Podcast Summary: All Of It – The Science and Medical Practice Behind Mifepristone and Other Birth Control

Host: Koosha Navidar (in for Alison Stewart)
Guest: Dr. Kristen Brandy, OB/GYN in private practice, New Jersey
Air Date: March 26, 2024

Overview

In this episode, All Of It centers on the intersection of medicine, patient experience, and reproductive rights. The discussion hones in on the Supreme Court case challenging the FDA’s approval of mifepristone (a medication used in abortion), the pain and practice surrounding IUD insertions, the prevalence of misinformation about birth control, and tips for patient advocacy.

Key Discussion Points & Insights

1. Patient Experiences and Pain Management in IUD Insertion

Timestamps: 02:49 – 06:42

• Dr. Brandy emphasizes individualized care, noting a wide spectrum of patient experiences with IUD insertion, from tolerable to excruciating pain.
• She advocates for tailoring accommodations: pain medication (oral, local anesthesia), even the option for general anesthesia.
  • "I've had some patients that have elected for general anesthesia to be entirely asleep during the procedure, because that's what they wanted to experience, and that's cool. That's fine." — Dr. Kristen Brandy (04:20)
• Dr. Brandy explains her approach:
  • Extended consultations to understand patients’ histories, preferences, and anxiety levels.
  • Recognizes diversity of needs, especially for marginalized groups (e.g., trans and non-binary individuals).
  • Critiques the broader field for failing to consistently prioritize pain management due to time, training, and sometimes financial constraints.
    • "Some of it is just not believing patients. And I think people generally don't take enough time to talk to people and get a sense of who they are and what they need." — Dr. Kristen Brandy (05:55)

2. Patient Self-Advocacy

Timestamps: 06:42 – 07:34

• Dr. Brandy advises patients to approach these visits with the expectation that their needs and preferences should be part of the conversation.
• She likens it to getting a haircut—some want a quick service, others need a detailed consultation.
  • Importance of preparing questions and clarifying personal goals for contraception.

3. Mifepristone in Medical Practice and Impact of Legal Challenges

Timestamps: 07:34 – 08:33

• Dr. Brandy outlines the centrality of mifepristone in reproductive healthcare:
  • Used for abortions (makes up 63% of abortions are medication-based).
  • Application extends to miscarriage management and cervical softening for other procedures.
• She expresses anxiety about the outcome of the Supreme Court case:
  • "I'm really worried about the outcome of this court case and what it will look like and whether we can continue to use it." — Dr. Kristen Brandy (08:15)
  • Any restriction would directly affect her practice and reproductive healthcare at large.

4. Barriers to Pain Relief and Insurance Coverage

Timestamps: 08:41 – 10:07

• Caller Colleen from New Jersey raises concerns about insurance coverage for pain management.
• Dr. Brandy reiterates the real barrier that insurance poses:
  • She strives to include anesthesia in IUD procedures without extra charge.
  • Systemic hurdles: getting insurance to approve sedation/general anesthesia often requires justification and bureaucratic wrangling.
  • "If it's not covered, it may not exist. It may not happen for a patient." — Dr. Kristen Brandy (10:00)

5. Social Media, Misinformation, and Birth Control Choices

Timestamps: 10:07 – 12:42

• Rising impact of social media misinformation about birth control (weight gain, mood changes, etc.) noted.
  • "I've been getting so much more conversations that are laden with misinformation and often it's coming from social media." — Dr. Kristen Brandy (10:23)
• Dr. Brandy distinguishes between real negative experiences and viral stories colored by amplification bias.
• She urges patients to check reputable sources and identifies bedsider.org as her most trusted online resource:
  • "You can do a little quiz and figure out what birth control is right for you. So it gives you the information, but it's also checked over by medical professionals." — Dr. Kristen Brandy (12:17)

6. How to Be an Intelligent Consumer of Medical Information

Timestamps: 12:42 – 13:17

• Use reputable news sources and official medical websites.
• Beware of anecdotal stories; every body reacts differently to medications.
• Encourage asking healthcare professionals clarifying questions.

7. Navigating Birth Control Options and Individualization

Timestamps: 13:17 – 14:16

• Dr. Brandy stresses there is no universal best option; individualized counseling is crucial.
  • She considers patient’s goals (prevention, side effects, menstruation, acne), and cost issues.
  • "Everyone’s body is different, reacts to things differently. So I encourage you to try to reach out a little bit farther and just check sources, see where you're getting the information. Make sure it's giving you the information you need to make a good decision for yourself." — Dr. Kristen Brandy (12:58)
• Emphasizes patient-led decision-making with the provider in a supportive, counseling role.

Notable Quotes & Memorable Moments

• “It's heartbreaking to hear these stories of people that have suffered through any type of medical process, particularly...having an IUD inserted. That's not the kind of care we want to be providing people.”
  — Dr. Kristen Brandy (03:00)
• "Some of it is just not believing patients...people generally don't take enough time to talk to people and just get a sense of who they are and what they need."
  — Dr. Kristen Brandy (05:55)
• "I'm really worried about the outcome of this court case and whether we can continue to use [mifepristone]."
  — Dr. Kristen Brandy (08:15)
• "If it's not covered, it may not exist. It may not happen for a patient."
  — Dr. Kristen Brandy (10:00)
• "I've been getting so much more conversations that are laden with misinformation and often it's coming from social media."
  — Dr. Kristen Brandy (10:23)
• "Everyone is different and there's not a right answer. I'm not going to give you the right answer...It's really based on what you need."
  — Dr. Kristen Brandy (13:32)

Timestamps for Key Segments

• 02:49 – 06:42: In-depth on IUD insertion experiences, pain management, and individualized care
• 07:34 – 08:33: The role and risks facing mifepristone in reproductive care
• 08:41 – 10:07: Coverage barriers for pain management in procedures
• 10:07 – 12:42: Misinformation about birth control on social media, and reliable resources
• 13:17 – 14:16: Counseling practices and personalized birth control options

Overall Tone and Takeaways

The conversation is empathetic, practical, and clear-eyed. Dr. Brandy repeatedly centers patient autonomy, informed decision-making, and the need for systemic improvement in reproductive healthcare. Both host and guest stress the intertwined nature of access, information quality, insurance coverage, and the legal landscape for birth control and abortion.

For more information or to listen to further discussions, follow All Of It at WNYC or connect via their social channels.