The Science and Medical Practice Behind Mifepristone and Other Birth Control

Summary

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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

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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.

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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.

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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)

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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

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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.

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

Transcript

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[Koosha Navidar]

This is all of it on WNYC. I'm Koosha Navidar in for Alison Stewart. We're spending this hour on reproductive rights and birth control. We started the conversation with reporter Shefali Luthra. She listened to the arguments before the Supreme Court today challenging the FDA's approval of mifepristone that's a used in abortions in the US And Luther explained what's at stake. Then we spoke with reporter Alicia Haridasani Gupta about IUDs and why so many women experience pain upon their insertion. And we heard from you listening right now. A lot of calls, a variety of people saying this is either working for me, the ID insertion was okay, maybe a little bit painful, but worth it. And other folks saying, listen, it was some of the worst pain I've experienced in my life. So access to birth control, people's experiences while using it, the ability to access abortion care, it's really all interconnected, connected. So we want to bring in a doctor, someone who comes to these topics through interacting with patients and talking with them about their choices. So joining me now is Dr. Kristen Brandy. She's an OB GYN in private practice in New Jersey. Dr. Brandy, welcome back to WNYC.

[Dr. Kristen Brandy]

Thanks so much for having me back.

[Koosha Navidar]

Absolutely. So you listened to our previous callers in the last segment. Wide variety of experiences like I mentioned. Any reactions?

[Dr. Kristen Brandy]

I mean, I can tell you that I was frustrated that I couldn't chime in right then and there. It's really heartbreaking to hear these stories of people that have suffered through any type of medical process, particularly something in my subspecialty having an IUD inserted. To hear stories of people that suffered through it that had pain and unimaginable experiences is awful. That's not the kind of care we want to be providing people. So I hope we can talk a little bit more about what we can do to actually fix that problem and how you can find a doctor that would actually give you the pain medicine that you deserve during this process.

[Koosha Navidar]

Absolutely. And listeners, our phones are still open, so if you have a question for Dr. Brandy, we're here for it. You can call us or text us at 212-433-9692. It's 212-433-WNYC. Or you can hit us up on social DM us on Instagram. We're oflovitnyc. So, Dr. Brandy, you mentioned that you want to chime in. It sounds like. And your subspecialty is in IUD insertion. Can you talk about the different you've had with patients? Do you make different accommodations for different people? Walk us through that.

[Dr. Kristen Brandy]

Absolutely. I try to accommodate each individual person because everyone's different. And so usually when I have a patient that is interested or thinking about an iud, it's a longer conversation than a five minute. Like, do you want it? Okay, let's do it. It has to be a conversation about what do you want the experience to feel like? I do the same thing for everything. Like, if I have a patient that's here for a Pap smear, I say ask the same thing. Have you had a Pap smear before in the past? How was it? For some people, it's not a big deal. They do it, no problem. For other people, it's anxiety producing. It's terrifying. It's the worst thing that they can imagine. And so both of those people need different types of management of how they're going to experience that, that process.

[Koosha Navidar]

Are those. Yeah, go ahead. Yeah, please.

[Dr. Kristen Brandy]

Oh, yeah. So for IUD insertions, I want to get an assessment of how someone's pain tolerance is like, is something like a speculum insertion for Pap smear terrible or not so bad? There's different types of pain. There's pain with the insertion of the speculum. There's pain with the actual insertion of the device. And I routinely offer people pain medicine, whether that's taking a pill, doing a local injection to help with some of the numbing, or some of the painful process by numbing the area. And 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. And so it just depends on that individual person and what they need.

[Koosha Navidar]

So it sounds like you go through a bespoke process where you understand the patient, what they're coming with, what they need. Is that typical? Are there doctors who, I guess, don't do that, or what's limiting that from happening more often?

[Dr. Kristen Brandy]

I mean, I'm sad to say that I don't think it's the routine. I think that I'm lucky because that's how I was trained. And particularly if you're looking for someone that has that special training in pain management during IUD insertions, you may want to look for someone that has specialty training and complex family planning. I think it's. I think a lot of things that Alicia mentioned are true. It's time. Doctors want to get in and out. They want to keep going to that next patient. And so adding that medication to numb maybe a couple extra minutes of the procedure, some of it is just not believing patients. And I think people generally don't take enough time to talk to people and just get a sense of who they are and what they need. Some of it may even be money that they may have to charge a patient more for that process of the insertion to have that, like, extra numbing medicine. So there's a lot of different nuances to it. But I think at the end of the day, our job is to serve our community. And if that's what our community needs, then we need that additional training. We need people to be getting further education about why, how we can make this experience better for people.

[Koosha Navidar]

And if you think about that community as a collection of individuals, and we bring it back to those calls that we heard. How would you advise patients advocate for themselves?

[Dr. Kristen Brandy]

I mean, I think I kind of think about it like when you go to the hair salon, like, some people go and just get their haircut. Some people go and get a consultation ahead of time. And I, I try to take that approach if I can during an actual visit or if someone has the time to actually talk to them before they even come in. Let's talk about what do you want the experience to look like? What do you want as far as the type of iud, the goals for your iud, particularly for some of the people that were mentioned earlier, like people that are trans and non binary, going through this process can be incredibly painful and it can be dysphoric. And so I want to make sure that people can get the individualized care that they need. And so part of it's just having a conversation with someone and really just getting to understand what they need.

[Koosha Navidar]

You know, earlier this hour we talked about the Supreme Court's mifepristone case, and I'd like, I'd love your take on it. How, how do you use mifepristone?

[Dr. Kristen Brandy]

Oh, I use it every day. I am an abortion provider, and so it's something that it's very common in my practice to use. Actually, they've found that now 63% of all abortion is medication abortion. And so the vast majority of people are using the combination of mifepristone and misoprostol, whether it's for abortion. I also use it for miscarriage management when I'm doing procedures, even like an IUD insertion. Sometimes we need a medication that can help soften the cervix to make the procedure easier. And mifepristone is one of those medicines. So it has a lot of uses. And 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 because it would.

[Koosha Navidar]

Impact you personally in your profession, right?

[Dr. Kristen Brandy]

Absolutely. Any person that's providing any type of reproductive health care often uses mifepristone. And so it's going to have a huge impact on reproductive healthcare at large.

[Koosha Navidar]

So we've got a caller who has a question for you. So Colleen from New Jersey. Hi, Colleen, welcome to the show.

[Dr. Kristen Brandy]

Hi. Thanks for taking my call. And thank you to the doctor for her dedication and understanding to all her patients. My thought as I'm listening to this is that it's wonderful that you offer a variety of options to address the pain. But I wonder how many of those options are actually covered by insurance for patients who may not have the option to pad a pocket to get general or local anesthesia or any other things you offer.

[Koosha Navidar]

Colleen, thank you so much. Doctor. Go ahead.

[Dr. Kristen Brandy]

No, that's a great point. And I think that is a barrier for a lot of people, either being able to get this kind of anesthesia or providing it if they're the provider. I usually try my best to kind of check that ahead of time if I can. And I will say that I do have patients that pay out of pocket. And if I have someone coming for an IUD insertion, I don't charge them extra. If they want the anesthesia, I include it in the package of whether or not they want that iud. But I would say that a lot of it is far. As far as getting something done under general anesthesia or under sedation is usually something around coding. I just have to make sure I can justify it as much as I can to the insurance company to say like, this is something that someone needs sedation for and these are the three reasons why they need that. Sometimes it takes a call to the insurance company, which is annoying for everyone involved. But I do my best, if I can, to try to make sure that it's covered. Because right. If it's not covered, it may not exist. It may not happen for a patient. So really important point.

[Koosha Navidar]

And Colleen, we really appreciate you bringing that to the table. The Washington Post recently reported that some women are getting off birth control due to misinformation they hear on social media. There are videos on TikTok and Instagram blaming weight gain and mental health issues on the pill. Has this been your experience?

[Dr. Kristen Brandy]

It has been. I've been getting so much more conversations that are laden with misinformation and often it's coming from social media. And I just want to name up front that. I think there are some people that have bad experiences with certain types of birth control, and that's real. And they are allowed to talk about their experiences. But I think social media elevates their platform when they have that platform on social media where it feels like that's the only story that we're talking about. We talked today about so many people that had good experiences with IUDs, but there are so many people on TikTok and social media sites that talk about the bad experiences. And that's what people hear. And so a lot of my job during the day is talking to patients about what they've heard, both on social media, also from friends, family, from their own personal experiences and kind of trying to dissect what if that is actual information fact. What if that is a lived experience? What if that is just kind of like one person's experience with it that may not be the same for your, your experience with it.

[Koosha Navidar]

What kinds of misinformation are you hearing?

[Dr. Kristen Brandy]

A lot that was mentioned. So things like weight gain, mood changes, things like it will throw off, like how I feel. A lot of it's been interesting ways that people have been managing their fertility naturally. And there are natural fertility methods that people can employ that are based in science, but there are other people that are using like natural chemicals that are trying to be used in lieu of birth control. I've heard all kinds of things and it really worries me because I want to make sure people are getting information from accurate sources. Even if that's the Internet, there are still good places in the Internet you can find that info. Can you say, make sure people.

[Koosha Navidar]

Yeah.

[Dr. Kristen Brandy]

Can you think?

[Koosha Navidar]

Can you, off the top of your head, are there good places that you recommend people go to if they need information from the Internet?

[Dr. Kristen Brandy]

Yeah, I mean, my usual go to is bedsider.org It's a website that has patient testimonials. It gives you information. 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 to make sure that the information out there is accurate. So I trust that site more than anywhere.

[Koosha Navidar]

And does that help people distinguish between what's science and I guess, just not science? Are there other ways that people can be intelligent consumers of information?

[Dr. Kristen Brandy]

It's hard to say. I mean, I think using like sources, like major news outlets to figure out what's out there, if there's a big controversy out there, kind of trying to dive deeper and figure out what the sources are. And I really encourage people to just reach out a little bit beyond social media. Again, often social media posts are based on one person's lived experience, which may be true for them, but it may not be the same thing that you may experience trying that same method. 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.

[Koosha Navidar]

And when a patient comes in and asks about birth control, how do you help them choose? Does it differ as you age? What are the best options if you want to prevent pregnancy? What should somebody come into that conversation ahead of time knowing?

[Dr. Kristen Brandy]

Sure. I think my number one motto is that everyone is different and there's not a right answer. I'm not going to give you the right answer. You know, TikTok or the Internet's not going to give you the right answer. It's really based on what you need. And so a lot of my counseling is usually going through all the options and thinking through what are the pros of this? What are the cons for this? What are your goals in seeking contraception? Is it to prevent pregnancy? Is it to have lighter periods? Is it to prevent acne? There's so many reasons why people choose the birth control they choose. Is there a cost issue that we need to consider? And then going through each option, kind of figure out which one fits the best? And then again, always making sure the patient is on board with that and making sure that they are the ones that are leading the conversation. And I'm just kind of counseling in the background.

[Koosha Navidar]

We've been talking to Dr. Kristin Brandi. She's an OB GYN in private practice in New Jersey. I want to thank everyone that's been listening for contributing to this. We have more calls than we had time to take. If you'd like to keep talking to us, hit us up on Instagram. DM us at all of it. WNYC. Dr. Brandy, thank you so much.

[Dr. Kristen Brandy]

Thanks so much.

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[McDonald's Customer]

I'm gonna put you on, nephew.

[Dr. Kristen Brandy]

All right, unc. Welcome to McDonald's. Can I take your order, miss?

[McDonald's Customer]

I've been hitting up McDonald's for years now. It's back. We need snack wraps. What's a snack wrap? It's the return of something great. Snack wrap is back.