If your mother came of age in the mid-seventies, there's a good chance that you grew up thinking that intrauterine devices (IUD) were metal nightmares that would rob you of your fertility and make you bleed out in the grocery queue. Maligned for decades, the IUD has slowly started to build up a trustworthy reputation with millennial women. Despite hearing our mother's insistence that these T-shaped death wishes would destroy our body, and enduring years of misguided motherly peeps of "It's uterUS not uterYOU."
The hubbub that these moms who were young women in the seventies are talking about involves the first IUD on the market, a device that looks like the exoskeleton of an undersea crustacean and was about as at home in a uterus as an undersea crustacean would be.
It was called the Dalkon Shield, which, incidentally sounds more like an achievement you'd earn in World of Warcraft than a birth control method. But, this was the seventies and women had become sexually liberated; they had the birth control pill (which, I might add, carries its own major risks) and the air was rich with first wave feminism. The idea that a woman could be protected from an unwanted pregnancy while having to do virtually nothing, to be granted temporary and reversible infertility for however long she wanted to focus on herself before, if ever, undertaking motherhood, was just as enticing -- if not more so-- than it is to young women today.
The Dalkon Shield is the one that managed to corrupt the fleetingly glamorous reputation of the IUD. And it started with a woman named Carrie Palmer.
She was a young mom, like many other patrons of "the shield" and she went to her doctor hoping to delay any additional children until the ones she already had were, presumably, walking and toilet trained. She wasn't interested much in the Pill, and many women at the time weren't either, since the risks were becoming more well-known. So, her doctor offered her the Dalkon Shield. It was that little sea-creature-shaped device, manufactured by A.H. Robbins, and it boasted "safety" and "the lowest pregnant rate" of all other IUDs on the market.
A few months after Palmer had the shield inserted, both of those claims proved to be frighteningly inaccurate; not only did she become pregnant but she almost died as a result of the shield. After being rushed to the emergency room, she lost the baby and nearly lost her life when attempts to staunch the bleeding failed. She went into septic shock and as a last ditch resort to save her, the doctors performed a complete hysterectomy. Palmer survived, but was livid to have woken up irreversibly infertile. Convinced that it was all the fault of the Dalkon Shield, she took A.H. Robbins to court and was awarded $6.2 million in punitive damages. But she wasn't the last woman to suffer from the faulty design of the device; 18 more woman would die from complications related to Pelvic Inflammatory Disease (PID), which was linked to the Dalkon Shield. Because of the very long "string" that came through a woman's cervix and hung down into her vagina, it was the perfect pathway from bacteria to directly enter her uterus and cause PID. Many other women survived but suffered miscarriages, infertility and stillbirths.
Eventually, the Shield went off the market, and it would be several decades before the IUDs we know and love today, Mirena, it's little sister Skyla and Paraguard became the poster-devices for IUDs. Even though they are very different in design, women still have hesitation about them because of the long and terrifying legacy of the Dalkon Shield.
Speaking from personal, anecdotal evidence, the decision to get an IUD was not one that I took lightly; I had certainly done my research on the subject and many older women in my life had plenty to say on the matter. Still, armed with my faith in science to improve shoddy designs and the general evolution of birth control since my mother's time, I decided that it was worth the attempt. At the very worst, I could have it removed.
It was not difficult to convince my OBGYN that an IUD was a suitable birth control choice for me. In fact, he seemed pretty giddy about getting to insert one. Particularly, he was excited to be able to offer me Skyla, Mirena's younger sister IUD, which is smaller and generally offered to women who have not had a baby (me) and therefore, might have a more difficult time with the insertion procedure. He was eager to inform me of all the great benefits to the IUD over all other birth control methods:
"An IUD is like an iPhone; they keep coming out with newer models that have more specifications and it's come a long way from the first model. And of course, you can upgrade to a fetus at any time."
Right on, then.
He happened to have an opening in his schedule that afternoon, so my partner and I walked into the exam room next door and I reclined on the table, feet thrown up in stirrups, and wondered if maybe I should had put it off until I could take a painkiller; having ovarian cysts, vaginal exams weren't me at my best, and I knew that in general, the insertion is uncomfortable.
The IUD sits on the end of this big insertion device that looks sort of like a gun; a precision rifle that's going to blast a piece of metal into my vagina. I swallowed hard and gripped my partner's hand. The OB kept apologizing the whole time, like an awkward virgin trying to find the right hole on his first go 'round. I gritted my teeth and shooed away his apologies, I just wanted it to be over. Needless to say, I no longer had any curiosities about labor. About six months earlier, my best friend had given birth to her first child, and as I watched, jaw gaping, as she progressed through her very long labor, I remember trying to empathize with her pain, but I had no basis of comparison. My uterus had experienced no such excitement. But, I can safely say, after having my cervix opened with a device that looked- and felt- like a carjack, the jerking and unfathomable stretching of something that usually dilates in hours, not minutes, gave me a true sense of empathy for her. After all, I only had to endure it for about fifteen minutes.
When it was over the OB reprised his role as awkward virgin and shuffled out of the room without making eye contact. The nurse took care of me, waiting to see if I would pass out or vomit (neither of which is an uncommon response, apparently) and it was decided that I wouldn't be allowed to drive myself home. Which, at that point, was a-okay by me. I blearily listened as she explained what the next few days would feel like, told me to come back if I thought it had perforated (come back to the office? I figured I'd go to a movie!) and apologized for having no painkillers to offer me (what kind of a doctor's office is this?)
For the next few days, while I alternately rested and cursed loudly, I did more in depth research on the funny little t-shaped device that now lived in my babyhaus. I marveled at its design; for such a small thing, it performs quite an impressive feat; effectively provides infertility that isn't permanent.
In case you came here for a sex ed lesson, allow me to expand upon this.
An IUD sits in the uterus and has two small strings, the consistency of fishing line, that peak through the cervix just enough so that you can check for their presence once a month or so (although, if the IUD was to fall out of your vagina, I would hope you would notice before string-checking-hour arrives). In the uterus, the IUD sends out hormones that are sucked up by the uterus and held there, making the IUD different from the Pill, which sends a cascade of these same hormones throughout your entire body. The more focused dissemination of hormones right to the hot zone is one of the reasons why the IUD is so consistently effective at preventing pregnancy.
Paraguard, another IUD that has been on the market longer than its competitors, Mirena and Skyla, works in a slightly different and more mysterious way; it contains no hormones, only copper.
Wait, you say, copper? In my baby-maker?
Yep. Copper is, apparently, a great spermicide. So, placing this device in your uterus kills any sperm that try to get in and- boom- you don't get pregnant. For women who have trouble taking hormonal methods of birth control, Paraguard can be a really great alternative; but science admits we're still not exactly sure how the whole copper-as-sperm-kryptonite thing works.
IUDs last for several years, anywhere from three on the short end to an entire decade on the longer end. Most insurance plans cover the cost, but even if you had to pay out of pocket, paying a large sum up front for the device eventually ends up costing you less than the Pill or other forms of birth control, like condoms, would for the same amount of time. An IUD requires no maintenance during that time (aside from checking for those strings) and if at any time you want to upgrade to a fetus, you can head to your OBGYN's office and they'll take it out and you're immediately fertile again.
The IUDs of today are designed with safeguards to help prevent the complications that the Dalkon Shield caused many women. While the device is not without flaws, and it is still possible to face major complications, the IUDs on the market for young women today are safe and effective. In fact, in every other country except the United States, the IUD is the most widely used method of birth control in the world.