By Ana Maria Dumitru, MD, PhD
July 10, 2019

Editor’s Note: Dr. Ana Maria Dumitru conducted this interview while in medical school as part of the FACTS online elective. She spoke with a couple that used several different fertility awareness based methods (FABMs) over more than thirty years. The interview is part of our series that highlights the benefits and challenges of FABMs by hearing from users of the various methods for family planning and reproductive health monitoring.

Introduction
I had the opportunity to speak with an older couple about their use of FABMs. Mr. and Mrs. T have been married for nearly thirty-five years. In that period of time, they have used the Standard Days Method (SDM), the Ovulation method, and the Lactational Amenorrhea Method (LAM). Their story is particularly compelling, since reliable information was less accessible when they began using FABMs. Nevertheless, they persevered despite the obstacles and external pressure to give up. The couple is very glad to have discovered FABMs early in their relationship.

Their Path to FABMs
Before they met, Mr. T had been in a long-term relationship with another woman and had used barrier methods for contraception. But when he met his future wife, she told him she wanted to use natural methods for family planning exclusively. She set the tone early in their relationship, making it clear this would be a deal breaker if he was not on board. She knew she wanted to have children and didn’t want to use anything artificial in her body. She had heard there were natural ways to space your pregnancies, so she wanted to go that route, and Mr. T agreed to give it a try. He was intrigued because he had never met a woman like her; most of the women and couples in his network were using contraception.

When they were first married, Mr. and Mrs. T found it very easy to use natural methods, perhaps because they were both excited to try to conceive. Mrs. T had regular cycles and had learned the basics about identifying her fertile window from older books she found in a library about the rhythm method. She became pregnant in the first cycle after they married, so before they celebrated their first wedding anniversary, Mr. and Mrs. T welcomed their first child into the world.

A Few Challenges
Things seemed to be going smoothly at that point, but then the couple hit their first bump on the road. They were using LAM while Mrs. T was post-partum. Yet, whether or not they used it correctly is still up for debate, since she quickly became pregnant again despite breastfeeding exclusively while their first child was less than six months old (i.e., they thought they were following the method’s rules). Although this was not exactly their plan, Mr. and Mrs. T decided they would figure out LAM the next time around, and welcomed their second child about a year after their first. They also went back to the books to learn why LAM wasn’t working for them in the post-partum period. They were determined to figure out how to build in some space between their first and future children.

After receiving supplemental instruction on LAM, they were able to space out several years before their final pregnancy. Mrs. T thinks part of the problem was that she didn’t chart much before they got married, and she had received very limited formal instruction. Early in their marriage no one they knew talked about using natural methods for avoiding pregnancy. There was no internet back then, so everything they knew was from the books and articles they could find, or second-hand information from another couple. Mrs. T said with all the chaos of several babies in a row, minimal formal instruction, and the pressure from family and friends to not have another child right away, it took her years to feel confident in identifying her fertile window. 

The Reality of Using FABMs
Today, Mrs. T is post-menopausal and proud of never using anything artificial for family planning. They admit their first few years of marriage, with their children arriving in succession, placed a large strain on their relationship, but they also can’t imagine their family any other way. Additionally, Mrs. T thinks the way things unfolded forced her and her husband to maintain open communication, and this kept them together in the long run.

In fact, when asked if she has any regrets about her family planning choices, Mrs. T said, “You know, at the time everyone thought we were crazy. Our parents, our siblings, our close friends, everyone was up in arms. I didn’t even tell most people I was pregnant again until the third trimester! But now, when I look back, my only regret is that we didn’t have more kids. If you had told me that back then, I would have said you were crazy, because I was exhausted and I couldn’t image MORE kids. But now, I think it would’ve been great to have more.”

Reflections from a Physician
I thought it was very helpful (and a little awkward) to have this discussion with Mr. and Mrs. T. She was definitely the talker on the subject, whereas Mr. T preferred to tune in and out, not sharing too many details. But the sense I got from them is that they both feel proud they remained open with each other and never used artificial birth control or barriers in their relationship. They were pretty open about the fact that it wasn’t always easy to abstain during the fertile window, and that inevitably it seemed like there was always some kind of obstacle during their infertile days – one of the kids was sick, someone had to work late, that sort of thing. But as they look back, they agree the only thing they would do differently is have more children. To me, this is a testament to the long-term positive effects of FABMs on relationships.

Editor’s Note: The successful use of FABMs, particularly to prevent or postpone pregnancy, requires learning from an instructor trained in the chosen method, since each FABM has its own rules, benefits, challenges, and effectiveness rate. The good news is there is a method for every woman and couple and for every stage of one’s reproductive life. At FACTS, we train speakers who teach medical professionals about fertility awareness all over the country, and there are also trained instructors of the different FABMs in every state. Your support of our work helps ensure every woman and couple has access to medical professionals knowledgeable about fertility awareness with a network of instructors to support users of FABMs. Thank you!

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Author Bio: Ana Maria Dumitru, MD, PhD earned her Doctorate in Medicine as well as a PhD in Biochemistry at Dartmouth’s Geisel School of Medicine. She has served as a FACTS Student Ambassador for three years and is also trained as a FACTS Speaker.

 

 

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