Possible pregnancy?

The first suspicion you may have is a late period, following intercourse without contraceptive protection or with inadequate protection. There may be other early symptoms – breast fullness or tingling in the breasts or nipples, sometimes a desire to pass urine more frequently and nausea, especially in the mornings. However, some women become pregnant without experiencing any early symptoms at all and only know they are pregnant because they miss a period. If you have been taking the contraceptive pill and want to get pregnant it is wiser to use the sheath as a contraceptive measure until after you have had a ‘natural’ period. This will be the second period after finishing the pill. After you have become pregnant it will then be much easier for you and your doctor to work out when the conception took place.

Assuming you had intended to become pregnant, there is no great rush to see the doctor and you need not make an appointment until six weeks after your last period started. The only reason for seeing the doctor sooner is bleeding from the vagina if you think you could be pregnant. At this early stage it could just be another period and you may not be pregnant at all, but if you are pregnant, bleeding may indicate a possible miscarriage. There are other causes for vaginal bleeding in early pregnancy but miscarriage is not uncommon. About one is six pregnancies do miscarry in the early months. Play safe. If you think you could be pregnant and are losing blood, telephone your doctor for advice and go to bed.

Home Treatment

In the early weeks of pregnancy, you can behave very much as normal. Eat a sensible diet, carry on with whatever work or exercise you are used to and with your usual sexual activity.

There are only two important exceptions to this:

• If you smoke, give it up. Even a few cigarettes a day can harm the development of a baby in the womb.

• Do not take any drugs without consulting your doctor or a pharmacist. This includes all patent medicines. Although aspirin and paracetamol are generally regarded as safe in the early months of pregnancy, try not to take even these if possible. If your doctor is prescribing for you and you think you could be only just pregnant, tell him, even if you have not missed a period. He will then know to avoid drugs which should not be taken in early pregnancy.

What the Doctor Will Do

If you see him six weeks after your last period, he may be able to tell by a vaginal examination whether or not you are likely to be pregnant. He may order a pregnancy test, which is done in the laboratory on a specimen of urine passed first thing in the morning. The test is reasonably reliable at this stage in pregnancy, although it is still sometimes negative even when there is a pregnancy present. However, it is not essential to have this test done. If all else is normal, your doctor may choose to see you again after a week or two to check on symptoms of early pregnancy or to perform another examination.

Having confirmed that you are pregnant, the doctor will perform a routine examination of heart and lungs if not previously done, and check your blood pressure. He will discuss with you the arrangements for your further care during pregnancy and for the delivery of the baby.

Female sterilisation is a more complicated operation and may require a few days in hospital. It is always carried out under a general anaesthetic. Both procedures are available without charge in NHS hospitals. The patient’s GP must make the referral and there is usually a waiting list before the operation is performed. Some surgeons will also carry out vasectomies privately. The charge is usually very moderate, as the expense of a private hospital bed is avoided. Sterilisation procedures should only be considered when a couple have finally decided that they do not want any more children, no matter what circumstances may arise in future. Then it can be a most useful method of contraception. Occasionally sterilisation can be surgically reversed, but this is by no means always possible, so it should be regarded as permanent.

The rhythm method. For those who have religious scruples about using any drug or mechanical device, the ‘temperature’ version of the rhythm method may be used. This method is a way of timing intercourse so that the fertile times of the month are completely avoided. Anyone who wishes to use this method should go to a Family Planning Clinic or the Catholic Marriage Advisory Council for instruction in its use. The details are complicated and vary with the individual so personal advice is required.

Other methods of contraception in general cannot be recommended. Do not rely on withdrawal (or ‘being careful’). This is an unsatisfactory method. It is not only unreliable because sperm are present in the fluid produced by a man before ejaculation, but it is also sexually unrewarding for both partners. Chemical creams, jellies, pessaries, foams or films cannot be recommended for use on their own, whatever the manufacturers say in their literature, if you definitely do not want to get pregnant. They kill off sperm, but are only really effective if used with a diaphragm or sheath. Used on their own, they reduce the chance of pregnancy very little.

Some may say they are better than nothing for occasional use, but we do not advise you to rely on them alone. Douching after intercourse is totally ineffective. Amazingly, some people still seem to believe some of the old wives’ tales; e.g. ‘You can’t get pregnant if you… have intercourse standing up, hold your breath during orgasm, urinate or jump up and down afterwards’. Needless to say all these are totally useless.

Home Treatment

The only method of contraception we can recommend for use without seeing the doctor is the sheath used together with a chemical ‘spermicide’. Sheaths (condoms, johnnies, French letters) may be bought from chemists, barbers’ shops or slot machines but are often cheaper by mail order. Buy well- known brand names such as Durex, Premier or Horizon, or check that the brand you buy has the British Standard ‘kite- mark’ on the packet. Rumours of sheaths splitting or having holes in them may have been true when standards of manufacture were not so high as today, but these events are rare with properly made sheaths. Used correctly, the sheath is an effective method of contraception but slight carelessness in use can result in failure.

The sheath should be unrolled onto the erect penis before any sexual contact takes place and care taken to ensure that there is no air inside – otherwise it is more likely to come off during intercourse. One reason for failure is leakage of semen around the base of the sheath after ejaculation, so the penis should be withdrawn from the vagina with the sheath in place immediately after ejaculation to avoid this happening. It is also important for the woman to use a chemical spermicide in addition to the sheath. The spermicide should be inserted in the vagina before intercourse and should deal with any spillage of semen. The simplest and most convenient type of spermicide is the pessary, which can be bought from the pharmacy (e.g. Ortho- Forms, Genexol, Staycept). Pessaries are like large cone- shaped tablets and should be inserted high into the vagina just before intercourse. The pessaries melt quite rapidly with the warmth of the body. Spermicides are also available as foams, creams, films or jellies. If you wish to use the sheath as a regular method of contraception it would be wise to discuss this with your GP or a doctor at the Family Planning Clinic. Other methods should always be considered.

What the Doctor Will Do

Your own GP will give you advice about contraception and he may be prepared to prescribe the pill, but he may or may not be prepared to fit contraceptive devices. At present only a minority of GPs fit coils and diaphragms. If your GP does not fit these devices. and you decide in discussion with him that such a device may suit you, then you will normally go to another GP or to a Family Planning Clinic to be fitted. You may also go direct to a Family Planning Clinic for any contraceptive advice without first seeing your GP. There is no charge for NHS contraceptive advice or supplies – whether from your GP or a clinic. Remember also that contraceptive advice is given in confidence, like all other medical advice.

Before the pill is prescribed, expect a routine medical history to be taken and a blood- pressure check. A vaginal examination will usually be performed then or soon after the pill has been started, and a cervical smear taken. Regular six- monthly blood pressure checks are routine and periodic vaginal examination may be performed.

The coil is usually fitted without anaesthetic using a speculum to visualise the mouth of the womb. The procedure may be a little uncomfortable but is rarely painful. If pain is felt it is like a period pain.

Your GP will not provide prescriptions for sheaths, although diaphragms and spermicides are available on NHS prescription without charge. If the sheath is used as a regular method of contraception and other methods- are medically unsuitable, a Family Planning Clinic may provide supplies of sheaths without charge.