need to know
October 1, 2012 1:25 PM   Subscribe

YANMD, but does my doctor need to know about a previous vaginal birth in order to insert an IUD?

I'm a 33ish year old woman who is considering getting an IUD for a number of different reasons (I want to get off the pill; I'm in a stable, committed, STD-free relationship; etc.).

But, about 14 years ago (I was 19), I was one of those idiot "I didn't know I was pregnant" girls and found out far too late to terminate the pregnancy (7 months). I arranged an infant adoption and as far as I know, my son ended up with a wonderful, loving set of parents.

Fast forward to now: I've moved far away from the city where this all happened, and have cut ties with anyone who knew about it (for reasons not really connected to this). As far as I'm concerned, that baby didn't happen.

But I'm aware that having a baby changes your body, and I'm wondering if this is something that my doctor needs to know about. Generally, I'm all for being honest with my doctor, but in this case, I feel so much better knowing that no one else around here knows this secret (the best way to keep a secret is not to tell anyone, right). Right now, the health system where I currently live knows nothing about it. Telling my doctor will probably mean that it gets added to my medical records.

From what I can tell the birth was pretty much complication free. I said yes to an epidural, no episiotomy, but had some natural perineal tearing which was stitched up. I walked out of the hospital less than 24 hours after checking in.

Is any of this relevant to decisions that my doctor might make when prescribing and inserting an IUD (probably Mirena)?
posted by anonymous to Health & Fitness (26 answers total) 2 users marked this as a favorite
Yes. The details will not be necessary at all, but you definitely should tell all OB/GYNs who see you (or family practice docs if your family practice doc does your GYN for you) that you have given birth. You don't have to tell them any of the rest of the story if you don't want to. And the fact that it's in your medical records doesn't mean anyone else needs to know. This is covered by doctor-patient confidentiality.
posted by treehorn+bunny at 1:29 PM on October 1, 2012 [11 favorites]

Every single gyno I've ever gone to has asked on intake paperwork both if you've ever been pregnant and if you've ever given birth before. I think this is something that you should probably share.

It will also likely make it easier for you to get an IUD, as doctors generally have more hesitation prescribing them to nulliparous women. Which is BS, but there you go.
posted by PhoBWanKenobi at 1:30 PM on October 1, 2012 [3 favorites]

I know a lot of doctors are more willing to put an IUD in I'd they know you've given birth before. When mine was put in my doctor mentioned that for women who had not previously been pregnant, there was an elevated risk that if it was dislodged it would go into the uterus and potentially cause perforation.
posted by HMSSM at 1:31 PM on October 1, 2012

Two ways in which it has a bearing that I am aware of (and there are probably more):
1. Old-fashioned physicians prefer not to place IUDs in women who are nulliparous - meaning have no prior vaginal births, although even if you are nulliparous, you can definitely still safely get an IUD.
2. Sizing of equipment changes for people who have had a vaginal birth, i.e. speculum size.
posted by treehorn+bunny at 1:32 PM on October 1, 2012

I am not an American, and thus I do not have these worries. But from a medical point of view a previous pregnancy is only an advantage in your situation. And an IUD is a wonderful thing.
posted by mumimor at 1:34 PM on October 1, 2012

Correction to myself - nulliparous applies to any woman who has not given birth, doesn't have to be vaginal.
posted by treehorn+bunny at 1:35 PM on October 1, 2012

You should never keep any relevant medical history from your doctor. And in this case, yes, it is absolutely relevant.
posted by Brittanie at 1:40 PM on October 1, 2012

As far as I'm concerned, that baby didn't happen

It's part of your medical history even if it's not part of your emotional history. It's never a good decision to hide facts from a doctor.

I highly doubt there will be any further questions beyond that. They don't care about where the child is. They care about your health.
posted by inturnaround at 1:40 PM on October 1, 2012 [4 favorites]

Well, I can't think of any reason your doctor must know. However, they will ask because apparently it is potentially a little more difficult to insert an IUD in a woman who has not had a child before and some docs are hesitant to do the procedure on a nulliparous woman.

However, consider why you are lying about this. Every time I have gone in for a ladyparts exam, there has been a box in the questionnaire about whether I've been pregnant or have had children. Doctors want a full picture of your story as it is known when they treat you. And they aren't there to judge you.

I used to lie to doctors about something, too. That something was that I was adopted. It was more, like, filling out the history of your parents and I'd put "none" down for everything. And then at some point I realized that they were fishing for genetic history and, guess what, my parents aren't my genetic parents. It wasn't until my 30s that I started telling the truth which was that I was adopted and had incomplete genetic medical history. No one batted an eye. No one asked why this was only coming up now. Nothing. It's common, I'm guessing.

So, I'd say, don't be afraid to say, 1 baby. If pressed, the answer is, I was 19 and gave my son up for adoption. The end.

They don't *need* to know, I don't think. But they will ask.
posted by amanda at 1:44 PM on October 1, 2012 [1 favorite]

What will happen is: they'll ask if you've ever been pregnant or given birth. You'll say 'yep'. Then they will move on to the next question.

Obviously this is a very big deal to you, but I would gently suggest that if you're considering lying to your OBGYN about whether you've been pregnant before, you may not be as over this as you think you are.
posted by showbiz_liz at 1:47 PM on October 1, 2012 [11 favorites]

Perhaps you could call a nurse advice line unaffiliated with your insurer/provider? I know Planned Parenthood affiliates sometimes have them. You could pick one away from your current town.

If it's a small town and/or you know people who work for your health care org I can understand the concern.
posted by momus_window at 1:49 PM on October 1, 2012 [1 favorite]

Yes, please tell your doctor. I understand wanting to keep the past private, but your medical records ARE private, and as you say, giving birth (or simply being/having been pregnant) makes a physical difference in your body. It could make a real difference in your care, and without your permission the doctor will not discuss it with anyone, including your partner.

By the way, if you have health insurance: you have mentioned the pregnancy there, right? Because some insurance companies will unethically and/or illegally use ANY unmentioned cause, any "pre-existing condition", to use to deny coverage.
posted by easily confused at 1:50 PM on October 1, 2012

It is useful information in fitting your IUD, yeah. They don't care that you chose not to parent after delivery, I promise--they just need to know about whether you've experienced vaginal delivery.
posted by Sidhedevil at 1:51 PM on October 1, 2012

The rationale I have heard for notifying your doctor is that giving birth modifies your cervix. Seeing as an IUD is inserted through the cervix, this is relevant information for the procedure.
posted by crazycanuck at 1:53 PM on October 1, 2012

Your doctor will be able to tell that you've given birth because your cervix will have changed shape. No point in lying. It's very brave of you to have given up a baby for adoption and I cannot imagine any ob-gyn who would not applaud you for that and applaud you for seeking contraception. And yes, IUDs are much easier to insert in woman who have given birth.
posted by mareli at 1:57 PM on October 1, 2012 [21 favorites]

Don't lie to a healthcare provider. They're there to help you, and they need the information in order to understand you as a whole person.

As others have said, there should be no judgment, and your privacy is assured.

Be matter of fact about it, and I guarantee, it won't be an issue.
posted by Ruthless Bunny at 1:57 PM on October 1, 2012 [1 favorite]

Seconding mareli: your doctor will likely be able to tell when looking at your cervix to insert the IUD, that you've given birth. There are some drawings here, if you're not the type to get squeamish. Basically, the opening through which they will be inserting the IUD changes shape permanently after a baby has come through it.

Please do tell your doctor the truth. They need to know your real history to provide you the best care, and if they notice that you're lying about this they might wonder what else you weren't forthcoming about.
posted by vytae at 2:38 PM on October 1, 2012 [2 favorites]

Don't lie to your doctor. Saying the baby didn't happen makes as much sense as saying an operation or serious illness in your past didn't happen or refusing to admit a previous abortion or miscarriage. The doctor has heard much worse things than a baby given up for adoption and won't care. I am a mother who gave up a child for adoption. It never occurred to me to lie to a doctor or on a medical form. I always thought they could tell when they examined you anyhow.

I never kept it much of a secret and am now reunited with my son who is 44. Do keep in mind that this child may need to know you some day, if only for medical history, and it is much healthier to be prepared than afraid. You did nothing terrible nor anything to be ashamed of. Your health care providers and people you are close to need to know about this part of your life, and you will feel much better without the burden of secrecy.
posted by mermayd at 2:42 PM on October 1, 2012 [3 favorites]

If you don't want to talk about your previous pregnancy, go ahead and ask your doctor or doctor's staff not to mention it. OB/GYNs know that pregnancy history can be emotionally charged, and they should respect your preferences. You can say "I've given birth vaginally once; I'd rather not talk about the details, please."

When I was a gynaecologist's receptionist, I encountered at least one case (that I remember) of someone who had a past pregnancy history that she did not want mentioned in front of her current partner. She took one of the medical staff members aside at an appointment she had come to alone, informed them of this one fact that was missing from the medical history on her record, and asked that it please not be mentioned or shown at her next appointment. The information and her preference was entered into a "private comments" area on her file, and the medical staff had me remove her pregnancy history from the report we sent to her general practitioner.

All of the staff in a medical clinic will be on your side when it comes to keeping something confidential. And you won't be the first person they've encountered who has this kind of concern.
posted by snorkmaiden at 2:56 PM on October 1, 2012 [6 favorites]

but your medical records ARE private

By the way, if you have health insurance: you have mentioned the pregnancy there, right? Because some insurance companies will unethically and/or illegally use ANY unmentioned cause, any "pre-existing condition", to use to deny coverage.

These two things contradict each other.

I second the idea of using Planned Parenthood and paying cash if you want to keep it private.
posted by small_ruminant at 4:02 PM on October 1, 2012 [6 favorites]

Is any of this relevant to decisions that my doctor might make when prescribing and inserting an IUD (probably Mirena)?

Well, previous vaginal delivery makes Mirena a better choice for you. If you've given birth vaginally then Mirena goes in easier. It's just a tiny piece of plastic but apparently women who haven't had children say that it can hurt going in. I've given birth twice and didn't even feel my mirena going in.

Honestly, your doctor does not care about a pregnancy that happened 19 years ago. You just check off a box on your intake paperwork. If you don't want to discuss it, write on it "no complications, child placed for adoption." I seriously doubt they will even mention it during the exam.

The way mirena works is a lot like NuvaRing - it releases a hormone over time. It just is in a convenient form that only has to be replaced once every 5 years instead of every month. The shape of your ladyparts only matters for the 30 seconds or so it takes to insert it.

I wouldn't bother lying because this honestly does not matter. Healthcare privacy is a big, big deal -- anyone who gossiped about something on your forms would get into major trouble. So do not worry about it.
posted by selfmedicating at 4:30 PM on October 1, 2012

If you truly don't want this in your records, wait until you are alone with your doctor and tell them orally instead of marking it in your intake papers.
posted by bq at 4:38 PM on October 1, 2012 [1 favorite]

If you truly don't want this in your records, wait until you are alone with your doctor and tell them orally instead of marking it in your intake papers.

Is the intent of this advice to prevent the information from being recorded? Because any doctor worth his salt will immediately document this information. He may do it afterward for discretion's sake, and he may separate it from the public parts of the file, but for both your protection (against inappropriate care) and his (against litigation) he will definitely document it.

And to be clear, I'm saying this to mean you should tell your doctor about your pregnancy.
posted by d. z. wang at 5:16 PM on October 1, 2012

I would be very surprised indeed if your doctor couldn't already tell you had given birth. It does change things.

Doctors need to know these things, and frankly with the health care privacy laws, someone could get in quite a bit of trouble for blabbing.

I am wondering if you are concerned because someone who works for your physician knows you?
posted by St. Alia of the Bunnies at 5:50 PM on October 1, 2012 [1 favorite]

As others noted, the minute you have a pelvic examination or IUD insertion, your doctor will very likely know that you had a previous delivery, and will potentially document the fact that your cervical examination is suggestive of prior delivery. Withholding this will hurt your relationship with your doctor, potentially affect the care you receive, and not necessarily prevent the information from ultimately making it into your medical record anyway. Withholding this information from an insurer could void your insurance, and may constitute fraud with whatever legal implications that might have (not a lawyer, consult with a local one and your insurers plan for more details).
posted by drpynchon at 7:46 PM on October 1, 2012

Your doctor will be able to tell that you've given birth because your cervix will have changed shape.

The very first time I was examined by my current gynecologist (a wonderful guy) he asked in a jovial tone, "So, do you have two children or just one?" I had not mentioned my pregnancy (which was at the time about 12 years previously). My son was a large baby. Yes, the doc could definitely tell, I imagine because my cervix was stretched or wrinkly. Had I had any reason to deny the pregnancy and done so, I'd have appeared quite foolish.
posted by RRgal at 6:24 AM on October 2, 2012

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