A Day to Celebrate
A Special Note: Earlier this week, we celebrated President’s Day. Today marks the birthday of our first president, George Washington, as well as the birthday of longtime FACTS supporter – Dr. Therese Duane, sister of our FACTS Executive Director Dr. Marguerite Duane. A trauma critical care surgeon, Dr. Therese Duane, has always been an incredible inspiration and role model for her sister. Even today, Dr. Therese Duane is dedicated to providing life-saving care to her patients in the United States and abroad, as she spends her birthday in Uganda serving with Mercy Trips Healthcare Outreach!
Educating Physicians to Empower Patients
By: Margaret Paules, MD
Director’s Note: Today, we share an interview written by Dr. Margaret Paules, a former FACTS elective student whose own medical school education in fertility awareness-based methods (FABMs) prior to the elective was minimal. Her professors described these methods as the “you are gonna get pregnant method.” As part of the elective course, Dr. Paules spoke with a woman who has used four different natural methods of family planning: Billings, Creighton, Marquette and now Sympto-Thermal. The piece highlights the importance of educating physicians in the various FABMs to provide women with accurate information about the pros and cons across various stages of life and family-planning goals. To facilitate patient participation in the decision-making process, FACTS offers a shared decision-making tool that clinicians can use to aid patients in selecting an effective FABM. [1] [2]
Like many people, Myra* was introduced to fertility awareness-based methods (FABMs) through a faith-based institution. She first heard of FABMs during her marriage prep course through her church and started charting using the Billings Ovulation Method prior to getting married in. She used Billings both to avoid and achieve pregnancy and gave birth to her first child shortly after getting married.
In the postpartum period, Myra used the Creighton Model to avoid pregnancy until she was ready to conceive again a couple years later. However, six months postpartum, she got pregnant sooner than expected. Following the birth of her third child, she switched to the Marquette Model. This method proved to be a more practical option postpartum, as Marquette has a protocol for postpartum and breastfeeding women.
Presently, Myra is training to become a nurse practitioner and is not ready for another child. She continues using Marquette to avoid pregnancy and also uses ovulation predictor kits and PROOV strips as second checks. Myra has been learning the Sympto-Thermal Method as well but is not currently monitoring basal body temperature because her schedule as a graduate student is quite unpredictable.
“Myra…described the empowerment that comes with knowing her body and explained that learning so much about her own body has equipped her to better advocate for it.”
Now a decade into charting, Myra shared several of the significant benefits she experienced in her life since she began using FABMs. She described the empowerment that comes with knowing her body and explained that learning so much about her own body has equipped her to better advocate for it. Myra also noted that she can now tell when her stress is going to impact her cycle. She even experiences mittelschmerz — stomach pain on one side associated with ovulation — and can use this information to identify which ovary is ovulating. Myra has become very in tune with her cycle since starting charting, but she has come across several medical professionals who were not supportive of her choice to use FABMs for family planning. Her impression was that they were uninformed about the methods and not interested in learning about them. This presented a particular struggle for Myra, as she lives in a rural portion of the United States and lacks access to care in general. Myra also struggled with her mood in the postpartum period and could have used support from the healthcare community. Fortunately, she recently found a new practitioner who expressed a willingness to learn about FABMs, which underscores the critical importance of education about these methods among the medical population.
“Myra has become very in tune with her cycle since starting charting, but she has come across several medical professionals who were not supportive of her choice to use FABMs for family planning. Her impression was that they were uninformed about the methods and not interested in learning about them.”
Prior to this elective, I knew nothing about FABMs and had many biases. However, these last four weeks have really opened my eyes. I have a completely different perspective and a fuller knowledge base that I am excited to bring into my future practice.
In addition to learning about the evidence scientifically backing different FABMs, the elective also lended insight into the relationship benefits for FABM users. During our conversation, Myra shared with me how using FABMs has shaped her relationship with her husband. In the beginning, they were not on the same page and had very different ideas about the role of sex in their relationship. However, using these methods has enabled Myra and her husband to grow in mutual respect for each other and enhanced their understanding of intimacy within their relationship beyond merely pleasure. Their story illustrated the importance of communication and starting on common ground.
“Using these methods has enabled Myra and her husband to grow in mutual respect for each other and enhanced their understanding of intimacy within their relationship beyond merely pleasure.”
Myra’s experience with FABMs taught me the applications for both avoiding and achieving pregnancy, as well as their utility in monitoring reproductive health in real time. My conversation with Myra made the practicality of FABMs real for me. I also realized how important it is, as future physicians, to educate ourselves on this subject for the sake of our patients. FABMs are rarely covered in medical school except sometimes in passing and as a bit of a joke. In my training, I have heard professors refer to these methods as the “you are gonna get pregnant method.” Now having learned about the science behind FABMs, I understand their true utility. I was deeply grateful for Myra’s willingness to share her story with me, and I hope to learn from more users in the future.
*Names have been changed to respect the privacy of the interviewee. All information is shared with permission.
References
[1] Faiman B, Tariman JD. Shared Decision Making: Improving Patient Outcomes by Understanding the Benefits of and Barriers to Effective Communication. Clin J Oncol Nurs. 2019;23(5):540-542. doi:10.1188/19.CJON.540-542
[2] Duane M, Martinez V, Berry M, Gilpatrick S, Manhart MD. Evaluation of a fertility awareness-based shared decision-making tool part 2: Patient experiences. PEC Innov. 2023;2:100169. Published 2023 May 23. doi:10.1016/j.pecinn.2023.100169
