Displaying items by tag: medical

How Female Hormones are Used Against Women

by Leontine Bakermans MSc PharmDHormonesPills.jpg
Coordinator One of Us, Netherlands


The birth control pill came on the market in the middle of the last century as a new remedy for menstrual disorders, such as painful or irregular periods, and it is still prescribed for these indications, usually for a short time. But what was first described as a side effect ("you can become infertile") quickly became the main indication.

The pill is now used by millions of women around the world. In the field of family planning, the pill is also presented as the instrument par excellence for the emancipation of women. Its use is promoted at all levels, such as the proposal of the Council of Europe with the resolution 'Strengthening women: promoting access to contraception in Europe' (1) and the UN population fund (UNFPA) (2).

However, there seems to be a turnaround, the number of women taking the pill is decreasing. This is because there are also negative sides of pill use, about which more and more is known.

Types of pills

There are different types of oral contraceptive pills. The most commonly used pills are the so-called combination pills and the pill with progestogen only, or the mini pill. This article is limited to the combination pill, which is most commonly used. At the end the morning-after pill and abortion pill will be discussed. The combination pill contains two artificial sex hormones: an estrogen and a progestogen. The pills can be further distinguished into so-called 2nd and 3rd generation pills. The 2nd generation pills contain levonorgestrel and norgestimate as progestogen and the 3rd generation pills contain e.g desogestrel. The estrogen is almost always ethinylestradiol.

The pill is swallowed for 21 days, after which nothing or seven placebo pills are taken for seven days During these seven days, what is called a “withdrawal bleed” occurs; it is not a real period. Because of these monthly hemorrhages, it seems as if there is a normal cycle, but this is a fake cycle.

The normal cycle

What happens during a normal cycle is summarized in the figure below:


Figure 1

The sex hormones oestradiol and progesterone are regulated from the brain (hypothalamus and pituitary) and via the ovaries:

  • The brain measures the amount of sex hormones circulating in the blood.
  • The pituitary gland uses this to produce the hormones LH and FSH, which, in turn, send messages to the ovaries to produce the sex hormones (3).

Because of this:

  • Due to the increase in progesterone, the endometrium becomes thicker and is well blooded. This is necessary to allow any fertilized egg to implant. If no egg is fertilized, no implantation takes place and the thick endometrium is rejected: menstruation. After this, another egg matures in the ovary and the whole cycle starts again (if a pregnancy takes place, the amount of progesterone remains high, as this is necessary to maintain the pregnancy).
  • The mucus in the cervix becomes thinner, which makes it easier for sperm to progress. This is also one of the symptoms used by natural birth control methods, as this phenomenon is usually easy to detect yourself.
  • But female sex hormones also influence emotions like attraction to the opposite sex, stress, hunger, behavior, friendships, aggression and how you feel (4).

Mechanism action of the pill

The effect of the pill is based on the same principles as the hormones in the normal cycle, but in the opposite direction (5). The artificial hormones in the pill weaken the signal given by the brain and this stops the natural cycle. The body itself no longer produces natural estradiol and progesterone, with the result that

  • No more egg cells mature and no more eggs are released. This is the intended main effect of the pill, because it prevents fertilization and pregnancy
  • The uterine lining does not thicken and is therefore unsuitable for the implantation of a fertilized egg
  • Cervical mucus becomes more difficult for sperm to penetrate

Side effects

Abortifacient effect?

To reduce side effects, the dosage of estrogens and progestogens in the pill has been reduced. The decreasing dosage of the pill has a direct effect on the effectivity and of course, a minimal amount of active ingredient is needed for a drug to have an effect. As a result, the main effect may no longer be 100% and egg ripening and ovulation are not always stopped. An egg can then still be released that could be fertilized. If this fertilized egg is implanted in the uterus despite the fact that the pill makes implantation more difficult, we have an ongoing pregnancy, despite taking the pill. But it is also possible that the fertilized egg cannot implant in the uterus, because the pill has not made the uterine mucosa suitable for it. The fertilized egg is then destroyed and the pill works as an abortifacient.

In practice there are a number of factors that reduce the efficacy of the pill. There are situations in which too little of the active substance from the tablet becomes available in the body, for example due to certain interactions with other medicines or diarrhea, or because a number of women have difficulty taking the pill consequently every day. Certain genes may also cause increased degradation. How often does an early abortion occur? There are no exact numbers, we can only say that it cannot be excluded that it happens (6,7).


Because research shows that some types of cancer depend on naturally occurring hormones for their development and growth, a lot of research has been done into the relationship between hormones in the pill and cancer. A study showed that taking the pill for more than 8 years showed an increased risk of cancer (8). By the way, the pill has a protective effect against cancer of the lining of the uterus and ovaries, but these types of cancer are very rare by nature and an improvement of a very small amount is still very small. The U.S. government has therefore added estrogens contained in the pill to the official list of carcinogens (9) and the WHO has also classified the pill as a group 1 (the heaviest type) carcinogen for breast, cervical and liver cancer (10). This is the same category as for tobacco and asbestos.

Breast cancer

The risk for a woman to get breast cancer depends on several factors, including a link with pill use, because estrogens affect breast tissue. The risk increases from 1.1 times higher with 1 year of pill use to 1.6 times higher with 10 years of use. Further, this risk is higher if you start taking the pill at a young age, because when breast cell proliferative activity is high, there is more chance for mutations in DNA, so the susceptibility to genetic damage in breast epithelial cells becomes higher. Women who have an abnormality in one of the breast cancer genes even have a greatly increased risk of developing breast cancer (11,12,13).

Liver tumors

"At the beginning of 2014, for a change, I went to see the doctor again, because I was still very tired. My liver values were always a bit higher than normal rates, but now they were even higher. "It is probably nothing, but just go to the gastrointestinal liver doctor" said my family doctor. When I got there, I heard "I'm sure it's nothing, but we are going to make an ultrasound of the liver". While I looked on the screen, I saw it immediately. A huge thing in my liver!" (14).


The pill plays a key role in the development of liver cell adenoma (benign tumor), usually after use for more than 5 years, but sometimes an adenoma develops as early as after 6 months of pill use. It occurs in about 3 out of every 100,000 pill users (15, 16).

Cervical cancer

Cervical cancer is the second most common type of cancer in females worldwide.

Human papillomavirus (HPV) is a group of viruses that are extremely common. Two HPV types (16 and 18) cause 70% of cervical cancers and pre-cancerous cervical lesions. HPV is mainly transmitted through sexual contact and most people are infected with HPV shortly after the onset of sexual activity. A condom gives insufficient protection because the virus is available in a broad zone around the sex organs. OC users might have more sex, with more partners higher chance of infection. Changes to cervical fluid caused by OC use may compromise one’s immunity higher susceptibility to HPV infection.

Women who take the pill for more than 5 years are twice likely to get cervical cancer. After 10 years, this can increase to a 3 times higher risk (17,18).


The amount of bone tissue in skeleton is known as bone mass and can keep growing until age 30. At that point, bones have reached their maximum strength known as peak bone mass (PBM). The PBM relates to lifetime fracture risk. Natural estrogen, plays an essential role in bone growth. By suppressing estrogen, as in OC-use, there is

a detrimental effect on the bone. In later life it increases the risk of brittle bones (osteoporosis) and therefore a rise in bone fractures (19).

Heart and blood vessels

Oral contraceptive hormones have an impact on the lipid and carbohydrate metabolism. They significantly affect plasma lipoprotein metabolism, which can raise the levels of plasma triglycerides, low-density lipoprotein, and high-density lipoprotein.

Taking the pill therefore increases the risk of thrombosis (the formation of a blood clot,


in a vein of the legs, lungs, heart (heart attack) or brain (stroke) 2 to 4 times (23, 24). The third-generation pills even give a 4 to 7 times higher risk of thrombosis (reason why they are now much less prescribed).

Myocardial infarction

Suppose, you're at work and suddenly you feel dizzy. You try to go outside for fresh air, but you don't feel your legs. You can only hang to one side and start vomiting. It turns out to be a brain attack.


Studies show that in young women taking the contraceptive pill more or less doubles the risk of having a stroke (20.21). Women who take both the pill and carry the variant of a certain coagulation factor gene are 20 times more likely to have a brain attack (22).

Lung embolism

"I was 21 and very tired and flustered for a while. I worked in preschool, so at first, I thought it was from the kids. But it got worse and worse. It felt like my heart was bothering me. I could hardly breathe. The next day it turned out I had a pulmonary embolism. After extensive examination doctors established that she was hypersensitive to the hormones from the pill. My pulmonary artery was pinched off by a blood clot. I really couldn't breathe, I was in mortal danger" (25).

In rare cases, a venous thrombosis or pulmonary embolism is fatal (26).

The risk of thrombosis when taking the pill is also greatly increased by the presence of risk factors such as smoking, age and obesity.


Psychological effects

In addition to effects on the ovaries, the sex hormones also influence emotional things like attraction, stress, hunger, behaviour, friendships, aggression and how you feel (4). Effects on this by suppressing the sex hormones through pill use is therefore inevitable, but only recently more clarity has become available. It appears that also the Hypothalamic-Pituitary-Adrenal axis (HPA axis) is involved. This axis also acts via the hypothalamus and pituitary gland, but with the adrenal glands as target organ. Via this axis, the renal glands release cortisol. Cortisol reacts to stress and regulates many body processes including, mood, emotions and sexuality. Sex steroids exert profound control over the HPA axis. Suppressing this system with artificial hormones, has an effect upon all the processes this axis regulates. The HPA axis continues to develop until after puberty.

A 2016 Danish study of women between the ages of 15 and 34 showed that among those who used hormonal contraceptives, there was a forty percent higher risk of taking antidepressants. Especially women between 15 and 19 years had a higher risk of becoming depressed (28). 

"When I was seventeen, I went on the pill. It was obvious when you were dating. Man, I thought it was exciting and mature. But after a month I cried all the time, for nothing, and wanted nothing more than to sit on my father's lap. At school I became very uncomfortable, which caused me to distance myself from my friends, who I thought were blaming me for that, so I made even less of a rapprochement, and I came home crying again. It was an incredibly unpleasant time" (27).

A link between pill use in young women and the risk of depression in adulthood has also been shown. This suggests that adolescence can be a sensitive period during which pill use can increase a woman's risk of depression, even years after use of the pill was stopped (29).

The Dutch researcher Estrella Montoya states: "It is almost certain that the pill has an effect on the brain, in areas that are important for mood, anxiety and pleasure (30).

In her book 'Your brain on the pill' (4), Sarah Hill, professor of psychology, describes new research on the effect on the brain and psychological influence of pill use. She came to the conclusion that by suppressing the natural hormone profile through pill use you can start to feel like a totally different person. This goes as far that, although the research is still in its very recent, this suggests that the pill could have an influence on who you find attractive (through pill use you could fall for a different type of man as without pill), on the dynamics of your relationships (pill extinguishes feelings of lust), how you react to the face of your partner, on your chances of ever getting divorced, etc.

MRI scans have recently shown that the size of certain parts of the brain, including the hypothalamus, was considerably smaller in women taking the pill than in women not taking it (31). And the hypothalamus is the organ from which the hormones are controlled. What effect this has in the longer term is still unknown.

Women under 19 years of age

The influence of sex hormones plays an enormous role in all gender-specific developments during puberty and adolescence, not only in the visible parts of the body, but also on the brain. Girls who are just menstruating are still busy with their brain development. Brain development is usually not finished until we are 20-25 years old. Sarah Hill advises against influencing your hormone balance with the pill before the age of nineteen or twenty and recommends more scientific research into the effects of the pill. Animal studies have found that hormones, especially when the brain is still developing, can irreversibly influence behavior. Adolescent girls have in addition a higher chance of getting breast cancer and reach a lower peak bone density with higher risk of fractures.

The morning-after pill

There are 2 types of morning-after pill available. One consists of the same progestogen as most commonly used in the pill: levonorgestrel. It can be taken up to 72 hours after unprotected sexual intercourse. Later, another one is added EllaOne® (ulipristal acetate). This is even effective up to 120 hours (5 days) after unprotected sexual intercourse. They are sold about 300,000 times a year in the Netherlands in a population of 17 million people (32).

The effect of the morning-after pill is partly based on ovulation inhibition, but if the pill is taken from the day before ovulation, i.e. in the most fertile period, ovulation can no longer be inhibited. If ovulation has already occurred, it can of course no longer be inhibited as well. In these cases, the efficacy is based on preventing implantation, an abortifacient effect (33).

The abortion pill

Despite contraception, many women get unplanned pregnancies. 60-70% of women who come for an abortion indicate that the unwanted pregnancy occurred despite the use of contraception (34).

At first, I didn't feel anything, after three hours my bowels started to rumble a bit and after that it got much worse very quickly. I couldn't get off the toilet for three hours, I emptied on all sides. I felt so miserable. I cursed myself, I cursed the contraceptive pill that hadn't worked. For three hours I sat on the toilet with a bucket (because in the meantime I also had to vomit) groaning, crying and shivering. I had never had so much abdominal pain in my life and didn't know how to sit or stand anymore'. (35)

The abortion pill is a series of 2 types of pills, to be taken 2 days in a row. The first pill to be taken, mifepristone, is an antiprogesterone drug, which suppresses the natural progesterone needed to maintain a pregnancy.  It loosens the baby. After 2 days another medicine has to be taken, prostaglandin, which causes the uterus to contract and expels the baby. This can be done up to ten weeks after the last menstruation in the U.S.

"She saw that there were still a lot of remains in my womb. She therefore decided that a curettage was still necessary. This would be the only way to stop the severe bleeding, and remove the remains'.

The abortion pill is not a simple and innocent remedy. It ends human life and it's not without risk. The leaflet therefore states that it is important to have access to appropriate medical care if an emergency situation arises and the patient must remain close to the treatment center (36). In addition, an ectopic pregnancy must first be excluded, because in that case the abortion pill does not work and medical intervention is required. Enormous cramps and heavy blood loss are common. Prolonged vaginal bleeding may occur. In some cases, severe bleeding may require surgical removal of the uterus. Rarely, the uterus may rupture or a fatal shock syndrome may result from a particular bacterium. Bleeding is in no way proof that the pregnancy has ended, because bleeding also usually occurs if the treatment fails. The non-negligible risk of failure (4.5 to 7.8% of cases) makes a control visit mandatory to check that the abortion has been completed. In case of an incomplete abortion, a curettage is still required to achieve complete abortion. A so-called "do it yourself abortion", which means that the pills are taken without medical supervision, can therefore have terrible consequences.

Abortion Pill Reversal

What if there is regret after the abortion pill? After taking the abortion pill, some women have regret and realize that they do want to keep their baby. If they have only taken the first pill, but have not yet started the medication for the following days, they are still eligible for the abortion pill reversal.

The abortion pill reversal consists of the drug progesterone because the woman’s body had stopped producing it naturally when the first abortion pill was taken.This was switched off by taking the first pill of the abortion pill. By not taking the second day's pills and taking the abortion pill stopper as soon as possible (at least within 72 hours) and continuing this until the 14th week of pregnancy, the baby can be saved up to 65% of cases (37).

Women pay a high price for controlling fertility

We are concerned about artificial sex hormones that men use in the gym because of all the effects they have on their bodies. But at the same time, healthy women are routinely prescribed female sex hormones and swallow them for years, despite the increased risk of cancer and thrombosis, sometimes with fatalities and severe emotional disturbances.

Influence on the environment

The hormones in the pill are excreted again and reach the water purification system via the sewer. The sewage treatment system does not succeed in breaking down all the female hormones in the wastewater, causing estrogens to re-enter the environment. Synthetic hormones can be active even at very low concentrations. Estrogens from the pill, for example, are ten times more active than the natural female estrogen (38). Hormone-disrupting effects in the aquatic environment have been clearly and frequently demonstrated. For example, feminization was found to occur in male fish.

What this means for humans and the environment is still unknown (39-43).

No pill, but what else?

There is an alternative to taking the pill. This alternative requires the cooperation of both partners, especially in the field of self-control, but it has no side effects: natural fertility management, also called 'Natural Family Planning' (NFP). NFP is based on the knowledge that, on the one hand, sperm cells only survive in the fallopian tubes for a maximum of five days and, on the other hand, an egg cell can only be fertilized for a few hours. A woman is therefore fertile for a week before ovulation until about a day after it. If one does not have intercourse during this period, pregnancy is impossible. To determine when the fertile period falls, there are several possibilities.

The Billings method makes use of the fact that around ovulation the mucus in the cervix is thinner. It is possible to draw 'threads' from it, as with the white of a raw egg. This is easy to determine yourself. You can even determine when a woman becomes fertile again after a pregnancy.

The sympto-thermal method, such as Sensiplan, is also based on the observations in the cervix mucus, but also uses the woman's body temperature: after ovulation the body temperature rises by about half a degree (five dashes). By taking the temperature daily, one has an extra control on ovulation.

Information about Sensiplan: www.sensiplan.nl




  1. Council of Europe, Parlementairy Assemblee, Empowering women: promoting access to contraception in Europe. http://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-EN.asp?fileid=25012&lang=en and https://www.unfpa.org/family-planning
  2. The Rights to Contraceptive Information and Services for Women and Adolescents https://www.unfpa.org/resources/rights-contraceptive-information-and-services-women-and-adolescents
  3. Wat doen de hypofyse en hypothalamus met je hormoonhuishouding (https://www.cyberpoli.nl/craniofaryngeoom/faq/1333
  4. Sarah Hill, je brein aan de pil. Nijgh en van Ditmar 2019. EAN 9789038805337
  5. https://www.nhg.org/standaarden/volledig/nhg-standaard-anticonceptie?tmp-no-mobile=1
  6. John Wilks. The impact of the pill on implantation factors-new research findings. Ethics and Medicine, 16.1, 2000
  7. Walter J. Larimore. The abortifacient effect of the birth control pill and the principle of the double effect. Ethics and Medicine, 16.1, 2000
  8. Philip C Hannaford et al. Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioner's oral contraception study. BMJ 2007;335:651
  9. Nelson. Steroidal estrogens added to list of known human carcinogens. The Lancet, 2002;360: 2053
  10. WHO- IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 91
  11. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives, Lancet 1996; 347: 1713-27
  12. Lina Morch et.al. Contemporary hormonal contraception and the risk of breast cancer, NEJM 7 de 2017
  13. Merethe Kumle et.al, Norwegian Swedish Womans Lifestyle and Health Cohort Study. Canc Epid, biomarkers and prevention, 2002, 11, 1375-1381,
  14. https://www.natuurlijklinda.nl/leveradenomen/
  15. TJM Teeuwen, T.J.M. Ruers, Th. Wobbes, Het leverceladenoom, een tumor bij veelal jonge vrouwen, NTVG 17-06-2007
  16. AW Hsing AW, RN Hoover, JK McLaughlin et al. Oral contraceptives and primary liver cancer among young women. Cancer Causes Control 1992;3:43-48
  17. Green et al. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16573 women with cervical cancer and 35509 women without cervical cancer from 24 epidemiological studies. Lancet 2007; 370:1609-21
  18. Smith et al. Cervical cancer and use of hormonal contraceptives: a systematic review. Lancet 2003; 361: 1159-67
  19. Jamie A Ruffing et al. The influence of lifestyle, menstrual function and oral contraceptive use on bone mass and size in female military cadets. Nutrition & Metabolism 2007, 4:17
  20. nl – Emma kreeg herseninfarct door de pil -6 november 2018 https://www.linda.nl/nieuws/interview/herseninfarct-emma-schuldgevoel/
  21. Nemo kennislink. Pil verdubbelt kans op vaatziekten, Elmar Veerman, 11 juni 2003
  22. De pil vergroot kans op hartinfarct met stollingsfactor gen 20x. Gezondheid.be. Aug 2019. https://www.gezondheid.be/index.cfm?fuseaction=art&art_id=5095
  23. Stichting anticonceptie Nederland, https://www.anticonceptie-online.nl/pil.htm overzicht tromboserisico
  24. JM Kemmeren et al. Third generation oral contraceptives and risk of venous thrombosis: meta-analysis. BMJ 2001;323:1-9
  25. B Tanis et al. Oral Contraceptives and the risk of myocardial infarction. N Engl J Med 2001;345:1787-93
  26. Nooit mee aan de pil -Ik was er bijna niet meer geweest. RTL nieuws 29 maart 2018 https://www.rtlnieuws.nl/magazine/artikel/4132041/nooit-meer-aan-de-pil-ik-was-er-bijna-niet-meer-geweest
  27. https://www.elle.com/nl/beauty-health/health/a30269840/anticonceptie-pil-sarah-hill/
  28. CW Skovlund et.al. Association of Hormonal Contraception With Depression, JAMA Psychiatry, 2016;73(11):1154-1162
  29. Ch Anderl et.al. Oral contraceptive use in adolescence predicts lasting vulnerability to depression in adulthood, 28 August 2019, the Journal of child psychology and Psychiatry
  30. ER Montoya, PA Bos (2017). How Oral Contraceptives Impact Social-Emotional Behavior and Brain Function. Trends in Cognitive Sciences
  31. RSNA Press Release Study Finds Key Brain Region Smaller in Birth Control Pill Users Released: December 4, 2019 https://press.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?ID=2136
  1. Morningafterpiladvies.nl. https://morningafterpiladvies.nl/wat-is-de-morning-after-pil/
  2. Mozzanega B, et al. Eur J Contracept Reprod Health Care 2019
  3. Evaluatie Wet afbreking Zwangerschap 2005
  4. ‘De abortuspil? Echt een heel heftige ingreep!' De Telegraaf 07 sep. 2016 in VROUW
  5. Productinformatie Sunmedabon https://www.geneesmiddeleninformatiebank.nl/ords/f?p=111:3::SEARCH:NO::P0_DOMAIN,P0_LANG,P3_RVG1:H,NL,106099
  6. Schreeuw om Leven, er is hulp, www.erishulp.nl
  7. AD Vethaak et al. Estrogens and xeno-estrogens in the aquatic environment of the Netherlands. Occurrence, RIZA/RIKZ-report no. 2002.001
  8. Stowa 2014 MICROVERONTREINIGINGEN in het water | een over zicht.
  9. Proefschrift Dr. Ir. T. de Mes, 2 november 2007
  10. Staatscourant: Hormonen ontregelen watermilieu nr. 243, 14 december 2007
  11. LOES: Landelijk onderzoek oestrogene stoffen in beeld. Ministerie van verkeer en waterstaat 2002
  12. ICBR (2011a). Evaluatierapport oestrogenen. Internationale Commissie ter Bescherming van de Rijn (ICBR), Koblenz. Rapportnummer 186

© One of Us Nederland

Doppler in the First Trimester

by Tammy Stearns MSAS, BSRT(R), RDMS, RVT, FSDMS
Ultrasound Consultant, Heartbeat International

Being a sonographer who is registered and has scanned first trimester obstetrical exams for over twenty years, I have had it repeatedly ingrained in me to never perform Pulsed Doppler in utero, especially in the first trimester. However, diagnostic exams that aid in the screening and diagnosis of congenital abnormalities in the first trimester have become available and seem to outweigh the benefits versus the risks. According to AIUM’s official statement on the Use of Doppler Ultrasound During the 11-14 Week Scans (or earlier in pregnancy), the use of Spectral Doppler should only be employed when there is a clear benefit/risk advantage and both T1 and the examination duration are kept low. Protocols that typically involve values of T1 lower than 1.0 reflect minimal risk.

What does this look like in our Pregnancy Care Centers?

Typically, the baby’s heartbeat is first confirmed with M-mode. The heart is identified and a curser is placed on the movement and by virtue of the motion of the anatomy waveforms are created by which the heartbeat can be calculated. Depending on the calibration of the software utilized, the calipers need to be placed either from one part of a waveform to the same part on the immediately preceding waveform. Some machines will measure by calipers being placed on one waveform, skipping a waveform, and then placing a caliper on the next waveform at corresponding locations.


The client can see the flicker of the heart by observing the image and M-mode provides the mechanism for measuring the heartbeat. For the vast majority of clients, this is all that is needed to realize the reality of the creation growing inside. The image of the flickering heart makes it real and answers the question on the viability of the pregnancy.

However, for some, hearing the heartbeat seems to make it ever so real. I was talking with a new dad recently and he shared his ultrasound experience. For him, the pregnancy was very abstract. He wasn’t experiencing any of the bodily changes that accompany a pregnancy so the reality of a life growing inside his wife was difficult to really believe. He saw the images on the screen along with the flicker of the heart, but he said it was when the imager let him hear the heartbeat for just a few seconds that he realized the reality of life within. This was a married couple not in a crisis pregnancy and it still was the audible heartbeat that allowed him to thoroughly connect with his child. How powerful might it be for our pregnancies that are seemingly in crisis?

The possible benefit of the life being saved far outweighs the possible risks, especially when the guidelines are followed to ensure that possible bioeffects are held to a minimum. It is imperative that the imager be skilled and that the exposure of spectral Doppler be held to a minimum time utilizing the ALARA principle with the T1 of less than or equal to 0.7. As with all ultrasound exams, an informed consent form should be signed. As with all protocols and policies, your Medical Director will be the ultimate authority on the use of spectral Doppler.

How COVID-19 Affects Pregnant and Breastfeeding Women

by Christa Brown BSN, RN, LAScoronavirus
Heartbeat International

One of the most important things we do in Pregnancy Help Organizations is to empower people with accurate information which allows them to make informed decisions. The recent outbreak of COVID-19 can create some fear and insecurities for moms trying to stay healthy during pregnancy and breastfeeding.

The National Perinatal Association states that we can help address anxieties and fears of the coronavirus disease 2019 (COVID-19) by doing the following:

  • Acknowledging that everyone's concerns are valid
  • Sharing our own experiences and reactions
  • Explaining proven public health responses
  • Promoting the evidence 
  • Dispelling the myths
  • Modelling healthy behaviors[1]

The information provided is for general education. If a client has a specific question about her health or the health of her child, she should consult with her own physician.

Empowering Clients to Make Healthy Decisions

by Christa Brown BSN, RN, Medical Specialist/APR CoordinatorEmpoweringClients

Should she/he…                                

  • Move in?
  • Get tested?
  • Leave the relationship?
  • Quit the job?
  • Continue the pregnancy?
  • Hang out with some old friends?

Clients we serve are often in the midst of making relationship, pregnancy, sexual, career, health, and a variety of other major life choices. We are given the honor and privilege of assisting them in this process. 

We want the best outcomes for the women and men we are called to serve. But how do we successfully assist them navigate these life-altering decisions when sometimes there is no clear right or wrong? How do we allow them to choose without imposing our will on them? How do we help them succeed?

Often we see the situations they face in only black and white, good and bad. But the choices they are making might not always be answered that way. And the backgrounds of clients, the present circumstances and their future goals in life are all different. The better thought process might be, “what is the wise thing to do?”

  • Not - what is everyone else doing?
  • Not - what can they get away with?
  • Not –what did they do last time?
  • Not – what’s wise for their friends?
  • Not – what are others saying they should do?

Many clients have had some conditional love such as, “If you make the decision I want you to, I’ll care about you”, but very little unconditional love. Friends and family with other agendas can create doubt in the patient's choices. Even a very positive decision can feel completely wrong and clients might waiver either for a moment or for an extended length of time. As they struggle to get footing, it’s important we are not yet another voice causing them confusion. Pushing the decision we want might cause clients to agree in the moment, but it will likely not remain a long-term decision.

The big question becomes –

“In light of past experience, current circumstances, future hopes & dreams, what’s the wise thing to do?”

Looking at past experiences can bring clarity to current decisions. But it can be easy to be deceived into thinking that doing the same thing will achieve different results. We all believe we can manage outcomes. We tell ourselves, “I know last time didn’t go well, but this time is different.” Decisions made in the past have created the realities of today.

It’s also important to look at current circumstances to understand how they are affecting decisions. It’s not uncommon to want the easier way or immediate satisfaction. It’s just human nature to avoid thinking of the many outcomes that one decision might bring.

And thirdly, the vision for tomorrow can guide today’s decisions. It’s important for clients to see clearly their hopes and dreams and understand how today’s decisions affect them. It’s almost always a bad idea to trade something desired now for something wanted in the future. Friends and family might not have the same ambitions, so decisions might not be understood or supported. It’s a good exercise to brainstorm those hopes and dreams and even write them down, so they can remain in focus.  

Here are some steps that can be used to help process decisions:

  1. Clearly outline the issue. “The decision I need to make is...”
  2. Outline all the options.
  3. Consider the risks and benefits of each.
  4. Slow down. Don’t make the decision under pressure or in haste.
  5. Gather information needed about all options.
  6. Create an action plan for the decision.
  7. Make a long-term commitment to this choice.

As these decisions are processed, clients might not be consistent. When the trajectory has been set for quite some time and suddenly a different plan is made, the line sometimes doesn’t stay straight. Clients sometimes take two steps forward and three steps back. But then a few more steps. It’s important that we show our pride in them for each accomplishment. We might be the only ones cheering them on. But it’s equally important to let them know they can always be honest about those steps backwards. We cannot help them if they never return. Even if they make decisions they know we might not agree with, clients need ongoing support offered without judgment and condemnation. That can be the most difficult part of working in a center - maybe one of the hardest things we will ever do. But it’s what God calls us to, and it’s what will make the difference – loving them unconditionally.

Assisting clients to navigate very complicated waters can be both challenging and rewarding. With education and support, most clients are well capable of making good, healthy decisions. We can be the voice of support and love that helps them make the best choices possible. One good move forward today can affect all of the future.

“Whoever is wise will observe these things, and they will understand the lovingkindness of the Lord.” Psalms 107:43 NKJV

Covey, S. R. (2004). The 7 habits of highly effective people: Restoring the character ethic ([Rev. ed.].). New York: Free Press.

Covey, S. (2014). The 7 habits of highly effective teens: The ultimate teenage success guide. New York, N.Y.: Simon & Schuster.

The LOVE Approach https://www.heartbeatservices.org/resources/resources-by-topic/volunteer-training/the-love-approach-3rd-edition-training-manual

Stanley, A. (2014). Ask It. The Question That Will Revolutionize How You Make Decisions. Danvers, MA: Multnomah Books.

You Are FULLY Equipped

by Lisa Kimrey RN, BSN, MBADayWithoutWomen

A day in the center

  • Torrents of emotion flood your mind as the abortion-minded client walks out the door. You lift fervent prayers for her return.
  • Beautiful brown hair falling over her downcast eyes (when her boyfriend is present) shows there's more to this story.
  • Symptoms she's describing are as dangerous as the lifestyle she's living.  You pray there is some way to get her off the streets.

Serving in Pregnancy Center Ministry is Stressful!

You see the clients who come in hurting. The enemy’s lies are weaved, even knotted, inside their stories. You teach. You pray. You fight. You hope. You never give up.


Because faith.

But long before lunch, your energy wains.

You need refueling. Without it, the enemy's lies will tease even you, the saint soldier.

The lies that make you wonder if it's worth the effort. Or, worry your words aren’t making a difference. The lies that create urgency; to hurry through—maybe skip—your necessary refuel and recharge.

But! You are equipped to overcome the enemy’s distractions. You decide to rest. You eat a nourishing meal. And so, God is pleased.

You Are Equipped for It All

The Lord gave you your calling, your spiritual gifts, and your form. Particularly in ministry, these all work together. Have you ever thought about the synergy between these three?

Your calling is to love the unborn. Thus, you say and do things that you never imagined you would, or could do.  Life-changing things; life-saving things.

And, the Lord gives you the opportunity to use your gifts to share the Gospel—which you do daily in your ministry work.  

But, what about your body? How does it collaborate with your Spiritual calling and gifts?

Let’s look at Scripture.

Psalm 100:3 says, "Know that the Lord is God. It is He who made us, and we are His; we are His people, the sheep of His pasture." (NIV).

“For the foolishness of God is wiser than human wisdom, and the weakness of God is stronger than human strength." (1 Cor 1:25 NIV).

Scripture shows that God is the wise creator of your body. But, He created it in a way that requires you to provide the needed support. His design is NOT a maintenance-free form.

Why do you think He chose this method?

Because, when you take care of your body, you use your gifts for your calling at your highest ability.

The Lord fully expects you to do the proper self-care.

Thus, self-care is a way to show obedience to God.  A form of worship.

Obedience is the Beginning

Paul states, "Don't you know that you yourselves are God's temple and that God's Spirit dwells in your midst?" (1 Cor 3:16) (NIV).

Temple worthy self-care shows obedience and honor towards the LORD. You glorify God when you do so because your focus remains on Him. You stay on mission.

Taking care of your body in this way will honor the Lord.

Perhaps, a healthy snack when needed. A short break for quiet or prayer. Getting enough sleep.

So, what do you do if you are not providing temple deserving self-care? Where and how do you begin?

You won’t find the courage to start by looking inward (your flesh) or outward (the world).

You must look upward. You need to pray!

He Also Provides the Right Motivation

Your obedience moves your focus away from yourself, and towards the LORD. You align with His will. You can trust Him.

“This is the confidence we have in approaching God: that if we ask anything according to his will, he hears us. And if we know that he hears us—whatever we ask—we know that we have what we asked of him.” (1 John 5:14-15).

With prayer, you are blessed with the confidence (or courage) to start doing the things your body needs for Kingdom work—even when it’s hard to do!

But here is the best part. When you center on the Lord, you move away from the desire to use your body for your pleasures and purposes, and towards the desire to use your body for God's glory.

Your desire to please God transforms into a prevailing source of motivation to start and continuedoing temple worthy self-care! And, it is another way of worship.

In closing, be encouraged! Your calling is no small feat, but it is so vitally important. It’s worth the effort, and your words are making a difference!

Remember that you are fully equipped to fulfill your calling to serve the unborn. Your unique gifts help you thrive in this ministry. Proper self-care is necessary to fight the good fight. And thankfully, you have everything you need for the battle.

Lisa is a writer and blogger at Mylifenurse.com where she provides ways to grow your faith while taking better care of yourself and family. She has 26 years of experience as an RN in a variety of settings and finds joy in writing health articles and insights from her nursing experiences. When she is not working, she loves to sit down with a good book and a chai tea.

Interested in learning more about using your faith to improve your self-care? See more here.  A mini-course introduction can be found here.

Celebrating National Nurses Week!

Compassion | Expertise | Trust

Join Heartbeat International in celebrating National Nurses Week May 6-12. We rejoice for each of you who lead the charge in medical care in each of our affiliate centers!

We certainly have plenty of reasons to celebrate the amazing nurses in pregnancy help organizations who serve with compassion and expertise, inspiring client and patient trust. Every day we are confronted with life and death. Yet babies are saved because of the compassion, expertise, and prayer we offer our clients. We inspire clients with the confidence and hope they need to carry their babies to term. We innovate new ideas and methods to best help them. And we influence our clients as they make healthy decisions for their relationships and pregnancies and then eventually in their strong parenting choices. It's these things that lead to amazing little every-day miracles, like precious healthy babies being born into the loving arms of their healthy mothers, sometimes even after an abortion has been stopped in its tracks.

I will seek the lost, and I will bring back the strayed, and I will bind up the injured, and I will strengthen the weak…Ezekiel 34:16

We hope you know, we are always praying for you, and if you have any specific prayer requests or praise reports, feel free to share them any time by clicking the button below!


button prayer requests and praise reports button nurses week deals


Sometimes It Can Be Challenging

Anyone who has labored in a ministry for any length of time knows that there can be struggles. Our work can be an odd endeavor. Sometimes our efforts do not produce immediate and “concrete” results that show our work was beneficial and effectual. Sometimes our clients take three steps forward, only to then take five steps back. As we try to wait with positive expectation, sometimes disappointment can creep in.

Don’t Forget Your Calling

It is critical to lean on the Lord because this is His work and His battle. Paul was an apostle, not because of his brilliance, his compassion, personal skills, or preaching ability. He was an apostle because he was called. And so were you! The calling is not what we do, it’s who we are. It literally goes with us everywhere. Our calling is simply to be fruitful in what He has called us to. He does the rest. And His call to a ministry is an invitation to unequaled privilege. We literally work in the midst of miracles every single day!

For God is not unjust so as to forget your work and the love which you have shown toward His name, in having ministered and in still ministering to the saints. Hebrews 6:10

He Moves Mountains

God loves the women and babies we serve with such a deep, unending love, He literally moves mountains for them. And that is a truth we can rest in. As we strive to do all He has called us to do, always remember, He will do more. He wants the best for each life He creates. And He fully knows all you have done and all you have carried.

Be ye strong therefore, and let not your hands be weak: for your work shall be rewarded. 2 Chronicles 15-7

We Appreciate You!

Each of us at Heartbeat International pray for you and are inspired by you. We appreciate your good works and your willingness to do God’s will each day. Thank you for being on the frontlines of care and for putting clients first no matter how grueling your day. We appreciate your kindness, dedication and healing touch. Today we honor each of you who are quite literally changing the world one heartbeat at a time.

Never doubt that a small group of thoughtful committed people can change the world, indeed it is the only thing that ever has.” Margaret Mead

There are two little words you may not hear every day. But to each of you, we proclaim a resounding, “Thank you!”


2017 Ultrasound Training at Pregnancy Help Institute a Huge Success

The 2017 Pregnancy Help Institute Ultrasound Track was a great success!

Heartbeat International was incredibly blessed to have Tammy Stearns, RDMS and Bryan Williams, RDMS facilitate the ultrasound training portion of PHI. Tammy and Bryan, along with several other volunteer sonographers, spent the week training ten participants, including nurses, an RDMS, a Nurse Practitioner and a physician, from Pregnancy Centers around the country. Trisonics and Preferred Medical Systems, in a joint collaboration, provided ultrasound machines for use during the week of training.

The ultrasound training not only contained a didactic portion and scan labs, but a spiritual component as well. Tammy opened each day reminding the class that this is a ministry, not just a skill, and that this ministry is something that can only come out of God’s overflowing presence in our lives, and not from within our own selves. Each day, Tammy’s devotions emphasized how the spiritual side of things was a big part of the ultrasound ministry.

“I appreciate that this training was tailored to working in a CPC. I learned not only technical training but the spiritual aspect of giving these babies a voice for the first time.”

Each morning there was a classroom-style teaching which covered topics from physics and QA in the ultrasound setting, to anatomy of mom and baby, and abnormal findings while performing ultrasounds. For many of the participants, this was the first time they had undergone such a training, and the curriculum was designed to be real and applicable.

The afternoon scan labs were a huge success. There were 7 instructors who were involved in the hands-on training, and about 40 “models” from the community who volunteered their time (and bellies) for the students to take turns scanning. In total, about 200 scans were performed by the class (about 20 per student) which went towards the recommended 50-75 training scans that is recommended for Limited OB Ultrasound training. The students learned the basics of scanning a typical client that may present in the PRC, as well as the unique instruction on how to dialogue with the abortion-minded client during a scan.

 “This was a very informative training. Each sonographer had a helpful hint to give, each one gave critical information for getting good ultrasounds. The didactic information was explained fully and in a helpful way. I believe I got way more than my money’s worth.”

The overall success of this year's ultrasound training will prove to be a huge tool in the PRC tool-belt as more qualified medical professionals are learning the ultrasound skills they need to be successful in the collective quest for life.


RDMS trainer Barb Sheriff (Trisonics) with PHI Student Sue Rowland










“In just a few short days these educators have filled me with more confidence than I thought I was going to finish this training with!”
“I got an excellent foundation at this training.”












PHI Student Peggy Rate, MD with RDMS trainer Sophie Calcara



Bearing Another's Burdens Without Being Crushed

by Jaimy Craemer-Adjei, LPN, Heartbeat Medical SpecialistBearBurdens

Bear one another’s burdens, and so fulfill the law of Christ. Galatians 6:2

What does it mean to bear one another’s burdens?

In the Pregnancy Center it can be a daily unconscious ritual to bear another’s burden, and in the attitude of Christ, it is part of our calling. In that “routine” moment when a woman pours her heart out to you behind closed doors, you are bearing the burdens of Christ. You are following the commands of Christ as you offer a listening ear and kind words. You may be the only friendly face this woman sees in her life right now, even though you are a stranger.

But isn’t that part of who we are? Strangers in this world – with a higher calling?

And what exactly is the law of Christ that we are to fulfill? In Mark’s Gospel, Jesus tells us that the two greatest commandments are, “Love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength…”  and “Love your neighbor as yourself” (Mark 12:30-31). As we put Christ first in our lives and love Him with everything we have, we can then turn and love our neighbors – our clients – the women coming to us with one of the biggest burdens in their lives – an unexpected pregnancy. But here she is, in your consulting room, and you are the one taking on her burdens in that crucial moment of her life.

As nurses we take on so many things. Our families, our profession, our education, our church – and life can get overwhelming. Jesus says in Matthew 11:28, “Come to me, all you who are weary and burdened, and I will give you rest.”  The problems in not just our lives, but the problems in the life of the pregnant, devastated woman sitting across from us, can be overwhelming at times.

But it is not our responsibility to bear these burdens forever.

We are told to come to Jesus with our burdens, and He will give us rest. It’s that simple. Give it to Jesus. The devastated woman who feels she simply cannot handle one more crisis… the unborn baby whose life hangs in the balance… everything that weighs us down at the end of the day… give it to Jesus.

Jeremiah 31:25 says, “For I have given rest to the weary, and joy to the sorrowing.”  He has given us rest and joy. Thank you Jesus for rest and joy! As we turn over the heavy loads we carry day in and day out, we will be able to rest in Him and have joy in our lives. What a privilege our Father in Heaven has given us to allow us to turn our sorrows and burdens over to Him.

As we play this unique role in life, as we touch the lives of so many, we have to be reminded to give it all to Jesus – it's all in His hands anyway. As you see your clients in distressing situations, remember to pray, and turn her problems (on your shoulders) over to Christ, and He will give you the rest you so desperately need.

God bless each and every Nurse doing the work of Christ, bearing the burdens of others, and making a difference in the born and unborn souls of this world. Happy Nurse’s Week!!!

Bear one another’s burdens, and so fulfill the law of Christ. Galatians 6:2


What does it mean to bear one another’s burdens?


In the Pregnancy Center it can be a daily unconscious ritual to bear another’s burden, and in the attitude of Christ, it is part of our calling. In that “routine” moment when a woman pours her heart out to you behind closed doors, you are bearing the burdens of Christ. You are following the commands of Christ as you offer a listening ear and kind words. You may be the only friendly face this woman sees in her life right now, even though you are a stranger.


But isn’t that part of who we are? Strangers in this world – with a higher calling?


And what exactly is the law of Christ that we are to fulfill? In Mark’s Gospel, Jesus tells us that the two greatest commandments are, “Love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength…” and “Love your neighbor as yourself” (Mark 12:30-31). As we put Christ first in our lives and love Him with everything we have, we can then turn and love our neighbors – our clients – the women coming to us with one of the biggest burdens in their lives – an unexpected pregnancy. But here she is, in your consulting room, and you are the one taking on her burdens in that crucial moment of her life.


As nurses we take on so many things. Our families, our profession, our education, our church – and life can get overwhelming. Jesus says in Matthew 11:28, “Come to me, all you who are weary and burdened, and I will give you rest.” The problems in not just our lives, but the problems in the life of the pregnant, devastated woman sitting across from us, can be overwhelming at times.


But it is not our responsibility to bear these burdens forever.


We are told to come to Jesus with our burdens, and He will give us rest. It’s that simple. Give it to Jesus. The devastated woman who feels she simply cannot handle one more crisis… the unborn baby whose life hangs in the balance… everything that weighs us down at the end of the day… give it to Jesus.


Jeremiah 31:25 says, “For I have given rest to the weary, and joy to the sorrowing.” He has given us rest and joy. Thank you Jesus for rest and joy! As we turn over the heavy loads we carry day in and day out, we will be able to rest in Him and have joy in our lives. It is such a privilege that our Father in Heaven has given us to allow us to turn our sorrows and burdens over to Him.


As we play this unique role in life, as we touch the lives of so many, we have to be reminded to give it all to Jesus, for it is all in His hands anyway. As you see your clients in distressing situations, remember to pray, and turn her problems (on your shoulders) over to Christ, and He will give you the rest you so desperately need.


God bless each and every Nurse doing the work of Christ, bearing the burdens of others, and making a difference in the born and unborn souls of this world. Happy Nurse’s Week!!!


Jaimy Craemer-Adjei, LPN

Shelf-Help: Hooked

by Joe S. McIlhaney, Jr., MD and Freda McKissic Bush, MD

by Ducia Hamm LAS, Associate Director of Affiliate ServicesHooked

Who of us has not heard these comments when addressing the subject of delaying sex until marriage with teens and adults alike...“You just don’t want me to have any fun!” “Everyone is doing it!” “We love each other so what does it matter if we’re married?”

Hooked is a must read for pregnancy help ministry staff, parents, those mentoring teens or young adults – truly for anyone interested in how our bodies were created by God to biologically form lasting, meaningful connections with each other.

Packed full of eye-opening, useful information, Hooked lays out, in easy to understand language, the recent research in the field of neuroscience confirming the adage that our brains are the largest and most important sex/relationship organ humans have.

Because of new state-of-the-art technology, some startling discoveries have been made. We have known for a while the bonding effects that oxytocin has in a woman’s brain when it is released during sex but did you know that men release vasopressin which has a very similar bonding effect in a man’s brain?

Scientists are now able to measure when and how much of specific chemicals are released and the corresponding changes the human brain experiences when we engage in sexual activity.

One of the most important discoveries talked about in Hooked is crucial information needed for a culture so accepting of casual sex, “...there is evidence that when [the] sex/bonding/breaking-up cycle is repeated a few or many times – even when the bonding was short-lived – damage is done to the important, built-in ability to develop significant and meaningful connection to other human beings.” (Pg. 55)

As I read Hooked, Psalms 139:13-14 kept coming to mind – “For it was You who created my inward parts; You knit me together in my mother’s womb. I will praise You because I have been remarkably and wonderfully made. Your works are wonderful, and I know this very well.”

We are indeed “remarkably and wonderfully made!” It is always exciting to see science corroborate what the Bible has always said – that sex is meant to be enjoyed to the fullest within the context of marriage between one man and one woman.

**One of the authors, Freda McKissic Bush, MD is a member of the Heartbeat International Medical Advisory Council, frequent presenter at the Heartbeat Annual Conference, Medical Director for Center for Pregnancy Choices in Mississippi and CEO of the Medical Institute for Sexual Health among many other activities and accomplishments.

Management of Psychotropic Drugs During Pregnancy

PregnantPillsThe following article synopsis was provided by Julie Lynch McDonald PharmD, a member of Heartbeat International’s Medical Advisory Council. This may be helpful information for any client considering abortion due to the medications they are taking for psychiatric conditions.

Management of psychotropic drugs during pregnancy
BMJ (01/20/16) Chisolm, Margaret S.; Payne, Jennifer L.

Whether to maintain a woman's psychiatric drug regimen when she becomes pregnant is a delicate decision that must consider the benefits and risks to both mother and child. With little research exploring the safety of mood stabilizers and similar medications during pregnancy, the knee-jerk reaction for many years has been to suspend the prescriptions. A review of studies published between January 2000 and December 2014, however, reveals that most psychotropic drugs are relatively safe for use in expecting women. Moreover, the review authors conclude, any risk presented by continuing use of these medications during pregnancy is eclipsed by the risk associated with discontinuing them. A high proportion of women with conditions such as bipolar disorder and schizophrenia relapse if they stop taking their prescriptions during the gestation period. That, in turn, can lead to unfavorable outcomes, including suicide and infanticide.

Read more here.

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