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Intrauterine: The Consequences Of Failed Birth Control

If I become pregnant and I don’t know it, it could end itself, and it could end me with it.

December 19, 2020

Karie Luidens
Sarah Mirk

ast night I dreamt I was a red-robed Handmaid. We were being herded at a steady pace into a concert hall, like that scene in season three where the whole town processes to the church for a blessing of the latest babies to be born.

There was just one baby in my dream, and it was dead.

I had slipped away in the lobby to use the women’s room, where I found one or two other Handmaids flushing a toilet, washing her hands. I was walking down a long line of stalls when I glanced into one and gasped: a baby.

Porcelain-pink skin, blue eyes, barely older than newborn, propped inside the bowl of the toilet. I backed away, knowing beyond the ordinary horror of it there was the added horror of how those guards would respond: that whatever had happened, miscarriage or stillbirth or live birth followed by murder, someone would pay for this.

Some woman.

“I didn’t see anything,” I whispered in a panic to the Handmaid at the sink.

“Good.” Her tone was acerbic.

I slipped away again, this time back out into the lobby past the armed guards into the theater. There was my Handmaid’s household all in a row with a seat saved for me between the driver and the commander. I nestled in, pressed between shoulders as tall as my nose.

As the lights dimmed for whatever was about to happen — the stories of our lives playing out as a show, perhaps — I pressed my left cheek further and further into the fabric of the driver’s jacket, while the commander’s shoulder pad and its rough, stiff angle grew larger and larger, covering my face and obscuring my vision.

Last week I noticed my nipples were tender — just the soft coral beads at the tip when I touched them directly. I inspected them in the bathroom mirror. The areolae looked normal, and that’s what matters, right?

Unless… were my breasts themselves plumper? No, I was seeing things. Or else their shape was slowly evolving, sure, because as months pass I gain a few pounds, lose a few pounds, get slightly older and slightly looser.

It’s been two and a half years since a nurse propped my vaginal canal open with a lube-slicked metal speculum and slid a tiny intrauterine device through the sharp cramp of my cervix.

That means I’ve got another two and a half years before its progesterone will be depleted and I’ll need to replace it.

The day after I noticed my nipples were sore against the cotton of my shirt, I spent the morning with nausea in my belly. Mild, but there — and rare.

Was I cramping, too?

I don’t cramp anymore, since the IUD ended my periods, except the occasional clenched-fist discomfort that’s hard to distinguish from indigestion.

I told my partner Harrison what I was feeling that night. Said I was a little worried, which made him — appropriately — a little worried, at which point we reassured each other: these are normal, mild, everyday sensations.

I’m primed to be paranoid, I said, because we’ve been watching The Handmaid’s Tale and because of all the news since Kavanaugh’s appointment to the Supreme Court last summer, the legislation being passed and challenged in Alabama, Ohio, Georgia, Kentucky, Louisiana, Missouri, Mississippi…

Not New Mexico, he pointed out.

No, I said. New Mexico’s already got an old law on the books outlawing abortion. If Roe v. Wade is overturned, it’ll kick back into effect by default.

Harrison frowned. I thought the state legislature repealed that this year?

They tried to, I said. But it didn’t pass. The old law still stands.


Last night Harrison and I exchanged shoulder rubs while watching TV. When he massaged down into my pecs I flinched: a sensitivity in my right breast, up near the armpit.

Hold on a sec

He withdrew his hands.

You okay?

Yeah, I just, felt something.

I slipped both my hands into the openings of my tank top and began to palpate my own tissue. There it was — not a lump, just a pad of milk ducts that felt tender, maybe slightly larger than its match on the left. Not that there are matches. Breasts are asymmetrical, between each other and within each one’s form.

I don’t do this enough, I realized — search their shape and texture and sensation with the attention of a medical examiner. Why don’t I? I cup them in the mirror and soap them daily and tuck them into bras and shirt and invite Harrison to kiss and fondle them and press the sweaty hair of his own bare chest to them during sex.

I love them.

Why don’t I examine them more exactingly, more often, so in moments like this I’d know whether their inner fibers have changed? Engorged? Starting to… prepare?

Here, you feel. I leaned back into him. He slid his hands under my shirt and grazed my skin softly, as if scanning for freckles.

No, like this. I laid my hands atop his, like I do now and then in bed to guide him or just to feel how he’s feeling me for an added explosive layer of pleasure. This time I pressed his fingers deeper into the pillow of the breast, more forcefully than he was comfortable imposing himself on me.

Do you feel anything? There.

No, I don’t.

Of course he didn’t. That sensation, the sensitivity, wasn’t in my hands. It was in the breast itself. Something he’ll never experience. Finally I sighed and laughed.

It’s probably nothing — more paranoia from the news we’ve been seeing, the dystopia.

My IUD is over 99% effective across users. But nothing is 100% effective. I know multiple women who’ve become pregnant despite using birth control.

Some gave birth, and I have the faces of their grown babies in my family photos to show for it. They remind me how fertile I might be, too.

Others had abortions, because they’d already had enough children or didn’t want children at all. They have nothing to show for it, or nothing they choose to show. They’ve confided to me privately, but told very few people. Why open their personal stories to others, even close friends or family?

We know the vitriol they’d face, how some people — people with power — want to criminalize what they’ve done and even imprison them. Not just their doctors; them.

My words in that dream, the manifestation of my subconscious worries: “I didn’t see anything.”

I have no problem with abortion myself. Despite my dystopian dream scene, I don’t picture it as full babies dropped in toilets, because that’s not what it is.

I picture specks of cells — poppy seeds, tiny wild raspberries — that happen to have lodged in a person’s bodily cavity. I picture the slick, translucent pink of shrimp in platters at the grocery store.

I picture a woman, or anyone with a uterus who’s had sperm ejaculated inside their body, playing an unwitting and unwilling host to a parasite that’s guaranteed to grow. It will feed on her circulatory system and stretch her ligaments and skin, until the day it rips its way out through her too-small orifice.

If all goes well.

If not, it will breach, it will lodge, it will choke, it will block septic infection up inside her while she clenches and keens. It will require surgery to be extracted and then to repair the tears.

It will make a wound of half her body.

It will induce postpartum blues, or depression, or at least sleep deprivation and chapped, chewed-up nipples drooping down deflated breasts. Stretchmarks and scars and a whole new lifelong, full-time role in the world.

Years of koala-cling and bodily fluids and anxiety and exhaustion.

It’s all worth it, of course, when a person actually wants to be a parent. Pregnancy can be beautiful; birth can be transcendent. Holdings one’s newborn for the first time is the stuff of poetry. I understand why others, risks and pain and all, would want to make a baby.

Some women want that, apparently. To be a parent.

I’d want to clean out the raspberry parasite early, with a pill or a Q-tip or whatever they use these days. Be an outpatient, and be done.

Be one person unto myself.

Which is why I have the IUD in place. It’s still in place, right? How would I know? I’ve never seen or felt it slip, so, I should be fine. And my periods haven’t returned, just the occasional single spot of blood staining my underwear.

So. I should be fine.

I felt fine enough last night that, after the shoulder rubs, when we went to bed, and Harrison wrapped the front of his body around the back of mine, I nestled my hips in closer to his pelvis. When his arm cradled the point of my elbow in the crook of his elbow, I found his fingers with my own and interlaced them.

Our hands moved together again, this time overtop my cotton tank, following swells and curves, slowly moving down toward the waistband of my pajama shorts. My eyes stayed closed as I felt him harden against me. I twisted myself open, shoulder blades still pressed to his chest so I could feel his breath deepening in my ear, hips unfolding toward his hand and his hardness.

He is so very good to me. To us, to each other.

The twisting, the kissing, the soft-on-hard-on-wet, the graze and the press, the breath, the breasts, the gasps and the moment of fully on, fully in, fully rocking together, fully coming together. His wet in my wet: thousands of sperm microscopically wriggling further up and into me.

We fell apart into the sheets ecstatic. More breathing. Eventually I kissed his warm forehead. I thought of the plastic toothpick-arms of my IUD standing guard in the heart-sized muscle of my womb, regulating its mucuses away from fertility.

I rose, went to pee, retrieved my clothes from the hardwood floor. Noticed a spot of dried blood in the underwear. Thought nothing of it. Thought everything of it. Fell asleep. Dreamed that dream.

IUDs prevent pregnancy, except when they don’t.

In those rare instances when sperm bypasses the IUD to reach an egg, you’re more at risk of an ectopic pregnancy, which is when a fertilized egg implants anywhere but the uterus. Then the poppy seed is an absolute threat to its mother. It slowly multiplies its way up into a wild raspberry — truly wild, growing not in a garden, but on the tiny vine of a fallopian tube, the hillside of an ovary, even further out into the fields of the viscera’s lining.

If an ectopic pregnancy keeps developing it keeps going, keeps growing into the comma of a proto-vertebrate, a cocktail shrimp, it will kill its host. And it can never be viable. Despite what ignorant lawmakers claim, writing their penal codes and shooting their mouths off, it cannot be surgically extracted and then inserted, with a lubed-up metal speculum in place of a penis, back through the pinch of the cervix into the uterus.

The uterus will reject it. It’s past the possibility of implanting into a lining that isn’t primed for it anyway. It would be, at this point, a dead clump of tissue. Dead clumps of tissue, inserted into an otherwise healthy individual’s body, can only lead to infection.

From parasite to infection: the renewed specter of death.

My IUD is supposed to halt three events: the ovaries releasing an egg, the sperm passing the cervix into the uterus, an unlikely egg-sperm pair implanting in the uterine lining. If it fails in each of those three events in succession, I could still end up with an embryo nestled in my womb.

In which case, as the poppy seed split into more and more cells of itself, populating its way up to the raspberry stage, it would literally bump up against the sharp T of my IUD. That failed contraceptive might continue to sit idly by. It might press harder and harder into its host organ.

Puncture the uterine lining, or the proto-placenta, unleashing a cascade of blood. Puncture the embryo — an accidental abortion before I even knew I had conceived.

Puncture the uterus wall, which would let my acidic guts spill in and my parasite spill out. Maybe. That’s what I’ve read, but I don’t know. Those state legislators sure as hell don’t know. The only one I’d trust to know is a doctor.

How would I know I needed to see a doctor? Would it take a piercing pain that doubles me over? A sudden stream of blood running down my thighs? When I told Harrison there was a teeny, tiny, paranoid possibility I could be pregnant, but how would I know? He said, reasonably, that I could take a pregnancy test.

How would I know I needed to take a pregnancy test?

Pregnancy tests are forbidden in the world of The Handmaid’s Tale. I guess because they’re unnatural, a deviation — like contraception and abortion — from the commandment that we be fruitful. I guess because they provide knowledge, like the Tree of Knowledge, whose fruit is forbidden.

I guess because knowledge is power — power over one’s body. The power to do something with or to one’s body, like end an unwanted pregnancy. If I become pregnant, and I don’t know it, it could end itself, and it could end me with it.

If I become pregnant, and the IUD’s tips end that pregnancy, maybe before I even know it’s there, would the authorities in Alabama charge me with manslaughter?

Would a legislator in Ohio claim I should’ve had the IUD removed and the embryo re-implanted, willfully oblivious to how the plastic and the mucus and the cells would likely be one single nonviable glob threatening infection within me?

I’ve been thinking, now and then over the last week since I first noticed my nipples were tender, I should stop by a drugstore and pick up a box of pregnancy tests. Having them in a drawer would be like checking the battery in the carbon monoxide detector. First you prevent any fatal leaks; then, as a backup, you engage a knowledge-is-power device, so if a leak happens anyway, you can take action.

Promptly. Save yourself before your body suffers any irreparable damage.

If I get pregnant, and I’m able to notice it not through missing a period that I don’t get anyway but by paying attention to the sensations in my breasts and the nausea in my lower belly and the stains in my underwear, and I pee on a stick to confirm my suspicions, I will schedule an appointment to have that growth and my IUD cleaned from me as one, safely, before they’re dangerous.

Then I’ll have a new IUD inserted and hope the odds are more in my favor this time, although they won’t be, because if this happens once it’s more likely to happen again.

I’d bring Harrison with me to the appointment. He’d offer anyway, because he’s a loving and supportive partner.

And I’d accept, and insist, not for me, but for him. Because he’d need to follow his sperm’s progress to the end of its viability in me, where he planted it, just as I’d be doing for my egg.

When we were talking about the tenderness in my breasts, and my nausea and cramps, and how unlikely it was that I could be pregnant… I said half-jokingly that if I were pregnant, then right after he accompanied me to get an abortion, I’d accompany him to get a vasectomy.

Deal? I extended a hand. He shook it, but his laugh seemed more apprehensive than amused. Which annoyed me, because actually this was not a joke. This was all very physically real.

Would I force him to get outpatient surgery on his genitals? Would he force me? No. But then yes. We take that risk each night we go hard and soft and wet together in bed and soak the sheets with a cocktail of our reproductive fluids.

He could, unintentionally, impregnate me and thus force me to choose whether to have the embryo extracted now or the fetus extracted later. Outpatient surgery now, or inpatient labor, which means work, contractions, dilation, screams, sweat, delivery, perhaps a C-section.

That’s essentially the equivalent of forcing me to get surgery on my genitals. In which case it seems only fair to me that he would follow through on his handshake and reciprocate.

Not that either of us want to contemplate these scenarios.

All we ever want to do to each other’s bodies is give pleasure. I hope that’s all we ever do — all we ever need to do. I hope my IUD is enough down there, working unseen with arms like miniature swords, holding back my eggs, fending off his sperm, keeping my uterus entirely mine.

Protecting me from my personal nightmare. And the society-wide nightmare.

A world in which women are treated like walking uteruses, marched and guarded, exchanging secrets about their reproductive experiences and choices in their own spaces but otherwise pressed silent between the shoulders of powerful men.

We might not be forced to wear red robes, but most of us keep our heads down and stay in line of our own volition.

We don’t talk openly about our birth control and the ways it works or fails us. We don’t talk about our abortions, past or potential, except in whispers hidden away from those who would shame us or attack us.

Each night there are women like me sleeping fitfully, worrying over the possibilities that loom. We slip in and out of women’s spaces, and men’s spaces, shared spaces, wary of those who want to control us across our moments of pleasure and pain.

We watch and palpate and protest and wait to see what will happen to our bodies.

Today, I’m going to go buy that box of pregnancy tests. Avoid eye contact with the cashier who rings me up, in case she glances up to search my face for signs of whether I’m making this purchase out of hope or fear.

I hope it’s a she, or rather, anyone with a uterus. Someone more likely to understand that hope or fear.

I’ll take the tests back to the privacy and the secrecy of my bathroom at home. I’ll follow the instructions, pause, start counting: one-Mississippi, two-Mississippi… ticking off the Mississippis that hover between me and knowing what will happen to my body.

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