1. Natural Family Planning: A Healthy Alternative With an overview of Creighton Model FertilityCare TM System 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 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

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, 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

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. 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. 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

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

15. How the Method is Taught FertilityCare TM 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 Studies have shown Creighton Model FertilityCare TM 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

18. 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.)

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 FertilityCare TM 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 – 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

21. 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

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 Visit informational websites for NFP programs and various methods, like www.creightonmodel.com or www.fertilitycare.org www.creightonmodel.com www.fertilitycare.org Browse some of the following websites to learn about NFP, its moral foundations, and research to support its benefits:

24. 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.nfpsite.aldred.org 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.boma-usa.orgwww.woomb.org www.nfpoutreach.org www.nfpandmore.org International site including research and a downloadable manual called Natural Family Planning: The Complete Approach www.nfpandmore.org www.omsoul.com is a website called One More Soul. It includes NFP information, stories, resources, and research www.omsoul.com

25. Browse NFP Websites www.canfp.org California Association of NFP includes and “Ask the Expert” feature www.canfp.org www.MyFertilityCycle.NET includes online education for charting, and an online charting system www.MyFertilityCycle.NET http://www.marquette.edu/nursing/NFP/Model.shtml for NFP using electronic fertility monitors, or http://www.epigee.org/guide/computers.html overview http://www.marquette.edu/nursing/NFP/Model.shtml http://www.epigee.org/guide/computers.html www2.cyclebeads.com www.ccli.org/nfp Couple to Couple League includes ecological breastfeeding (lactational amenorrhea) www.ccli.org/nfp http://healthmattersmagazine.com/issues/hmm15.pdf See page 19 for a fun, colorful article http://healthmattersmagazine.com/issues/hmm15.pdf

26. References Hilgers, T.W., (2001), Creighton Model FertilityCare TM System: An authentic language of a woman’s health and fertility. (5 th ed.) Omaha: Pope Paul VI Institute Press. Hole, J., (1987), Reproductive systems. In Human anatomy and physiology. (4 th 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 http://www.epigee.org/guide/natural.html http://www.epigee.org/family-planning-new- methods.html

27. Family Planning Method Comparison Chart Adapted from brochure by American Academy of Natural Family Planning Feb. 1999 MethodsPossible Side EffectsEffectiveness % Theoretical Effectiveness % Actual Continuation Rate at 1 year Creighton Model FertilityCare SystemNone99.596.889% 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 SpermicidesAllergic reaction or irritation947943% 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% Intrauterine Device (IUD) - requires replacement every 5 years Heavy, irregular or painful periods, painful intercourse, infection, ectopic pregnancy, perforation of uterus, infertility 989780 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 99.69472 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

28. Which Family Planning Method is Most Ideal? Rate these:CondomBCPIUDNFPSterilization 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.

29. This presentation was sponsored by Health Vista, Inc. Revised 10-22-09