How doctors accidentally fall pregnant

For me, my history with hormonal birth control is intricately wrapped up with my work. I started taking an oral contraceptive pill called Triphasil as a medical student. I really only chose this pill because it was so freely available at the various primary care clinics I rotated through. The foil packets with 28 brown and white tablets could be found in the desk drawer of almost any consulting room, and nursing sisters would shove six months’ worth of the stuff at anyone who asked.

In my third or fourth year of University I remember attending a few lectures by someone who gave us the low-down on the many forms of contraception, from rhythm to barriers to pills to injections to stickers to intrauterine devices to operations. Afterwards, a group of us huddled around the lecturer, pleading desperately for her to tell us for once and for all, what was the best contraceptive? The most reliable? The least side effects? The easiest to take? She just smiled and shrugged and said each woman and couple had to figure it out for themselves.

For a long time, the best for me seemed to be contraception that was free, and that I didn’t need a to make a special appointment to get a script and a checkup for. I got a friend to do my blood pressure every now and then, and was unburdened by the side-effects that many of my friends said Triphasil gave them, compelling them to go for more expensive options. But even back then, I had one major problem with oral contraceptives: compliance. I would just forget to take the pill. I was frequently doubling or even tripling up after forgotten days, and more than once had to abandon a whole pack when I forgot so many days in a row that I had premature withdrawal bleeds.

This problem did not get better as I got older, or entered into a serious relationship which involved regular intercourse and the serious threat of pregnancy. When I started working as a doctor, the erratic shifts and odd hours just compounded the problem. I kept the pills next to my toothbrush, where I would theoretically see them every day, but working 30 hour shifts meant I didn’t brush my teeth at home every day. When I did finally get home, I would shower and brush my teeth and look blearily at the pills and think ‘I’m just too exhausted for this one last little thing’ and tell myself I’d double up the next day. If people came to visit, I’d put the pills out of sight and then forget about them myself. I was almost thirty and still using condoms and popping morning-after pills because of pure carelessness.

One day, when I was a surgical registrar, I went to see a gynaecologist to request an intra-uterine device, but she talked me out of it. It was so expensive, she pointed out, and frequently caused intolerable discomfort and pain in the nulliparous uterus. I would more likely than not develop heavy or erratic menses. If remembering to take pills every day was a problem, she said, why not use a patch that only needed to be applied once a week. It seemed like a good compromise. I could make changing the patch a Monday morning thing. It had a two- or three-day grace period, so I still had Tuesday and Wednesday to get to it, if I’d forgotten on the Monday.

Obviously, I was as lousy at the patch as I was at the pill. I set alarms on my phone to remind myself to change the patch, but frequently failed to get to a pharmacy before my monthly box ran out. I got colleagues to write repeat scripts for me so I didn’t have to make an appointment to get one, but pharmacies seldom stocked more than one or two boxes at a time, necessitating a monthly visit for restocks. I know this seems like nothing, and it was manageable during lighter rotations, but there were times when I was on call every third night, with no days off in-between. Not only was it impossible to get to a pharmacy, but time also became really blurry. I struggled to remember when last exactly I had used a patch, when last exactly I had menstruated, or even when last exactly I’d had sex. And then suddenly, I was pregnant.

I can see how surprised people are when they hear my pregnancy was unplanned. It’s like doctors are supposed to be party to some kind of secret ‘extra’ information or knowledge that should provide some extra protection against accidental conception. But really, everyone knows the basics of how contraception works. You take it when you should, be that every day or every week or every few months. If you forget, you should be extra careful. If you’re not extra careful, you get pregnant. Lay-people know this as well as doctors. Doctors are just as prone to forgetfulness or laziness as lay-people. We also make mistakes and have accidents. We are also just human.

After the birth of my son, I had an intra-uterine device inserted. I never have to think about it, and it will last me until I wish to fall pregnant again. Maybe after my next pregnancy I’ll consider an implantable hormonal device. I know that I need something that is with me constantly and that doesn’t depend on me remembering to take it. That’s just how I am, and the beauty of modern contraception is that there’s an option for everyone.