Natural Family Planning: A Healthy Alternative

1. Natural Family Planning: A Healthy Alternative Including overview ofCreighton Model FertilityCareTMSystem By Mary Knutson RN, MSN, FCP

2. Goals and Objectives • To improve health in individuals, families, and communities by increasing use of Natural Family Planning (NFP) • To list one or more natural signs of fertility • To describe two methods of Natural Family Planning • To discuss effectiveness of NFP • To compare NFP’s advantages to its disadvantages in your own situation • To list a way to find out about NFP classes in your area

3. What is Natural Family Planning? • Using natural signs of human fertility to understand a woman’s cycle • Making decisions about having children based on that information • NFP can be highly effective to avoid or achieve pregnancy • Develops a couple's respect for each other and their fertility • Fully supports ideals of Christian marriage and the value of children as gifts or blessings • NFP is safe, healthy and natural

4. Natural Signs of Fertility • There are signs of fertility that can be observed by a woman to understand her fertility patterns: • Mucus secreted before and during the time of ovulation • A sensation of lubrication • A small but measurable rise in basal body temperature which occurs after ovulation • Changes in the cervix that happen around the time of ovulation

5. Natural Family Planning • If a couple wants to avoid pregnancy, they avoid intercourse or genital contact on days of fertility • If a couple wants to achieve pregnancy, they focus intercourse on the days of fertility • Education by a qualified instructor is needed • Observation and charting needs to be done consistently • An instructor guides the couple until they are confident, and are using the method correctly • Some methods offer self-study or online education

6. NFP is a Shared Method • Both husband and wife share responsibility, and the chart belongs to both of them • Charting and interpreting observations at the end of each day promotes the couple’s communication as they decide together whether to have intercourse or not • When they do come together in the marital act, they give themselves to each other fully • This method cooperates with the natural procreative cycle, and promotes both physical and spiritual health

7. Some Natural Family Planning Methods • Ovulation Methods do not require taking temperatures • Sympto-Thermal Methods include temperatures • Basal Body Temperature Method-temperature only • Calendar “Rhythm” is not effective because irregular cycles cannot be predicted • Cycle Beads or Standard Days Method is only effective for regular cycles of 26-32 days • Electronic fertility monitors, like the Marquette Model, are new ways to check fertility hormones • Child spacing through breast feeding

8. Basal Body Temperature Method BBT Chart Diagram by epigee.org (2004)

9. What is the Creighton Model FertilityCare System? • A scientific, modern way to understand a woman’s cycles of fertility • Observing mucus and lubricative sensations on the outside of the body • Recognizing the approach of ovulation (when the egg is released from the ovary and conception is possible) • Determining fertile and infertile days • Sharing standardized charting with your doctor (optional) to monitor reproductive health

10. Ovulation Events: Before ovulation, estrogen is dominant. Levels of estrogen peak sharply just before ovulation, causing changes in mucus that comes from the cervix to the opening of vagina. In post-ovulatory phase, progesterone is higher, causing significant changes Diagram by Hole, J., (1987), Human Anatomy and Physiology

11. Creighton Model Observations • Only external checks are needed, using folded toilet tissue and wiping front to back • Women check for mucus before and after toileting • Check sensation: lubricative (slippery) or dry • Check color and consistency by “finger testing” any mucus (“Stretchy” is a stretch of 1 inch or more) • Final check is at bedtime, after bearing down • Chart the most fertile sign of the day, and how often it was observed

12. Cervical Mucus • Mucus is charted with white baby stamp as a reminder of possible fertility • Before ovulation, sperm can live several days in cervical mucus, increasing possible pregnancy • Sperm do not stay alive without cervical mucus • Peak day, the last day of clear, stretchy or slippery mucus, is the estimated ovulation time • An additional count of 3 days past the peak day is considered fertile • Change occurs: Dry or non-peak mucus (sticky, tacky, gummy, cloudy) usually follows peak

13. Creighton Model Charting • Dry days that are not within the count of 3 are marked with green stickers, because they are considered infertile days • Each new cycle begins with menstrual bleeding that is marked with red stickers • The length of cycles can vary widely, because of early ovulation or delayed ovulation, but the number of days in the cycle after the peak day (post-peak phase) is quite stable • Natural Family Planning usually allows women to predict the date of their next menstrual period

14. Charting Examples: Regular, Short, and Long Cycles Continuous Mucus: Using Yellow Stamps

15. How the Method is Taught • Creighton Model FertilityCareTM Professionals introduce the method at group Introductory Sessions • Progressive instructions are scheduled for individual couples (usually 8 follow-up sessions) • Used with regular or irregular cycles • Yellow stamps are often given to effectively manage “continuous mucus” • Additional instructions are given for infertility, breastfeeding, post-pill, post abortion, premenopause, or postpartum-not breastfeeding

16. Basic Method Instructions • To avoid pregnancy, couples have intercourse only on dry days not within the count of 3 • To achieve pregnancy, couples use the days that are the greatest quality and quantity of mucus, and the first 2 days after that Menstrual Cycle Diagram by Epigee.org (2004)

17. Effective to Avoid Pregnancy • Research show Creighton Model FertilityCareTM System, the Sympto-Thermal Method, and Billings Ovulation Method TM are as effective as “the pill” • They are theoretically 99% effective – much more effective than barrier methods • NFP methods can be used long-term throughout reproductive years • Has only positive “side effects”, like fertility appreciation, and decreased divorce rate • Couples can easily change their intention from avoiding to achieving pregnancy at any time

18. Learning Activity and Discussion • Find current NFP and contraceptive statistics online or in reference books • How do methods compare for effectiveness? • Compare continuation rates. How could continuation rates affect pregnancy risk? • Pregnancy rates in many NFP studies include couples who chose to achieve pregnancy. Could some NFP statistical comparisons with other methods be unfair? • Family Planning Method Comparison Chart at the end of this presentation shows couples trying to avoid pregnancy

19. Effective to Achieve Pregnancy • Very effective for couples with normal fertility • Also is effective for many infertile couples, but is most effective to achieve pregnancy when also using medical testing and intervention • Creighton Model FertilityCareTM Medical Consultants can be used to diagnose and treat reproductive problems or infertility in morally acceptable ways

20. Some Disadvantages of NFP • Abstinence during fertile time can be difficult, but couples can plan ahead to do other things to show their love • Genital contact (even without intercourse) can cause pregnancy during fertile time • It takes time and effort to learn the method • Does not protect against Sexually Transmitted Diseases • NFP is recommended for couples in a stable, marital relationship

21. Using Barrier Methods with NFP • Using condoms, spermicides, or other barriers along with NFP is discouraged because they: • They cause irritation and confusing mucus signs • Barrier methods take away from the open giving of each other in marital acts • They cause increased chance of pregnancy • Effectiveness of barrier methods is poor when calculated over the whole cycle. • Using them with NFP would focus their use on the few days that are actually fertile

22. NFP’s Advantages and Benefits • Completely natural • No side effects • Morally acceptable to all religions • Cost-effective, and comparatively inexpensive • Can be used by women in all stages of their reproductive lives • Cooperative with the body’s natural cycles, and its procreative, reproductive system • NFP is a shared system that respects the dignity of women and marriage

23. How to Find Out More: • NFP information and resources are available from a Catholic Diocese Office in your area • Couples of any religion are encouraged to find out more about NFP methods and to use them • Visit informational websites for NFP programs and methods, like www.creightonmodel.com • Optional learning activity:Write a short summary of what you learned from some of the following NFP websites and share it with others. • Read about various NFP methods and the moral foundations and research that supports their benefits:

24. Browse NFP Websites • www.nfpsite.aldred.orgfor an overview of NFP • www.boma-usa.orgorwww.woomb.orgorwww.nfpoutreach.orgfor information on the Billings OvulationTM method, andsome moral and religious aspects of contraception and natural family planning • www.nfpandmore.orgInternational site including research and a downloadable manual called Natural Family Planning: The Complete Approach • www.omsoul.comis a website called One More Soul. It includes NFP information, stories, resources, and research • www.creightonmodel.com or www.fertilitycare.org for Creighton Model FertilityCareTM Services (an ovulation method)

25. Browse NFP Websites • www.canfp.orgCalifornia Association of NFP includes and “Ask the Expert” feature • www.MyFertilityCycle.NETincludes online education for charting, and an online charting system • http://www.marquette.edu/nursing/NFP/Model.shtml for NFP using electronic fertility monitors, orhttp://www.epigee.org/guide/computers.htmloverview • www2.cyclebeads.com • www.ccli.org/nfpCouple to Couple League includes information about breastfeeding and child spacing

26. References • Hilgers, T.W., (2001), Creighton Model FertilityCareTM System: An authentic language of a woman’s health and fertility. (5th ed.) Omaha: Pope Paul VI Institute Press. • Hole, J., (1987), Reproductive systems. In Human anatomy and physiology. (4th ed., p.833). Dubuque: Brown. • Williams, M. T. (2009). Family Planning. In epigee.org website. Retrieved 10-22-09 from http://www.epigee.org/guide/natural.html or http://www.epigee.org/family-planning-new-methods.html

27. Family Planning Method Comparison ChartAdapted from brochure by American Academy of Natural Family Planning Feb. 1999

28. Which Family Planning Method is Most Ideal? Give 1 point for poor, 2 points for satisfactory, and 3 points for good. Total up the points at the bottom of page.

29. Sponsored by Health Vista, Inc. Revised 2-11-10