Friday, August 28, 2020

FETAL HYDROCEPHALUS (VENTRICULOMEGALY)

What is ventriculomegaly?

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The two components of the central nervous system are the brain and the spinal cord. The entire surface of the brain and spine cord is bathed by a clear, colorless fluid called cerebrospinal fluid (CSF). Cerebrospinal fluid is a clear, watery liquid that surrounds the brain and spinal cord, and is also found throughout the ventricles (brain cavities and tunnels). CSF cushions the brain and spinal cord from jolts.

We term Ventriculomegaly, when the fluid filled structures (lateral ventricles) in the brain are too large. When you are pregnant you will have an ultrasound. With the ultrasound the doctor will look at your fetus’s brain and measure the ventricles. If the lateral ventricles are 10 millimeters or greater in size then you will be told that your fetus has "ventriculomegaly". p=""

Sometimes the ultrasound will only show one of the ventricles even though there are two (one on the right, and one on the left side). Ventriculomegaly seems to occur more often in male fetuses than in female fetuses.

What is the outcome for a fetus with ventriculomegaly?

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The outcome of ventriculomegaly depends on several factors including the actual size of the ventricles, whether or not there are any other findings on the ultrasound, such as agenesis of the corpus callosum, and the results of the amniocentesis. In general, the outcome is worse when the ventricles are larger, the amniocentesis is abnormal, or there are other problems seen on the ultrasound. The best outcome is typically observed when: 1.) the fetus' ventricles are only mildly enlarged (measure between 10-15 millimeters in size, 2.) when there are no other problems seen on the ultrasound, and 3.) the genetic testing results are normal—this is called “Isolated Mild Ventriculomegaly”.

The exact outcome for your child’s health is difficult to know. The most common effect in the child is developmental delay. This seems to be related to the size of the ventricles. We are now studying fetal MRI to see if the information from the fetal MRI can tell us the chance of disability and can provide families with more information on what to expect for their child's health and development. This information will help parents make decisions during pregnancy and prepare in advance for challenges their child and the family may face.

How serious is my fetus’s ventriculomegaly?

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If your doctor sees ventriculomegaly, they may refer you for several tests. These include a more detailed ultrasound (often times called “Level II ultrasound” or “Fetal Survey”), amniocentesis and/or microarray (to look at the genetic makeup of your fetus, and to look for any signs of infection), and fetal magnetic resonance imaging (Fetal MRI).

Fetal MRI is another way to safely look at your fetus’s brain. It gives pictures of your fetus’s brain using different technology than ultrasound. Because it uses a different technology, fetal MRI can detect other problems in your fetus’s brain that cannot be detected on ultrasound. We can then look at the results from all of the tests together and your physician can speak with you about the significance of these test results.

What are my choices during this pregnancy?

There is no treatment before birth for fetuses with ventriculomegaly. Treatment after birth involves managing the child's symptoms. It is important during your pregnancy to get a detailed diagnosis (via detailed ultrasound, amniocentesis, and MRI) in order to determine if there are any additional problems. Our staff can talk to you about these test results and inform you what challenges you may expect. If there is evidence of more severe handicaps which require long-term care, we can help direct you to the appropriate specialists.

Hydrocephelus and ventriculoperitoneal shunt (VP shunt)

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If tests show that your baby's cerebrospinal fluid is not draining well, then hydrocephelus is indicated. Hydrocephalus is the build up of cerebrospinal fluid which causes pressure on the brain. In such a situation, a ventriculoperitoneal shunt (VP shunt) may be recommended. Hydrocephelus is a progressive problem so usually the fluid builds up slowly over the course of weeks after your baby is born. In most cases we will know by 6 months if your baby will need a VP shunt.

A VP shunt is the surgical implantation of a small plastic catheter that drains the cerebrospinal fluid into a part of the body that can easily absorb the fluid such as the abdomen or peritoneum (membrane that forms the lining of the abdominal cavity). The VP shunt procedure will be performed by a pediatric neurosurgeon. It is a very safe procedure which can help your child's development as it helps relieve pressure to the brain caused by the build up of cerebrospinal fluid. Your child will not have to stay in the hospital as the shunt lives under the skin. Many people live their lives healthfully with a VP shunt. Patients with a VP shunt will require regular follow up with neurosurgery to make sure the shunt continues to function properly.

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Monday, August 24, 2020

GESTATIONAL DIABETES

Gestational diabetes is a type of diabetes that develops during pregnancy. Diabetes means your blood glucose, also called blood sugar, is too high. Too much glucose in your blood is not good for you or your baby.

Gestational diabetes is usually diagnosed in the 24th to 28th week of pregnancy. Managing your gestational diabetes can help you and your baby stay healthy. You can protect your own and your baby’s health by taking action right away to manage your blood glucose levels.

How can gestational diabetes affect my baby?

High blood glucose levels during pregnancy can cause problems for your baby, such as

  • being born too early
  • weighing too much, which can make delivery difficult and injure your baby
  • having low blood glucose, also called hypoglycemia, right after birth
  • having breathing problem

High blood glucose also can increase the chance that you will have a miscarriage or a stillborn baby. Stillborn means the baby dies in the womb during the second half of pregnancy.

Your baby also will be more likely to become overweight and develop type 2 diabetes as he or she gets older.

How can gestational diabetes affect me?

If you have gestational diabetes, you are more likely to develop preeclampsia, which is when you develop high blood pressure and too much protein in your urine during the second half of pregnancy.

Preeclampsia can cause serious or life-threatening problems for you and your baby. The only cure for preeclampsia is to give birth. If you have preeclampsia and have reached 37 weeks of pregnancy, your doctor may want to deliver your baby early. Before 37 weeks, you and your doctor may consider other options to help your baby develop as much as possible before he or she is born. Learn more about preeclampsia.

Gestational diabetes may increase your chance of having a cesarean section, also called a C-section, because your baby may be large. A C-section is major surgery.

If you have gestational diabetes, you are more likely to develop type 2 diabetes later in life. Over time, having too much glucose in your blood can cause health problems such as diabetic retinopathy, heart disease, kidney disease, and nerve damage. You can take steps to help prevent or delay type 2 diabetes.

Symptoms & Causes of Gestational Diabetes

What are the symptoms of gestational diabetes?

Usually, gestational diabetes has no symptoms. If you do have symptoms, they may be mild, such as being thirstier than normal or having to urinate more often.

What causes gestational diabetes?

Gestational diabetes occurs when your body can’t make the extra insulin needed during pregnancy. Insulin, a hormone made in your pancreas, helps your body use glucose for energy and helps control your blood glucose levels.

During pregnancy, your body makes special hormones and goes through other changes, such as weight gain. Because of these changes, your body’s cells don’t use insulin well, a condition called insulin resistance. All pregnant women have some insulin resistance during late pregnancy. Most pregnant women can produce enough insulin to overcome insulin resistance, but some cannot. These women develop gestational diabetes.
 

Being overweight or obese is linked to gestational diabetes. Women who are overweight or obese may already have insulin resistance when they become pregnant. Gaining too much weight during pregnancy may also be a factor.

Having a family history of diabetes makes it more likely that a woman will develop gestational diabetes, which suggests that genes play a role.

Tests & Diagnosis for Gestational Diabetes

When will I be tested for gestational diabetes?

Testing for gestational diabetes usually occurs between 24 and 28 weeks of pregnancy.

If you have an increased chance of developing gestational diabetes, your doctor may test for diabetes during the first visit after you become pregnant.

How do doctors diagnose gestational diabetes?

Doctors use blood tests to diagnose gestational diabetes. You may have the glucose challenge test, the oral glucose tolerance test, or both. These tests show how well your body uses glucose.

Glucose Challenge Test

You may have the glucose challenge test first. Another name for this blood test is the glucose screening test. In this test, a health care professional will draw your blood 1 hour after you drink a sweet liquid containing glucose. You do not need to fast for this test. Fasting means having nothing to eat or drink except water. If your blood glucose is too high—140 or more—you may need to return for an oral glucose tolerance test while fasting. If your blood glucose is 200 or more, you may have type 2 diabetes.

Oral Glucose Tolerance Test (OGTT)

The OGTT measures blood glucose after you fast for at least 8 hours. First, a health care professional will draw your blood. Then you will drink the liquid containing glucose. You will need your blood drawn every hour for 2 to 3 hours for a doctor to diagnose gestational diabetes.

High blood glucose levels at any two or more blood test times—fasting, 1 hour, 2 hours, or 3 hours—mean you have gestational diabetes. Your health care team will explain what your OGTT results mean.

Your health care professional may recommend an OGTT without first having the glucose challenge test.

Managing & Treating Gestational Diabetes

How can I manage my gestational diabetes?

Many women with gestational diabetes can manage their blood glucose levels by following a healthy eating plan and being physically active. Some women also may need diabetes medicine.

Follow a healthy eating plan

Your health care team will help you make a healthy eating plan with food choices that are good for you and your baby. The plan will help you know which foods to eat, how much to eat, and when to eat. Food choices, amounts, and timing are all important in keeping your blood glucose levels in your target range.

If you’re not eating enough or your blood glucose is too high, your body might make ketones. Ketones in your urine or blood mean your body is using fat for energy instead of glucose. Burning large amounts of fat instead of glucose can be harmful to your health and your baby’s health.

Your doctor might recommend you test your urine or blood daily for ketones or when your blood glucose is above a certain level, such as 200. If your ketone levels are high, your doctor may suggest that you change the type or amount of food you eat. Or, you may need to change your meal or snack times.

Be physically active

Physical activity can help you reach your target blood glucose levels. If your blood pressure or cholesterol levels are too high, being physically active can help you reach healthy levels. Physical activity can also relieve stress, strengthen your heart and bones, improve muscle strength, and keep your joints flexible. Being physically active will also help lower your chances of having type 2 diabetes in the future.

Talk with your health care team about what activities are best for you during your pregnancy. Aim for 30 minutes of activity 5 days of the week, even if you weren’t active before your pregnancy. If you are already active, tell your doctor what you do. Ask your doctor if you may continue some higher intensity activities, such as lifting weights or jogging.

Read tips on how to eat better and be more active while you are pregnant and after your baby is born.

How will I know whether my blood glucose levels are on target?

Your health care team may ask you to use a blood glucose meter to check your blood glucose levels. This device uses a small drop of blood from your finger to measure your blood glucose level. Your health care team can show you how to use your meter.

Recommended daily target blood glucose levels for most women with gestational diabetes are 

  • Before meals, at bedtime, and overnight: 95 or less
  • 1 hour after eating: 140 or less
  • 2 hours after eating: 120 or less

Ask your doctor what targets are right for you.

You can keep track of your blood glucose levels using My Daily Blood Glucose Record (PDF, 45 KB). You can also use an electronic blood glucose tracking system on your computer or mobile device. Record the results every time you check your blood glucose. Your blood glucose records can help you and your health care team decide whether your diabetes care plan is working. Take your tracker with you when you visit your health care team.

How is gestational diabetes treated if diet and physical activity aren’t enough?

If following your eating plan and being physically active aren’t enough to keep your blood glucose levels in your target range, you may need insulin.

If you need to use insulin, your health care team will show you how to give yourself insulin shots. Insulin will not harm your baby and is usually the first choice of diabetes medicine for gestational diabetes. Researchers are studying the safety of the diabetes pills metformin and glyburide during pregnancy, but more long-term studies are needed. Talk with your health care professional about what treatment is right for you.

Preventing Gestational Diabetes

What increases my chance of developing gestational diabetes?

Your chance of developing gestational diabetes are higher if you

  • are overweight
  • had gestational diabetes before
  • have a parent, brother, or sister with type 2 diabetes
  • have prediabetes, meaning your blood glucose levels are higher than normal yet not high enough for a diagnosis of diabetes
  • are African American, American Indian, Asian American, Hispanic/Latina, or Pacific Islander American
  • have a hormonal disorder called polycystic ovary syndrome, also known as PCOS

How can I lower my chance of developing gestational diabetes?

If you are thinking about becoming pregnant and are overweight, you can lower your chance of developing gestational diabetes by losing extra weight and increasing physical activity before you become pregnant. Taking these steps can improve how your body uses insulin and help your blood glucose levels stay normal.

Once you are pregnant, don’t try to lose weight. You need to gain some weight for your baby to be healthy. However, gaining too much weight too quickly may increase your chance of developing gestational diabetes. Ask your doctor how much weight gain and physical activity during pregnancy are right for you.

After Your Baby is Born

After I have my baby, how can I find out whether I have diabetes?

You should get tested for diabetes no later than 12 weeks after your baby is born. If your blood glucose is still high, you may have type 2 diabetes. Even if your blood glucose is normal, you still have a greater chance of developing type 2 diabetes in the future. Therefore, you should be tested for diabetes every 3 years.

How can I prevent or delay type 2 diabetes later in life?

You can do a lot to prevent or delay type 2 diabetes. Here are steps you should take if you had gestational diabetes:

  • Be more active and make healthy food choices to get back to a healthy weight.
  • Breastfeed your baby. Breastfeeding gives your baby the right balance of nutrients and helps you burn calories.
  • If your test results show that you could get diabetes and you are overweight, ask your doctor about what changes you can make to lose weight and for help in making them. Your doctor may recommend that you take medicine such as metformin to help prevent type 2 diabetes.

How can I help my child be healthy?

You can help your child be healthy by showing him or her how to make healthy lifestyle choices, including

  • being physically active
  • limiting time watching TV, playing video games, or using a mobile device or computer
  • making healthy food choices
  • staying at a healthy weight

Making healthy choices helps the whole family and may protect your child from becoming obese or developing diabetes later in life.

Reference: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Last Updated: March 2020

Related Topics

This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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CESAREAN SECTION (C-SECTION)

A Cesarean section (often called a C-section) is a surgical procedure to deliver a baby. The baby is taken out through the mother's abdomen. Most cesarean births result in healthy babies and mothers. But c-section is major surgery and carries risks. Healing also takes longer than with vaginal birth.

Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. Still, the cesarean birth rate in the United States has risen greatly in recent decades. Today, nearly 1 in 3 women have babies by c-section in the United States. 

What are the reasons for having a C-section?

Your doctor might recommend a C-section if he or she thinks it is safer for you or your baby than vaginal birth. Some C-sections are planned. But most C-sections are done when unexpected problems happen during delivery. Even so, there are risks of delivering by c-section. Limited studies show that the benefits of having a c-section may outweigh the risks when:

  • the mother is carrying more than one baby (twins, triplets, etc.)
  • he mother has health problems including HIV infection, herpes infection, and heart disease
  • the mother has dangerously high blood pressure
  • the mother has problems with the shape of her pelvis
  • there are problems with the placenta
  • there are problems with the umbilical cord
  • there are problems with the position of the baby, such as breech
  • the baby shows signs of distress, such as a slowed heart rate
  • the mother has had a previous C-section

What happens during a C-section?

Most C-sections are unplanned. So, learning about C-sections is important for all women who are pregnant. Whether a C-section is planned or comes up during labor, it can be a positive birth experience for many women. The overview that follows will help you to know what to expect during a nonemergency c-section and what questions to ask.

Cesarean delivery takes about 45 to 60 minutes. It takes place in an operating room. So if you were in a labor and delivery room, you will be moved to an operating room. Often, the mood of the operating room is unhurried and relaxed. A doctor will give you medicine through an epidural or spinal block, which will block the feeling of pain in part of your body but allow you to stay awake and alert. The spinal block works right away and completely numbs your body from the chest down. The epidural takes away pain, but you might be aware of some tugging or pushing. Medicine that makes you fall asleep and lose all awareness is usually only used in emergency situations. Your abdomen will be cleaned and prepped. You will have an IV for fluids and medicines. A nurse will insert a catheter to drain urine from your bladder. This is to protect the bladder from harm during surgery. Your heart rate, blood pressure, and breathing also will be monitored. Questions to ask:

  • What are my options for blocking pain?
  • Can I have music played during the surgery?
  • Will I be able to watch the surgery if I want?

During surgery

The doctor will make 2 incisions. The first is about 6 inches long and goes through the skin, fat, and muscle. Most incisions are made side to side and low on the abdomen, called a bikini incision. Next, the doctor will make an incision to open the uterus. The opening is made just wide enough for the baby to fit through. One doctor will use a hand to support the baby while another doctor pushes the uterus to help push that baby out. Fluid will be suctioned out of your baby's mouth and nose. The doctor will hold up your baby for you to see. Once your baby is delivered, the umbilical cord is cut, and the placenta is removed. Then, the doctor cleans and stitches up the uterus and abdomen. The repair takes up most of the surgery time.

After surgery

You will be moved to a recovery room and monitored for a few hours. You might feel shaky, nauseated, and very sleepy. Later, you will be brought to a hospital room. When you and your baby are ready, you can hold, snuggle, and nurse your baby. Many people will be excited to see you. But don't accept too many visitors. Use your time in the hospital, usually about 4 days, to rest and bond with your baby. C-section is major surgery, and recovery takes about 6 weeks (not counting the fatigue of new motherhood). In the weeks ahead, you will need to focus on healing, getting as much rest as possible, and bonding with your baby — nothing else. Be careful about taking on too much and accept help as needed.

Questions to ask:

  • Can my baby be brought to me in the recovery room?
  • What are the best positions for me to breastfeed?

Can I have a vaginal birth after C-section (VBAC)?

Some women who have delivered previous babies by C-section would like to have their next baby vaginally. This is called vaginal delivery after C-section or VBAC. There are many reasons why some women want a VBAC. Some want to avoid the risks and long recovery of surgery. Others want to experience vaginal delivery. Of women who try VBAC, 60 percent to 80 percent are able to deliver vaginally.

But VBAC isn't the right choice for everyone. Some women have health or pregnancy complications that make VBAC unsafe. For other women, the risks of C-section are more acceptable than the risks of VBAC. Still, others don't live near a hospital where VBAC is possible.

Your doctor can tell you if you are a good candidate for VBAC. VBAC might be an option for you if:

  • You had 1 previous planned c-section done with a low, horizontal incision ("bikini" incision)
  • You have no other uterine scars (aside from the prior c-section) or problems
  • You have no known problems with your pelvis
  • A doctor will be present during all of labor and delivery and can perform an emergency c-section if needed
  • A surgical team is immediately available in case an emergency c-section is needed.

Your doctor can explain the risks of both repeat cesarean delivery and VBAC. With VBAC, the most serious danger is the chance that the C-section scar on the uterus will open up during labor and delivery. This is called uterine rupture. While very rare, uterine rupture is very dangerous for the mother and baby. Less than 1 percent of VBACs lead to uterine rupture. But doctors cannot predict if uterine rupture is likely to occur in a woman. This risk, albeit very small, is unacceptable to some women.

The percent of VBACs is dropping in the our country for many reasons. Some doctors, hospitals, and patients have concerns about the safety of VBAC. Some hospitals and doctors are unwilling to do VBACs because of fear of lawsuits and insurance or staffing expenses. Many doctors, however, question if this trend is in the best interest of women's health.

Choosing to try a VBAC is complex. If you are interested in a VBAC, talk to your doctor and read up on the subject. Only you and your doctor can decide what is best for you. VBACs and planned c-sections both have their benefits and risks. Learn the pros and cons and be aware of possible problems before you make your choice.

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CONTRACEPTION


Contraception, also known as birth control, is designed to prevent pregnancy. It also allows individuals to plan the timing of pregnancy.

Types of Contraception

Not all contraceptive methods are appropriate for all situations, and the most appropriate method of birth control depends on a woman's overall health, age, frequency of sexual activity, number of sexual partners, desire to have children in the future, and family history of certain diseases.

Individuals should consult their health care providers to determine which method of birth control is best for them. Some types carry serious risks, although those risks are elevated with pregnancy and may be higher than the risks associated with the various methods.

General methods of contraception include:

1) Continuous abstinence

2) Natural family planning/rhythm method

3) Barrier methods

  • Contraceptive sponge
  • Diaphragm, cervical cap, and cervical shield
  • Female condom
  • Male condom

4) Hormonal methods

  • Oral contraceptives — combined pill ("The pill")Oral contraceptives — progestin-only pill ("Mini-pill")
  • The patch
  • Shot/injection
  • Vaginal ring

5) Implantable devices

  • Implantable rods
  • Intrauterine devices

6) Permanent birth control methods

  • Sterilization implant
  • Surgical sterilization

7) Emergency contraception

Individuals should consult their health care provider to determine which method of birth control is best for them. It is also important to discuss birth control methods with your sexual partner.

How effective is contraception?

Different methods of contraception have different rates of effectiveness in preventing pregnancy.

Contraception is most effective when used correctly and consistently. The failure rate increases if a method of contraception is used incorrectly.

Can contraception reduce the risk of getting a sexually transmitted disease (STD)?

Only male and female condoms are effective at reducing the spread of STDs.

The male latex condom is the best method for protecting against STDs, including HIV/AIDS. Polyurethane condoms are an effective alternative if either partner has a latex allergy.

Natural/lambskin condoms do not prevent the spread of STDs because of the presence of tiny pores (holes) that may allow viruses such as HIV, hepatitis B, and herpes to spread.

The female condom has properties similar to the male condom, but researchers have not studied its effectiveness in reducing the spread of STDs as much as they have studied the male condom.

The most common STD is the human papilloma virus, or HPV. No method of contraception can fully prevent the transmission of HPV, because it can infect areas not covered by a condom.

However, using a condom with every sex act can lower the risk of transmission.

If you have questions about birth control and STDS, talk to your health care provider.

If you think you may have an STD, you should see your health care provider.

What are the health risks and side effects associated with contraception?

Different forms of contraception carry different health risks and side effects, and some of them are serious. It is important to talk to a health care provider to determine your specific health risks and which method of contraception is right for you.

Combined hormonal birth control methods can increase the risk of heart disease, high blood pressure, and blood clots. The risk of these conditions is higher in pregnancy than with any currently marketed birth control methods, so women need to weigh the benefit of protection from pregnancy with the risk of any specific birth control method. Women are at higher risk for these outcomes if they are more than 35 years old and smoke tobacco or if they have histories of blood clots or breast or endometrial cancer. They may be advised not to use combined hormonal methods of birth control.

It is important to monitor any side effects and consult your health care provider if you experience discomfort.

What are the health benefits associated with contraception?

Contraception is most often used to help prevent pregnancy. It can be helpful for women who do not wish to become pregnant and who are at higher risk for health problems associated with pregnancy. These can include an increased risk for high blood pressure, blood clots, gestational diabetes, heart disease, and stroke.

The risks of these conditions are higher in women who are obese, are older than 35, or who smoke tobacco. For women with high risk factors who need to avoid pregnancy, IUDs and implants may be the most effective methods.

Progestin-releasing IUDs may also reduce or prevent bleeding problems. Other health benefits for certain methods include reducing acne, treating anemia associated with excessive bleeding, and reducing the risk of endometrial, ovarian, or colon cancer. It is important to discuss the risks and benefits of the methods as well as the risk associated with pregnancy with your health care provider.

How well do different kinds of birth control work? Do they have side effects?

All birth control methods work the best if used correctly and every time you have sex. Be sure you know the right way to use them. Sometimes doctors don't explain how to use a method because they assume you already know. Talk with your doctor if you have questions. They are used to talking about birth control. So don't feel embarrassed about talking to him or her.

Some birth control methods can take time and practice to learn. For example, some people don't know you can put on a male condom "inside out." Also, not everyone knows you need to leave a little space at the tip of the condom for the sperm and fluid when a man ejaculates, or has an orgasm.

Here is a list of some birth control methods with their failure rates and possible side effects.

 
MethodFailure rate (the number of pregnancies expected per 100 women)Some side effects and risks

Sterilization surgery for women

Less than 1 pregnancy
  • Pain
  • Bleeding
  • Complications from surgery
  • Ectopic (tubal) pregnancy

Sterilization implant for women
(Essure®)

Less than 1 pregnancy
  • Pain
  • Ectopic (tubal) pregnancy

Sterilization surgery for men (vasectomy)

Less than 1 pregnancy
  • Pain
  • Bleeding
  • Complications from surgery

Implantable rod
(Implanon®)

Less than 1 pregnancy

Might not work as well for women who are overweight or obese.
  • Acne
  • Weight gain
  • Ovarian cysts
  • Mood changes
  • Depression
  • Hair loss
  • Headache
  • Upset stomach
  • Dizziness
  • Sore breasts
  • Changes in period
  • Lower interest in sex

Intrauterine device
(ParaGard®, Mirena®)

Less than 1 pregnancy
  • Cramps
  • Bleeding between periods
  • Pelvic inflammatory disease
  • Infertility
  • Tear or hole in the uterus

Shot/injection
(Depo-Provera)

Less than 1 pregnancy
  • Bleeding between periods
  • Weight gain
  • Sore breasts
  • Headaches
  • Bone loss with long-term use

Oral contraceptives (combination pill, or "the pill") 

5 pregnancies

Being overweight may increase the chance of getting pregnant while using the pill.
  • Dizziness
  • Upset stomach
  • Changes in your period
  • Changes in mood
  • Weight gain
  • High blood pressure
  • Blood clots
  • Heart attack
  • Stroke
  • New vision problems

Oral contraceptives (continuous/extended use, or "no-period pill")

5 pregnancies

Being overweight may increase the chance of getting pregnant while using the pill.
  • Same as combination pill
  • Spotting or bleeding between periods
  • Hard to know if pregnant

Oral contraceptives (progestin-only pill, or "mini-pill")

5 pregnancies

Being overweight may increase the chance of getting pregnant while using the pill.
  • Spotting or bleeding between periods
  • Weight gain
  • Sore breasts

Skin patch
(Ortho Evra®)

5 pregnancies

May not work as well in women weighing more than 198 pounds.
  • Similar to side effects for the combination pill
  • Greater exposure to estrogen than with other methods

Vaginal ring (NuvaRing®)

5 pregnancies
  • Similar to side effects for the combination pill
  • Swelling of the vagina
  • Irritation
  • Vaginal discharge

Male condom

11-16 pregnancies
  • Allergic reactions

Diaphragm with spermicide

15 pregnancies
  • Irritation
  • Allergic reactions
  • Urinary tract infection
  • Toxic shock if left in too long

Sponge with spermicide (Today® Sponge)

16-32 pregnancies
  • Irritation
  • Allergic reactions
  • Hard time taking it out
  • Toxic shock if left in too long

Cervical cap with spermicide

17-23 pregnancies
  • Irritation
  • Allergic reactions
  • Abnormal Pap smear
  • Toxic shock if left in too long

Female condom

20 pregnancies
  • Irritation
  • Allergic reactions

Natural family planning (rhythm method)

25 pregnancies

None

Spermicide alone

30 pregnancies

It works best if used along with a barrier method, such as a condom.
  • Irritation
  • Allergic reactions
  • Urinary tract infection

Emergency contraception ("morning-after pill," "Plan B® One-Step," "Next Choice®")

1 pregnancy

It must be used within 72 hours of having unprotected sex.

Should not be used as regular birth control; only in emergencies.
  • Upset stomach
  • Vomiting
  • Lower stomach pain
  • Fatigue
  • Headache and dizziness
  • Irregular bleeding
  • Breast tenderness

What should I do if I want to become pregnant?

If you want to become pregnant, talk to your health care provider about stopping your birth control.

When taking oral contraceptives, ovulation can be restarted by stopping taking the pill. It is possible to become pregnant during the next menstrual cycle after stopping the pill, but it may take 1 or 2 months before you return to the previous timing of your cycle.  If you are using a contraceptive patch or vaginal ring, removing the device stops the delivery of hormones, and the results are similar to stopping oral contraception. Recovery of fertility after injections of Depo-Provera® may take longer, up to 10 months in some cases.

IUDs must be removed by a health care professional. After removal, pregnancy is possible at any time.

An implanted rod must also be removed by a health care provider. The implant is removed through a small cut in your arm, and pregnancy is possible any time after the implant is removed.

Is contraception used for things other than preventing pregnancy?

Yes. Use of oral contraceptives can also reduce severe menstrual cramps, make menstrual bleeding lighter, and clear up acne. There is also evidence that use of the pill can reduce the risk of endometrial,ovarian, and colon cancer, reduce the occurrence of cysts in the breasts and ovaries, protect against iron deficiency anemia, and improve bone density. The hormonal IUD can also reduce severe menstrual cramps and make menstrual bleeding lighter.

Oral contraception can also be used treat other gynecological disorders, such as uterine fibroids, endometriosis, and polycystic ovary syndrome. The pill may also offer some protection against pelvic inflammatory disease, which can lead to infertility if left untreated.

What is the best method of birth control (or contraception)?

There is no “best” method of birth control. Each method has pros and cons.

All women and men can have control over when, and if, they become parents. Making choices about birth control, or contraception, isn’t easy. There are many things to think about. To get started, learn about birth control methods you or your partner can use to prevent pregnancy. You can also talk with your doctor about the choices.

Before choosing a birth control method, think about:

  • Your overall health
  • How often you have sex
  • The number of sex partners you have
  • If you want to have children someday
  • How well each method works to prevent pregnancy
  • Possible side effects
  • Your comfort level with using the method

Keep in mind, even the most effective birth control methods can fail. But your chances of getting pregnant are lowest if the method you choose always is used correctly and every time you have sex.

Can all types of birth control prevent sexually transmitted infections (STIs)?

No. The male latex condom is the only birth control method proven to help protect you from STIs, including HIV. Research is being done to find out how effective the female condom is at preventing STIs and HIV. For more information, see Will birth control pills protect me from sexually transmitted infections (STIs), including HIV/AIDS?

Where can I get birth control? Do I need to visit a doctor?

Where you get birth control depends on what method you choose.

You can buy these forms over the counter:

  • Male condoms
  • Female condoms
  • Sponges
  • Spermicides
  • Emergency contraception pills (girls younger than 17 need a prescription)

You need a prescription for these forms:

  • Oral contraceptives: the pill, the mini-pill
  • Skin patch
  • Vaginal ring
  • Diaphragm (your doctor needs to fit one to your shape)
  • Cervical cap
  • Cervical shield
  • Shot/injection (you get the shot at your doctor’s office)
  • IUD (inserted by a doctor)
  • Implantable rod (inserted by a doctor)

You will need surgery or a medical procedure for:

  • Sterilization, female and male

Are there any foams or gels I can use to keep from getting pregnant?

You can buy spermicides over the counter. They work by killing sperm. They come in many forms:

  • Foam
  • Gel
  • Cream
  • Film
  • Suppository
  • Tablet

Spermicides are put in the vagina no more than 1 hour before having sex. If you use a film, suppository, or tablet, wait at least 15 minutes before having sex so the spermicide can dissolve. Do not douche or rinse out your vagina for at least 6 to 8 hours after having sex. You will need to use more spermicide each time you have sex.

Spermicides work best if used along with a barrier method, such as a condom, diaphragm, or cervical cap. Some spermicides are made just for use with the diaphragm and cervical cap. Check the package to make sure you are buying what you need.

All spermicides contain sperm-killing chemicals. Some contain nonoxynol-9, which may raise your risk of HIV if you use it a lot. It irritates the tissue in the vagina and anus, so it can cause the HIV virus to enter the body more freely. Some women are sensitive to nonoxynol-9 and need to use spermicides without it. Medications for vaginal yeast infections may lower the effectiveness of spermicides. Also, spermicides do not protect against sexually transmitted infections.

How effective is withdrawal as a birth control method?

Not very! Withdrawal is when a man takes his penis out of a woman’s vagina (or “pulls out”) before he ejaculates, or has an orgasm. This stops the sperm from going to the egg. “Pulling out” can be hard for a man to do. It takes a lot of self-control.

Even if you use withdrawal, sperm can be released before the man pulls out. When a man’s penis first becomes erect, pre-ejaculate fluid may be on the tip of the penis. This fluid has sperm in it. So you could still get pregnant.

Withdrawal does not protect you from STIs or HIV.

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Be sure to follow specific instructions given to you by your physician or health care professional.

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