CONTRACEPTIVE CARE OF THE OLDER PATIENT – DESIRE FOR PREGNANCY? (AMBIVALENT FEELINGS)
Some women are able to recognize their ambivalence only when their desire for a pregnancy looks as if it could become a reality.
Mrs Y. and her husband decided to stop using the sheath. She was 38 years old and her youngest child was at secondary school. She had always loved having babies and decided to have one last fling. However, the first time they made love without the sheath she was suddenly aware of what it really meant. Until then she had remembered only the happiness of having a new baby. Now she also remembered the disturbed nights, and the lack of freedom to enjoy life with her husband and the other children. Recognizing the reality of having a baby at this stage in her life she decided to come for postcoital contraception.
It is important for the doctor to understand such ambivalent feelings for they lead to apparently inconsistent behaviour by women and their partners. It will be difficult to avoid judging patients if the doctor makes decisions based on his or her own rational ideas, and that will make it difficult to meet their needs.
The question of whether it is better to use the postcoital IUCD for patients in this age group rather than the oral (Yuzpe) method, should be considered. The postcoital IUCD appears to give 100% security from pregnancy, thus avoiding the difficult dilemma of whether to terminate or continue with an unwanted pregnancy. There is less likely to be a risk of pelvic inflammatory disease than in the younger unmarried patient, and the device can be kept in as a permanent method if the patient wishes.
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