A Case for FABM Instructors

Editor’s Note: This interview with three different users of fertility awareness-based methods (FABMs) brings into the discussion something too often neglected: the needs and goals of the women seeking care. Calley Gober, a fourth-year medical student, interviewed these women while on the FACTS elective. Beyond sharing their stories, she provides information about the Sympto-Thermal Method, other FABMs, and the essential role of FABM instructors.

Choosing Health

Today, marketing, media, and medicine encourage the everyday person to take charge of his or her health. Women especially are eager to join this movement to know themselves and their bodies. Many are seeking a better standard of health as they dig into information on their own and make independent changes. Rather than choose a pill to cover up symptoms, they proactively seek to manage their wellness by learning to listen to how they feel, and then using this information to guide them toward choices that improve or maintain health.

Macy, Abigail, and Cat* are among these women who have embraced a movement for body literacy and autonomy. They decided to care for their bodies “naturally,” trusting that the body is capable of self-regulation when supported in the right way, like eating nutritiously, exercising regularly, avoiding excess and, when appropriate, seeking the care of a medical professional. Fertility awareness-based methods fit nicely into this holistic care decision each of them made.

What are FABMs?

FABMs are a way of monitoring one’s physical signs of fertility to understand the inner cycle within a woman’s body. There are several models for monitoring, with some overlap in how each specific method works. A number of models have a higher level of evidence behind them to support their efficacy. These include the Billings Ovulation Method, the Creighton Model, the Sympto-Thermal Method, the Marquette Model, and the Lactational Amenorrhea Method (LAM). Each method offers different advantages depending on the intended practice and goals of the user.

Three Stories

When Macy, Abigail, and Cat started learning about FABMs, each had different initial motivations. Abigail wanted to transition from hormonal birth control to something more natural. Macy wanted a method to avoid pregnancy that aligned with her faith and familial community. Cat wanted to know the patterns of her body as an indicator of overall health. Separately, each of them was introduced to the concept of tracking her temperature and cervical secretions daily, or the FABM known as the Sympto-Thermal Method. Macy learned about this method from church, Cat from a natural women’s health blog, and Abigail from a friend. The Sympto-Thermal Method works by noting the rise in basal body temperature (BBT) that occurs after progesterone rises following ovulation. The temperature shift is then plotted against the day of the woman’s cycle and other cyclic symptoms, including cervical mucus secretions and sometimes cervical position, to elucidate the various phases in her cycle (menstruation, fertile window, and luteal phase).

In discussions regarding their experiences, I learned that while each of them had enough knowledge of these methods to successfully meet their goals, each still had uncertainties or questions about the method, and their partners also had unanswered questions. As each woman had learned these methods semi-independently, with some help from community members and internet resources, none had a definite place to go to for counsel or follow-up questions. Ideally, they would have asked their physician, but to their knowledge, no one in their existing healthcare team even knew about these methods.

Did a practitioner who operates within the context of these FABM models even exist to provide the support they were seeking? Yes!

The Value of an FABM Instructor

An FABM instructor is trained to educate and follow up with a woman or couple regarding her cycle observations. Most methods offer trained instructors, and some people are trained in more than one method. These instructors may be non-clinical or medical professionals — including nurses, PA’s, nurse practitioners, and physicians — who know how to teach the use of the methods effectively and can interpret the nuances of charting. They can jump-start the process and then follow up with the woman or couple as time goes on, offering guidance, answering questions, and making referrals when appropriate. As the needs of the users shift, the instructor is there to respond and place the FABM in the new context of the users’ lives. They also offer a view into a larger community of users, helping to normalize the use of these methods as well as challenges that present.

For example, if a user’s basic pattern of cycle signs changes, an instructor can help determine if the new pattern is appropriate or if further investigation is necessary. Instructors can also help couples build confidence in the correct use of the method for family planning goals. They can even check in on the user’s psychosocial wellbeing and provide resources for support beyond the chart.

The case for partnering FABM users with a trained instructor is about more than education in a one-time setting. FABM charting is a dynamic process with potential to fluctuate from month to month as the woman’s life ebbs and flows. Take, for instance, something as simple as a head cold that shifts the basal body temperature in response to the virus rather than a hormonal shift. How does the user learn to interpret this additional temperature shift? Or perhaps the introduction of a new lubricant has altered the appearance of the cervical mucus, and the user may not draw a connection between these changes.

And what about the complex interplay that day-to-day changes in exercise, diet, stress levels, and schedules have on a woman’s body? FABM instructors can counsel clients on these dynamic interactions and help them interpret the potential variation that could be overwhelming for anyone to sort out on their own. FABM users can benefit greatly from an instructor who partners with them as their goals and needs evolve throughout their reproductive years, being available to help them adapt to new knowledge as needed and desired.

A Shift Toward Prevention and Autonomy

The current trend towards natural healthcare and ownership of one’s health has remarkable potential to replace a system of reactive medicine to one of stewardship and preventive medicine.

FABM and charting open a door for women to discover their bodies and tune into their lives in a meaningful way that impacts their self-awareness, sexual and reproductive health, and communication with their partners. As they make these discoveries, a trained FABM instructor is uniquely positioned to walk with clients to field questions, facilitate further discussions, and offer resources or referrals when needed.

Editor’s Note: The recently launched FACTS directory for FABM-trained physicians, clinicians, and educators is a tremendous resource to connect practitioners and educators with the women and couple who seek their care. Follow the link to list your practice and to find a practitioner or instructor in your area.

*Names have been changed for privacy.

ABOUT THE AUTHOR

Calley Gober

Calley Gober is a fourth-year medical student at the Chicago College of Osteopathic Medicine, where she is a Pre-Doctoral Osteopathic Manipulative Medicine Teaching and Research Scholar. She is excited to continue her career in medicine by training as an Ob-Gyn physician. In the meantime, she’ll keep busy with her sourdough baking, green growing, and city biking.