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Contraception: Understanding the Options, Part 2

with Bill Cutrer, Dr. Mark Povich | July 18, 2008

Today on the broadcast, Dr. Bill Cutrer, a former OB-GYN and current professor at Southern Baptist Theological Seminary, and Dr. Mark Povich, a family physician, talk to Dennis Rainey about the many birth control options available to couples today, including those not often considered, like Natural Family Planning.

Today on the broadcast, Dr. Bill Cutrer, a former OB-GYN and current professor at Southern Baptist Theological Seminary, and Dr. Mark Povich, a family physician, talk to Dennis Rainey about the many birth control options available to couples today, including those not often considered, like Natural Family Planning.

Contraception: Understanding the Options, Part 2

With Bill Cutrer, Dr. Mark Povich
|
July 18, 2008
| Download Transcript PDF

Mark: For Christian couples, I encourage them not to have a sterilization because they may find that, down the road, God moves in their heart to have another child, and if they've done something permanent, then they've cut off what God would want them to do.  So I do not encourage sterilizations, and I will encourage them not to.

Bob: This is FamilyLife Today for Friday, July 18th.  Our host is the president of FamilyLife, Dennis Rainey, and I'm Bob Lepine.  We'll talk today about vasectomies, tubal ligations, the IUD, and other methods of contraception.  Stay tuned.

And welcome to FamilyLife Today, thanks for joining us on the Friday edition.  This has been an interesting week.  We have been talking about some of the medical ethics, some of the biological ethics that go into determining which methods of contraception may be appropriate for Christians to use and as we begin, Dennis, you address the fact that ultimately God is the one who decides how large our family is going to be, no matter what we try to do.  There are a lot of couples who would love to have a baby, who have been unable to conceive.  There are other couples who take steps to try to prevent having children, only to find that God overrules them, and they become pregnant.

And yet God has invited us to participate in this process to think about and to pray about and to study His word on this subject, and so what we've been trying to do is to help people think biblically and to develop some biblical wisdom on this topic.

Dennis: And, you know, I started the week out by reading Genesis 1:28, which, I'll not read it all, but it says, "God blessed them, and God said to them, 'Be fruitful and multiply and fill the earth.'"  And I think God in heaven must look down, and He must wonder about us.  He has said He blesses us with children, He rewards us with children, He gives us a quiverful and says, "That man is fruitful, he's" …

Bob: "He's blessed."

Dennis: Yeah, "he's just been given life."  He creates a heart for becoming a mother, becoming a father, and He gives us the privilege of starting this thing called a family and joining Him in a miracle, and then we, as human beings, spent countless hours and dollars and resources and energy and time trying to avoid having children.

Bob: We've talked a lot medically and technically this week, but I hear you saying if you just pull back to the big picture, there is a fundamental question, which is do we see children as an intrusion and an interruption, or do we see them as a blessing?

Dennis: Early in our marriage, I remember looking at Barbara, and I said, "You know, I wonder if this is an area where we" – meaning Dennis and Barbara – "are missing it?"  And I wonder if the Christian community – and, by that, I'm speaking primarily the Protestant, the Protestant community, I wonder if we've missed it, because we're not talking a lot about it, and we don't seem to be grappling around the issues.

And that's why we started this series, back on Monday, where we wanted to talk about the subject of birth control and contraception, and we have brought Dr. Bill Cutrer, who is a professor of Christian Ministry at Southern Baptist Theological Seminary in Louisville, and Bill has written extensively in the area of sexual function and dysfunction in marriage.  He is an OB doctor, right?

Bill: Yes, I am.

Dennis: And he, along with his wife, are the proud parents of three children.  And joining with us is Dr. Mark Povich, who is a physician in the Upper Peninsula of Michigan.  You have nine children.  We haven't really exploited that, Bob, his nine children here.

Bob: You have had to face the facts that your convictions on this issue have some very practical implications for you, not as a doctor but as a husband and a dad, right?

Mark: Well, certainly, I've got an OB-GYN friend of mine who knows that I am a supporter of natural family planning as a method of spacing children, and he also knows that I have nine children, and he kids me about that, and I always tell him, "Well, not a bad start, is it?"

[laughter]

Dennis: Yesterday we talked about the pill, and we talked about how the pill can be a form of birth control.  I want us to take the remaining methods of preventing a pregnancy and just discuss them.  But I want you to list them, Mark.  You're a physician.  List all of them off, and this will be our working list for the rest of the day.

Mark: Okay.  Methods that are available to couples include a condom, a diaphragm, a cervical cap – and those can be used with a spermicidal jelly.  There are sterilizations, a tubal sterilization in the female and a vasectomy in the male.  There are IUDs, there's a medication called Norplant, which is placed within the tissue of a person; DepoProvera, which is a shot; there are the oral contraceptive pills of several different types; and there is natural family planning, which is another way that's available.

Dennis: Bill, as an OB doctor, let's start with Norplant.  What are left to believe about this as a method of family planning?

Bill: Well, Norplant puts the progesterone in a little plastic rod that's inserted under the skin, and it slowly absorbs through the body and is supposed to prevent ovulation.  It does have effect on the endometrium lining that we've been talking about, making it very unreceptive, and it does have some breakthrough ovulation rates.  So I am uneasy about prescribing it.  It's not been that popular in this country because of it's expense and because of breakthrough bleeding, and many of our patients are not interested in having that sort of side effect.

Bob: Do I remember right – I think I read somewhere that having the Norplant device inserted under the skin prevents pregnancy for up to five years?

Bill: Correct.  They are implanted with the intent of not removing them for five years.  You can take them out sooner, but the amount of the slow-release progesterone in the little rods is supposed to give protection for five years.

Bob: So if you're deciding to go with Norplant, you're making a long-term decision, and you're saying that it's also a decision that may have ethical concerns like we've talked about.  It may actually allow for an egg to be fertilized and then ultimately disposed of, right?

Bill: Right.  I think it does have the ethical concerns, but you can have the thing removed at one year, two year, if you wish.

Dennis: Let's talk about another form, which is using a condom along with a spermicide.  Bill, is there a problem ethically with that method?

Bill: I don't think there is an ethical issue with it because what it does is – its intent is to prevent the sperm from getting to the cervical mucus and on up the racetrack to the egg that we've talked about.

Bob: And when you say there is not an ethical issue, you're saying at least not in regard to the question of whether a fertilized egg is going to be disposed of.  There are some who would say, "Now, wait, we still have some ethical questions about the barrier methods, whether it be a condom or a cervical cap or a diaphragm?"

Bill: Right.  We need to make the decision whether any form of contraception is appropriate and, if so, what kinds are appropriate and then the major ethical construct that we've built has been about the abortion issue.  But, yes, there are those who would choose not to use this or any of these techniques.

Dennis: Dr. Povich, let's talk about the diaphragm.  Do you see an ethical issue with the use of a diaphragm?

Mark: The diaphragm is strictly a barrier method, which would not have the moral problem of causing an abortion.

Bob: We asked you yesterday with regard to the pill, and you said you wouldn't prescribe the pill.  A woman comes into your practice and says, "Okay, I understand that.  I agree with you.  That runs a risk.  I'd like to be fitted for a diaphragm."  Will you refer her out to have a diaphragm fitted, if that's the choice she's making?

Mark: If that's her choice, I would have no problem doing that.

Bob: Can I just say something about these barrier methods that I think – as we talk about them, you know, they don't sound real inviting, you know what I mean?

Bill: You raise a good point, because it sort of gets in the middle of things, it takes away from spontaneity.  Now, some married ladies will use the diaphragm, put it in every evening, and if romance happens, it happens, so they don't have to stop in the middle of things.  But these are clumsy, cumbersome, and messy at times.

Dennis: Well said.  Bill, let's talk about IUDs.  Explain how an intrauterine device works.

Bill: The IUD has a rich history in that apparently it was discovered that if you put a peach pit or something in a camel's uterus, they wouldn't get pregnant.  So they learned it by putting some sort of …

Dennis: Now, wait a second.

Bill: I kid thee not.

Dennis: What?

Bill: By putting an artificial something within the uterus, it would not carry a pregnancy.

Bob: And this – this – you know, the camels were thrilled with this.

Bill: The camels were pretty excited, I'm sure.

[laughter]

Bob: That's right.

Bill: So this is the kind of high-tech stuff we're talking about but, in fact, most of them are plastic devices of various shapes.  Some of them have a little hormone, some of them have a little chemical that goes inside the uterus.  Now, the problem is, how do they work?  The best evidence suggests that it prevents the embryo from implanting which, for me, would be an enormous ethical obstacle, and I didn't use IUDs.  They also increase cramping and risk of infertility, which, obviously, wouldn't be something I'd like to do.

Others have held that it's appropriate.  It has a very fine contraceptive rate, but I think it raises a huge moral issue.

Bob: Is it being used much these days?  Are there many people prescribing and using the IUD?

Bill: It's dropped off considerably because of the malpractice risk, not so much because it was ineffective.

Dennis: One of the shocks that I had in doing the research for this series, was to find out that a larger percentage of women have been sterilized than presently use the pill.  Twenty-eight percent, according to a study done in 1995, 28 percent of the women had used sterilization as a form of contraception, and 27 percent were using the pill.  Explain, Dr. Cutrer, why sterilization has become so popular?

Bill: Well, my guess is that we baby-boomers have gotten older, and most people don't want to have babies in their late 30s and 40s, and so many, at the end of their childbearing years, whatever they choose to do – use that as a permanent method as opposed to the risk of the pill increases after age 35, and other things have, as we've discussed, are messy and cumbersome.  So many have opted for the permanent sterilization of the one operation – tubal.

Bob: These are the folks who say we are done with a family, we have all the children we want, we're going to make sure we don't have any more.  When faced with that option, do more women get their tubes tied – that's what we're talking about, right?

Bill: Correct.

Bob: Or do more men get a vasectomy?

Bill: Well, in our culture, unfortunately, the weight has fallen mostly to the women, even though it's a more complicated operation.  It needs to go into the abdominal cavity, but the male sterilization, the vasectomy, has become a bit more popular, but still tubals outweigh.

Dennis: I've got to tell you, I was on my way to see my mother in Southwest Missouri, and I was traveling north out of Branson on Highway 65, Bob, and there was a sign – I could not believe it, but there was a sign lit up, bigger than life, that said, "Call 1-800" and it had the number there – "for a vasectomy reversal."

Bill: Right.

Dennis: And I'm not sure, but I think there were results guaranteed.

Bob: Yeah, I have seen the same billboard you're talking about.  In fact, that billboard has popped up all around the country.  There are a lot of baby-boomers who made a decision not to have any more children and then regretted the decision, right?

Bill: That's exactly right – some for theological reasons; others just for family circumstances.  But sometimes right after the delivery of a child, bad decisions can be made, and one they're rethought in the cool of the day, they can be reversed, but it's expensive, and it's not perfect.

Bob: Dr. Povich, let me ask you, as it relates to either a tubal ligation or a vasectomy, if a family comes to the point – let's say that they have four children.  The husband has just been laid off, and the wife has been told that she's high risk.  If she were to have another pregnancy, it could create significant medical complications for her.  And she said, you know, "We just think the smartest thing for us to do at this point is for me to go ahead and have my tubes tied."  Would you affirm her decision?

Mark: I would have her get a second opinion, first of all, on her medical condition to see if that is a legitimate thing.  Because I've heard women told that before, and many of those don't hold up when they are more fully examined.  So that would be the first thing I would do – is another proposition for her.

For Christian couples, I encourage them not to have a sterilization because they may find that, down the road, God moves in their heart to have another child, and if they've done something permanent, then they've cut off what God would want them to do.  So I do not encourage sterilizations, and I will encourage them not to.

Bob: Okay, Dr. Cutrer, same scenario, a woman comes in, and she says, "Boy, I've gotten this opinion." Let's say she gets a second opinion, and the doctor says, "Yeah, there might be some concerns here."  There are a lot of couples who go, "Well, now, do we trust in the Lord, or do we have a medical procedure?"  You know, how do you respond to that?

Bill: Well, I think there are some circumstances that pregnancy does put the woman's life at risk.  I've had some of those cases – one with a cardiac situation, one with a valve, and one that had a dissecting coronary artery.  Basically, a pregnancy likely would have taken their lives and, in fact, one chose to get pregnant, and it did cost her her life.  So these aren't just theoretical kinds of things.

Now, is one lacking trust because they choose to raise the large family that they already have and not put themselves at risk?  I think in those rare circumstances, and they are rare, but they do exist, that sometimes permanent intervention might be appropriate.

Dennis: One of the things we haven't talked about are injections.  Dr. Cutrer, you practiced for 15 years in the area of OB.  Would you give these injections as a method of birth control when you practiced?

Bill: When I practiced in the early years, we did.  We used Depo Provera because it was a simple shot, once every three months, and it had a pretty effective contraceptive rate.

Dennis: And how did it work?

Bill: Basically, you give this injection, and the hormone is high enough so it suppresses all of that delicate symphony of hormones that we talked about on the first day so that ovulation doesn't take place.  That's how it's supposed to work.  Now, as the effective level drops off in some women, they would have the breakthrough ovulation, and they would be at risk of that abortion complication that we talked about.  It's inexpensive, and it's easy, so in some countries it's all the contraception that is available.

Dennis: But today you have a bit of a problem with that method?

Bill: Today I wouldn't use it.

Dennis: Because of the potential abortive effect of the hormones?

Bill: My understanding of the way it works at this point in time would be that I would think it would be a sufficient risk.  And I don't know the risk, nobody's quantified that, but you have to prayerfully make a decision of what do we know at this point, and that would be one I would probably shy away from.

Bob: I think that's an important point you make, lest anyone think you're just hedging and say at this point, you know, some of this can sound like a politician talking, but medicine is an advancing science, and some of the things that 20 years ago you looked at and said, "I'm very comfortable with this," you look at today and say, "The research is different," and that gives you pause for concern about what you would elect to do.

With all of the methods that we've talked about this week, there is one that we haven't touched on that we're going to spend some time on – it's the issue of what I think is commonly referred to as "natural family planning."

Dennis: And explain to our listeners what natural family planning is.

Mark: Well, natural family planning is a term that refers to a couple learning the signs of fertility.  There are natural things that occur within the female every month, and those can be taught to a woman and the husband in order to know if a woman is fertile or not.  There are only about seven days or so – five to seven days in a month that a woman is actually fertile; that she could get pregnant.  And if a woman is taught to recognize those, that information can be used by the couple to either work to achieve a pregnancy or to avoid a pregnancy.

Bob: Let me see if I remember stuff right from the class we took, and this was 15 years ago.

Dennis: You've already remember more than I wanted you to remember.

[laughter]

Bob: The symptoms, the things you're talking about that show signs of fertility – one of those is an elevated – I think they called it a "basal" temperature.  This was before Mary Ann would get out of bed in the morning, she'd take her temperature, and she would plot it on a chart.

Mark: There are several different types of natural family planning that vary a little bit in what you monitor – what body systems you monitor.   They are all based on monitoring ovulation primarily through the cervical mucus that's produced, mucus that can be a little sticky or tacky or a mucus that's very slippery and stretchy and clear.  That is the primary indicator that women are taught.

One of the methods called Sympto-Thermal Method includes checking the temperature every morning as an indicator of whether ovulation is occurring.

Bob: But the cervical mucus is the thing that's the standard kind of an observation.

Mark: That is, that's the key thing that's checked.  The more stretchy it is, is the indicator that the ovulation is about ready to occur.

Dennis: One of the major pillars of our broadcast is that of a passing on a legacy of spiritual vitality to the next generation.  You can't pass that spiritual vitality on if there aren't human beings to pass it onto.  And I do think one of the great needs in this culture is for us to evaluate our opinion of children.  Are we a culture that says "Two and no more?"  And if we are, within the church, then I think we need to step back and say, "Do we really believe the Scripture?  Are they a blessing?"

Frankly, six children have been the biggest challenge of anything I've ever done in my lifetime.  We built a ministry that has touched 113 countries around the world.

Bob: That's piece-of-cake stuff, right?

Dennis: We touch millions through this broadcast, but, Bob, all those problems and the issues that come with that are really nothing compared to the challenge of attempting to raise six children who walk with Jesus Christ and know Him personally and learn to obey Him and become His ambassadors to the next generation.

And as we conclude this weeklong series talking about the subject of contraception, I think it's only fitting that our focus for this last day has been a positive one on children, because He is the One who commanded us to be fruitful and multiply and fill the earth, and I want to say thanks to Dr. Cutrer and Dr. Povich, thanks for being with us on FamilyLife Today, and for entering into one of the most delicate discussions we've, perhaps, ever had here on our program.

Bill: Thank you, it's been a great privilege.

Mark: I've enjoyed being here, thank you very much.

Bob: It's also been a fairly technical conversation.  I'm thinking of the listeners who may wish that they had some of this information written down.  We actually have transcripts of the entire week's worth of programs on our website at FamilyLife.com.  And for those who would prefer to listen than to read, we have CDs available so that you can listen to this material again or you can also access again on our website at FamilyLife.com.

When you go to our home page, on the right side of the screen, there will be a box that says "Today's Broadcast," and if you click the button that says "Learn More," that will take you to an area of the site where you can review the transcripts or listen back to various programs.  In fact, we've had a number of listeners who have been leaving comments for us on the broadcast transcripts as they've read through this material. 

You can also request a copy of the book that Dr. Cutrer has written, along with Sandra Glahn, called "The Contraception Guidebook," and it will provide for you more information about different methods of contraception and help you think through the spiritual and the ethical and moral considerations with each of those different methods. 

Again, the book is called "The Contraception Guidebook," and you can order it from us here at FamilyLife, either on our website at FamilyLife.com, or by calling 1-800-FLTODAY.  That's 1-800-358-6329, that's 1-800-F-as-in-family, L-as-in-life, and then the word TODAY.  When you get in touch with us, just mention you'd like Dr. Cutrer's book or the CDs of the programs we featured this week, and we're happy to send those out to you.

Let me say a quick word of thanks, Dennis, to those listeners who have contacted us this month to make a donation to the ministry of FamilyLife Today.  I think most of our listeners know that we are listener-supported.  It's folks like you who not only listen but who also contact us from time to time to help support this ministry.  You are the ones who keep us on the air on this station and on other stations all across the country.  So we appreciate those of you who do get in touch with us and make a donation.

This month we would like to send you a thank you gift if you are able to provide some of the financial support for FamilyLife Today.  We have a CD that features a conversation we had not long ago with our friend, Nancy Leigh DeMoss, on the subject of forgiveness.  She has written a book called "Choosing Forgiveness," and the CD features almost an hour and a half's worth of conversation on the subject, and we're happy to send it out to you as a way of saying thanks for your financial support.

If you are donating online, and you'd like to receive the CD, when you come to the keycode box on the donation form, just type in the word "forgive."  If you're calling 1-800-FLTODAY to make a donation over the phone, just ask for the CD on forgiveness, or the CD from Nancy Leigh DeMoss.  Again, the toll-free number to make a donation is 1-800-358-6329, 1-800-FLTODAY, or you can donate online at FamilyLife.com, and we appreciate, again, your financial support.

Well, I hope you have a great weekend.  I hope you and your family are able to worship together this weekend, and I hope you can join us back on Monday when we're going to talk about what couples can do to help work through some of the sludge that can build up in a relationship – how you can clean out the gunk.  Rich Rollins is a pastor who is going to be here to help us work through that issue.  I hope you can be with us as well.

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 Monday 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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