Lost IUD

Yesterday I delivered a baby, and we had been working on it all night-- so I was tired and cranky when I got home after finally having to do a C/Section for failure to progress. It was a mystery why the labor stalled, and I was disappointed, as was the mom, although we were all relieved to have a healthy baby come into the world. I was just starting to eat breakfast, when I got called to the ER. Bummer! There was a lady with a lost IUD who wanted it removed. I had seen her a few days before, and she had been crampy. We had done an ultrasound to show it was centrally placed in the uterus, and the string was visible. So I had told her to keep trying the anti-inflammatories for a few more days and see how it goes. Now she couldn't stand it any more, and the ER doc said the string was no longer visible. So I stopped at the office to get my "little bag of tricks"-- hooks and narrow-tipped graspers, for going fishing in the uterus. I gave her iv fentanyl and toradol, and a paracervical block. She was not febrile and there was no evidence of infection. I used each instrument twice, with a twisting motion. The third time was the right one, and the little hook was able to grasp the t-bar of the IUD and get it out. The string had twisted itself upward and around the long bar, as though it were ivy climbing a tree, up away from the cervix. The tip of the string was poking upward, so it perhaps was the reason for the persistent cramping. The woman was very relieved that we could get it out, without having to go to the OR. And I started thinking about all the crazy things women have to do to be responsible about contraception; and other ways we get tortured to be what we think "women are supposed to be". I have one woman who comes in with the pointiest high heels, and I feel so sorry for her feet! I usually like the Mirena IUDs, as they reduce cramping and bleeding. This is only the second time in my career that a woman needed to have one removed because she couldn't stand the cramping. I thought about this woman, in her early 40's-- going out to feed her horse, getting so nauseated and crampy that she couldn't stand up, and had to come to the ER to get this IUD out. In the afternoon I went to see the movie "Babies". My friend and fellow FMM person, Janet, has a cameo role in the movie as the pediatrician of Hattie. Watching the babies in Africa and Mongolia was a trip. I really thought about contraception, and how the world has changed since the OCPs were developed in the 1960's. I thought about people in Africa and Asia needing the kind of contraception that the Mirena can offer-- but it costs us $600 for each IUD. I want to see all those babies fed and comfortable, and playing with their moms and siblings. I want the dads to arrive and laugh and play, at the end of the work day. I want to see animals around them peacefully playing. I do not want to see starving children in refugee camps, and mothers who have lost their babies to disease listlessly sitting in grief.