NFP and Coumadin: A dilemma

I have an interesting dilemma on my hands and I want to hear your thoughts…

Since I’ve been diagnosed with the crazy clotting gene, that in the unlikeliest of events I inherited from both of my parents, I am going to be treated intensely with blood thinners. I’m currently taking two different kinds. The hematologist may recommend putting me on one of them, a pretty hard core drug called Coumadin, for life; at the very least I’ll be on it for quite a few months.

So Coumadin is really incompatible with pregnancy. If you get pregnant while taking it it’s not good. Here’s what one medical journal has to say about it:

One of the drawbacks for Coumadin is the potential for birth defects and/or hemorrhage in the offspring of mothers taking the drug. There is a link between some birth defects and Coumadin taken by the mother during early pregnancy. Coumadin should be avoided in women of child bearing age unless there is absolutely no other option.

If a young woman needs to start Coumadin during the child-bearing years, it is very important to educate the patient on the potential harm to the unborn child and establish an effective birth control plan. Before starting therapy, female patients should be asked about their intent to bear children in the future, their birth control methods at present, and their religious beliefs.

For the woman who is not planning or desiring further children, sterilization by tubal ligation or hysterectomy would be the most reliable preventative step. In younger women anticipating a new or enlarging family, Coumadin should not be prescribed if any other possible choice can be used. If Coumadin is still required for clinical reasons, then birth control intervention must be prescribed as well.

A longer acting form of birth control such as an IUD or Norplant are probably best, since daily birth control pills could be accidentally or purposefully discontinued, risking an unwanted or unexpected pregnancy while taking Coumadin. Educational services like Planned Parenthood can assist in selecting birth control methods that are acceptable to the patient and their lifestyle and/or values. Prevention is far better than dealing with the consequences after a pregnancy has occurred.

Evidently I’m one of these “no other choice” people. I should really be on Coumadin. My doctor has not yet discussed birth control options with me, but I’m sure he’s going to push hard for me to do Norplant or some other form of birth control. (As this article suggests, I could always talk to our good, honest friends at Planned Parenthood about it!)

So here’s the situation: I’m on a drug that could cause big problems to an unborn child if I should get pregnant while I’m on it. I have a history of weird cycles so it’s not unlikely that I could get pregnant accidentally and be pregnant for a while and without realizing it.

I want to trust God and the Church and shun contraception, but there are a few different ways I could do that:

1. Take the Coumadin and have an intimacy-free marriage, practicing abstinence indefinitely (I don’t think this is really a serious option).

2. Take the Coumadin and trust that God will take care of any unexpected children that may come along and that the drug wouldn’t harm them.

3. Get off of Coumadin and trust that God will take care of me and the blood clot issue without it.

And then I suppose the other option would be to blow off Church teaching and go ahead and use contraception. So what do you think?

There’s another post coming about my thoughts on the struggle of trusting Church teaching on this very controversial issue as someone so new to the faith, but I’ll save that for later. Meanwhile, what would you do if you were me?

[NOTE: I know that one obvious answer is "talk to your hematologist and see about getting on some other drug." I do plan to do that, but since I don't know what the answer will be let's assume for the sake of argument that Coumadin is my only option for treatment.]

—————–

UPDATE: I am about to pass out. Right after I hit Publish my pharmacy called about my Lovenox prescription, the alternative to Coumadin that I’m also taking right now. She said that my insurance didn’t cover all of the one month refill I just called in and asked if I still wanted it if I had to pay for part of it. I asked her what my portion was. Anyone want to guess? No? It’s $875!!!! Is this some sort of liquid gold/diamon mixture? This is the price after my insurance actually covered part of it?!?! So…this one’s out as a long term solution as a possible alternative to Coumadin. Almost $900/month is a bit out of my budget.

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Enter the Conversation...

19 Responses to “NFP and Coumadin: A dilemma”
  1. Ersza says:

    Wow. I couldn’t honestly tell you what I would do. It would require a lot of thought. I would like to know what you decide, though. Please do update with your decision and your discernment process. I promise not to judge you no matter what your choice.

  2. Elena says:

    Jen, I think you might want to seek out some help and information from these folks: http://www.popepaulvi.com/

  3. Ersza says:

    Wait. I can say one thing. Number two is not an option. I would never do number 2. I would go for 1 or 3, if coumadin was truly the necessary and only treatment for my condition.

  4. SteveG says:

    1. Be careful about the advice you receive on-line regarding this issue (including mine).

    2. Find a doctor who is in line with Church teaching and is supportive of the concept of not using artificial contraception. If this is going to be workable for you, they would be the ones qualified to help make it happen. Finding such a doctor may not be as difficult as you might think.

    There is a group called One More Soul who has a website that compiles just such information. All you have to do is plug in your zip code and they will list everything from NFP centers, to NFP teachers, to (most importantly) NFP supportive doctors.

    You should find a Family Practitioner, and/or an OB/GYN (both exist in your area) who will work with you to keep you, and any potential children safe, while still respecting the Church’s teaching on contraception. I am thinking that you really need a person who is both a medical professional, and a committed Catholic to guide you through this.

    3. Talk to your pastor about your situation. He may also be able to refer you to someone in the medical profession who can help.

    Also, he will be able to offer spiritual direction as you work through this, which will likely be just as (if not more) important as you literally seem to be under attack as you come closer to making the faith your own.

    In that vein, I want to quote a short bit from Salt of The Earth by then Joseph Cardinal Ratzinger (Benedict XVI). The book is a wide ranging interview with Peter Seewald. In the section on contraception, Seewald puts two questions to Cardinal Ratzinger.

    SEEWALD: The question remains whether you can reproach someone, say a couple who already have several children, for not having a positive attitude toward children

    CDL. RATZINGER: No, of course not, and that shouldn’t happen, either.

    SEEWALD: But must these people nevertheless have the idea that hey are living in some sort of sin if they…

    CDL. RATZINGER: I would say that those are question that ought to be discussed with one’s spiritual director, with one’s priest, because they can’t be projected into the abstract.
    (Salt of the Earth p. 203)

    4. I will not even offer a thought on option (2) or (3), but I’d like to suggest that (1) isn’t necessarily the only option that involves abstinence. From what I understand, even with weird cycles, NFP can be practiced extremely conservatively and can be made to mirror even sterilization in effectiveness.

    I have a friend who has lupus. She and her husband believed that they were destined to abstain in perpetuity. Through conversations between my Couple to Couple Leauge (CCL) contacts, the couple, and some research I did, the CCL folks were able to come up with a plan for her and her spouse. While fairly rigorous (i.e. a good bit more abstinence than I think any married couple would care for), they were not required to abstain from sexual relations at all times.

    I’m already on record as saying how difficult this can be when serious need arises (which this seems to be), but from my own experience, and from others I know who’ve fought this fight, it is doable.

    Again, an NFP supportive doctor will be able to give you better advice on that possibility.

    Finally, I’ll just throw out a few other resources that you might find useful…

    Couple to Couple League
    Pope Paul VI Institute

    …I can’t think of any groups more in the fore on the battle for supporting church teaching in this area.

    As always, prayers aplenty will be said for you and yours.

  5. SmartBlkWoman says:

    Steve G seems to have covered just about everything that needed to be said but I just wanted to add this: I currently have the copper T IUD ( the 10 year IUD) and thus if you have any “operational” questions about IUDs feel free to ask me.

    Some women don’t have periods with the IUDS ( although I’m not one of them) and I’m sure that if you find a Catholic doctor or one familiar with NFP they should be able to assist you in keeping with Catholic doctrine.

  6. Anonymous says:

    Have you asked your doctor why can’t you simply take aspirin (aspirin therapy using baby aspirin)?

    I’m not a doctor but I looked up a few other drugs:
    Orgaran (Organon)
    Heparin
    Innohep
    Persantine
    Ticlid Roche
    Plavix

    A second opinion might be a good idea here.

    Hannah @hana10134@yahoo.com

  7. Anonymous says:

    I don’t think any of us can really say what we would do in your particular circumstances because none of us are living those circumstances with your life experiences, needs, and other variables involved.

    How does your husband feel about all this? Whatever your decision is, it goes without saying that you guys will need to be bastions of support for each other.

    If NFP is your choice, get thee to a competent NFP counsellor/practitioner just as soon as possible, letting her know the seriousness of your situation.

    Remember when being pressured to use artificial means of birth control that NO BIRTH CONTROL, short of 100% abstinence or a complete hysterectomy is 100% effective. I know friends/acquaintances who have had pill babies, nfp babies, iud babies, condom babies, etc, etc. I’m sure you know of quite a few yourself. So yes, no matter what method you use, there is going to have to be some measure of trust in God involved. I do believe that God intends for us to use our heads and the other legitimate means He has given us to be responsible with our own health and that of our families.

    I will be praying for you. As one who suffers from a chronic disease and greatly fears pregnancy as a result, I can really, truly empathize. It’s not an easy cross to bear.

    God bless.

  8. GLouise says:

    Wow- it is hard to say what “I” would do in your shoes, especially when trying to care for a toddler and newborn. It is a lot to think about.

    I would say that #1 is definitely out of the question for me! It’s not good for a marriage to be void of intimacy like that, esp. *forever*. (I Corinthians 7).

    I am praying for you… for peace in your heart, and wisdom and discernment from your husband, doctors and spiritual leaders.

  9. majellamom says:

    Okay, I really don’t have much to add in terms of advice…but going with your update on your prescription costs being $875…check around and see if there is some sort of prescription assistance program…

    Some medicines are ridiculously expensive (my MIL and SIL both have MS and are on a drug that costs well over $1000 a month, and my MIL has a $500 copay each month on it!) And since this may be a long term thing, make sure you check into all of your options, including changing your health insurance if necessary…

    I’m so sorry that you have to deal with all of this right now!

  10. knit_tgz says:

    I don’t have an advice to offer, but can say I am going to pray for you and your husband, so that God will offer you guidance and inspire you (and, probably, the doctors and priests you are going to discuss this matter with) to get to the best solution.

    One side opinion: It is so absurd that chronic medical treatments are sometimes so expensive!

  11. Tony says:

    There’s another post coming about my thoughts on the struggle of trusting Church teaching on this very controversial issue as someone so new to the faith, but I’ll save that for later. Meanwhile, what would you do if you were me?

    As someone new to the faith, your thought processes will be different than someone who has “marinated” in the faith. I will not offer any advice because any I offered would be based on risks *I* would be willing to take, and based on *my* position in *my* faith journey.

    I would counsel (as Steve did) to get all the facts, and consult with a spiritual advisor before any course of action is contemplated.

  12. Jennifer F. says:

    Thank you for all these wonderful comments. And don’t worry, no pressure, I wasn’t going to choose my course of action based solely on anything anyone says here. :) Just wanted to see what you guys thought about it as a hypothetical.

  13. Barb, sfo says:

    In the past 24 hours I have read in 2 different places (one a National Catholic Register article) about the birth control pill’s association with blood clots. And Norplant has been discontinued in the US because of that as well.

    I advise you to get in touch with Couple to Couple League (see SteveG’s comment for the link) and do a LOT of research before making a prayerful decision. I am a user and former teacher of NFP and it CAN work for you if you are properly instructed & supported.

  14. Jennifer says:

    Barb:

    You are dead on.

    Prescribing birth control AND a blood thinner is about as inefficent a treatment plan as it gets.

    There are always alternatives.

    Not necessarily as expensive either.

    My thrombophilia is not as serious as yours but I also have a heart condition that makes clotting a VERY dangerous issue (inefficent beating of the heart makes throwing clots to the brain more likely even WITHOUT thrombophilia)…

    …I take baby aspirin.

    You NEED a Catholic doctor who is scrupulous about birth control. Check out pharmacists for life on these supposed instances of NECESSARY birth control.

    The medical establishment treat birth control like it is benign and NECESSARY and in most cases its just LAZY to prescribe it and it is the pharmaceutical companies that put millions into promoting the clinical necessity of birth control. It is a profit generating myth masquerading as science.

    They resent objections to using birth control which they see as their right, as enlightened scientists, to prescribe at will.

    Right on, Barb for picking up on the ludicrousness of this. Though, sadly, passed off very frequently as sound science while, ironically, the alternatives are scoffed at as medieval and unethical.

    Stupid Catholics, why won’t they just take the Pill?

    Ignorant Catholics, ENDANGERING women’s lives.

    It’s horse flooey.

    Follow your gut, Jen and find a Catholic doctor that can consult with you over the phone.

    Boy, this ticks me off.

  15. Catholic Mom says:

    Jen, I am a retired Catholic family physician. I practiced medicine for about twenty years (mostly part time) then decided to stay home full time as my kids got older and needed me more. Most family physicians can manage coumadin, though the lab test may not be in their office. Once your dose of coumadin is regulated, testing may only be once monthly. It is just an ordeal to find the dose that will keep you adequately anti-coagulated. I am guessing that you have what is called a thrombophilia. Please talk to your doctor about the effects of oral contraceptives on this condition. Women with thrombophilias are much more likely to have recurrent DVT’s when they are on oral contraceptives. In other words, oral contraceptives will make you more likely to have another DVT, but the hematologist is counting on the coumadin to counteract this. If you do have a thrombophilia, you might want to look at this web site. You really need a doctor who can tell you what your choices are, not just tell you what to do. I am sure you will need the coumadin for 3-6 months, but the long term need is a little less clear. Your risk for recurrent clotting problems is greater if you don’t use an anti-coagulant. But how much greater? Is it a risk you are willing to accept? I think you should be able to find a hematologist who will work with your using NFP. I will pray that you do. God Bless You!

  16. Anonymous says:

    There are reasons why aspirin and coumadin are used together, but this is usually the case for people who have stents in their heart from heart surgery. While both are bloodthinners, they act differently, and on occasion when aspirin is removed, there is a subsequent stroke.

    What I read in the excerpt was that when coumadin is needed during pregnancy, then they recommend using heperin.

    So, one scenario could be, Jen, you do your best with expert guidance to use nfp. If you become pregnant, you will certainly know sooner than you would if you were using artificial birth control — and you can switch to heperin right awway to minimize the bad affects.

    Doctors are like the rest of us, if they can prevent some work for themselves, they will. In this case though, you just need to stand up for yourself demand that your moral concerns be treated as importantly as your medical concerns. You are in charge of you, and sometimes drs forget that.

    I hope you are beginning to feel a little bit better about your options.

  17. Anonymous says:

    You may have resolved this by now, but Heparin is a safer alternative. It’s an injectable, which is an annoyance, but it’s known not to cross the placenta.

    And thanks for saying this:

    “As this article suggests, I could always talk to our good, honest friends at Planned Parenthood about it!”

    You would be surprised that many pro-lifers regard them as the enemy.

  18. catholic09 says:

    I don’t know if you ever check old posts, but how did you come to your answer regarding this? I’m in the same position: a new convert and taking drugs incompatible with pregnancy. My rheumatologist won’t prescribe them without assurance that you are using birth control. I’d love to hear what your decision was and how you came to it and how you dealt with your doctors. Thanks!

  19. tubal reversal says:

    This does not surprise me with the laws. I know of a state where a couple wanted to have IVF treatments to have a child due to a previous tubal ligation and the physicians would not do it because the couple was not married. Which the woman ended up having tubal reversal surgery performed at mubabydoc Tubal Reversal Center which was outside of the couples home state. Not only was it cheaper but the pregnancy success is much better.
    There are people that change their minds but they should be the ones to make the decisions and not the government.
    I would start by asking the physician if there is anyone else he/she can suggest to contact. If this does not work then I would be searching quite a bit. The answer is out there somewhere.
    The suggestion are highly appreciated
    http://www.mybabydoc.com