December 16, 2021

By Grace Gearhart

 

Persevering with FABMs: One Couple’s Experience with the Creighton Model

Editor’s Note: This interview with a user of the Creighton Model provides an example of a fertility awareness-based method (FABM) that is a true form of family planning, as it enables couples to use it to avoid or achieve pregnancy. Beyond family planning, the woman’s story also highlights the clinical applications of this versatile method. Grace Gearhart conducted the interview while on the FACTS elective. Like so many students on the elective, Grace felt the experience enhanced her learning as she witnessed the significant impact FABMs can have in the lives of women, couples, and families.

Introduction

“Unleashing the power of a woman’s cycle” is a phrase utilized by the Creighton Model FertilityCare System. This method of natural family planning allows a woman to track the quality of her cervical mucus throughout her cycle to identify the potential fertile window and infertile phases of the cycle. The standardized system also serves as a tool to aid in the diagnosis and management of medical conditions such as endometriosis, infertility, polycystic ovarian syndrome (PCOS), and more. 

I chose to interview Jane,* who initially used the Creighton Model to achieve pregnancy, and now, to postpone pregnancy. She is a 26-year-old woman with no significant medical history. She is not on any medications. Her menstrual cycle is consistently around 28 days long with a menses length of six days and light spotting at the end. She reports her luteal phase ranges from 8 to 14 days and rates her painful cramping per cycle at a three out of ten, sometimes spiking to a five.

Jane’s parents used FABMs, so she grew up hearing about the various methods of spacing children naturally. She decided to learn the Creighton Model because her mom and sister use it. It was the right decision for her, as she could go to them as a resource if she needed assistance. Jane learned how to use this method from a trained instructor who had an overview class, and then met with her one-on-one throughout the year. 

A Shared Responsibility

Every different FABM has its own learning curve. Jane remarked, “It was hard to learn in the beginning because it can seem very subjective. I doubted my observations a lot. It took a little bit of time to get consistent with observations, which is the most important part for the method to be effective. I had a hard time identifying my peak day, and this became particularly frustrating once I was married and hoping to achieve pregnancy.” This was where her husband’s involvement with the method was so helpful. He was encouraging and helped her stay committed to that method when she wanted to try another one, and when she thought she was not doing it correctly. It required both of their attention to help her not feel overwhelmed with being the only one responsible for their fertility. 

Jane noted that using the Creighton Model has made her so much more in tune with her body. She knows what is happening at different stages of her cycle and how her hormones are impacted by certain things, such as stress. She started charting while planning a wedding during the pandemic. Even though she had a period every month, she learned that her lack of a peak day was her body responding to high levels of stress, in addition to another abnormality. What she thought was her inability to understand the method was actually the method working correctly. The Creighton Model enabled her to detect abnormalities in her cycle, indicating its merits as a diagnostic tool. 

Charting and Targeted Hormonal Therapy

As Jane explained, “I was not confident in my observations of mucus to identify a peak day. I had a period every month but couldn’t pin down what a ‘normal’ mucus buildup was for me. I seemed to have mucus patches but no consistent buildup and peak. My practitioner encouraged me to share my chart with my doctor, who is Creighton trained, and she had my hormones tested.” 

Jane’s physician was able to do targeted hormone testing during the luteal phase because Jane was charting, and thus able to identify what was likely her post-ovulatory (luteal) phase. This is important because the levels of estradiol and progesterone vary throughout a woman’s cycle. In Jane’s case, these tests indicated she had a very low estradiol level in the luteal phase; therefore, her doctor prescribed estradiol for 10 days during her luteal phase.* 

Jane got married in May, had hormones tested in July, started estradiol in August, and got pregnant the next cycle in September. She is grateful to have started charting before marriage, since it enabled them to identify a problem, fix it, and conceive as planned. That month, she was finally more confident identifying her peak day and noticing a mucus buildup. She also felt different.

“I noticed my breasts being very tender more than two weeks before my expected period,” Jane recalled. “I took a pregnancy test a week before my period was supposed to start and it was negative. I took another one a couple of days after my missed period, and it was positive.” 

The couple now has a three-month-old baby girl! 

Postpartum Strategies

The couple plans to postpone another pregnancy until after their baby turns one. Being three months postpartum, Jane is facing new challenges with charting. She is fully breastfeeding her three-month-old and has not had a return of menses, so she is correctly using the lactational amenorrhea method (LAM). She has begun transitioning back to the Creighton Model by meeting with her instructor every two months until the return of menses. This way, she can get back in the habit of charting before she is six months postpartum and can no longer rely on LAM for family planning. 

Commenting on another charting challenge postpartum, she noted, “It has been harder to get rid of seminal fluid postpartum, and that is a problem with a method that is entirely based on mucus observations. I think it is more challenging because my pelvic floor muscles are still recovering from pregnancy and labor.” Jane has been encouraged to continue the Kegel exercises after intercourse to attempt to eliminate this confusion. Despite these challenges, Jane is grateful her husband encouraged her to be consistent and stay with one method. 

To women unsure about using FABMs, Jane shared that the Creighton Model gave her so much more than a tool to space their children. Her hormone imbalance affected her in more ways than just her desire to get pregnant. Although it takes some work in the beginning to learn the method, once you use it consistently every day, it becomes second nature. 

For medical professionals, she offered the following advice, “Encourage your patients to follow one method consistently. There will probably be the exceptional patient who wants to take a deep dive into all the fertility signs, but for the average patient, they need simple consistency. Trying to follow all the signs of fertility could easily lead to burnout and becoming overwhelmed. Be encouraging and supportive of how much goodness it can bring them personally and for their marriage.”

Lessons Learned

In interviewing Jane, I was able to see how FABMs enriched the life of a real person in the ways I learned during the FACTS elective. First, using FABMs to aid in diagnosing medical conditions is based on the fact that a woman’s hormonal fluctuations during a single cycle alter the cervical mucus, cervical position, and basal body temperature. Jane could not identify her peak day because she was observing her cervical mucus and noticed it was not manifesting in the expected pattern with normal hormones. This prompted hormonal testing and treatment, and it aided in achieving pregnancy. 

Second, we learned how FABMs can improve a couple’s communication and bring union to the marriage. Jane was frustrated and ready to give up. She wanted to move on to a different method. Why not? There are plenty of methods to choose from; however, sometimes too many options can be overwhelming. Jane’s husband encouraged her to persevere with her choice of the Creighton Model, which in turn led to a quick turn-around of hormone testing and a positive pregnancy test. She was grateful to her husband and did not feel alone in her frustration and responsibility for their fertility. Switching would have required classes to learn another method with its own learning curve, possibly leading to more frustration and stress. 

Through this couple’s story, I gained a wealth of knowledge about Jane’s cycle and FABMs in general, and it solidified my learning about the science behind a woman’s cycle. I got to see these values play out in ONE patient. Imagine how much more information and value we can obtain by continuing to learn and teach about the power of a woman’s cycle. 

*Editor’s Note: Readers familiar with FABMs and their clinical applications may be intrigued that estradiol was used for luteal phase support in this patient. In this case, the woman was able to conceive and had a live birth. Various studies, including a 2017 systematic review assessing articles from 2000 to 2016 as well as a 2013 study, provide some support for adding estradiol to progesterone in the luteal phase to potentially enhance the likelihood of implantation in certain subsets of patients. The current literature confirms the need for further study to provide more conclusive evidence regarding the use of estradiol in this context.

* The patient’s name was changed to protect her privacy, and permission was granted to use all quotes and information.

References

[1]  Pinheiro LMA, Cândido PDS, Moreto TC, Almeida WGD, Castro EC. Estradiol use in the luteal phase and its effects on pregnancy rates in IVF cycles with GnRH antagonist: a systematic review. JBRA Assist Reprod. 2017;21(3):247-250. Published 2017 Sep 1. doi:10.5935/1518-0557.20170046.

[2]  Kwon SK, Kim CH, Lee KH, et al. Luteal estradiol supplementation in gonadotropin-releasing hormone antagonist cycles for infertile patients in vitro fertilization. Clin Exp Reprod Med. 2013;40(3):131-134. doi:10.5653/cerm.2013.40.3.131.  

ABOUT THE AUTHOR

Grace Gearhart

Grace Gearhart is a fourth-year medical student at Kansas City University. Having completed the first two years of medical school in Joplin, MO, she moved back home to Wichita, KS to complete the final two years. She plans to practice family medicine in Wichita. Grace desires to encourage and aid women in using FABMs to diagnose medical conditions and plan their families. She took the FACTS electives to gain an all-encompassing knowledge of the world of FABMs and how to incorporate them in patient care.

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