather than preventing ovulation. Christian couples must exercise due care in choosing a form of birth control that is unquestionably contraceptive, rather than abortifacient." --Dr. Albert Mohler, President of The Southern Baptist Theological Seminary in an article titled "Can Christians Use Birth Control?"

Dr. Mohler offers a key insight in his statement. "Christian couples must exercise due care in choosing a form of birth control that is unquestionably contraceptive, rather than abortifacient." This evaluation tool will be helpful to keep in mind as we move forward to discuss other birth control options.

In addition to the risk of aborting a baby, there are many other significant risks associated with IUDs that are often downplayed in the doctor's office. John Jefferson Davis seems to do a good job of summarizing some of them:

"Significant medical complications continue to attend the use of even the newest forms of the IUD. Studies indicate that users of these devices are three to five times more likely than nonusers to develop pelvic inflammatory disease.24 Such pelvic inflammations can cause permanent sterility. 'Infertility following IUD use is an important potential risk,' notes Dr. Robert A. Hatcher. Thus, states Hatcher, 'I find myself searching more diligently for alternatives and leaning away from the use of IUDs in women who hope to bear children later.'25

Accidental pregnancies in women using IUDs have an unusual risk of being ectopic ('tubal') or resulting in a septic (infected) abortion.26 The spontaneous abortion rate for users of IUDs is approximately three times that for pregnancies not complicated by such devices.27 If a woman becomes pregnant with an IUD in place, the chances are more than one in twenty that the pregnancy will be ectopic.28" (Evangelical Ethics, pp. 33-34)

So, if the sperm do connect with and fertilize the egg, and if the fertilized egg (aka newly-formed human life) is not aborted due to the alteration of the uterine lining, there is a good chance that it will be spontaneously aborted in miscarriage or that it will implant in the wrong place (ectopic pregnancy) and likely die. Yikes!

Hopefully, I have provided helpful information for you as you evaluate this form of birth control. My goal was to provide secular as well as Christian (both Catholic and Evangelical) perspectives on the mechanisms and ethical considerations regarding the IUD. There is much more information available, so feel free to do additional research.

I've saved the most challenging two for last... hormonal technologies (the pill, the patch, vaginal rings, and injections like Depo-Provera and Lunelle) and sterilization (tubal ligation and vasectomy).

Family Planning Post #7: Withdrawal

Amber is still working on her post regarding the "What-if"s of family planning/birth control. However, she's has had a crazy couple of weeks and hasn't been able to sit down and get it all together. So hang tight on that one.

In the meantime, I'm going to continue working through specific methods of birth control/family planning and then discuss how we are to think through all this information in a God-honoring fashion--demonstrating good stewardship of our bodies, the lives of others, and the gift of sex within marriage.

So far, we've covered some very basic information about Natural Family Planning/Fertility Awareness Method as well as barrier methods. This post will be a discussion of an age-old method of birth control...

Withdrawal

Otherwise known as "coitus interruptus" or "pulling out", this is the simple act of male withdrawal right before ejaculation (Sorry, Bro, I had to use "the word").

In general, this method is only as good as the guy's ability to recognize what's happening with his body and get out of dodge in time. Apparently, he cannot always know without fail when it's about to happen. Even if he's got it down, there tend to be small amounts of sperm that escape throughout intercourse, so the method is not 100% reliable. According to Toni Weschler in Taking Charge of Your Fertility, the method failure rate of withdrawal is about 4% (which means that 4 in 100 women will become pregnant by the end of one year's perfect use of this method). When you factor a man's wrong guesses, the user failure rate is typically about 19%. (p. 355)

Among Christians, the discussion surrounding the morality of withdrawal is based on a scripture reference to Onan in Genesis 38:1-10, taken here from the English Standard Version of the Bible:

Genesis 38:1 It happened at that time that Judah went down from his brothers and turned aside to a certain Adullamite, whose name was Hirah. (2) There Judah saw the daughter of a certain Canaanite whose name was Shua. He took her and went in to her, (3) and she conceived and bore a son, and he called his name Er. (4) She conceived again and bore a son, and she called his name Onan. (5) Yet again she bore a son, and she called his name Shelah. Judah was in Chezib when she bore him. (6)And Judah took a wife for Er his firstborn, and her name was Tamar. (7) But Er, Judah's firstborn, was wicked in the sight of the LORD, and the LORD put him to death. (8) Then Judah said to Onan, "Go in to your brother's wife and perform the duty of a brother-in-law to her, and raise up offspring for your brother." (9) But Onan knew that the offspring would not be his. So whenever he went in to his brother's wife he would waste the semen on the ground, so as not to give offspring to his brother. (10) And what he did was wicked in the sight of the LORD, and he put him to death also.

Essentially, there are two different ways to look at this sin of Onan. The first interpretation is that God killed Onan because of what he did--spilling his semen on the ground--because it was a disgrace to the marital covenant. Additionally, this is seen as the basis for the opinion that all forms of unnatural birth control are also unbiblical and ungodly.

The second interpretation is that God killed Onan because of WHY he did what he did--he spilled his semen on the ground because he was rejecting his lawful obligation to provide children for Tamar. Since it was Onan's older brother who had died without leaving any children behind, Onan would get the birthright and inheritance that would have been his brother's. He was so greedy and selfish that he refused to fulfill his obligation to provide children in his older brother's line, children who would get that birthright an inheritance, but who would also care for Tamar. In effect, he was "leaving her to the wolves", because in that day, widows with no sons to provide and care for them were in real danger of not making it--all in the name of keeping all the rights and inheritance to himself and his family.

Just about any material produced by the Catholic Church will suggest that it is the first interpretation that is correct, so you will see this theme throughout materials published by the Couple to Couple League. (This is also tied to their fundamental view of the purpose of sex which I mentioned in an earlier post--that every act of intercourse must be equally open to the gift of children, and if you're preventing pregnancy, the only appropriate way to do this is abstinence.)

On the other hand, almost all material produced by Evangelical Christians suggests that the second interpretation is correct. They would say that it was Onan's failure to do everything he could to provide a child for Tamar, his duty according to Jewish law, which is the sin leading to Onan's punishment.

It is this second interpretation with which I also agree. Again, this is my personal opinion (which happens to be shared by many others), but there are also many who disagree. This is the point at which you need to study the Word in addition to reading outside sources--so you know the biblical foundation for why you believe what you believe.

Additionally, it is not my intention to pit Catholics against Evangelicals in any way, but rather simply to point out the differences in interpretation so that you can understand the basis for the conclusions in materials you are reading.

I have touched on the purpose of sex within marriage in a sort of scattered fashion through many of these posts, but I do plan to write a bit more about this theme in a concentrated fashion and provide you with additional resources to help you think through this important issue. After all, we need to have this issue settled if we are to consider whether or not ANY form of contraception is acceptable.

Up next... the IUD, then "the pill", then sterilization.