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Northwest Family Services, January 4, 2012 (About Natural Family Planning)

1. What is Natural Family Planning (NFP)?

NFP is an effective, scientifically based method of family planning that treats fertility as a normal, healthy process. Based upon observations of changes in the woman's body that reliably reflect her fertility or infertility, the couple using NFP interprets this information and then either abstains from or engages in marital relations during the fertile time, depending upon their family planning intention.

2.What are the signs of fertility observed for NFP?

Depending on the method of NFP used, couples using NFP may observe natural biomarker changes in the woman's cervical mucus, vaginal sensations, changes in the cervix itself as well as changes in her waking temperature.

3.Are there different methods of NFP?

Yes. Some NFP systems utilize just the cervical mucus observation. Others include an awareness of vaginal sensations. The Sympto-Thermal Method incorporates observation of the cervical mucus, vaginal sensations, changes in the cervix itself, as well as the woman's waking temperature.

4. How is NFP different than "Rhythm"?

It's not Calendar Rhythm which gave only a guesstimate of fertile times. Modern methods of NFP are based on daily observations so any variation (earlier signs of fertility or delay in fertility) may be taken into account. It can be used after childbirth and discontinuing hormonal contraceptives and during premenopause.

5.I don't have 28-Day cycles, can I still use NFP?

Some women think that "regular" means having a 28-Day cycle. A typical cycle range is 23-40 days, so a week variation in one's cycle is considered typical. Even women who do not have "regular" cycles can use NFP. In all cases, it is important to learn from a certified NFP Provider.

6.What about using NFP with cycles that aren't typical?

NFP works no matter what the woman's cycling pattern. It can be used with long or short cycles, when discontinuing hormonal contraception, as well as during breastfeeding and pre-menopause. While Calendar Rhythm required regular cycles because it was based upon a woman's cycling history, modern NFP methods are based upon day-to-day observations with decisions about fertility based upon those observations.

7.How can NFP help a couple who wants to have a baby?

A great benefit of NFP is the same information couples use to avoid a pregnancy, can help them know the best time to achieve a pregnancy. It also provides for very early identification of pregnancy and the information to set a correct due date. NFP chart information helps identify fertility problems and the best times in the cycle for a doctor to administer fertility tests.

8.I am expecting a baby and will be breastfeeding it. Will I be able to use NFP while breastfeeding?

The return of fertility after giving birth depends upon whether or not a woman is breastfeeding and how she is breastfeeding. It also depends upon the individual woman since there is a wide range of when fertility returns. The best thing to do in this circumstance is to consult with an NFP Provider for specific recommendations for your cycling pattern based upon your charting and to take a free NFP While Breastfeeding Refresher Class.

9.What's involved in using NFP while breastfeeding?

Just as at other times, it is important to chart while breastfeeding, even if cycling is delayed for many months. Ovulation can precede your first bleeding, and you will need to make observations as well as chart and interpret them to know when you become fertile. Because ovulation may not occur for many months, the cervical mucus observation is the focus during this time. However, it is recommended, for Sympto-Thermal users, that the temperature observation may be made as well. It is important to work with a certified NFP Provider for feedback during this time.

10.What's involved in using NFP as one approaches menopause?

During this time of life, cycles may become more irregular - both shorter and longer. Because of this it is important to consider the days of menstruation to be possibly fertile. If a short cycle occurs, the cervical mucus flow may begin during the heavy flow days and be masked by the bleeding. Beyond that, it is important that there be good, consistent charting. Both the cervical mucus sign and temperature pattern provide valuable information about the fertile and infertile times. We offer free NFP During Menopause Refresher Classes for couples in this time of their reproductive lives.

11.I want to discontinue hormonal contraception. Should I learn NFP first and then discontinue it or should I discontinue it now?

To really learn NFP, it is best for you to discontinue your use of contraception. While you may be able to learn the method in a theoretical sense, an important piece of learning NFP is to apply the information to your own cycles. While it may get you in the habit of observing and charting, any charting you do while using hormonal contraception will reflect those hormones and not your own cycling pattern.

12.How long will it take for me to return to my own cycling pattern?

It depends on the type of hormonal contraception you were using and your individualized response to it. Those discontinuing a hormonal IUD or birth control pills have a quicker return to typical cycling than someone discontinuing injectable contraception or implants. No matter how long it takes for cycling to return, NFP can be used confidently. It is important to work with a certified NFP Provider for feedback during this time.

13.How important is it that I take my temperature at the same time each day?

For those using the Sympto-Thermal Method of NFP, it is important to get a usable temperature pattern and so it is very important to take your temperature pattern at roughly the same time each day while you are trying to establish infertility. You can take it up to 45 minutes before or after your usual time without considering the temperature disturbed, provided all temperatures are taken before 7:30 a.m. Once you are in the post-ovulatory infertile time, you can relax regarding this point.

14.What if I work a night shift?

For women who regularly wake up later than 7:30 a.m. or have jobs with irregular hours, they can take their temperature when they wake up. Generally, they would give more emphasis to the cervical mucus signs and clarify with one's NFP Provider first.

15.How long should I take my temperature?

If you are using a digital thermometer, the recommendation is that you take your temperature a minute beyond the beep indicating that an initial reading has been reached. This enhances the accuracy so necessary for NFP.

16.What about using an ear thermometer?

The tympanic or ear thermometers are not accurate enough to be used for NFP.

17. What about taking my temperature under my arm?

Axillary or temperatures taken under the arm are not accurate enough to be used for NFP.

18.What should I do if I am sick or sleep in?

Take your temperature anyway, chart it, and make a note of the disturbance.

19.What if I have to get up during the night?

As long as you have one hour uninterrupted sleep prior to taking your temperature, you should get a usable reading. Light activity such as getting up briefly to care for a child or to go to the bathroom should not affect the temperature reading. However, if you are up repeatedly for extended periods of time, you may find that your reading is disturbed. Just make a note of it on your chart.

20.How many times a day do I have to do the tissue exam?

You should do the tissue exam every time you go to the bathroom - both before and after urinating or having a bowel movement. Bear down, as if trying to force mucus down, before the last tissue exam of the day.

21. If I have a yeast infection and don't feel confident of my mucus observation. What should I do?

If you don't feel confident of your mucus observation, give greater weight to the temperature observation. This is a perfect time to apply a temperature-only rule to determine the post-ovulatory infertile time.

22. What's involved in learning NFP?

Learning NFP may be done in a class situation, one-to-one instruction, or through an online course. Whatever format is utilized, instruction may consist of a presentation, learning activities, and personalized follow-up with chart review. Simply reading a book, or even attending a class without personal attention, is not adequate.

23. Is it difficult to learn NFP?

The observations themselves can be learned fairly quickly. In one World Health Organization (WHO) study, 97 percent of women were able to identify the cervical mucus changes in the first cycle. Most people are familiar with taking a temperature reading and find it takes just a little effort to establish a habit of taking it upon waking. However, each woman's situation and cycling pattern is unique, so personal attention is a very important component of instruction. This may take place face-to-face, over the phone, or in email correspondence. It is critical for a couple to learn from a certified NFP Provider.

24. What's involved in follow-up?

In follow-up, the NFP Provider reviews the client's chart for correct and consistent charting and interpretation. There is a dialogue about how the observations are being made and the correct understanding of definitions and rules are clarified. It is also an opportunity for the client to ask questions, receive information appropriate for the specific cycling pattern being experienced, and be encouraged and supported in the practice of NFP.

25. Is it difficult to use NFP?

The basics aren't hard. Most people master them fairly quickly and easily. Since most of the observations can be done during a woman's daily person care, it takes very little time. The challenge in using NFP can be integrating NFP into the couple's lifestyle and adjusting to the periodic abstinence required if avoiding pregnancy.

26. How much abstinence is involved?

Because each woman's cycling pattern is just a little different, and each cycle is unique, there is no hard and fast rule about the amount of abstinence. For a woman who has typical cycling, the average number of days of fertility is about 9-12, at least for beginners. It is important to keep in mind that studies have consistently shown that couples using NFP to plan their family have as many (or more!) acts of marital relations during a cycle as other couples, it is just distributed differently.

27. How does periodic abstinence affect the couple's relationship?

In a five country trial, the WHO found that "marital friction" as a result of periodic abstinence was uncommon in 80-99 percent of cycles according to both men and women. In this same study, over 95 percent of both men and women rated their satisfaction with NFP as good or excellent. Couples using NFP report increased and enhanced communication, increased self-esteem, and enhanced spirituality.

28. Does NFP really work? How effective is it?

Modern methods of NFP have been shown to be highly effective with method effectiveness figures ranging from 97-99.9 percent. Use effectiveness, reflecting the actual experience in day-to-day life, shows 90-99 percent effectiveness. To achieve these effectiveness figures, it is important that couples participate in a structured learning program with individualized follow-up, that they chart consistently and correctly, and that they follow all rules, especially complete genital abstinence during the method-defined fertile time.

29. What are some reasons for using NFP?

Biological reasons, such as one's health and concern about the side effects of artificial methods, including sterilization. Many couples don't want to take the risk of harmful side effects just to make sex convenient. Some have started on Depo-Provera to simplify their lives, but gain weight or suffer depression. Others decide that they just want to be hormone-free, buying or growing vegetables that are chemical free and realizing that they have the same concern for their own body's ecology. Many find that NFP is a better way for them.

Psychological reasons, such as the positive interaction that can occur as the couple manages family planning together. One "side effect" is that 70 percent of NFP couples who were surveyed indicated that the practice of NFP increased their communication level. One husband relates:

"I never thought that after twenty years of marriage that I would ever feel the intensity of desire for my wife I felt when we were first married. Yes, we still loved each other, but there was something missing. I just chalked it up to being older, having kids, being together for twenty years. Something amazing happened when we learned NFP - the abstinence brought back the freshness, the anticipation, we had enjoyed when we were first married.

We were using a barrier method of family planning before NFP, but I hated suiting up for sex. It seemed wrong to establish a barrier from the person you were to be as intimate as possible with - it contradicted the unity of the act. NFP is so much more spontaneous and congruent with what sex means in a committed, loving relationship."

Moral and ethical reasons, such as the recognition that some forms of contraception actually interfere with the implantation process after conception has taken place. These methods may act as abortifacients. In the words of one husband: "I had heard that hormonal contraceptives can cause really early abortions by preventing implantation, so I asked my doctor about it. She said that this isn't true. However, the more I read, the more it seemed that there really is the possibility that this is true. I'm not willing to take that chance and I also think it is an injustice for me, as a man, to ask my wife to negate her biology just so she can be sexually available without concern for pregnancy. Justice requires that we both share in the responsibility for family planning. NFP fulfilled this for us."

Philosophical and religious reasons, such as faithfulness to one's religious beliefs and an understanding of sexuality as comprised of a unitive and procreative dimension - inseparable parts of a whole. NFP allows the couple to respect this part of who they are and to practice responsible parenthood.

NFP helped me appreciate the cycle of life. It makes me very thankful that there is a God who has made this - how wonderfully it all works together. As Psalm 139 says, we are fearfully and wonderfully made! I feel good about NFP because it allows me to live congruently with Catholic teaching. I'm not putting an obstacle between myself and my relationship with God, and my relationship with God has gotten closer.

30.Are there any fertility devices or tests that can be used for NFP?

There are a number of devices and hormonal tests that are marketed with FDA approval for identifying the fertile time of the cycle. To date, none of them have been FDA approved to help avoid pregnancy. Such approval expects a high standard of technological effectiveness to identifying fertility and infertility. Right now, learning the method through classes is the most effective way to practice NFP. Some women find the devices reinforce what they have learned in classes, providing them with more confidence while learning.