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Valerie SchultzMarch 15, 2009

It’s not what you’re thinking. The reason an IUD was inserted into my uterus earlier today is medical. It is one more attempt in a two-year succession of attempts to tame my monstrous, perimenopausal menstrual cycle that has plunged me into insecurity and anemia. (And I’m not sure which is worse.)

The brochure from my doctor inquires, Is your bleeding heavy? Do you pass clots? Do you wear dark clothing because you worry about accidents? Does your bleeding affect your work, social, athletic, and sexual activities? Yes, yes, yes, and heartily yes. Here is where I will stop with the graphic details: I am only burdening you with too much information in order to explore the moral implications of the procedure that has made me so crampy and introspective.

I am a former instructor of the Ovulation Method of Natural Family Planning, a Church-sanctioned way for a married couple to space the births of their children, and to keep their lovemaking both unitive and procreative. I felt uneasy from the moment my doctor suggested an IUD, or Intrauterine Device. I used to teach that IUDs were not only contrary to Church teaching on birth control, but possibly abortifacient. Even now, the literature confesses that the science of how the IUD prevents pregnancy is uncertain: it may inhibit ovulation, or it may alter cervical mucus enough to prevent fertilization, or it may thin the lining of the uterus so that the fertilized ovum is unable to implant. While all of these actions are problematic, it is the last that is particularly unacceptable.

I used to think of the IUD as the boogeyman, as the Intrauterine Devil. Now one abides in me. I would never have predicted such a future for myself. My husband and I have been pretty strict Catholics throughout our childbearing years. It has sometimes been a sacrifice, but we have tried to make our decisions out of love for each other and respect for our faith.

Reproductive technology, for a Catholic, can be a blessing or a nightmare. Lines become blurry; areas become gray; ends fall short of justifying means; moral ambiguity can keep us awake at night.  A couple who is unable to conceive the low-tech way can often be aided by a fertility specialist’s expertise in testing, drugs, and procedures. The Church expects the infertile couple to stop short of in vitro fertilization, or any technology that separates the sex act from conception. It’s a lot to ask of a woman whose deepest longing is to carry a child, give birth, and be a mother. Like stuffing the proverbial genie back into his bottle, to deny the advances of science to a potential parent seems harsh and unrealistic. In my younger days, if my heart had been broken by infertility, I’m not sure what I would have done. I know I would have been tempted to try to achieve a pregnancy by any means possible. I’m grateful not to have been in that agonizing and slippery position. Fertility was never our problem.

My IUD decision, in contrast, seems simple: I am not using it for its birth control magic.  My husband and I will still follow the Ovulation Method, as we have throughout our marriage. We will abstain from sex on days of indicated fertility, so that there is no possibility that our fertilized egg cannot implant its poor self. I am hopeful only that the IUD will control and diminish my flow until I finally cross the bridge to menopause.

Once again I am reminded of the Scriptural woman with the hemorrhage, desperate for healing, touching a cloak, her faith her salvation. My meeting with the IUD is neither a miracle nor a cure: it is merely another treatment of symptoms. It is also an opportunity for a Catholic girl to consider the convoluted ethics of fertility in the modern world.

Valerie Schultz

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15 years 8 months ago
Valerie, From someone in a similar place, I know you have to make a decision for your health, and the doctor has certainly spelled out to me the dangers for the heart of being anaemic. In my case I am fortunate that so far medication is working. I hope you are soon feeling like you are in a much healthier space.
15 years 8 months ago
I'll keep you in my prayers. If you haven't done so, you might try contacting a doctor who has received training at the Pope Paul VI Institute, based in Omaha: www.popepaulvi.com. The folks there have done a lot of scientific research to correct, within the Church's moral framework, conditions like the one you've been burdened with.
15 years 8 months ago
Valerie: By your description of symptoms it seems clear that you suffer from heavy periods, likely unpredictable ones as well. I am sorry that you are experiencing these problems: I know how difficult they can be from trying to help my own patients. You don't say what treatments you have attempted before this. For an IUD to possibly be helpful for this situation, it can only be one that releases a progestin. The effect of this on the lining of the womb is the same as if you were taking the pill, or using Depo-Provera. Further, there is a reasonable likelihood that it will have a similar effect on the cervical mucus, diminishing it, and making your use of OM for avoiding conceiving less reliable. It can do this without affecting the likelihood of ovulation, so the possibility of conceiving and losing the pregnancy, even before recognizing its presence (abortifacient effect) is still there. It is certainly unknown how likely or unlikely this is. There are other treatments for heavy and/or irregular bleeding that are effective, and do not involve a treatment that is, at best, morally problematic, and at worst, morally objectionable. There are a variety of medical and surgical treatments that are not morally problematic, including hysterectomy if other treatments are not effective. It is disingenuous and misleading to imply that the fact that Church teaching does not condone the use of IVF for infertile couples -- and this is harsh and unrealistic for a couple who 'just want a baby' -- in some way justifies your decision to employ this morally questionable technology, given your stated intention to engage in sexual intercourse. Even though you intend to use the IUD for its medical effect, that intention does not change the abortifacient potential whan it is used, unless you abstain from intercourse completely. You do not know whether your mucus observations will be a reliable indicator of fertility given the effect of the hormone in the IUD.
15 years 8 months ago
Valerie: Thanks for sharing with us this difficult decision. Thank you, too, for your powerful witness. I pray that the IUD does help your symptoms while further diagnostic efforts are made to determine the cause. I am not sure that the ethics of fertility are convoluted, but I know from my personal experience that living what the Church teaches is often difficult and brings up lots of tough questions, not only about the dos and and donts of marital sexuality, but about my own commitment and the reasons for it. Anyway, thanks again for you thoughtful words.
15 years 8 months ago
Valerie: Thanks for sharing this. It seems to me that you are faithfully applying Catholic moral teaching to your difficult predicament. Thank you for your wonderful witness. God Bless
15 years 8 months ago
One cannot "faithfully apply Catholic moral teaching" to doing something that is intrinsically evil. There are many other solutions available to problems--as someone noted above, contacting the Paul VI institute would be far more useful than just coming up with justifications for using abortifacient contraceptions. St. Augustine says in _On Christian Doctrine_ that the difference between medicine and witchcraft is knowing why something works. It doesn't matter if it's an MD or an herbalist. If someone gives you something and says, "I don't know exactly why this works, but it seems to," then that's superstition. If they have a *reason*, it's medicine. To say, "We don't really know how it works" is to try to skate the issue. I sympathize with your medical condition. I currently have a brain aneurysm, a thoracic aortic aneurysm and a possible lung tumor. If anyone came to me with a "cure" for any one of those conditions and that cure went against my conscience, I would refuse it in a heartbeat. Why doesn't anyone listen to Jesus anymore? "Whoever loves father or mother more than me is not worthy of me, and whoever loves son or daughter more than me is not worthy of me; and whoever does not take up his cross and follow after me is not worthy of me. Whoever finds his life will lose it, and whoever loses his life for my sake will find it." (Mt 10:37-39).
15 years 8 months ago
St. Augustine used condoms to avoid getting his common law wife pregnant. JC - go to the doctor - your life is not yours to throw away. If there are treatments you should take them. I do not find the author's action morally problematic under any circumstance. Additionally, given the Church's misunderstanding of the nature of life prior to gastrulation, I would counsel her to not worry about the moral implications of her actions - there are none. Just be well.
15 years 8 months ago
I will hope for your support in faith and friendship with the difficult crosses you bear, JC, but I find your response judgmental, rigorous, and moralistic. I am glad that you are not her confessor. Can't we appreciate the pain she so willlingly tries to explain and appreciate the ambiguities that some of modern technologies create? This type of response seems neither to advance good theology or pastoral practice.
15 years 8 months ago
Valarie, as someone who taught natural family planning, you know it is not 100% effective. Thus, you are deceiving your readers and yourself by having said, "We will abstain from sex on days of indicated fertility, so that there is no possibility that our fertilized egg cannot implant its poor self." There definitely is a possibility that an fertilized egg will not be able to implant because of your IUD. I think you really need to consult with an orthodox priest, as your rationale is faulty. It may mean the difference btw life and death for your offspring. Best regards, Karen

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