worried about a friend

[Pam]

help!
have a good friend, we'll call her rachel, and i just found out that she and her boyfriend don't use condoms anymore when they have intercourse. basically, they're not using protection at all. now believe me, i have plenty to say about *that* but it doesn't really help to yell at her. she is adamant in saying that it feels better for her and her boyfriend, although really i think it's just the boy who's pressuring her. I think that's a crappy deal for her, and i know she has low self-esteem and i feel awful about it, but at this point there's really nothing i can do to convince her otherwise. it's not healthy, but that's the way it is.
that said, rachel says she would consider going on the pill...i think i convinced her anyway. she said she would be more willing to get depo-provera or a diaphragm, but those aren't as effective against pregnancy, right? the pill is the best she can do without a condom, i think. (?) (i know, that doesn't protect against diseases, but considering that she refuses to use a condom, i figure the pill will at least help keep her from getting pregnant).

Anyway, she says that the obly objection she has to the pill is that she doesn't want her breasts to get bigger - that i understand, because she is a 32DD and i have been bra shopping with her - it's nearly impossible to find anything pretty. pretty darn big. she has a prescription for ortho-tricyclen, but it was for her skin and she doesn't want to take it for the aforementioned reason; she never even filled it.
but i figure if she goes to a good doctor who will take the time to understand what's up and help her find the right pill, she doesn't have much to worry about in the way of weight gain, right? that kind of doctor is probably not a harried clinician at planned parenthood. so i'm thinking she should go to her own gyn, except she doesn't have one. bad rachel! she's not 18, but she doesn't want to tell her mom, so can we find her a gyn and get a referral from her regular doc (insurance thing) and all that stuff without her mother being called? (we're not so much worried about what shows up on the insurance bill). is there something we can do? I care very much about this girl, and i'm worried about her, but she is stubborn and i feel like this is all we can do.

sorry this is so long. thanks all.

[Daisy]

Honestly, it's going to be tough to find a hormonal method that will not increase her breasts even a little. Estrogen simply usually has that effect.
But maybe you should point out that it ain't going to even come close to what being pregnant does in terms of breast size?

Stories like this make me nutty, and it's hard to know how to help, because in all truth, if she's needing to be babysat to take care of birth control, she's really not mature enough to be sexually active. Period.

[vetta]

Well as you said, the pill is better than nothing tho I'm sure most people on these boards would say that is barely adequate protection. Its not perfect at protecting against pregnancy while a condom is as close as it gets to perfect. Not to mention the STD problem. If she is stubborn and is not willing to listen, then I cant think of 2 much you can do. Id imagine that telling her what she should do more might just make her even more stubborn against doing what you say.

[Pam]

well, i did talk to her, and she said that she wants to go on the pill or use some other kind of birth control. she's been to the clinic before, i think. she is willing to go again, and she did ask me to go with her. my question is really about how she can find herself her own gyn - i get the feeling that she's not really confortable with her experience at the clinic, so she wants to get a private practice gyn.
questions:
1. is it possible for someone who is under 18 to choose her own gyn, get a referral from her regular doctor, and put it on her insurance without overt parental consent? (i'm not talking about "could her mom find out." i mean "does her mom have to sign something for this to happen?")
2. which is the most effective against pregnancy, assuming that condoms are (grrr) out of the question? depo-provera, the pill, a diaphragm? i just want to tell rachel the right thing to do.
i know she's not really mature enough to be sexually active, and it makes me sad. i just want to help her as much as i can, if you know what i mean. thank you so much

[cherry]

Well, somebody correct me if I'm wrong here...but if she's underage, then she can't sign the insurance paperwork. If the insurance is in her parents name, then I don't think that she can sign the papers since she's under 18. I know that I couldn't sign the insurance papers until I was 18, but then I can't promise that it applies to everybody. And beyond that, it will show up on the statement that the insurance will send to her parents. Also, since she's a minor, her parents will be allowed access to her medical records, so it would also show up there, I think.

[Daisy]

Not if it's family insurance, she can't. Toi my knowledge, she'd have to have her OWN inusrance to fully sign off on it.
But she could get her own GYN and pay for it herself. After all, she'd better at least have less than a hundred bucks laying around if she's flirting with accidental pregnancies.

And *you* can't tell her which method is best for her because that has a lot to do with her body and her habits. Only she and a GYN can really work that out.

However, my guess is that someone who has aa problem with condoms and the whole concept of them is going to have even more problems with a diaphragm.

[cowgirl]

When I was 16 I just called my hmo's clinic and said I need an anual for birth control. Most if not all family practice clinics have Nurse practitioners or ob/gyns. They never blinked an eye. I went in payed the copay and that was that. This was quite a while ago things may have changed. But I can't remember when I have had to sign anything at my regular dr's office.

[vic]

Just an FYI:
In the states, the requirements for parental consent vary from state to state. In Minnesota for example, a physician *must* keep confidential all information pertaining to contraception, chemical dependency and mental health. That is, for purposes of health care, the minor has control over what the parents can hear and not hear. It's the responsibility of the office to file this information differently or edit it if the parent wants to view the chart--something he or she does have the right to do. It's a tricky subject, because in some ways a parent's guiding voice is exactly what is required in tough situations such as unwanted pregnancy or STDs. In other ways, such as the one described above, it's very good--a minor might not seek medical care at all if they have to go through a parent. Wisconsin law is less explicit than Minnesota's but has a similar requirement of confidentiality. I don't know about any of the other states but the information may be available online. Your doctors office should know the requirements where they practice. This does *not* apply to insurance. If mom and dad are getting the bills, a record of the bill which may or may not include diagnosis may show up to the person who carries the insurance. Also, a family doctor or a pediatrician should be able to provide many of the service regarding sexual health such as pap smears and birth control, so a visit with a new doctor wouldn't show up on parents bills.
Hope this helps

Vic