FACTS Spotlight: National Breastfeeding Month
Fertility Awareness-Based Methods During the Postpartum Period
By: Johanna Lonngren
Editor’s Note: Johanna Longrenn, a midwifery student and FACTS Ambassador, conducted an interview with a fellow midwife to explore the role of midwives in educating women and couples about the option of fertility awareness-based methods (FABMs) throughout a woman’s reproductive lifetime, especially during the postpartum period. With the use of the FACTS Shared Decision-Making Guide (coming soon to the FACTS online shop!), it is now easier than ever for midwives and other health professionals to educate women about FABM options, so they can make informed decisions about family planning and choose an FABM that is best for them. FACTS also provides continuing educational opportunities via our conferences and CME courses. If you missed the presentation by Dr. Summer Holmes Mason on Reproductive Transitions in the Postpartum Period during our final conference session last weekend, stay tuned – recordings will be made available through a future CME course.
Newborn babies, with their small little bodies, bring life, smiles, laughter, and joy into homes. This is a new and exciting time for families, whether it is baby number one or eight. But with all the joy comes many sleepless nights and new struggles. It is also a unique time for a couple’s love life. With a new baby in the home and the variable return of a woman’s fertility, the postpartum period presents a challenge to family-planning goals.
I had the pleasure of chatting with Christine Mesich, a midwife in Austin, Texas. As a midwife and Billings Ovulation Method instructor, she has one-on-one conversations with couples about their family planning goals just two weeks after their baby has been born. She introduces them to Fertility Awareness-Based Methods (FABMs) and explains how they work, their pros and cons. Often, couples have never heard of FABMs but they are excited to learn this new information and have an alternative to hormonal contraceptives, especially since FABMs do not interfere with breast milk production. Christine explained that this is a great time to educate couples about these natural methods because the couple is already refraining from sexual activity, which is helpful in the early weeks of learning to chart. Some women may also be breastfeeding exclusively, which may allow them to use the Lactational Amenorrhea Method (LAM). If a couple would like to learn the Billings Ovulation Method, Christine can begin instruction immediately with the option for them to follow up for additional support once the woman’s body starts showing signs of returning fertility.
“Often, couples have never heard of FABMs but they are excited to learn this new information and have an alternative to hormonal contraceptives, especially since FABMs do not interfere with breast milk production.”
Christine finds that, even among her colleagues, there is a misunderstanding about FABMs. A common misconception is that women can only chart if they have regular cycles. Postpartum and breastfeeding women experience return of fertility at variable times and do not cycle regularly, so midwives may not offer it as a valid family-planning option. She believes these midwives would benefit from hearing the scientific explanation of charting and cervical mucus observations to better understand why it is indeed a valid option for postpartum family planning. People are open and thirsty for this information; most just need someone to teach them.
What is the scientific explanation of FABMs postpartum?
The answer lies with cervical mucus. The cervix has different kinds of crypt cells that produce different types of mucus throughout a woman’s cycle. The rise and fall of estrogen and progesterone act on the cervical crypts, determining the type of mucus produced. As estrogen rises, signaling the approach of ovulation, the cervix produces Types L, S and P mucus. The L-Type attracts low-quality sperm to prevent them from entering the uterus. Meanwhile, the S-Type mucus supports and stores the sperm and, with the P-type, creates pathways to help transport high-quality sperm. When estrogen is low and progesterone is high, Type G cervical mucus is created to form a plug in the cervix to block sperm from entering the uterus. [1]
Even when a woman’s menses has not returned, she can learn how to observe and distinguish different cervical mucus patterns from a trained instructor to determine if ovulation is impending. Charting is all about the cervical mucus and ovulation – not just about the period! A common challenge among postpartum women is chronic discharge, which can add to the complexity of charting. However, with an appropriate method and an instructor’s support, couples can modify their behavior when ovulation is approaching to avoid conception.
“Even when a woman’s menses has not returned, she can learn how to observe and distinguish different cervical mucus patterns from a trained instructor to determine if ovulation is impending.”
Parenthood is both exciting and uncertain, but FABMs may provide answers to many questions that new parents face about their family-planning concerns. During the postpartum period, midwives are well-suited to educate women and couples and enable them to make informed decisions about the option of FABMs to meet family-planning goals. Not only that, but all FABM-trained physicians, clinicians, and educators are in a unique position to challenge misconceptions around the effectiveness of FABMs postpartum by educating not just their patients, but also their own colleagues. There is work to be done, but change is happening and FABMs will continue to become more widespread thanks to the efforts of midwives like Christine.
Sources
[1] Odeblad E. Cervical Mucus and Their Functions. J Ir Coll Physicians Surg. 1997;26(1): 27-32.
ABOUT THE AUTHOR
Johanna Lonngren
Johanna Lonngren studies at the National Midwifery Institute. She is passionate about spreading fertility awareness so that women can be body literate and make well informed decisions about their health and reproduction. She plans to incorporate fertility awareness into her future midwifery practice and work with women who have endocrine disorders and infertility. Besides studying women’s health, she spends her time as a missionary with Eight Days of Hope, serving those affected by natural disasters and building homes for those rescued from sex trafficking.
