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Kousha Navidar: This is All Of It on WNYC. I'm Kousha 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 pill used in abortions in the US, and Luthra explained what's at stake.

Then we spoke with reporter Alisha Haridasani Gupta about IUDs and why so many women experience pain upon their insertion. We heard from you listening right now, a lot of calls, a variety of people saying, "This is either working for me, the IUD insertion was okay, maybe a little bit painful, but worth it." Other folks saying, "Listen, it was some of the worst pain I've experienced in my life."

Access to birth control, people's experiences while using it, the ability to access abortion care, it's really all interconnected. We want to bring in a doctor, someone who comes to these topics through interacting with patients and talking with them about their choices. Joining me now is Dr. Kristyn Brandi. She's an OB-GYN in private practice in New Jersey. Dr. Brandi, welcome back to WNYC.

Dr. Kristyn Brandi: Thanks so much for having me back.

Kousha Navidar: Absolutely. You listened to our previous callers in the last segment, a wide variety of experiences, like I mentioned. Any reactions?

Dr. Kristyn Brandi: 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.

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.

Kousha Navidar: Absolutely. Listeners, our phones are still open, so if you have a question for Dr. Brandi, 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 @allofitwnyc. Dr. Brandi, you mentioned that you wanted to chime in, and your subspecialty is in IUD insertion. Can you talk about the different experiences you've had with patients? Do you make different accommodations for different people? Walk us through that.

Dr. Kristyn Brandi: Absolutely. I try to accommodate each individual person because everyone's different. 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. If I have a patient that's here for a pap smear, I 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. Both of those people need different types of management of how they're going to experience that process.

Kousha Navidar: Are those-- sorry, yes, go ahead. Yes, please.

Dr. Kristyn Brandi: Oh, yes. For IUD insertions, I want to get an assessment of how someone's pain tolerance is. Like, is something like a speculum insertion for a 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 painful process by numbing the area. 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. It just depends on that individual person and what they need.

Kousha Navidar: 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? What's limiting that from happening more often?

Dr. Kristyn Brandi: 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 a specialty training in complex family planning. I think a lot of things that Alisha 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 of extra minutes of the procedure.

Some of it is just not believing patients. 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 extra numbing medicine, so there's a lot of different nuances to it. 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 how we can make this experience better for people.

Kousha Navidar: 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. Kristyn Brandi: I think about it like when you go to the hair salon. Some people go and just get their hair cut. Some people go and get a consultation ahead of time. 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. I want to make sure that people can get the individualized care that they need, and so part of it is just having a conversation with someone and really just getting to understand what they need.

Kousha Navidar: Earlier this hour, we talked about the Supreme Court mifepristone case, and I'd love your take on it. How do you use mifepristone?

Dr. Kristyn Brandi: 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 have found that now 63% of all abortion is medication abortion. 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. 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.

Kousha Navidar: Because it would impact you personally in your profession, right?

Dr. Kristyn Brandi: Absolutely. Any person that's providing any type of reproductive healthcare often uses mifepristone, and so it's going to have a huge impact on reproductive healthcare at large.

Kousha Navidar: We've got a caller who has a question for you. Colleen from New Jersey. Hi, Coleen. Welcome to the show.

Colleen: 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 pay out of pocket to get general or local anesthesia or any other things you offer.

Kousha Navidar: Colleen, thank you so much. Doctor, go ahead.

Dr. Kristyn Brandi: No. That's a great point. 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 check that ahead of time if I can. 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.

I would say that a lot of it, 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 if it's not covered, it may not exist. It may not happen for a patient, so really important point.

Kousha Navidar: 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. Kristyn Brandi: It has been. I've been getting so much more conversations that are laden with misinformation, and often it's coming from social media. I just want to name upfront 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. 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.

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 trying to dissect what if that is actual information fact? What if that is lived experience? What if that is just one person's experience with it? That may not be the same for your experience with it.

Kousha Navidar: What kinds of misinformation are you hearing?

Dr. Kristyn Brandi: A lot that was mentioned, so things like weight gain, mood changes, things like it will throw off how I feel. A lot of it's been interesting ways that people have been managing their fertility naturally. There are natural fertility methods that people can employ that are based in science, but there are other people that are using natural chemicals that they are trying to use 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 on the internet you can find that info.

Kousha Navidar: Can you think--?

Dr. Kristyn Brandi: I want to make sure people are making--

Kousha Navidar: Off the top of your head, are there good places that you recommend people go to if they need information from the internet?

Dr. Kristyn Brandi: Yes, 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. It gives you the information, but it's also checked over by medical professionals to make sure that the information out there is accurate. I trust that site more than anywhere.

Kousha Navidar: Does that help people distinguish between what's science and just not science? Are there other ways that people can be intelligent consumers of information?

Dr. Kristyn Brandi: It's hard to say. I think using sources like major news outlets to figure out what's out there. If there's a big controversy out there, trying to dive deeper and figure out what the sources are. 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 and reacts to things differently. 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.

Kousha Navidar: 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. Kristyn Brandi: 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. TikTok or the Internet's not going to give you the right answer. It's really based on what you need. 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? Then going through each option and figure out which one fits the best. 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 counseling in the background.

Kousha Navidar: We've been talking to Dr. Kristyn Brandi. She's an OB-GYN in private practice in New Jersey. I want to thank everyone that's been listening or 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 @allofitwnyc. Dr. Brandi, thank you so much.

Dr. Kristyn Brandi: Thanks so much.

 

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