Two and possibly three Baltimore women today were to be the first in the metropolitan area to be implanted with Norplant, the revolutionary reversible contraceptive that protects against pregnancy for a five-year period.
Two of the women were to undergo the procedure at Francis Scott Key Medical Center and a third was tentatively scheduled for the procedure at a Johns Hopkins Hospital clinic.
The implant procedure is said to be minor, quick and almost painless and requires an eighth of an inch incision and a local anesthetic.
Dr. George R. Huggins, chairman of the obstetric-gynecology clinic at Key and Dr. Dean Moutos, a fellow in reproductuve medicine at Hopkins, were to insert six small, flexible capsules, each 1.3 inches long and about as thin as a match stick in a fan-shaped configuration in the fleshy part of the upper arm of the women just above the elbow.
In 15 minutes, the procedure is finished. No stitches are necessary.
And, most importantly, if the woman changes her mind and wants to have a baby, the implant is removed and her previous level of fertility is fully restored almost immediately, the experts say.
The women at Key were described as typical candidates for Norplant, which releases a synthetic hormone called levonorgestral that suppresses ovulation. They are described as older women, perhaps 40, who already have several children and want no more, but they are not ready for sterilization. Huggins said he has about 25 women on a waiting list for Norplant.
The woman scheduled at Hopkins was younger, in her 20s and apparently not completely satisfied with her present birth control method, Moutos said.
Huggins and Moutos are among a handful of physicians in the Baltimore area who are fully trained to insert and remove Norplant and counsel and monitor women who opt for the implant.
"There are no medically serious short-term side effects from Norplant," Huggins said. "But, there are what I call nuisance side effects and they occur in 70 percent of the users. These involve abnormal menstrual period. The bleeding tends to last longer, or stops altogether, or gets spotty. We have to educate American women about this because in the past, they have been taught to associate some irregular bleeding with cancer.
"In addition, some people gain weight, some develop acne or headaches, but there are almost no long term, serious side effects," Huggins said.
Moutos said that Norplant has a potential benefit for teen-agers. "Those are the girls who are the least likely to remember to take birth control pills. They're teen-agers and they think they can't get pregnant. They think it's not going to happen to them and that's why the teen-age pregnancy rate is so high."
Yesterday morning, some 65 physicians, nurse midwives and nurse practitioners practiced how to insert and remove the Norplant system, using foam rubber to practice on at a training session sponsored by Planned Parenthood of Maryland and the Association of Reproductive Health Professionals. The session was held at the Quality Inn in Towson.
The session, which included lectures, demonstrations and videos and which lasted about four hours, also taught the health professionals how to counsel women interested in the contraceptive, which is said to be second to sterilization in effectiveness.
But, Dr. Doris Tirado, medical director of Planned Parenthood, stressed that additional training will be needed before the 65 can actually begin inserting the device in patients.
Women who opt for Norplant should make sure they are getting the implant from a fully certified doctor, she stressed. "Women should look on the walls of doctors' offices for some evidence or simply ask them when and where they were trained. I know that we in the Planned Parenthood system have to show that we have been trained."
She said Planned Parenthood has 25 women on a waiting list for Norplant, which will cost the average paying patient between $500 and $700. The state will pick up the $500 bill for Medicaid patients. Blue Cross has not yet decided whether it will cover Norplant, but some HMOs, like CareFirst and the Johns Hopkins Health Plan, will, Tirado said.