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Contraception: Understanding the Options, Part 1

with Bill Cutrer, Dr. Mark Povich | July 17, 2008

On the broadcast today, Dr. Bill Cutrer, a former OB-GYN and current professor at Southern Baptist Theological Seminary, along with Dr. Mark Povich, a physician in family practice, talk to Dennis Rainey about the benefits and risks of taking the Pill.

On the broadcast today, Dr. Bill Cutrer, a former OB-GYN and current professor at Southern Baptist Theological Seminary, along with Dr. Mark Povich, a physician in family practice, talk to Dennis Rainey about the benefits and risks of taking the Pill.

Contraception: Understanding the Options, Part 1

With Bill Cutrer, Dr. Mark Povich
|
July 17, 2008
| Download Transcript PDF

 

Bob: Tens of millions of Christian women are taking oral contraception, the birth control pill, as a way to attempt to regulate the size of their family or to prevent a pregnancy.  But are there any problems with Christians taking the pill?  Here is Dr. Bill Cutrer.

Bill: The birth control pill has been around a while, and our understanding of its function; that is, the mechanism of action, I think, is growing deeper.  More research needs to be done before we actually have the definitive answer.  Certainly, its primary mode of action is to prevent ovulation – no egg, no fertilization.  But I think some compelling questions have been raised.

Bob: This is FamilyLife Today for Thursday, July 17th.  Our host is the president of FamilyLife, Dennis Rainey, and I'm Bob Lepine.  We'll take a look today at the pill, pro and con, and other forms of contraception.  Stay tuned.

And welcome to FamilyLife Today, thanks for joining us on the Thursday edition.  You know, when a couple is facing marriage, they are also facing a whole lot of decisions – everything from what's the china pattern supposed to look like to where do we want to go on our honeymoon to where are we going to live after we get married and whose car are we keeping or are we going to get new cars? 

And then there is the issue of contraception, and that's what we've been trying to grapple with this week – helping couples think through the whole issue of family planning, and we've already laid a pretty good medical foundation for this subject.

Dennis: Actually, we had a listener call as a result of Monday and Tuesday's broadcast who was asking for their cap and gown.

Bob: Wanted to be board-certified right here as an OB.

Dennis: They're ready to take their medical tests.

Bob: The board, ready for the boards.

Dennis: Absolutely.  We're not trying to do that, really, but we are trying to equip you, as an individual, to decide what you believe about the subject of contraception because the entire discussion of birth control is one that is bantered about in our culture freely, and so in order to begin on the simplest common denominator, today we're going to talk about birth control.

And to help us discuss this, we have a couple of physicians, Dr. William Cutrer and Dr. Mark Povich, joining us on the program.  Mark, Bill, welcome back to FamilyLife Today.

Bill: Thank you.

Mark: Thank you, it's good to be here.

Dennis: Dr. Povich is a family medicine physician in northern Michigan – about as northern as you can get up there.  His wife and nine children live in – how do you pronounce that city?

Mark:  Escanaba.

Dennis: Escanaba.  It's probably not a city, either, is it?

Mark: Oh, sure it is – for Upper Peninsula standards.

Dennis: For the Upper Peninsula of Michigan.  Dr. William Cutrer is – he is the professor of Christian ministry at Southern Theological Seminary in Louisville, Kentucky, and he lives there, along with his three children and wife, and is not only a theologically astute professor but also a doctor.  You practiced for how many years in OB?

Bill: Fifteen.

Dennis: Fifteen years.  Well, what I want to do today is I want us to take all the different methods of birth control that are used in our culture, and I just want us to just go down the list, one after another, and I want to start with a birth control method that is totally unacceptable to any Christian, and you wish this was true, across the board.  The reality is there are some Christians who have embraced abortion. 

But, Dr. Cutrer, abortion is viewed today as a means and a method of birth control.

Bill: Unfortunately, that's true.  It is often the backup plan for failures in other contraceptive methods, but I would hold that in that category are not only the surgical abortions but also the chemical abortion – the RU486, which became available in this country.  It's been available in Europe for quite some time.

Dennis: And Dr. Cutrer touched on this but, Dr. Povich, is abortion really viewed by this culture, then, as a method of birth control?

Mark: Again, we talk definitions.  If birth control is preventing a life birth then yes, indeed, it is a birth control.  In our country, there are approximately 1.3 million abortions every year, and about 50 percent of those are obtained because of a contraceptive failure.  So abortion in many people's eyes is the backup plan for failed contraceptives.

Dennis: You know, that just – when you said that, it so struck me, as a nation, how selfish we've become, that we would view the taking of a child's unborn life as a method of preventing not just a few but a lot, hundreds of thousands, of live births.  Does that astound you, Dr. Cutrer?  You worked in the area of helping couples get pregnant, and you assisted them in all kinds of options that they had to have children.

Bill: Well, it is amazing to me, because so many young women that are facing a pregnancy don't appreciate it as human life.  We have, as a society, convinced them that it's a blob of tissue, it's an inconvenience, it's something else, and so they don't see a real moral issue with interrupting it because it interrupts their plans for their life.

At the Crisis Pregnancy Center, we sometimes, just by showing them the pregnancy on a sonogram, showing them that this is baby with arms and legs and a heartbeat and it moves, can change the whole equation from birth control technique to this is a child, this is my child.

Dennis: And we spent the better part of two days talking about when an egg that is released from a woman's ovaries, when it's fertilized by a sperm, that it becomes a person.  Now, it's not viable outside the uterus yet, but it's alive, and when that egg is fertilized, I believe that is when it becomes a person.

Bob: And yet as you gentlemen told us yesterday, that's not necessarily commonly agreed to even among Christian physicians.  There are some who would say until it's implanted it's not really a human being.  That's what some of the medical literature says?

Mark: That's correct.  The American College of Obstetrics and Gynecology, which is the premier group of baby doctors in our country, has the definition that defines pregnancy as when the egg, fertilized egg, implants into the uterus.

Dennis: Let's remove this from the hypothetical, and let's talk about a couple that I married about two years ago.  They decided before they got married that they would not use the pill because they had heard that the pill actually would cause an abortion, all right?

They got married and began to practice their method of family planning at that point and moved to a different city and went to another doctor and that doctor said, "Oh, no, no, no, no, that's not the case at all.  You can take the pill, and it will not cause an abortion."

Now, I want to ask you, Bill, as a former OB, now a seminary professor, who is that couple supposed to believe?  Two doctors have given them contradictory advice and counsel about this subject?

Bill: Well, I'm not at all surprised.  You'll get those same two views if you ask different physicians around.  The birth control pill has been around a while, and our understanding of its function; that is, the mechanism of action, I think, is growing deeper.  More research needs to be done before we actually have the definitive answer, but I think some compelling questions have been raised.  Certainly, it's primary mode of action is to prevent ovulation, no egg, no fertilization.  But it also works by making the cervical mucus a bit thicker so it's a little harder for the sperm to make the trip, and because of the dosage of estrogen and progesterone in the combination pill and even in talking about pills, there are so many different kinds and categories, that I don't want to lump them all together.

But the most commonly used one is a combination pill, which has both estrogen and progesterone in it, and because of the levels of hormone in the pill, the uterine lining that we have exhaustively discussed, does not grow to the same depth as it would if the normal follicle maturation; that is, the preparation of the egg, is taking place.

So that suggests the possibility that if an egg escapes; that is, if there is an ovulation that takes place, and if that egg is fertilized that perhaps when it gets to the uterus, the uterine lining will not be able to receive it.  So those that believe that line of thinking would say birth controls shouldn't be used because they might, in those rare instances, and no one even knows at what rate that is, what the risk might be.  But if it can happen, if it does happen, then Christians shouldn't use combination birth control pills.

Bob: So it's kind of a triple-action pill – it's first line of defense is don't let the egg come out in the first place …

Bill: Correct.

Bob: The second line of defense is slow down the sperm as it approaches the egg in the Fallopian tube …

Dennis: And we've got to say there that there is no problem with either one of these at that point.

Bill: Correct.  If those are the functionings, then we don't have an ethical issue.

Bob: Right.  Not in terms of human life being destroyed.

Bill: Correct.

Bob: A third line of defense related to the cervical mucus leaves open the potential for a fertilized egg to come down and not implant and at that level you could say you have contributed to an abortion?

Bill: Well, we want to be very careful because so many people for so many years have used birth control pills, and there is also very good reasoning by Christian physicians that should this event take place, the preparation of the egg to be released requires a certain amount of estrogen.  The actual release of the egg requires additional progesterone.  To suggest that the uterine lining would be precisely the way it would be under the ideal conditions of only using the birth control pill in this unique situation where the breakthrough ovulation has taken place, the hormones are now changed, and Christian physicians say there is sufficient estrogen to prepare the egg, sufficient progesterone after the egg is released, so that when the fertilized egg reaches the uterus it can then implant.  So you get both sides of the issues from good and godly scholars.

Bob: Okay, my head is spinning a little bit with progesterone and estrogen and, Dr. Povich, what kind of body-altering stuff does it do?

Mark: Our previous discussions have talked about how the complex cycle is regulated by hormones.  Oral contraceptives substitute an artificial amount of hormones to trick the body into thinking it's in a pregnancy state so it will not release an egg.  So there is an exposure of the body to artificial hormones contained in the birth control pill and, in some women, they have significant side effects from those, which can include weight gain, headaches, nausea, as well as many others – some that could be very serious and others that are more nuisance.

Bob: Dr. Cutrer, I've heard of some young girls being prescribed the pill not because they are sexually active, not because they are trying to prevent a pregnancy, but to regulate your cycle, maybe to reduce the severity of menstrual cramps.  I've heard of people getting prescribed the pill to help their acne.  Are there other valid uses for the birth control pill?

Bill: Well, those are all true in that birth control pills are a combination of hormones, and there's lots of variety out there, and as practicing physicians, sometimes those combinations can help women with circumstances medically that are totally unrelated to pregnancy.  The more we learn about them and the risk and the benefit ratio, I think it's important for the patient to be informed.

I would hate to see birth control pills labeled as "abortion pills" when they are so useful for some other things.  I think a patient ought to be informed before taking them for contraception to understand where the state of the science is now.  What we know, what we don't know, and be open to be educated as information comes in.

Bob: So apart from prescribing the pill for somebody who is wanting to prevent a pregnancy, what other valid uses for prescribing the pill would you – as a doctor, somebody comes to you and says, "Here is my condition."  Where would you say, "For that condition I'd prescribe this birth control pill?"

Bill: Sometimes, gynecological circumstances, abnormal bleeding, might require it.  Persistent benign cyst, it might be of benefit.  While it is beneficial for acne, I think it may be a bit risky just to use it for that purpose alone.

Bob: Okay.

Bill: So the combination of hormones is very valuable.  As Dr. Povich said, we can control the hormonal environment in the body.  I don't think you should do that for very long.  There may be an indication for a short-term course of particular hormones, but we should be careful of putting someone on it, long term, without knowing the side effects.

Dennis: Bill, I want to come back to our young married couple who have been told by two doctors contradictory counsel.  They have been told that it's okay to use the pill, it doesn't cause an abortion of a fertilized egg, and they've been told by a physician that it does, okay?  What's a couple to do?  I mean, are they to weigh the knowledge they have and then make their decision?  What would you advise them?

Bill: Well, I've been around long enough to see a lot of things being accused of causing miscarriage – ultrasound, computer monitors, cell phones, microwaves, and none of those things, of course, proved to cause abortion.  But the evidence here is compelling that I think a couple ought to understand what the risks are, be informed that at the current state of medical information, all we can say is, is it possible that this is an effect?  Yes, it is possible, and that there are other things that they can choose for contraception.

Dennis: And, Dr. Povich, you deal in this area as well.  How would you answer that question?  What would you say to a couple?

Mark: Well, I would also agree that if a couple comes in to me requesting information on contraceptives, I will lead them, as well, into a discussion of how a particular contraceptive is going to affect them as well as looking at their moral framework upon which they base decisions and making sure I would point out to them the potential for birth control pills to impact them.

Bob: And if they say to you, "Okay, we understand that potential, but that's a risk we're willing to take.  Go ahead and write that prescription for us."

Mark: I have taken the position that I do not want to be responsible for the potential loss of human life that would occur from a prescription that I wrote, so I no longer will write birth control prescriptions.

Dennis: And, Bill, would you write a prescription for birth control pills?

Bill: For contraceptive use, at this point, with a well-informed patient, I still think it's a possibility.

Dennis: Okay.

Bob: You know, Dennis, we've got a lot of folks listening very carefully because there is a large percentage of our audience, undoubtedly, that has been using, continues to use, the birth control pill, and they're starting to say, "Well, are you telling me that's wrong for me to do that?"  Dr. Povich?

Mark: It's true that most women that are on the pill have not heard this discussion before – that one of the effects of being on a birth control pill could be an early abortion that they're not even aware of.  And I would argue that it is the duty of a physician to obtain informed consent to accurately explain that to the patient, and if she then chooses that, that's up to her, and she'll have to deal with whatever ramifications that has.

But, interestingly, when you look at the material that the drug manufacturers publish in regard to their products, especially with birth control pills, if you read down the list of mechanisms of action of birth control pills, you're going to see that it reads, "inhibits ovulation and thickens cervical mucus."  You will not read that there is another potential mechanism that can play.

If you then go to the Physicians' Desk Reference, or PDR, and read through that list that the FDA approves, it's published, it will list the third mechanism that it could make the endometrial lining hostile to an egg so it would not implant.

Dennis: A fertilized egg?

Mark: A fertilized egg, thank you.

Bob: So you're saying the drug companies are saying one thing to the doctors and something else to the patients?  They're not giving them the whole story with regard to what the pill might be doing?

Mark: I don't think that patients have the full knowledge in order to make an informed decision as to what birth control method they are going to use.

Bob: You know, I know when Mary Ann and I first got married, we hadn't had any discussion like this – no depth, no understanding of potentials, and I don't know how much was known way back then when we were getting married.

Mark: Right.

Bob: But I remember it was the kind of thing where you just went to your doctor and said, "Hey, we're getting married.  Can you write a prescription?"  That was about as much conversation as anybody had on any of this, and Marcus Welby got out his pen and said, "Why, sure," and wrote you the prescription, and you went on your way.

Dennis: And so you're left to deal with the question of what have I done?  And here is where I just think, as believers, as we look at the cross, and as we look at who God is, there are mistakes that we've made in life where we may have not known we made a mistake that cost somebody something.  I mean, it was sin, it was wrong, but it impacted someone's life.  I think God's grace covers that.  That's not cheap grace, in my opinion.  I believe God forgives that.

There are those decisions, as we look back on a subject like this, that you can say, "Gee, you and Mary Ann, Barbara and I started out on the pill when we were just kids," and we didn't have any access to information like this.  We didn't even have a discussion like this.

Well, I believe that couple, that person, needs to just go before the Lord and say, "Yes, Lord, thank you for forgiving all of my sins.  Those that I know I've committed and those that were unknown to me."  But the bottom line is I thank God for the cross of Christ, Bob.

Bob: Well, and let me ask you as a dad and as a grandfather now – if your daughter or your son comes to you and says, "We're thinking about the pill as a method of contraception" would you steer them away from that?

Dennis: Well, I've just listened to two doctors – one who says he can't prescribe it, one who says he could.  And I think what's happened is I think there is a great deal of information that's coming out, and I do think you have to decide which side you're going to err on.  And I don't want to be dogmatic but, on the other hand, if I’m going to err on one side or the other, I think I'd rather err on the side of life.

Bob: Well, and, again, as you've said, this is where couples have to discuss and pray and study and come to a conclusion on their own.  Dr. Cutrer's book is one of the tools that's going to help them do that.  It's a book called "The Contraception Guidebook" that looks at options and risks and provides helpful answers for Christian couples, those who want to look more specifically at the issue of the birth control pill. 

Randy Alcorn has written an article on this subject and, again, not everybody is going to necessarily agree on where Randy lands on this subject, but it's something they ought to read and consider and pray through and think about.  We've got a link to that article on our website at FamilyLife.com.

In fact, if you go to the home page of our website, on the right side of the screen, you'll see a box that says "Today's Broadcast."  Click the button there that says "Learn More," and that will take you to an area of the site where you'll not only find the link to Randy Alcorn's article, but you'll also find information on how you can order "The Contraception Guidebook" from Dr. Cutrer.  There is a link to a list that you shared with us this week, Dennis, about things Christians should consider, as they are making their choice about what they want to do regarding family planning.

Again, all of this is on our website, FamilyLife.com, and to get to it, you just need to click on the right side of the home page where it says "Today's Broadcast."  Click the "Learn More" button, and you'll be right where you need to be in the site. 

Or, if it's easier, you can call 1-800-FLTODAY to request a copy of Dr. Cutrer's book – 1-800-358-6329, that's 1-800-F-as-in-family, L-as-in-life, and then the word TODAY, and when you contact us, someone on our team will make arrangements to have a copy of the book you need sent out to you.

You know, you mentioned that there may be some folks who have regrets in this area and, Dennis, we had a conversation not long ago with Nancy Leigh DeMoss talking about the issue of forgiveness – not only forgiving others but also understanding God's forgiveness and how He is gracious and merciful when we make mistakes, when we sin against Him.  We have a CD that's available that includes almost an hour and a half long conversation we had with Nancy on this subject of forgiveness, and we're making it available this month when our listeners help support the ministry of FamilyLife Today with a donation of any amount.

You can make that donation on our website at FamilyLife.com, and if you do that, and you'd like the CD, when you come to the keycode box on the donation form, type the word "forgive" in there, and we'll know to send you a copy of the CD, or call 1-800-FLTODAY.  You can make a donation over the phone and just request the CD on forgiveness, or the CD with Nancy Leigh DeMoss.  Again, the toll-free number for a donation is 1-800-FLTODAY, and let me just say thank you in advance for your financial support of this ministry.  We appreciate your partnership with us.

Well, tomorrow we're going to continue looking at some of the most popular forms of birth control on the market today and talk about the pros and the cons of those different kinds of contraception.  I hope you can be with us for that conversation.

I want to thank our engineer today, Keith Lynch, and our entire broadcast production team.  On behalf of our host, Dennis Rainey, I'm Bob Lepine.  We'll see you back tomorrow for another edition of FamilyLife Today.

FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas – help for today; hope for tomorrow.   

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