By: James Friedl III, DO
Editor’s Note: As we continue celebrating National Breastfeeding Month, we are featuring a patient interview — conducted by James Friedl, a former FACTS elective participant — with Simone,* an African American family physician and Marquette educator. Simone has used several different methods when planning her family, including extended breastfeeding, which made it easier for her and her husband to space out their children. Learn more about the various fertility awareness-based methods she and her husband used to plan their family.
The Patient Experience
Simone first learned of fertility awareness-based methods (FABMs) when she was preparing for marriage. She began using the Standard Days Method but later decided to look for alternative methods with observable biomarkers. She considered the Sympto-Thermal Method, but since both she and her husband were physicians with varying sleep schedules, she needed a method that did not heavily rely on temperature readings.
After further research, she opted to use the Marquette Model, because it not only included cervical mucus observations, but it also utilized urinary estrogen and LH measurements. Although Simone and her husband had decided on this method, they did not follow the protocol and got pregnant shortly after marriage. Following the birth of their first child, they tried using the Creighton Model but found it difficult due to irregular mucus patterns that are common postpartum.
The couple then decided to use the Lactational Amenorrhea Method. By exclusively breastfeeding, Simone’s menstrual cycles did not return for 12 months following delivery, which is not uncommon for women who exclusively breastfeed or follow the seven standards for ecological breastfeeding. This allowed Simone and her husband to space out their children for their family-planning goals.
“By exclusively breastfeeding, Simone’s menstrual cycles did not return for 12 months following delivery, which is not uncommon for women who exclusively breastfeed or follow the seven standards for ecological breastfeeding.”
After one miscarriage, they decided to recommit to using the Marquette Model. A second pregnancy and subsequent miscarriage left them devastated and confused as they struggled to conceive again. It wasn’t until Simone trained as a Marquette practitioner that she realized she may have been misidentifying her fertile window. The experience taught her the importance of finding a FABM that tracked the biomarkers that best met her family-planning goals. Although some may find it more confusing to monitor multiple biomarkers, there is value in utilizing both the mucus readings and the urinary hormone testing in conjunction, rather than relying on only one data source.
The Physician’s Calling
Simone said she was fortunate to receive training at a family medicine residency program that allowed her to practice medicine in accordance with her values. After completing her residency, she hoped to find a way to incorporate different FABMs into her practice. She connected with FACTS and soon was able to develop a practice model to best served patients in need.
Now a family physician, Simone explained that she feels particularly called to care for undocumented immigrants. She plans to start a practice to care for immigrant women who are pregnant or postpartum — a group that is often overlooked and does not usually receive health care in America. This may change, however: A new law took effect on July 1, 2022 that provides undocumented immigrants free Medicaid services from conception up to one year postpartum.
When Simone first heard about the new law, she was conflicted about opening her practice. The Medicaid coverage expanded the pool of practitioners willing to see this population, which made her question her role. After further thought, however, she realized that more physicians willing to see these women would not necessarily guarantee comprehensive care that included training in FABMs. Simone’s mission now is to make sure these women feel valued and show them that their fertility is a gift by teaching them to monitor their reproductive cycle using different FABMs. Simone stressed that it is far too common in the medical world to suggest a pharmaceutical form of birth control immediately following pregnancy, rather than teach women about the Lactational Amenorrhea Method to space out their children or the Marquette Method to delay or achieve pregnancy.
“Simone’s mission now is to make sure these women feel valued and show them their fertility is a gift by teaching them to monitor their reproductive cycle using a FABM that works best for them.”
As both a user and a practitioner, Simone continues to promote the Marquette Model for its practicality and accuracy. She recognizes its value, especially during the postpartum and perimenopausal periods when cervical mucus can be an unreliable marker. However, she believes that lack of education, research, and cost all present barriers to a more widespread adoption of the method. She hopes more medical professionals will learn about the method’s usefulness and that the urinary hormone monitor will become more affordable over time.
Lessons Learned
Nearly half a dozen FABMs later, Simone’s story provides several interesting takeaways. Her experience with exclusive breastfeeding lends credence to ecological breastfeeding and the Lactational Amenorrhea Method method as a valuable method in preventing pregnancy. Her experience with the Marquette Model also demonstrates the importance of understanding and utilizing urinary hormone measurements to identify the fertile window. Finally, it is refreshing to hear from physicians, like Simone, that have a heart for impoverished and often neglected populations. She understands the value of a woman’s fertility and seeks to empower women by teaching them the different FABMs. We, as physicians, have a responsibility to inform ourselves about the full spectrum of family-planning options, including the many different FABMs, so we can share this information with women and couples.
*The name has been changed to respect the privacy of the interviewee, and all information is shared with permission.
ABOUT THE AUTHOR
James Friedl III graduated from Lake Erie College of Osteopathic Medicine and is now a first year family medicine resident at UPMC Horizon in Pennsylvania.
He completed the FACTS elective as a fourth year medical student and looks forward to educating patients on FABMs.
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