Sh*tbird

So ok look. The point is not the flared leg by itself. These cannot be yoga pants. These are, and you have to understand this if you are too young to have worn them, BLUE JEANS. And this was the last years before all jeans were 70% spandex.

They were denim, and they weren't bell bottoms. They hung loose from the knee in a way that would make a wizard envious. We all walked around like we were wearing hakama. And they dragged on the ground. That was important. Ragged cuffs. If your jeans weren't so long that they had ratty cuffs, they were embarrassingly short.

And the thing about denim is that it's a twill weave and it's cotton. So not only does it hold a lot of water, it wicks. Walking around in these suckers on a wet day could get you wet to the knees even if you never stepped in a puddle.

Then you'd go inside and take off your shoes and try to avoid letting your freezing, wet, filthy pant legs touch your skin.

Whereas the reality is far more like

He's close to getting his goal met.

I spoke with the patient and she was literally shaking with anxiety. I asked her to describe her prior experiences as well as what she liked about her IUD and what she didn't like. She said that she wished she didn't have to get it replaced so often, so I recommended we place a Mirena instead of just inserting a new Kyleena IUD. She was nervous about this because she didn't want an IUD that was big. I explained that the Mirena and Kyleena are essentially the same size but the Mirena lasts 3 years longer and would likely bridge her to menopause given her age whereas with the Kyleena she'd probably need another replacement to get there. She was okay with trying the Mirena.

I then talked to her about pain control during the procedure as this was what she was most worried about. I asked about her prior experiences and then laid out what I wanted to do to try and improve her experience during this procedure. I told her I planned to give her prescription strength ibuprofen, a heating pad, and a very dense anesthetic block in her cervix to hopefully make it a better experience. If she had had someone to drive her home I would've also given her an ativan because we have studies that show patients who report higher rates of anxiety surrounding a procedure also report higher rates of pain associated with it.

She was down for this plan. I gave her a very dense block, she only felt three small injections and then nothing else. She was shocked when I told her that her old IUD was out and the new one was in. She didn't believe me when I told her it was over.

I don't tell this story because I wanna brag about how amazing of a doctor I am because I'm not. I tell this story because this is the way IUD insertions SHOULD go and I want people to know that IUD insertions do not need to be traumatic. And I want other providers who may insert IUDs to know that a paracervical block should be your standard when it comes to IUD insertions.

When people find out I'm an OBGYN, complete strangers, acquaintances, etc. , the two things they like to tell me immediately are their horrible birth trauma story and their terrible IUD insertion story and I'm trying to at least make the latter one a little less common.

If you place IUDs and aren't doing a cervical block, you need to start. This should be the standard but over 90% of OBGYNs in the US aren't doing them and it's unacceptable. We are traumatizing people and it's entirely avoidable. We are scaring people away from one of the most effective and long lasting forms of birth control in a time when people are losing their ability to end unwanted pregnancies all for no justifiable reason.

"It takes too long:" No it doesn't, that visit took me 20 minutes with a highly anxious patient from start to finish.

"It's not worth it for such a short/small procedure." It's worth it for the patient.

"It's too expensive." You can do a paracervical block with just normal saline. You don't even need lidocaine if you use a generous amount of volume. And if you place Nexplanons I know you stock lidocaine in your office, stop being fucking cheap at the expense of women's pain.

"Patient's don't need it, they'll get over it." I'm telling you they do need it and they aren't getting over it as evidenced by literally everyone wanting to tell me about their terrible IUD insertion experience as soon as they find out I'm an OBGYN.

We should do better. The cervix has nerve endings, stop acting like it doesn't.

I have had people freak out and act like it was crazy that I once let a dentist give me a (very shallow) filling without novacaine. Yet it was less painful than itching a bad mosquito bite. The norm in dentistry is to give local anaesthetic before anything that might cause much pain, and use a numbing agent before the injection.

Rarely a dentist might offer to do something without anaesthetic like that one filling, but only if they really know what they're doing and think it's highly unlikely to be painful. And even then if you yell out, they'll stop and numb you if you want. 100% of the time.