Living and Dying in Brick City (14 page)

I’ve always heard that God works in mysterious ways. I couldn’t give Mr. and Mrs. Givens the news they wanted in the emergency room that day. But maybe my role was broader: to plant the seed of possibility.

This means not having sex (vaginal, anal, or oral)
at any time
. It is the only sure way to prevent pregnancy and protect against sexually transmitted infections (STIs), including HIV.

This method means either you do not have sex or you use a barrier method on the days you are most fertile (most likely to become pregnant). It also involves checking your cervical mucus and recording your body temperature each day. Cervical mucus is the discharge from your vagina. You are most fertile when it is clear and slippery like raw egg whites. Use a basal thermometer to take your temperature and record it on a chart: Your temperature will rise 0.4 to 0.8°F on the first day of ovulation. You can talk with your doctor or a natural family planning instructor to learn how to record and understand this information.

Contraceptive sponge

This barrier method is a soft, disk-shaped device with a loop for removal. It is made out of polyurethane foam and contains nonoxynol-9, which kills sperm (spermicide). Before having sex, wet the sponge and place it, loop side down, inside your vagina to cover the cervix. The sponge is effective for up to twenty-four hours, including more than one act of intercourse. It needs to be left in for at least six hours after having sex to prevent pregnancy. It must then be taken out within thirty hours after it is inserted.

Only one kind of contraceptive sponge is sold in the United States: the Today Sponge. Women who are sensitive to the spermicide nonoxynol-9 should not use the sponge.

Diaphragm, cervical cap, and cervical shield

These barrier methods block the sperm from entering the cervix (the opening to your womb) and reaching the egg. Before having sex, add spermicide (to block or kill sperm) to the device. (You can buy spermicide gel or foam at a drugstore.) Then place it inside your vagina to cover your cervix. All three of these barrier methods must be left in place for six to eight hours after having sex to prevent pregnancy. The diaphragm should be taken out within twenty-four hours. The cap and shield should be taken out within forty-eight hours.

Female condom

This condom is worn by the woman inside her vagina. It keeps sperm from getting into her body. It is made of thin, flexible, man-made rubber and is packaged with a lubricant. It can be inserted up to eight hours before having sex. Use a new condom each time you have intercourse. And don’t use it and a male condom at the same time. Condoms, both male and female, are the only methods listed here that also offer protection from STIs.

Male condom

A male condom is a thin sheath placed over an erect penis to keep sperm from entering a woman’s body. Condoms can be made of latex, polyurethane, or “natural lambskin.” The natural kind do not protect against STIs. Condoms work best when used with a vaginal spermicide, which kills the sperm. You need to use a new condom with each sex act.

Oral contraceptives—combined pill (“the pill”)

The pill contains the hormones estrogen and progestin. It is taken daily to keep the ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining the egg.

Many types of oral contraceptives are available. Talk with your doctor about which is best for you.

The patch

Also called by its brand name, Ortho Evra, this skin patch is worn on the lower abdomen, buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch once a week for three weeks. The fourth week you don’t use a patch in order to have a period.

Shot/injection

The birth control shot often is called by its brand name, Depo-Provera. With this method you get injections, or shots, of the hormone progestin in the buttocks or arm every three months. A new type is injected under the skin. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg. The shot should not be used more than two years in a row because it can cause a temporary loss of bone density.

Vaginal ring

This is a thin, flexible ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg. It is commonly referred to by its brand name, NuvaRing. You squeeze the ring between your thumb and index finger and insert it into your vagina. You wear the ring for three weeks, take it out for the week that you have your period, and then put in a new ring.

Implantable rod

This is a matchstick-sized, flexible rod that is put under the skin of the upper arm. It is often called by its brand name, Implanon. The rod releases progestin, which causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining an egg. Less often, it stops the ovaries from releasing eggs. It is effective for up to three years.

Intrauterine devices or IUDs

An IUD is a small device shaped like a T that goes in your uterus. There are two types:

Sterilization implant (Essure)

Essure is the first non-surgical method of sterilizing women. A thin tube is used to thread a tiny spring-like device through the vagina and uterus into each fallopian tube. The device works by causing scar tissue to form around the coil. This blocks the fallopian tubes and stops the egg and sperm from joining. It can take about three months for the scar tissue to grow, so it’s important to use another form of birth control during this time. Then you will have to return to your doctor for a test to see if scar tissue has fully blocked your tubes.

Surgical sterilization

For women, surgical sterilization closes the fallopian tubes by cutting, tying, or sealing them. This stops the eggs from going down to the uterus where they can be fertilized. The surgery can be done a number of ways. Sometimes, a woman having cesarean birth has the procedure done at the same time, so as to avoid having additional surgery later.

For men, having a vasectomy keeps sperm from going to his penis, so his ejaculate never has any sperm in it. Sperm stays in the system after surgery for about three months. During that time, use a backup form of birth control to prevent pregnancy. A simple test can be done to check if all the sperm is gone; it is called a “semen analysis.”

Plan B One-Step or Next Choice. It is also called “the morning after pill.”

Emergency contraception keeps a woman from getting pregnant when she has had unprotected vaginal intercourse. Emergency contraception can be taken as a single pill treatment or in two doses. A single dose treatment works as well as two doses and does not have more side effects. It works by stopping the ovaries from releasing an egg or keeping the sperm from joining with the egg. For the best chances for it to work, take the pill as soon as possible after unprotected sex. It should be taken within seventy-two hours after having unprotected sex. A single-pill dose or two-pill dose of emergency contraception is available over-the-counter (OTC) for women ages seventeen and older.

All birth control methods work 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. For more information about birth control methods, call
womens+health.+gov
at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

There are four basic types of adoption:

As the chart below shows, requirements, costs, and timing vary between and within the different types of adoption. To decide which is best for you, think seriously about the type of child you would like to adopt (for example, an infant, an older child or group of siblings, a child from another country, a child who has special needs, etc.).

Type of Adoption

Public agency adoption

Definition

an adoption directed and supervised by a state or local Department of Human Services (or Social Services, or Human Resources, or Health and Welfare, or Child and Family Services, etc.)

Children Available

children with special needs (kids who are harder to place due to emotional or physical disorders, age, race, membership in a sibling group, backgrounds); rarely infants

Approximate Cost

from $0 to $2,500 (depending on the state, up to $2,000 of “nonrecurring” adoption costs for eligible special needs children may be reimbursed)

Who Can Adopt

flexible eligibility requirements for adoptive parents; on a case-by-case basis, will consider single parents, parents over the age of forty, parents who have other children, parents with low incomes, etc.

How Long It Takes

starts slowly, but for those who have an updated home study, placement can occur as soon as a few months after selecting a child

Type of Adoption

Private agency adoption

Definition

an adoption directed and supervised by a privately funded, licensed adoption agency

Children Available

sometimes handle special needs children; more commonly associated with younger children and infants

Approximate Cost

$5,000 to $40,000; lower for special needs children; some agencies have sliding fee scales

Who Can Adopt

agencies may recruit parents based on race, religious affiliation, etc.; for infant adoptions, birth mother often chooses

How Long It Takes

a few months to a few years (sometimes longer for infant adoption)

Type of Adoption

International adoption

(not legal in all states; also known as “private adoption”)

Definition

process of adopting a child who is not a U.S. citizen, which may be accomplished privately through an attorney or through an international adoption agency

Children Available

nearly seventy countries allow their children to be adopted by U.S. citizens; ages range from infants to teens; health conditions vary

Approximate Cost

$15,000 to $30,000 (varies by country; travel and travel-related expenses may be additional)

Who Can Adopt

depends on agency and country requirements; some countries will accept single parents; most prospective parents are between ages twenty-five and forty-five

How Long It Takes

six months to several years depending on the child’s age and health and the country’s political climate

Type of Adoption

Independent adoption

Definition

an adoption initiated by prospective parents and completed with help from an attorney or adoption counselor

Children Available

generally infants

Approximate Cost