June 19, 2019
Editor’s Note: As part of the FACTS two-week online elective through Georgetown University College of Medicine, a medical student summarized her experience with fertility awareness based methods (FABMs). Her insights as a medical student well versed in fertility awareness from personal use offer a unique perspective on the benefits and challenges of FABMs and the need to incorporate this important topic into the medical school curriculum.
Planning for Medical School
When I chose a method of family planning, it was important to me to find a method that did not interfere with the healthy functioning of my body, and one that was not an embryocidal (i.e., had no possibility of causing the loss of an embryo). It was also important to me to choose a highly effective and reliable method, since I was starting medical school shortly after my marriage and desired to postpone pregnancy until I finished the 3rd year clerkships. I was thankful to be informed about the option of natural family planning (NFP)/FABMs through my church, as I had not learned of these methods from my physician.
So Many Choices!
After reading online about the different available methods of NFP, including the Billings Ovulation Method, the Creighton Model, the Marquette Model, and the Sympto-Thermal Method, my fiancé and I chose to learn the Creighton Model. This method has strong data supporting its effectiveness, and we appreciated the standardization and decreased subjectivity of the observations. There was a significant financial and time commitment to learn the method ($300 and eight one hour-long lessons) but it was worth it for us to be confident in our understanding of a highly effective method. After learning to use the Creighton Model from a trained educator, we used the method to postpone pregnancy for 3.5 years, and then we were able to use it to achieve pregnancy as well.
Following the birth of our son, I chose to use the Lactational Amenorhea Method (LAM) for six months before resuming use of the Creighton Model. Unfortunately, I did not receive accurate information about LAM from my healthcare professional, who was not educated about the method’s requirements and effectiveness. Thankfully, as a medical student, I was able to research LAM myself to determine it was a good fit, since I met the requirements for use of the method to achieve its high effectiveness.
Some of the challenges I have faced using a natural method include having a continuous mucus pattern throughout the follicular phase of my cycle and a lengthy time without ovulatory cycles postpartum. These challenges made it more difficult to clearly interpret my FABM charting to determine days of infertility. With basic Creighton Model charting, having this pattern during the follicular phase meant that all days until 4 days “post-peak” were classified as possibly fertile. Thankfully, my trained FABM educator (a Creighton Model instructor) worked with me to determine my personal pattern of infertility to decrease the number of days unnecessarily classified as fertile.
Benefits of FABMs
An important benefit of using the Creighton Model has been to gain awareness of how my hormonal cycles affect my mood and behavior. This has helped me identify when the timing of my cycle is impacting my emotions and work through them in a more productive manner.
Another benefit to using a natural method is that it promotes conversations with my husband about our family planning goals. Each cycle prompts a discussion about whether we want to try to avoid or achieve a pregnancy this month. With both of us in medical training, this has helped us to be very conscious of when would be a good time to grow our family. Beyond promoting conversations to maintain open communication about our family planning goals, using an FABM has helped us achieve pregnancy more quickly than many couples, partly due to awareness of the times of highest fertility. We are very thankful we were able to conceive twice after attempting to achieve pregnancy for only two months each time.
FABMs and the Culture of Medicine
As a patient, I have not had any negative experiences regarding my use of an FABM in my interactions with medical professionals, including an obstetrician-gynecologist, a family physician, a certified nurse midwife, and a nurse practitioner. While they do not recommend or offer FABMs as an option, when I mention I use “fertility awareness with periodic abstinence” as my family planning method, they ask whether I am satisfied or would like another option and then move on to other topics.
However, in my interactions with physicians as a medical student, I have heard many inaccurate, judgmental, and condescending statements regarding FABMs. These statements have included equating FABMs with the rhythm method, jokes about users of these methods being constantly pregnant, and inaccurate comments regarding FABMs. The derogatory tone I have noticed when mentioning these methods is, in my opinion, highly unprofessional and not acceptable behavior for medical professionals.
With so many benefits of FABMs, it is important for all medical professionals to be aware of the modern science-based fertility awareness methods, including their effectiveness and suitability for a variety of women throughout the different stages of their reproductive lives. Many physicians and allied health professionals lack knowledge of these methods and continue to perpetuate outdated and inaccurate information. Women should be informed about these methods as an option for family planning and as valuable tools to facilitate the diagnosis and treatment of some common women’s health concerns.
PHYSICIANS AND MEDICAL STUDENTS!
DO you feel prepared to educate women & couples about FABMs?
DO you know the latest science about these safe,
effective options for family planning & health monitoring?
ARE you curious about the latest fem-tech?
Increase Your Understanding
of Fertility Awareness, the Female Cycle,
and their applications in Women’s Health
RESIDENTS and STUDENTS
Join the expanding and popular FACTS Ambassador Program!
We invite you to take advantage of this unique opportunity for medical residents and students! Enjoy monthly calls with experts in the field. Learn how to handle questions that come up in clinical settings regarding women’s health, fertility awareness, charting, and much more.
Benefits of being a FACTS ambassador
- Participating in research
- Getting published early in your career
- Developing public speaking and presentation skills
- Attending national meetings and learning from experts in the field
- Expanding your clinical knowledge and skills in women’s health
- Building and growing your network
- Making connections that will last your entire career
- Working with other students & residents interested in fertility awareness
- The opportunity to become a trained speaker for FACTS
- Learning from one another and growing professionally together
- Getting to work with the FACTS team!