July 1, 2021
By Karen Hayde, DO
Editor’s Note: The mission of FACTS is to educate medical professionals about the evidence behind fertility awareness-based methods (FABMs) so they may teach their patients and incorporate these versatile tools into practice. We educate medical professionals through CME conferences, enduring materials, and our popular online elective, through which we taught 225 students during the 2020-21 academic year.
In the year of the pandemic, the FACTS team expanded the elective to accommodate the increased demand for high quality online education. We also offered two highly successful virtual conferences, with a combined attendance of more than 500 medical and health professionals. Outstanding educators like Dr. Christine Cimo Hemphill imparted new knowledge and innovative ways to approach familiar conditions such as abnormal uterine bleeding and polycystic ovarian syndrome (PCOS).
This interview with Dr. Hemphill describes ways in which a fellowship in NaProTECHNOLOGY enhanced both her training and practice as a physician specialized in obstetrics and gynecology (Ob-Gyn). While on the FACTS elective, Dr. Karen Hayde was grateful to interview Dr. Hemphill to learn how FABMs and NaProTECHNOLOGY may be incorporated in clinical practice.
An Important Last Elective
During my last month as a medical student, I was fortunate to enroll in both parts of the FACTS elective on fertility awareness. Graduation was quickly approaching, and I planned to start residency training in obstetrics and gynecology shortly after the course. It was during Part A of the elective (FABMs for Family Planning) that I first heard about a fellowship in Medical and Surgical NaProTECHNOLOGY.*
The Napro fellowship is a one-year intensive medical and surgical experience where Ob-Gyn physicians develop additional skills in restorative approaches to treat women’s health problems with a design to cooperate with the menstrual and fertility cycle. As someone who is strongly considering fellowship training, I was quite shocked to discover a fellowship program within my specialty that I had never heard of prior to the FACTS course.
In medicine, mentorship and connection play a large role in the journey from medical student to resident and beyond. I sought to connect with and interview a Napro-trained Ob-Gyn physician to learn about her journey within medicine, the decision to pursue fellowship, and how her training and approach differ from that of her colleagues.
A NaPro-trained Physician
Dr. Christine Cimo Hemphill is a NaPro-trained Ob-Gyn physician who was practicing at Geisinger Holy Spirit in Camp Hill, PA at the time of this interview. Her interest in the world of medicine began in childhood. She was a bright and inquisitive student at an early age and sought to put her talents to use through the study of medicine. Like many physicians, she received no formal training in fertility awareness-based methods during medical school, though she was familiar with FABMs prior to medical school and residency.
During her senior year of college, Dr. Hemphill and her husband participated in a marriage course in which they learned about FABMs, and she remained interested in these methods throughout her medical training. She explained, “During my fourth year of medical school, I attempted to do the Creighton Model Medical Consultant course, which is open to any physician. I became aware of the fellowship program and decided that I would eventually like to pursue that training, too.”
She remained in close contact with the program director, Dr. Hilgers, and was offered the opportunity to apply for the fellowship early on in her training. She was accepted as a second-year Ob-Gyn resident, and the unique training she received continues to impact her practice of medicine on a daily basis.
Below are just a few of the surgical applications of NaProTECHNOLOGY in two common women’s health conditions: endometriosis and PCOS.
Surgical Approach in Endometriosis
As a NaPro fellow, Dr. Hemphill completed over 400 surgical cases in one year — more surgical cases in a single year than in four years of residency! Many of the cases she encountered involved patients with endometriosis. She learned three tenants to the surgical management of these patients: visualization, identification, and diagnostics.
The classic lesions most surgical trainees are taught to identify are the brown and red lesions that are fairly easy to visualize. Beyond this, as a NaPro-trained physician, Dr. Hemphill is trained to notice the smallest changes within the abdomen: a “tear-drop lesion” that may be mistaken for normal fluid or a strange tenting on the peritoneum. These lesions are explored in depth, excised, and sent to pathology to confirm the diagnosis.
A diagnostic laparoscopy for the management of endometriosis during Dr. Hemphill’s residency training could be a relatively short procedure. It consisted of a single entry through the umbilicus and a cursory glance to identify lesions with no additional trocars to evaluate the anatomy beneath the ovaries or other structures. As a Napro-trained surgeon, the thorough diagnostic laparoscopy requires patience, time, and practice to explore the entire surface area in the pelvis and also the abdominal cavity.
Surgical Approach in PCOS
The ovarian wedge resection was the gold standard treatment to manage and restore fertility in PCOS in the early 1900s. There were three principal shortcomings in the surgical management in its infancy; scars, infections, and pain. The operation was done through a laparotomy, making for a painful recovery, with antibiotics not readily available and limited options for pain control. As advancements emerged in the medical management of PCOS, this approach was favored over surgical management. Yet, during the past century, a rapid advancement in surgical techniques has led to better surgical outcomes for PCOS patients.
Like many physicians during Ob-Gyn residency training, Dr. Hemphill had never performed an ovarian wedge resection. Part of the training philosophy of the fellowship in NaProTECHNOLOGY is to restore health rather than mask conditions with medications. The ovarian wedge resection has proven to be an excellent and safe option to restore fertility in these patients.
A Vital Skill to Develop
When asked what advice Dr. Hemphill would give to a student or resident considering a NaPro fellowship, she laughed and said, “Become very familiar reading Creighton charts.” She was taught how to do this by a Creighton FertilityCare Practitioner (CFCP) in April during her Chief Year of Ob-Gyn residency.
“NaProTECHNOLOGY has allowed me to have additional tools in my toolbox to address the concerns and problems my patients bring to me. I use these tools multiple times each day and cannot imagine practicing without them. I have been in practice with successful use of NaProTECHNOLOGY as my primary approach for a decade.”
In September 2021, Dr. Hemphill will return to South Carolina to practice at Women’s Health of Kershaw in Lugoff, SC, where she will continue to offer NaProTECHNOLOGY services to her patients. She is “excited to be able to offer this approach to women’s healthcare in my home state.”
*Editor’s Note: The Creighton Model, the foundation for NaProTECHNOLOGY, is an FABM based on a woman’s observations of her cervical fluid, which she tracks on a chart that is then interpreted by a Creighton-trained medical professional. It is one of the FABMs with applications not only for family planning but also in the medical and surgical care of common conditions impacting women’s health. For specific stories of women and couples who have benefited from this approach, visit our blog and search “NaProTECHNOLOGY” and the “Creighton Model.”
Special thanks to Dr. Hemphill for her time and willingness to share some of her story.
Author Bio: Karen Hayde, DO conducted this interview as a fourth-year medical student at the Edward Via College of Osteopathic Medicine-Virginia campus. She will soon begin residency in obstetrics and gynecology at Riverside Regional Medical Center in Newport News, VA. She is thankful for Dr. Hemphill and the FACTS elective course for expanding her understanding of reproductive endocrinology, FABMs, and the benefit of targeted treatment to restore fertility.
THE FACTS CME COURSE IS HERE!
The FACTS 4-part CME Course – Fertility Awareness Based Methods (FABMs) for Family Planning and Restorative Reproductive Women’s Healthcare prepares you as a medical professional to present more comprehensive options for family planning and women’s health monitoring and management of a range of reproductive health concerns. Through online lectures, live case study discussions, and readings, this course will explore the broad applications of modern Fertility Awareness-Based Methods (FABMs) and their role in pregnancy prevention, infertility, and women’s health.
The course is divided into four parts; you may elect to do any or all of them and they may be completed in any order. Each part is worth up to 14 AAFP-approved CME credits.
• Part A, An Introduction to Modern FABMs for Family Planning
• Part B, Special Topics in FABMs for Helping Couples Achieve or Avoid Pregnancy
• Part C, FABMs for Restorative Reproductive Medicine and at Various Stages of Life
• Part D, Medical Applications of FABMs
Click here to download the full lesson schedule for the course.