Natural Family Planning: A Healthy Alternative

With an overview of Creighton Model FertilityCareTM System By Mary Knutson RN, MSN, FCP

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

What is Natural Family Planning? Using the 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 the ideals of a Christian marriage and the

value of children as gifts or blessings NFP is safe, healthy and natural

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

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

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

Some Natural Family Planning Methods Ovulation Methods, like Creighton Model or

Billings Method do not involve 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 ecological breast feeding

Basal Body Temperature Method

BBT Chart Diagram by epigee.org (2004)

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

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

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

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

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

NFP usually allows women to predict the date of their next menstrual period

Charting Examples: Regular, Short, and Long Cycles

Continuous Mucus: Using Yellow Stamps

How the Method is Taught 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

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)

Effective to Avoid Pregnancy Studies have shown Creighton Model

FertilityCareTM System to be as effective as oral contraceptives

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

Learning Activity and Discussion Find current NFP and contraceptive statistics Do continuation rates affect risk for pregnancy? Pregnancy rate of NFP in most studies include the

couples who chose to achieve pregnancy With that in mind, are NFP statistics truly

comparable with other methods? See Family Planning Method Comparison Chart

at the end of this presentation. (Those Creighton Model statistics show effectiveness for couples who were seriously trying to avoid pregnancy.)

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

Some Disadvantages of NFP Abstinence during fertile time can be difficult –

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 NFP is recommended for couples in a stable,

marital relationship Does not protect against Sexually Transmitted

Diseases

Using Barrier Methods with NFP Using condoms, spermicides, or other barriers

along with NFP is discouraged because they: Cause irritation and confusing mucus signs Barrier methods take away from the open

giving of each other in marital acts Cause increased chance of pregnancy -

Effectiveness of barrier methods is poor when calculated over the whole cycle. But using them with NFP would focus their use on the few days that are actually fertile

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

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 Visit informational websites for NFP programs

and various methods, like www.creightonmodel.com or www.fertilitycare.org

Browse some of the following websites to learn about NFP, its moral foundations, and research to support its benefits:

Browse NFP Websites Optional learning activity: Choose a website to browse.

Write a short summary of what you learned about NFP. Share it with other students.

www.nfpsite.aldred.org for overview of NFP www.boma-usa.org or www.woomb.org or

www.nfpoutreach.org for information on the Billings method, and some moral and religious aspects of contraception and natural family planning

www.nfpandmore.org International site including research and a downloadable manual called Natural Family Planning: The Complete Approach

www.omsoul.com is a website called One More Soul. It includes NFP information, stories, resources, and research

Browse NFP Websites www.canfp.org California Association of NFP includes

and “Ask the Expert” feature www.MyFertilityCycle.NET includes online education

for charting, and an online charting system http://www.marquette.edu/nursing/NFP/Model.shtml

for NFP using electronic fertility monitors, or http://www.epigee.org/guide/computers.html overview

www2.cyclebeads.com www.ccli.org/nfp Couple to Couple League includes

ecological breastfeeding (lactational amenorrhea) http://healthmattersmagazine.com/issues/hmm15.pdf 

See page 19 for a fun, colorful article

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

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

Methods Possible Side Effects Effectiveness % Theoretical

Effectiveness % Actual

Continuation Rate at 1 year

Creighton Model FertilityCare System None 99.5 96.8 89%

Barrier Methods (condom,

diaghragm,

sponge

Allergic reactions and irritation, inc. risk of toxic shock syndrome

97

94

80-91

88

82

64-82

63%

58%

52%

Vaginal Spermicides Allergic reaction or irritation 94 79 43%

Sterilization Surgeries

Tubal ligation

and vasectomy

Surgical bleeding and infection, inc. risk of hysterectomy, ectopic pregnancy, painful periods, prostate cancer

99.8

99.9

99.6

99.8

100%

100%

Intrauterine Device

(IUD)

- requires replacement every 5 years

Heavy, irregular or painful periods, painful intercourse, infection, ectopic pregnancy, perforation of uterus, infertility

98 97 80

Birth Control Pill (2 hormones) Breast tenderness, wt. gain, headaches, nausea and vomiting, depression. May delay return of fertility and inc. risk of CV disease and some CA

99.6 94 72

Progestational Agents (Norplant, and Depo-Provera )

Local infection and bruising , anxiety, acne, wt. gain, headaches, breast pain and irregular menses

99.9

99.7

99.9

99.7

85

70

Which Family Planning

Method is Most Ideal?

Rate these: Condom BCP IUD NFP Sterilization

Completely Safe

Effective

No Side effects

Obtainable

Affordable

Acceptable

Future pregnancy

Give 1 point for poor, 2 points for satisfactory, and 3 points for good. Total up the points at the bottom of page.

This presentation was sponsored by Health Vista, Inc.

Revised 10-22-09