Natural Family Planning...

Recently for school I was asked to choose a method of contraception to present to my fellow peers. There were many techniques discussed during the day of presentations. Everything from combination oral contraceptives, progestin only mini-pills, Nuva-Rings, Implanon, barrier methods, sterilization, IUDs...the list goes on. However, I was most interested in natural family planning due to its lack of side effects. I thought I would share a bit from that presentation.

This is  a technique if you prefer an "all-natural" method, cannot tolerate hormones, do not want a foreign body inside of you for whatever reason, you subscribe to a cultural or religious philosophy that prevents use of birth control, or if you are wanting to become pregnant. Be advised, some of these techniques get you in close touch with your body. So, often some of these methods are uncomfortable for some women because of it. Luckily, there are a variety of methods to choose from.


What is natural family planning? Also called fertility awareness and formally called the "rhythm method". This is based on monitoring the reproductive cycle and having intercourse only during infertile periods. This works by either abstinence or barriers during fertile periods. There are many methods contained within this: basal body/temperature, ovulation/cervical mucus, symptothermal, and calendar.

Basal Body Temperature Method: Take temperature every day before getting out of bed. Record those. The fertile period is on the first temperature drop or the first elevation. (I find this to be the most confusing technique and the one open to most error.) This works best if you have 3-6 months of recordings.

Ovulation/Cervical Mucous Method: Just as it says - Checking cervical mucus. When you wipe after using the restroom exam the paper to see what the mucus consistency is (if any is present). Here is an interpretation key:

–Post-menstrual: scant or undetectable

–Pre-ovulation: cloudy, yellow/white, sticky

–Ovulation: clear, wet, stretchy, sticky AND slippery

–Post-ovulation fertile: quick, cloudy, sticky

–Post-ovulation, non-fertile: scant or undetectable

Preovulation - you'll need to abstain 24 hours after intercourse for interpretation as seminal and vaginal fluids may obscure interpretation. Obviously, abstain or use barrier during fertile, and then no restrictions 4 days after last day of wet, clear, slippery mucous.


Two-day Method: (My personal favorite due to its ease of use and low rate of failure) Also based on cervical mucous but less detailed. Basically, woman asks, "Did I notice any secretions today or yesterday?" If no for two days, then may proceed with unprotected intercourse unless desiring pregnancy.
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Symptothermal: A combination of two or more methods, usually cervical mucous and basal body temperature but may also include things like mittelschmerz (abdominal pain mid-cycle) or cervical position changes, and libido changes (heightened during fertile periods). 

Calendar Method: Keep record of menses for 6-12 months. Take shortest cycle and subtract 18 days (A) i.e. 27 days, then take longest cycle and subtract 11 days (B) i.e. 32 days. Possible fertile period is days A through B - days 9-21. Standard days method is a form of calendar method and uses an average typical female cycle to determine approximate fertile days to be 8-19. There are "cycle beads" either physical ones or electronic ones that can aid in this. Obviously, abstinence or barrier during fertile periods unless desiring pregnancy.

Here is a comparison of effectiveness rates - this is based on 100 woman years of use and this would be failure rate in the first year. The lower the number, the higher the effectiveness at preventing pregnancy. Overall, two-day had one of the better rates. Below is also a chart from World Health Organization comparing the various methods of contraception. There you can see where this method compares with the others. Obviously, not as high as hormone based, IUD, or sterilization, but still better than withdrawal, spermicide, or nothing.

Method/Typical use/Perfect use

- Calendar/25/9

- Standard days/12/5

- Ovulation/25/3

- Symptothermal/25/2

- Two day/13.7/3.5

Candidates for this method would be those with a regular menstrual cycle and minimum risk for sexually transmitted infections (i.e. monogamous relationship), those wanting to avoid hormones or devices, and couples motivated and committed. This is not a recommended technique for adolescents (adolescents having sex - scary - but happens all the time).

There is also a medical eligibility list to follow to see if this would be an acceptable method of contraception:
- Is there an existing medical condition that would make pregnancy dangerous?
- Are menses irregular or cycles prolonged?
- Bleeding between periods?
- Are periods just starting?
- Recent pregnancy?
- Currently breastfeeding?
- Any other condition that might affect menses?
- Recently discontinued Depo or other combined hormones?
- Any current or recent infections (i.e. STD, pelvic inflammatory disease, or other vaginal infections such as yeast)?

If yes to any of the above, this method might not be appropriate as a form of birth control since fertile period might not be predictable. And obviously, if pregnancy would be dangerous, another form of contraception would be advised.

Side effects/Disadvantages:

- Up to 25% failure rate

- Does require time, energy, commitment, and careful record keeping

- No protection against STDs, including AIDS

- Many things can alter or make this technique difficult

Benefits/Advantages:

- Control over when children are conceived without use of drugs or devices

- No interruption due to barrier devices (during non-fertile times)

- No side effects or health risks accompanying other methods

- Minimal cost

I am an advocate of empowering women and their families with the ability to plan, as much or as little as desired, for their families. There are numerous studies supporting spacing children a minimum of 2 years specifically related to maternal and infant outcomes. I know this is not always possible but maybe with some natural family planning, it may assist in those efforts.

As always, this is me passing along information. I am not acting in an official health care provider role. As with any kind of contraception method, discuss with you health care provider prior to initiation. 

References

•American Congress of Obstetricians and Gynecologists. (2011). Natural family planning. Retrieved from http://www.acog.org/publications/patient_education/bp024.cfm

•Cooper, P.G. (2010). Natural Family Planning. Clinical Reference Systems. McKesson Health Solutions LLC.

•Cycle Technologies. (2010). Cycle beads: Plan or prevent pregnancy naturally. Retrieved from http://www.cyclebeads.com/

•Planned Parenthood. (2007). Comparing effectiveness of birth control methods. Retrieved from http://www.plannedparenthood.org/health-topics/birth-control/birth-control-effectiveness-chart-22710.htm

•Zieman, M., Hatcher, R.A., Cwiak, C., Darney, P.D., Creinin, M.D., & Stosur, H.R. (2010) Man:aging contraception. Tiger, GA: Bridging the Gap Foundation

What aspects of natural living or natural parenting do you subscribe to?