Was she afraid I'd end up getting an abortion?
March 4, 2010 7:14 PM Subscribe
Is it normal for a nurse to refuse to prescribe me something solely on the reasoning that if I accidentally got pregnant while using it, it would cause birth defects?
This is Retin-A we're talking about, by the way.
We were talking about the various different things she could prescribe, and when I asked more about Retin-A, she said it wasn't a good idea because it would cause birth defects if I got pregnant while using it. (It doesn't have lasting effects after the use is stopped.)
When I said that I had zero intention of getting pregnant, being unmarried and in the middle of professional school, she hemmed, hawed, and asked me a serious of extremely detailed questions about my sexual and birth control practices. She only relented after hearing I'd be abstinent for the immediately forseeable future.
WTF? Is this normal? Or is this the next stop down on the slippery slope from people refusing to provide the morning after pill?
This is Retin-A we're talking about, by the way.
We were talking about the various different things she could prescribe, and when I asked more about Retin-A, she said it wasn't a good idea because it would cause birth defects if I got pregnant while using it. (It doesn't have lasting effects after the use is stopped.)
When I said that I had zero intention of getting pregnant, being unmarried and in the middle of professional school, she hemmed, hawed, and asked me a serious of extremely detailed questions about my sexual and birth control practices. She only relented after hearing I'd be abstinent for the immediately forseeable future.
WTF? Is this normal? Or is this the next stop down on the slippery slope from people refusing to provide the morning after pill?
As far as I'm aware, this is perfectly normal and extremely common with prescriptions like Retin-A and Accutane that are known to cause birth defects. Some drugs like Accutane even require birth control and blood tests (that test for pregnancy as well as other things) during treatment (I do not know if this is the case with Retin-A). Even if you have no intention of getting pregnant, if you do get pregnant and decide to keep the baby, it has a strong chance of being born with birth defects.
It has nothing to do with preventing someone from having an abortion, but about preventing you from having a child born with birth defects.
posted by dayintoday at 7:24 PM on March 4, 2010
It has nothing to do with preventing someone from having an abortion, but about preventing you from having a child born with birth defects.
posted by dayintoday at 7:24 PM on March 4, 2010
Anecdote: My doctor would not write me a prescription for Accutane because it can cause serious birth defects, even though I have an IUD.
posted by lilac girl at 7:28 PM on March 4, 2010
posted by lilac girl at 7:28 PM on March 4, 2010
Right, this sounds like it is in the "first, do no harm" category. The grilling was most likely to make really sure you were serious about your answer, and really understand that bad things could happen if you weren't serious.
I'm curious, where is it that nurses are allowed prescribing power?
posted by gjc at 7:31 PM on March 4, 2010
I'm curious, where is it that nurses are allowed prescribing power?
posted by gjc at 7:31 PM on March 4, 2010
Retin-A is usually used topically for acne or other dermatological problems, and the risk of birth defects with that use is apparently limited. It's a different story with oral Retin-A. I was prescribed the cream in my early twenties and no one said a word about pregnancy being a concern. However, a friend on Accutane had to be on two forms of birth control (and abstinence did not count), and take regular pregnancy tests for that one. I'd kind of wonder if the nurse had the two drugs a bit confused, unless you are talking about oral and not topical use.
posted by dilettante at 7:35 PM on March 4, 2010
posted by dilettante at 7:35 PM on March 4, 2010
That sounds like a bit much for Retin-A (topical, as opposed to Accutane.)
I was recently able to get my doctor to call in a prescription for generic Retin-A without a visit.
Retin-A is pregnancy category C. Accutane is category X. I think her behavior may be overkill for category C.
posted by needs more cowbell at 7:38 PM on March 4, 2010
I was recently able to get my doctor to call in a prescription for generic Retin-A without a visit.
Retin-A is pregnancy category C. Accutane is category X. I think her behavior may be overkill for category C.
posted by needs more cowbell at 7:38 PM on March 4, 2010
Wow. Was this at a GP office? I was prescribed Retin A from my dermatologist who made NO mention of possible birth defects or even asked if I was pregnant! He mentioned no alternative and loaded me with samples and coupons. I guess it goes to show you the difference where certain drugs fuel certain types of practices.
posted by Juicy Avenger at 7:41 PM on March 4, 2010
posted by Juicy Avenger at 7:41 PM on March 4, 2010
Response by poster: I was recently able to get my doctor to call in a prescription for generic Retin-A without a visit.
I, also, got a prescription once before, when I was was 15, without any birth defects discussion, so that's why I was surprised when this happened. This time, I wanted it for a scar on my knee, so yeah, it wouldn't be the oral version.
Thanks for the answers, everyone.
posted by Ashley801 at 7:44 PM on March 4, 2010
I, also, got a prescription once before, when I was was 15, without any birth defects discussion, so that's why I was surprised when this happened. This time, I wanted it for a scar on my knee, so yeah, it wouldn't be the oral version.
Thanks for the answers, everyone.
posted by Ashley801 at 7:44 PM on March 4, 2010
Normal? Are you kidding me? This is Retin-A, which is leagues away from Accutane in birth defect land. No, this is not normal, and way way beyond defensive medicine.
posted by ch1x0r at 7:46 PM on March 4, 2010 [5 favorites]
posted by ch1x0r at 7:46 PM on March 4, 2010 [5 favorites]
Hell, in my office we prescribe medications that require monthly birthcontrol surveys by the MD, the patient, and the pharmacist all three, as well as a monthly pregnancy tests for the 'women of child bearing age.'
But for Retin A? Someone is being a little anal, and it's not the proctologist.
posted by SLC Mom at 8:03 PM on March 4, 2010 [1 favorite]
But for Retin A? Someone is being a little anal, and it's not the proctologist.
posted by SLC Mom at 8:03 PM on March 4, 2010 [1 favorite]
It's odd for Retin-A.
There is a whole elaborate process you have to go through with Accutane. You have to be on two forms of birth control and you have to certify each month through a little online test that you are still using birth control before they'll renew your prescription.
I had been celibate for four years when I got on Accutane and I still had to answer insanely detailed questions about my nonexistent sex life and certify every month to get my prescription.
posted by winna at 8:04 PM on March 4, 2010
There is a whole elaborate process you have to go through with Accutane. You have to be on two forms of birth control and you have to certify each month through a little online test that you are still using birth control before they'll renew your prescription.
I had been celibate for four years when I got on Accutane and I still had to answer insanely detailed questions about my nonexistent sex life and certify every month to get my prescription.
posted by winna at 8:04 PM on March 4, 2010
Side story: my lesbian sister had to go on BCP and take pregnancy tests on Accutane.
posted by k8t at 8:52 PM on March 4, 2010
posted by k8t at 8:52 PM on March 4, 2010
k8t - Accutane is in a completely seperate class of drugs from Retin-A. It will seriously, seriously fuck up a fetus. Whether the drug taker is gay, straight, or a nun, it's a risk.
To the OP: Who knows what was running through the nurse's mind. It sounds like "I'm on birth control" would have been a satisfactory answer (if it were true, of course) and she would have happily prescribed the drug.
posted by pintapicasso at 9:03 PM on March 4, 2010
To the OP: Who knows what was running through the nurse's mind. It sounds like "I'm on birth control" would have been a satisfactory answer (if it were true, of course) and she would have happily prescribed the drug.
posted by pintapicasso at 9:03 PM on March 4, 2010
When I discussed Accutane with my derm he said I had to promise to not get pregnant while on it. He said he would not require me to have a birth control precription and even if I did, he wouldn't know if I was actually taking it or not. Still would have had to take the monthly blood tests though, I believe that's a federal law
Anyway, my point is that couldn't you tell the nurse to give you a birth control Rx with th Retin-A and then just not take it?
posted by elsietheeel at 9:34 PM on March 4, 2010
Anyway, my point is that couldn't you tell the nurse to give you a birth control Rx with th Retin-A and then just not take it?
posted by elsietheeel at 9:34 PM on March 4, 2010
I'm curious, where is it that nurses are allowed prescribing power?
gjp, Nurse Practitioners are frequently fully capable of prescribing drugs and therapies in many states. In some states, they can even run their own clinics. These are the people you see when you go to your General Practitioner and the Doctor is unavailable.
posted by disillusioned at 9:50 PM on March 4, 2010
gjp, Nurse Practitioners are frequently fully capable of prescribing drugs and therapies in many states. In some states, they can even run their own clinics. These are the people you see when you go to your General Practitioner and the Doctor is unavailable.
posted by disillusioned at 9:50 PM on March 4, 2010
I'd say yes, what you experienced was normal. It's been my experience with Retin-A and similar drugs (like Ziana) that prescribers have been cautious to prescribe it to women of childbearing age WITHOUT first determining the woman's plans to prevent pregnancy because the active ingredient has been shown to cause birth defects.
The real danger is, I've been told, in the first trimester; many women, unless they're actively trying to have a baby, won't even know they are pregnant and will continue a risky medication. First trimester is also the most critical trimester when it comes to fetal formation because that's when all the organs start developing and so on. So that's why the NP asked. She may have come off judgmental to you, but it truly is a risk and she wanted to do her due diligence and mitigate her liability.
An anecdote for you, when I was off BCP and actively trying to conceive, I broke out badly. My dermatologist prescribed a couple of rosacea meds along with Ziana to take to control my acne, with the promise that I would stop using Ziana the moment I knew I was pregnant. I was charting my basal temps, knew when I was ovulating and was confident in my ability to tell when I could be pregnant based on this (and the conventional peeing on a stick) so she let me use it. But I don't blame her for mitigating her liability in my situation.
posted by FergieBelle at 5:44 AM on March 5, 2010
The real danger is, I've been told, in the first trimester; many women, unless they're actively trying to have a baby, won't even know they are pregnant and will continue a risky medication. First trimester is also the most critical trimester when it comes to fetal formation because that's when all the organs start developing and so on. So that's why the NP asked. She may have come off judgmental to you, but it truly is a risk and she wanted to do her due diligence and mitigate her liability.
An anecdote for you, when I was off BCP and actively trying to conceive, I broke out badly. My dermatologist prescribed a couple of rosacea meds along with Ziana to take to control my acne, with the promise that I would stop using Ziana the moment I knew I was pregnant. I was charting my basal temps, knew when I was ovulating and was confident in my ability to tell when I could be pregnant based on this (and the conventional peeing on a stick) so she let me use it. But I don't blame her for mitigating her liability in my situation.
posted by FergieBelle at 5:44 AM on March 5, 2010
Whether the drug taker is gay, straight, or a nun, it's a risk.
Pregnancy isn't spontaneous. It's not a risk unless the person engages in procreative activity, in which case she'll know it.
If this is topical retin a her judgment is poor and you should find a new provider. If it's oral, then it's your call whether you want provider who doesn't treat you as an adult.
I see the potential utility of a blanket policy of requiring bc with accutane, for example for a teenager (or nun!) who might not be willing to admit to sexual activity, but I when possible I want a doctor who treats *me*, not some hypothetical edge case.
posted by Salamandrous at 5:53 AM on March 5, 2010 [1 favorite]
Pregnancy isn't spontaneous. It's not a risk unless the person engages in procreative activity, in which case she'll know it.
If this is topical retin a her judgment is poor and you should find a new provider. If it's oral, then it's your call whether you want provider who doesn't treat you as an adult.
I see the potential utility of a blanket policy of requiring bc with accutane, for example for a teenager (or nun!) who might not be willing to admit to sexual activity, but I when possible I want a doctor who treats *me*, not some hypothetical edge case.
posted by Salamandrous at 5:53 AM on March 5, 2010 [1 favorite]
Side note: The law requiring birth control with accutane is really there for minors whose parents would otherwise refuse birth control because "my little girl is innocent and would never have sex", especially because those same people often refuse abortions in accidental pregnancies. I personally think that asking lesbians to take it is a bit much, but I think the blanket rule was the only way for the government to sneak it under the anti birth control people's radar.
posted by atrazine at 12:15 AM on March 7, 2010
posted by atrazine at 12:15 AM on March 7, 2010
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posted by torquemaniac at 7:23 PM on March 4, 2010