
“Give it Three Cycles” – Advice from an FABM User
By: Stephanie E. Nonawzki, DO
Director’s Note: Dr. Stephanie Nonawzki, a Pediatrics resident and former participant in the FACTS elective, interviewed a woman who countered the stereotypes about fertility awareness-based methods (FABMs) and the patients who use them. The patient shared her positive experience with the Creighton Model as an effective family-planning method but acknowledged the challenges and commitments that accompany these methods. Her advice to women and couples considering these methods? Give it three cycles and check in with your partner. It’s hard, but it’s worth it. As always, FACTS recommends learning how to use an FABM with guidance from an educator or clinician trained to teach these methods.
There are many myths about Natural Family Planning (NFP): it’s not effective; it’s the “rhythm method;” it’s too complicated; it can only be used by women with regular cycles, etc. However, my conversation with Katharine* disproved those assumptions and stereotypes. Beyond Katharine’s example, there is also strong research and science to back up modern methods. Media portrayals can be far from accurate.
Katharine was first introduced to NFP, or fertility awareness-based methods (FABMs), before she and her husband, Thomas,* could begin marriage prep with their parish priest. The couple was not required to use FABMs in their marriage, but they did have to learn about them. Katharine was trained in the Creighton Model and the couple continues to use the method. She has also chosen an NFP-only doctor to ensure she isn’t pressured into methods that conflict with her desires and beliefs.
Katharine and Thomas have successfully used Creighton to both avoid and achieve pregnancy. She is currently trying to avoid pregnancy because she’s nursing her youngest and likes to have some spacing in between children. After asking if she plans to have any more children, Katharine said that she never says she’s definitively done — but she’s done for now.
Katharine appreciated that FABMs, like Creighton, have taught her more about her cycle and her body. Using FABMs has also brought her closer to her husband because these methods require communication about everything, from their family plans to her cervical mucus to navigating the desire for sexual intimacy when trying to avoid pregnancy during a fertile period.
“Katharine appreciated that FABMs, like Creighton, have taught her more about her cycle and her body.”
She has also enjoyed the inside jokes and camaraderie with her friends who practice FABMs too – the comments made about sexual intimacy, the finger movements used to imitate checking mucus stretchability. She is grateful to have a group of couples also familiar with and practicing these methods.
FABMs are not without their challenges, however. They can be difficult, time consuming, and require a financial investment depending on the method and the biomarkers a woman chooses to monitor. It takes a lot of mental energy to keep track of things like cervical mucus, especially when you don’t record it until the evening. Katharine was also frank about how difficult it can be to abstain during the ovulatory phase when your “libido is highest.”
“Katharine was also frank about how difficult it can be to abstain during the ovulatory phase when your “libido is highest.”
Katharine continues to chart with the Creighton Model and uses a phone app developed by a friend to track her cycles. She and Thomas have found that it works best when he helps her chart at the end of the day, but the app does not allow her to share her chart with him. She wishes there was a way for them both to edit and stay up-to-date because it is currently an obstacle to her consistent charting.** Presently, she chooses to remain aware of her mucus but doesn’t write anything down. Even though it’s “against the rules,” Katharine believes that she has practiced the method long enough to have a good sense of her fertility without recording her observations every day.
Katharine gives this advice to anyone interested in trying FABMs: give it at least 3 cycles or 3 months. Check in with your partner to see how things are going. You have to make the mental commitment for a short period of time. It’s hard but worth it. Katharine noted that FABMs can be more challenging for some couples depending on the woman’s cycle, but she feels she’s had it easier than many.
“To anyone interested in trying FABMs: give it at least 3 cycles or 3 months. Check in with your partner to see how things are going … make the mental commitment for a short period of time. It’s hard but worth it.”
Katharine also shared her recommendations for practitioners unfamiliar with FABMs. She’s met friends and nurses who have never encountered these methods. It’s not the rhythm method anymore as many people still assume. Incorporating more training, even if just an introductory session, for medical professionals would be beneficial to broaden care for their future patients.
Lastly, Katharine joked that a lot of people blame the woman for an unplanned pregnancy – “Well, you were fertile, you got pregnant.” When in actuality, it takes two, and some could argue with that logic that it’s always the man’s fault because he’s always fertile. At least the woman gives you some chance of avoiding pregnancy because she’s only fertile for up to six days a cycle!
*Names have been changed to respect the privacy of the interviewee. All information is shared with permission.
Addendum
**The Creighton Model now offers patients the option of purchasing the official Creighton FertilityCare App as an alternative to paper charting. This app is a web based app that seamlessly weaves observations, charting, and instructions and support from a woman’s FCP. Both the woman and her partner can access the app from their cell phones or computers and she can easily send a snapshot of her chart to her FCP as needed. Presently, as a web based application, this app is only available through the St. Paul VI Institute Publications Department rather than an app store. For more information, clients can inquire with their FertilityCare Practitioner (FCP) to purchase the official app.
ABOUT THE AUTHOR
Stephanie E. Nonawzki, DO
Stephanie E. Nonawzki, DO, a graduate of the New England College of Osteopathic Medicine, has a passion for social justice and advocacy work. She spearheaded the start of the University of New England’s Equity and Diversity Advancement Committee and served as the Council of Osteopathic Student Government President’s Diversity Representative. She began her pediatric residency at the University of Rochester Golisano Children’s Hospital in June 2021, where she intends to continue her diversity, equity, inclusion, and advocacy work.