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I took out my first IUD today!

A friend (and student midwife) asked me to take her IUD out awhile ago, wanting to keep it private from others in her circle of midwives and friends and when I told her I didn't know how, she really wanted me to learn how. I asked a CNM friend who told me it really was very easy - to take the ring forceps (or extra long clamps) and grab the strings and pull gently and it would come out, easy as pie.

So, today my friend was on the table and the speculum I used was too small so I had to use another one. Her cervix got tucked behind the speculum blade and I had to nudge it out by turning the spec this way and that, trying to pull the cervix out from behind the blade. When it (she?) came out, it was pointing towards the left wall instead of midline. I used a drumstick (a long q-tip thing with a thick cotton end) to try and nudge it midline, but it didn't want to, so I removed the speculum again.

I was sweating, so turned the fan on, cleaned up the area that had the two specs, the two drum sticks I'd used, the pair of gloves and dirty chux and tucked the forcep into a glove. I was going to start all over.

Mostly, I didn't want my friend to hurt. There is nothing more uncomfortable than having a speculum inserted, opened, closed, removed, inserted, opened, manipulated, manipulated some more, then closed and removed. Yikes! My friend was so kind and said I didn't hurt her at all. She said that as I was putting the speculum in, it was very helpful to help her labia not be slid inside her vagina along with the blades. My apprentice and instrument-hander-overer made the comment that it is SO uncomfortable to have our labia squish inside with the speculum blades and how kind it was that I would help them remain out by pushing the blades in slightly, pull the labia out slightly, and repeat. She said she'd never had a doctor ever do that. My friend said she hadn't either and they both made comments about their hair being pulled and how sucky that was - that even if it took a few moments longer.

So, the table didn't have any more specs and I had to go to the storage room to get them. Being in a disarray (that will be fixed tomorrow), I just grabbed the three bags of plastic specs (one bag of smalls, one of mediums, and one of larges) and I knocked before entering and when I walked in with the bags, my friend laughed out loud. I told her I was going to show that cervix who was boss and that I had plenty of speculums to get the job done. She just laughed and laughed saying under her breath, "I hope we don't use them all." I laughed then!

So, I re-set up with the drum sticks, sterile gloves, a couple of speculums (for good measure), and a new sterile forcep.

My apprentice had to step out and I no longer had anyone to hand me things. Hmmm. I'd already gloved and saw she put the lubricant up in my doppler case (it's a Tinkerbell writing box, actually), so I went and picked up the Tinkerbell box with my inner elbows and carried it to my friend. We both were laughing as she opened it and took out the lube, squirted a pile on the sterile glove's inner wrapper, put the tube back in the box and I inner-elbowed the box back to the desk.

I took the speculum and needed to adjust the lamp - and burned the crap out of my arm since I'd left the lamp on the whole time I'd been out foraging for speculums!!!

Oh my god, her poor vulva. I felt like I'd created a comedy of not-so-funnies at the GYN exam visit. I told her I thought her vulva was sufficiently tanned - and then asked her (seriously) if I'd burned anything off. She said she had been burned at the GYN before, but no, I hadn't burnt her. I apologized profusely. She just laughed. I told her it was a damn good thing she was a friend or I'd have certainly lost a client being so (seemingly) incompetent.

Okay, so all is ready, I opened her vagina, her cervix stood up front and center, I wiped the mucus off the os, and still couldn't see the threads from the IUD. But, I knew they were there. I talked to her IUD and told her I knew those threads were there - and took the forceps and went right to the os and clamped and got a string! Woo hoo!

My friend said, "oh!" and I pulled the string and I watched it get longer and then woosh the IUD was out! I asked if it hurt and she said it didn't, but she was ready if it did and I pulled the forceps out with the IUD attached and held it aloft and she was so happy! So was I!!

I removed the speculum slowly, gave her Kleenex, took the IUD with me to clean with antibacterial soap and put in a lab bag and left the room.

When I returned, I cleaned everything up, stocked the table, high fived with my friend and we went to lunch to celebrate her re-found fertility.

I won't be so nervous next time, either. It's so funny how we're so brainwashed to believe we need extensive training to do things like take an IUD out when it really wasn't such a big deal at all. I was counseled that if it didn't come not to pull, so I knew it could certainly imbed in the uterine lining, but it wasn't nearly as complicated as I imagined it would be.

I'll let you know when she conceives!

Reader Comments (4)

This is so COOL!

This is another example of how
a.) a female provider,
b.) a midwife especially and
c.) you specifically

make a difference in the care of your clients (and friends!) The consideration and gentleness is so important.


Thank you, Hannah!

I know next time it will go more smoothly.

I suspect it's why we all (students/nurses/midwives/doctors) all practice on each other first, eh? To get the kinks out?

Hey, Hannah... some day you gotta tell me how you got into Grand Rounds. I'm not ready yet, but I'd sure like to be involved in Grand Rounds in the future.

Thanks again... it feels good to be "home" again.

May 6, 2006 | Unregistered CommenterNavelgazing Midwife

thank you so much for the step by step description of your "trial and error" with getting a spec into this woman. I've been under the illusion that all experienced MWs just plop the things in and presto a cervix, while I on the other hand feel like I am shooting in the dark each time I do a pap...which are far and few between. Got to do two today and the second one was amazing in that it was a very tight fit at the introitus and I didn't want to hurt her and she sat up and said can I put it (the speculum) in? I said sure and she did and then I took it back and opened it and presto there was a cervix! and I didn't have to cause her any pain!

May 10, 2006 | Unregistered Commenterjewel

Hmmm, Jewel, I have been wondering how much of a storm I would cause at my preceptor site (with an ob) if I start having moms put their own speculums in... If any of them want to try it, I'll post the results. Including what the doc says! LOL

January 14, 2007 | Unregistered CommenterHighland Midwife

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