Lesson 10 - Natural Family Planning

https://eberlyscienceonline.psu.edu/courses/biology177/book/ex...

Lesson 10 - Natural Family Planning
By the end of this chapter you should be able to:

Describe the history of natural family planning. Describe the variants of natural family planning. Explain the motivations behind the use of natural family planning. Differentiate between natural family planning and pharmaceutical contraceptive measures.

What is Natural Family Planning?
Often, a couple may want to engage in sexual intercourse (extensively) and at the same time avoid pregnancy. In cases such as these a number of strategies are employed specifically to this end. The term contraception literally means "against conception", so contraceptive measures either prevent pregnancy from occurring or prevent it from progressing after it has occurred. Needless to say, there are profound implications at many levels when addressing contraceptive issues. Without a doubt, contraceptive strategies are in widespread use, and even considered to be mainstream in many places. Contraceptive measures are classified as being behavioral, barrier, or chemical methods. Behavioral methods are the subject of this lesson. The various artificial forms of barrier and chemical strategies directed toward contraception, pertaining to the most common use of that term, is the subject matter for the next lesson. In some cultures and in some religious traditions, the use of artificial chemical or barrier contraceptive or birth control measures is considered to be contrary to the dignity of both women and men, and therefore to be avoided. Many persons incorrectly assume that this is a religious issue when, in fact, it is not. For example, many women insist upon natural childbirth, rather than using analgesia such as an epidural. Is the woman who opts for an epidural to manage the pain of childbirth any more or less religious than a woman who opts not to use pain medication? Moreover, there are many people of many different faiths, and persons with no religious beliefs or even religious inclinations, that support the idea of spacing the births of children, or avoiding conception altogether, by using natural family planning (NFP) strategies. One of the most commonly cited reasons, by women, for using natural family planning methods is not wanting to continually fill their bodies with chemicals (e.g. the pill, injections, subcutaneous implants) that they fear may produce long-term harm. There are also a great many rumors about natural family planning is and what it is not. These rumors often range from the mildly uninformed to the completely preposterous; for example, inasmuch as men produce about 200 million new sperm each day, frequent ejaculation is NOT to be considered as an effective form of avoiding pregnancy by trying to lower one's sperm count!

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Lesson 10 - Natural Family Planning

https://eberlyscienceonline.psu.edu/courses/biology177/book/ex...

Everyone has heard, over and over and in many venues, that the most reliable (100%) method of birth control is abstinence, which means not engaging in sexual intercourse. Of course, this is not practical for married couples or persons who are otherwise living together. For those persons who do not wish to use contraceptive measures, natural family planning is a very suitable alternative. At the onset of this lesson it is important to make plain the fact that natural family planning is NOT the same as the calendar-based rhythm method that was developed in 1930 by the Dutch physician Dr. John Smulders and which was prevalent into the 1960s and early 1970s. In fact, NFP is really an umbrella term that involves a variety of techniques used to achieve, or avoid, pregnancy. Any couple that is interested in natural family planning should always take a class from another couple that is certified in natural family planning and who can explain the subtleties of the methods. How does natural family planning work? Succinctly, natural family planning is based on the couple being able to identify the woman's fertile period during her monthly cycle and then avoiding intercourse on those specific days. In the old days of the rhythm method, the assumption was that ovulation occurred at the same time each month, and that a pregnancy would result only if you were 'off-beat'. While it is true that the average time of ovulation is approximately the fourteenth day of the menstrual cycle, natural family planning recognizes the fact that there is (normal) month-to-month cycle variation that a woman experiences and that there are specific signs which, when recognized, will point to the days of peak fertility when intercourse is to be avoided if pregnancy is not an objective that particular month. Recall that post-ovulation, the average lifespan of an ovum is only about 12-24 hours. The keys to understanding natural family planning involve (1) understanding that a woman's basal body temperature rises about 1° following ovulation, (2) monitoring vaginal secretions, which change as the fertile days of the monthly cycle approach, and (3) recognizing other physical manifestations such as changes in the position of the cervix. Temperature tracking is a useful way to tell if a woman is ovulating and changes in vaginal mucus signal the fertile days. For these reasons, natural family planning approaches are sometimes referred to as 'fertility-awareness methods', and the only piece of equipment that needs to be purchased is a basal temperature thermometer.
The Big Three

1. Basal body temperature (BBT) is your temperature just as you awaken in the morning and before you do anything at all. Women using natural family planning should just sit up in bed, take and record their BBT, and only then get out of bed. By far the most common method is to measure the temperature orally, though it can also be taken rectally or even vaginally. There is a rise of about 0.2 - 1° on the day of ovulation, and this slightly elevated temperature usually persists until the onset of the next menstrual cycle. Because of this rather small change in temperature, families with an interest in basal body temperature monitoring should purchase what is known as a basal thermometer from a local pharmacy. Older style basal thermometers made of glass usually only register temperatures between 96 - 100°F and are accurate to 0.1° so that it is much easier to detect subtle body temperature increases. All of the

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Lesson 10 - Natural Family Planning

https://eberlyscienceonline.psu.edu/courses/biology177/book/ex...

basal body thermometers are now digital, and with this type of instrument, one is able to take an accurate BBT reading within about one minute. Basal thermometers typically range from $10 $15. 2. Cervical mucus condition is a second key indicator of fertility. Just after menstruation, discharge from the cervical canal, i. e., cervical mucus, is almost nonexistent. These no-mucus days are characterized by a feeling of dryness. When mucus begins to appear it is typically tacky to the touch and cloudy in appearance. When a woman is ovulating, her cervical mucus will have changed in such a way that it now resembles egg whites, in terms of both consistency and color, accompanied by stretching when placed between two fingers, as shown in the figure on the right. This is a clear sign that a woman is in her most fertile part of her monthly cycle and is loosely known as the 'egg white phase' or 'prime time'. Methods for examining cervical mucus include examination of any discharge that may be present on the undergarments, wiping the entrance to the vagina with bathroom tissue just prior to urination, or gentle placing a clean finger into the vaginal opening in order to acquire a mucus sample. The following are typical guidelines for interpretation of the condition of the mucus: "Early mucus is usually described by one of these terms: scanty, not a lot present, the consistency is thick and sticky, it usually holds it shape. The color is white or opaque. Next there is transitional stage. Some of the characteristics of this stage are: increasing amounts of mucus, mucus will be thinner, and cloudy in appearance and color. At this stage, it is slightly stretchy. The final stage before ovulation is the highly fertile stage. At this time, mucus will usually be visible in profuse amounts. It’s thin, and transparent. It’s often called 'egg white cervical mucus' because of its stretchy properties." [Quotation courtesy of www.babyhopes.com]. 3. Position of the cervix is a third major sign that women can use to monitor the fertile part of their month cycle, though this seems to be used less frequently than monitoring cervical mucus consistency and basal body temperature. As a woman proceeds through her monthly cycle, the position of the cervix actually shifts. At the beginning of one's cycle, the cervix is what is considered to be in the low position, and it rises up just before and during ovulation. Cervical position can be determined by direct manual examination in an attempt to assess if the cervix is low (easy to reach) or high (more difficult to reach), if the cervix feels firm, soft, wet, or dry, and whether the opening of the cervix feels open or closed: "Prior to ovulation, during the first half of your menstrual cycle, the cervix is normally low (easy to reach) and feels firm, like the tip of your nose. It feels dry and the opening to the uterus remains closed. During and around

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Lesson 10 - Natural Family Planning

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ovulation, the cervix now rises up to the top of the vagina, is opening up and is very wet with cervical mucus. All of this is happening in order to create a more fertile, hospitable environment for the sperm. The cervix feels softer and is very sensitive to the touch as well. At the height of ovulation, the cervix may be difficult to reach, when it has risen so high that the fingers cannot touch it. Within a few days after ovulation, the entrance begins to close and the cervix returns to a firmer state. The cervical position will be lower and easier to reach." [Quotation courtesy of www.ovulation-calendar.net]. Many women will seek assistance from their doctor in order to learn how to properly assess the position of the cervix. So why doesn't everyone embrace natural family planning? The major objections that many couples have to NFP is that is it requires commitment and cooperation from both parties, and that it tends to diminish spontaneity. However, many couples who do use natural family planning methods remark that their relationship is solid, loving, and mutually respecting. Many persons who are proponents of NFP often refer to it as "sex au naturel" and state that "abstinence makes the heart grow fonder!"
Before moving on, be sure you are comfortable with the following terms:

Abstinence: avoiding sexual intercourse. Basal body temperature: a person's baseline temperature as measured immediately upon waking and before doing any type of work whatsoever. Birth control: any intentional means, either natural or artificial, by which the birth of children is spaced or altogether avoided. Contraception: literally, a means by which conception is avoided following sexual intercourse. This term is often used as a synonym for 'birth control'. Subcutaneous: under the skin.

NFP Variants
An historical perspective of natural family planning includes several versions of a non-contraceptive manner through which a couple has control over the spacing of their children. What all of these methods have in common is the recognition of the exact days in her monthly cycle when a woman is able to conceive, and in so doing, avoid intercourse on those days if pregnancy is not an objective, or engage in intercourse on those days if pregnancy is an objective. What follows is a list of the better known variants of natural family planning. There are many, many others that are discussed in detail elsewhere. Learning about the methods described below will provide a reasonable understanding of the objectives and the methododologies associated with natural family planning. The Billings Ovulation Method (the Billings method) was developed by Drs. John and Evelyn

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Lesson 10 - Natural Family Planning

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Billings, Australian physicians, in 1972. In the Billings method a woman is taught to use observations about changes in her body as an indicator of when she is most fertile. Women using this approach essentially develop their own vocabulary to describe their observations, keeping a written record. This method is considered to be the least reliable (meaning the least effective) variant of natural family planning. Follow this link to learn more about the Billings Ovulation Method. The Creighton Model (the Creighton Method) is a modification of the original Billings method. As with the Billings method, mucus observations are most conveniently made just prior to urination. A woman then compares what she observes to a standardized list of mucus descriptions, matching her observations as closely as possible to those provided. Periods of fertility and infertility are identified based on these mucus descriptors. Follow this link to learn more about the Creighton Model. The Symptothermal Method is based upon making observations about natural changes in a woman's body as each cycle progresses, much like the Billings and Creighton methods, and also includes making observations about changes in body temperature. Although this method is more complex than either the Billings or Creighton methods, it is considered to be much more accurate at predicting fertility. Follow this link to learn more about the Symptothermal Method. The Standard Days Method is a relatively new variant of natural family planning that was developed in 1999 at Georgetown University in Washington, DC. In order to use this method properly, a particular woman's cycle must range from 26 to 32 days long. Day 1 of the cycle is the first day of menstruation (standard definition), and if the couple wishes to avoid pregnancy then they abstain from sexual intercourse on days 8 - 19. Follow this link to learn more about the Standard Days Method. The Two-Day Method requires making observations, as in the Billings and Creigton methods, and is regarded as easier to learn than either of these methods. It incorporates what is known as the two-day rule which involves the assessment of cervical mucus secretions and relating those observations to what was observed over a two-day period (i.e., what was observed today and what was observed yesterday). This method is regarded by some people as less effective than the Standard Days method. Follow this link to learn more about the Two-Day Method. Finally, and perhaps the oldest known form of natural family planning, is the Lactational Amenorrhea Method (newer name is the Ecological Breast-Feeding Method). It is well-known that nursing one's newborn has the effect of delaying the return of ovulation for weeks, if not months, following the birth of a child. While not 100% effective (no method of family planning, natural or otherwise, ever is), this is the only method that does not require periodic abstinence. Follow this link to learn more about the Lactational Amenorrhea Method.

Facts and Fallacies
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Lesson 10 - Natural Family Planning

https://eberlyscienceonline.psu.edu/courses/biology177/book/ex...

Facts
Fact: Natural family planning is a reversible process. This statement is made in the context of surgical procedures that are intended to render either the male (vasectomy) or the female (tubal ligation) permanently sterile. With natural family planning, a couple can begin to have children as soon as they are ready. Fact: Natural family planning is just as useful for achieving pregnancy as it is for avoiding it. This is a fundamental difference between NFP and contraception. Many couples report using NFP specifically when they wish to have another child. Fact: Natural family planning does not protect either partner from sexually transmitted diseases (STDs), should one of the partners bring an STD into the relationship. Since there is no physical barrier between the male and the female, intimate contact could lead to an STD infection. Fact: Natural family planning is extremely economical. There is nothing to buy each month. The only up-front investment is the purchase of a basal temperature thermometer.

Fallacies
Fallacy: Natural family planning is for religious zealots. This is incorrect. The truth is that NFP is based on solid scientific research, as are other methods of birth control. Fallacy: Natural family planning and the rhythm method are one in the same. Completely false: the rhythm method is calendar based and does not focus on recognition of monthly physiological changes. Natural family planning is all about fertility awareness, i.e. recognizing the signs associated with fertility, which are not calendar-based. Fallacy: Coitus interuptus is a form of natural family planning. Coitus interuptus is another technique that is infrequently used to control births. It involves withdrawal of the penis from the vagina before the male ejaculates. This is an extremely unreliable method of birth control because (1) the pre-ejaculate fluid that was described in lessons 4 and 5 contains sperm that may eventually fertilize an awaiting ovum, and (2) early withdrawal requires tremendous self-control, which men often loose in the heat of the moment, so to speak. Although coitus interuptus does not involve any drugs or mechanical barriers, it is not considered a form of natural family planning because technically, sexual intercourse is not completed because the male ejaculates after 'pulling out' of the vagina. Fallacy: Natural family planning is unreliable. This is inaccurate. Several scientific studies have shown that, when used consistently and correctly, some forms of NFP can be as much as 99% effective.

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Lesson 10 - Natural Family Planning

https://eberlyscienceonline.psu.edu/courses/biology177/book/ex...

Before moving on, be sure you are comfortable with the following terms:

Coitus interuptus: early withdrawal of the penis from the vagina before ejaculation occurs. Tubal ligation: severing of the fallopian tubes as a permanent birth control measure. Vasectomy: severing of the vas deferens of each testicle as a permanent birth control measure.

Online Assignments for Lesson 10
Please complete the following assignments no later than 11:59pm on Sunday, November 4, 2012.

1. Read all of the material in this lesson. Be sure to follow all of the external links and have a working knowledge of that material. 2. Post your thoughts to this week's discussion board topic and then, as usual, please respond to the postings of at least TWO different classmates. Please be assured that each posting will be received by your classmates with the respect that you deserve and will be responded to in a non-judgmental manner. The opinion of each student is to be valued without prejudice. In this week's lesson, on the page titled "NFP variants" there are several types of natural family planning methods described, each of which has a link to an external site with more information. In your posting to the discussion board, please state (1) which of these methods you personally think is the most reliable (and why), and (2) if you, personally, would ever consider using it, and why or why not. Out of respect for your privacy, if you don't really want to state your personal feelings in this matter, then instead describe the circumstances that a person of your sex (female or male) might feel comfortable using that natural form of family planning. 3. Take the quiz for lesson 10 on Angel no later than 11:59pm on Sunday, November 4, 2012.

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