Next Steps: The Insertion

In our last blog, we discussed the process of a birth control consultation with a medical provider. To most, the consult is the easiest part. The actual insertion of a long acting reversible contraceptive device, or LARC device, can lead to anxiety and stress. We hope to alleviate that a bit for our readers, as we talk through that insertion appointment beginning to end today.

Insertion appointments begin as any typical medical appointment. The patient arrives a bit early to fill out the necessary paperwork. Then a nurse or medical assistant calls them back, takes their vitals, and places them in a room. The medical provider checks in with them answering any questions they may have before they get started. There is a chance they may ask for the patient to urinate in a cup at this time. It is important to ensure that the patient is not pregnant before inserting a birth control device. Some STI testing can be done from the urine cup, as well. A Step Ahead clients are offered free STI testing, along with their well woman exam and birth control device.

If a patient is receiving an arm implant, the insertion begins with a numbing shot in their non-dominant upper arm. Within a few minutes, the arm is numbed up and ready for insertion. The provider will make a small incision in the numbed area. The arm implant comes in an applicator making it very easy to insert. The provider will take the applicator and slide the needle portion under the skin. There is a button on top of the applicator that the provider will push. That button slides the arm implant through the needle that is inserted in the arm. The provider will remove the applicator needle leaving only the birth control device inside the arm. A bandage is placed over the incision and the insertion is complete.

If the patient is having an intrauterine device (IUD) inserted, they will be given a gown and instructed to undress and put the gown on while the provider steps outside of the room. Once the patient is in the gown and ready to begin, the provider and nurse or medical assistant will enter the room again. The patient would have been instructed to take a certain amount of over the counter painkillers prior to the appointment to help with the pain. They will lie back on the table and place their feet in stirrups. There is a speculum inserted into the vaginal canal in order to visualize the cervical canal where the device will be inserted. If there is a need for a pap test or if the patient would like one, that would be done at this time. A Step Ahead clients are also offered Pap testing free with their well woman and birth control device. The provider will do some swabbing and apply some antiseptic solution. Next, the patient will feel a slight pinch as the provider uses what is called “tenaculum forceps'' to grasp the upper lip of the cervix in order to align the vaginal and cervical canals. The provider then uses a long, narrow tool to measure the uterus. This measurement is used to ensure that the device applicator is set to the correct length for insertion. Rather than having the device stored in a needle applicator like the arm implant, the device is in a long tube. The applicator tube is inserted into the uterus and the button is pushed to release the IUD. The provider removes the applicator and trims the strings of the IUD. A portion of the strings are left hanging outside of the uterus. The patient is able to perform string checks themselves by feeling for the string and ensuring their device has not moved. The provider will also use those strings to perform the removal when the time comes.

The actual insertion of a LARC device takes about 5-10 minutes maximum. After both procedures are complete, there may be some pain or discomfort. The arm will be sore for a few days with the arm implant. This can be treated with over the counter painkillers such as Tylenol or Ibuprofen. With an IUD insertion, it is common for the patient to experience consistent cramping for about 24-48 hours after the procedure. The patient may also experience bleeding or spotting as their body adjusts to the device. Every physical body is different and adjusts at its own pace. Therefore, this process could take as little as 1-3 months or as long as 6-9 months depending on the body. But A Step Ahead clients are not sent home unprepared! Every ASA client is sent home with a bag that includes items to assist in the adjustment period. Items include over the counter painkillers such as Ibuprofen and panty liners to help protect against any bleeding or spotting that may occur. As these devices do not protect against STI transmission, the client is also sent home with a condom to ensure further protection, as well as some other goodies just for comfort such as pampering items and chapstick!

There is a 6 week follow up appointment where the provider will check the device placement and discuss any issues that the patient may have had. A Step Ahead covers this appointment cost, as well. Our staff is available to talk with and discuss any questions the client may have at any point in the process. We also cover the full consultation appointment to ensure that the client has a chance to discuss any questions or concerns with the medical provider before choosing a birth control method. At A Step Ahead we strive to prepare our clients and make them feel as comfortable as possible going into their medical appointments.

By: Ashley Hullett