FACTS Men’s Health Series
For FABMs and family planning, it takes two!
By Tyler Raeford
Editor’s Note: As part of National Men’s Health Month, we are featuring patient interviews conducted by some of our male medical students that highlight couples who collaboratively used fertility awareness-based methods. Dr. Tyler Raeford, an aspiring family physician and former FACTS elective participant, interviewed Lucy and Robert* about how each of them took an active role in using the Creighton Model to successfully plan their family.
Lucy and Robert were kind enough to sit down with me and answer questions regarding their use of fertility awareness-based methods (FABMs) for family-planning. Lucy and Robert have been married for 16 years and have two boys and a girl, ages 12, 9, and 6. Lucy, a nurse and long-time user of the Creighton method, began charting her cycles while she and Robert were engaged. The couple has used the method consistently throughout their relationship to both achieve and postpone pregnancy. She has also made a career of teaching the method to other women as a certified Creigton FertilityCareTM Practitioner.
“The couple has used the method consistently throughout their relationship to both achieve and postpone pregnancy.”
Lucy’s story illustrates the importance of FABMs to her overall reproductive health: charting enabled Lucy and her clinician to identify low progesterone during her cycle. Initially, her cycles remained relatively normal, and she did not require supplementation for her first pregnancy or other symptoms related to low progesterone.
However, in her second pregnancy, she experienced first-trimester bleeding caused by a subchorionic hemorrhage. Bleeding in the first trimester can lead to preterm premature rupture of membranes (PPROM,) preterm delivery, low birth weight and small for gestational age (SGA) babies, and even pregnancy loss. Research on this topic shows that there is evidence supporting progesterone supplementation in women with first trimester bleeding [1], but there is no official recommendation. Since Lucy and her clinician were aware of her progesterone levels through charting, they intervened early with supplementation. Lucy had a normal, full-term pregnancy and healthy baby.
FABMs proved vital again in her third pregnancy; Lucy’s familiarity with her own body allowed her to quickly identify bacterial vaginosis, which was subsequently treated and caused no harm to her pregnancy.
My interview with Lucy and Robert was not, however, limited to Lucy’s experience learning the Creighton method and implementing FABMs. I was particularly interested to hear from Robert. He, like myself (and probably most men), knew nothing about charting or cervical mucus before becoming engaged. By attending the sessions with Lucy, he learned a lot about the anatomy and physiology of fertility. Robert encourages male partners to be active in reproductive health by charting their female partner’s cycle observations each evening.
“Robert encourages male partners to be active in reproductive health by charting their female partner’s cycle observations each evening.”
The couple both agreed that the hardest part of implementing the Creighton method is trusting the system. They have had to re-train their brains, shaped by the pervading notion that in order to prevent pregnancy, one has to abstain from sex often, as it may lead to pregnancy. Over time, they gained confidence in charting by learning the science and identifying their window of fertility based on biomarker patterns, enabling them to have a healthy sex life without fear of an untimely pregnancy.
From Lucy’s perspective as a Creighton educator, developing a routine to implement the method is one of the biggest challenges for most women. Her recommendation is that couples refrain from sex for one full cycle, per the method instructions, while they learn to systemtically observe the mucus signs. The next most common issue arises with patients who are squeamish about the mucus itself. For a large number of Lucy’s patients, touching and evaluating their own mucus seems not only uncomfortable but perhaps even taboo. Yet, Lucy feels strongly that we should keep teaching these methods and has already started to have great reproductive health conversations with her 12-year-old son and 6-year-old daughter.
Lucy and Robert were a great resource to get a patient’s perspective on not only Creighton Method but the reproductive health of a couple. I owe them a special thank you for sharing with me and look forward to working with more couples like them in my career.
*All names have been changed to respect the privacy of the interviewees, and all information is shared with permission.
References
[1] Coomarasamy A, Devall AJ, Brosens JJ, et al. Micronized vaginal progesterone to prevent miscarriage: a critical evaluation of randomized evidence. Am J Obstet Gynecol. 2020;223(2):167-176. doi:10.1016/j.ajog.2019.12.006
ABOUT THE AUTHOR
Tyler Raeford
Tyler Raeford recently graduated from the Philadelphia College of Osteopathic Medicine. He will be a Family Medicine Resident at Prisma Health USC School of Medicine – Seneca FMRP in Seneca, South Carolina. The knowledge gained about FABMs from the FACTS elective is invaluable to him as he plans to deliver full-spectrum family medicine in a rural or underserved area. He welcomes the opportunity to talk to young couples with varied backgrounds and levels of health literacy about their fertility and looks forward to speaking to other physicians and medical students about all the options for family planning.
