by Michele James-Parham Despite being invented in the latter part of the 1800s, the diaphragm did not really get popular in America until around the 1940s. Then its popularity took a major dip in the late 1960s after the IUD was introduced. In the last five years, my midwifery practice has seen the comeback of the diaphragm. More people are looking for a birth control method that is reversible, easy to manage, non-hormonal, economical, and that does not always require an office visit. There are two types of diaphragms on the market that are accessible in America with a prescription. The first is made of latex and requires a fitting from a healthcare provider. It is also recommended that diaphragm users be refitted after an increase in weight of more than 10 pounds, after any pregnancy that lasts more than thirteen weeks, and after vaginal or cesarean birth. Latex diaphragms are typically replaced every one to three years. The second type of diaphragm is made of silicone and is a one size fits most design, which does not require a fitting from a healthcare provider. However, it is still recommended that a person try one out with the aid of a healthcare provider to determine if the fit is correct for them. Silicone diaphragms are typically replaced every ten years. Regardless of which type a person uses, it is recommended that they use a water based spermicidal gel to aid in insertion and efficacy. With a properly fitting diaphragm that is used with spermicidal gel, during every instance of sexual intercourse, and left in position six to eight hours after intercourse there is a perfect use efficacy rate of 94%. In contrast to that, the efficacy rate of the typical use of diaphragms is only 88% – this means that there is a 12% fail rate for typical use or that 12 in 100 diaphragm users will become pregnant. Diaphragm users who have experience using menstrual cups seems to have an easier time using diaphragms, especially regarding figuring out insertion and removal techniques. In my midwifery practice, I like to recommend diaphragms as back up or additional pregnancy protection for clients who are using the Fertility Awareness Method and or exclusive chestfeeding as their birth control of choice. Diaphragms offer a better efficacy rate for clients who want to still be able to have sexual intercourse during the fertile period…

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