February 11, 2021
By Daniel Ortiz, DO
Editor’s Note: In this conversation with a woman who began charting her cycles during the postpartum period, we see some of the shortcomings as well as strengths of fertility awareness-based methods (FABMs). Dr. Daniel Ortiz spoke to a woman who has used an FABM successfully for several years and learned the importance of having expert support along the way. As a physician, Dr. Ortiz values the work of FACTS “to promote FABMs, especially for medical professionals looking for a scientifically and clinically sound approach to family planning and women’s health beyond hormonal contraception.” Since FABMs are not promoted or even part of the curriculum in most medical schools, Dr. Ortiz found the FACTS elective invaluable. “Being a part of the elective during residency allowed me to gain more insight into the benefits of FABMs, and I look forward to utilizing that information moving forward in my future practice.”
Meet Renee and her Baby
I interviewed Renee* as she held her sleeping 2-month-old baby. A Creighton Model user of about two years, Renee began her journey of using FABMs in a “do-it-yourself” manner. She learned about these methods and cycle charting in college while dating her future husband. Desiring to be consistent with her morals and to avoid the side effects of hormonal contraception, she found that a natural method of family planning would be a good fit for them once they were married.
Renee taught herself to chart her cycles using a “mash-up” of various methods. As a medical student, she felt she was knowledgeable enough about the menstrual cycle to chart on her own. Despite feeling like she was guessing at times with charting, Renee and her husband were able to use her improvised method to avoid pregnancy for several years.
Greater Confidence with Proper Instruction
After the couple became pregnant with their first child, they began to have more detailed discussions about family planning, and Renee decided to learn a “more official” method. She chose the Creighton Model at the recommendation of a friend and after hearing a lecture by a NaPro-trained physician at her medical school. Once she understood how important it is to learn the method from a trained instructor, she quickly found a FertilityCare Practitioner (FCP) to instruct her in the method after giving birth.
The Creighton Model identifies phases of fertility and infertility based on observations of cervical mucus secretions. A woman can chart her cycles accurately by using the method’s standardized system to describe observations of her cervical mucus, also noting “dry” days with no cervical mucus as well as patterns of bleeding.
One of the benefits of charting with a modern FABM like the Creighton Model is that any woman can learn how to chart, whether her cycles are regular, irregular, or in an anovulatory state such as the postpartum period.
Support for Postpartum Challenges
Despite the flexibility of the method, charting can be particularly challenging for breastfeeding women during the postpartum period, since their menstrual cycles will not return for some time after childbirth. A suckling infant stimulates a rise in the hormone prolactin within the mother’s body, suppressing estrogen and making ovulation impossible. This temporary absence of the typical markers of the menstrual cycle can be frustrating, especially for women who wish to only use FABMs to avoid pregnancy. Given that Renee began learning to chart in the postpartum period after her son was born, she noted her introduction to the Creighton Model was, in fact, quite challenging.
Renee’s postpartum charting was complicated by the continuous mucus pattern she experienced. In the postpartum period, most women will observe a “dry” pattern because breastfeeding suppresses estrogen. However, some breastfeeding women do observe continuous mucus that may not indicate a return to fertility or ovulation. Understandably, this pattern can cause anxiety and confusion.
To manage this continuous mucus pattern, Renee worked with her FertilityCare Practitioner to implement Creighton’s postpartum “yellow stamp” protocol. This helped her recognize qualitative changes in her mucus observations that alerted her to possible fertility and the approach of ovulation. By working with her instructor and becoming more aware of her body’s signs of fertility, Renee was able to learn the method, chart accurately, and anticipate her return to cycles. The couple avoided pregnancy until they were ready to become pregnant again over a year after their son was born.
Looking back, Renee feels that learning to chart during the postpartum period was “worth it.” In particular, she appreciated being able to see her cycles eventually go back to normal when transitioning from the postpartum period. Her charts provided reassurance that her health and recovery were progressing properly. Now, as she navigates another postpartum period after welcoming her second child, she finds charting much easier.
No Need to Struggle Alone
In speaking with Renee and learning her story, I gained two main insights. First, I recognized the benefits of using FABMs in the postpartum period. As a physician, it was interesting to re-evaluate the science behind the postpartum period and gain a better understanding of how FABMs can help women going through this transition.
Thanks to specific postpartum protocols in some FABMs, a woman can continue to rely on these modern methods with confidence despite the unique challenges of this phase of her reproductive life.
It was great to hear how one of these specialized protocols within the Creighton Model allowed Renee to be successful in charting while postpartum even as a new user of the system.
A second insight I gained from her story was the importance of having a trained FABM educator to teach charting and provide guidance.
Prior to finding her FCP, Renee was on her own when it came to charting, which in her case did not promote confidence in family planning. With correct use of the Creighton Model and the support of a trained FCP, the unintended pregnancy rate with perfect use is 0.5 per 100 women-years. Renee felt confident learning the system, given that she had an instructor to review the chart with her and troubleshoot any issues she experienced.
It was a pleasure to learn about FABMs through a user’s perspective, and I look forward to using the knowledge I gained from this interview and the rest of the FACTS elective in my practice.
Editor’s Note: With FABMs, there’s no need to struggle and figure out everything on your own. In fact, it’s not a good idea. For this reason, FACTS developed and recently launched a database where patients throughout the country may find FABM-trained physicians, practitioners, and educators. Our goal is that, like Renee, women and couples everywhere may have expert guidance and support every step of the way. If you are a physician, other medical professional or a fertility educator interested in listing your practice in the FACTS medical practitioner directory, follow this link.
*A fictitious name was used to protect the patient’s privacy.
Author bio: Daniel Ortiz, DO is a third-year family medicine resident at Community Hospital East in Indianapolis, IN. He completed medical school at the University of North Texas Health Science Center Texas College of Osteopathic Medicine and his undergraduate education at the University of Texas at Austin. He participated in the FACTS elective to better familiarize himself with the different FABMs and their role for both family planning and women’s health. He plans to practice medicine cooperatively with patients’ charts and to support patients in their use of FABMs.
Did You Know?
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As a FACTS member, you are able to view and download more than 160 research articles. The searchable database groups articles into 12 categories including Charting and the Science of the Cycle, FABM Effectiveness for Preventing Pregnancy, FABMs for Infertility and Achieving Pregnancy, Fertility Awareness Apps and FemTech, Psychosocial Aspects of FABMs, and more.
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