A Natural Approach to Birth Control

Did you know there’s a birth control method that works completely with your own body’s fertility signs and signals? Are you aware that this method can be used safely during breastfeeding, and doesn’t require any drugs or chemicals, or contraceptive devices? It’s true! It’s called Natural Family Planning, and it’s safe, effective and easy to use once you’ve had some practice. This is a great method for a woman who is looking for a natural way to prevent pregnancy, and one which works well if she is nursing her baby.

Before we get started, it should be understood that this method can be used without artificial protection of any kind, such as condoms, so it’s best for women who are in monogamous relationships where both partners have been tested and found to be clean for sexually transmitted diseases and infections.

We’re going to talk about a specific style of Natural Family Planning called the Fertility Awareness Method. This is a method which relies on some signals from your body that you observe, to figure out when you are fertile. It’s during fertile times that you will either abstain from vaginal intercourse, or use a condom or other barrier method (such as a diaphragm), to prevent sperm from entering your vagina.

Your cycle has three phases: pre-ovulatory (which starts with your menstrual period; the first day of a new cycle is the first day of your period. This is known as Cycle Day 1); ovulatory (the period leading up to and including the day you ovulate, which is when your body releases an egg that may be fertilized by sperm if they are present in your reproductive tract); and luteal, which is the last phase and the one where you are no longer fertile because the egg either has been fertilized and will implant in your uterus, or it will die because it did not meet up with sperm to be fertilized. In learning how to use the Fertility Awareness Method of NFP, you will be watching your body’s signals to understand which part of your own cycle you are in at any given time, and acting accordingly, by either avoiding sex or using condoms during the fertile time, or enjoying unprotected sex during the phases where you are unable to become pregnant.

Your body gives you some clear signs when you’re fertile. The Fertility Awareness Method requires you to observe two things daily: your basal, or waking, temperature, and your cervical mucus. A third optional sign is your cervical height and/or opening. Your basal temperature is your body’s temperature when you first wake up in the morning, before you’ve gotten out of bed, and after having had at least two hours of sleep. You can buy a special basal thermometer at any pharmacy or discount store, and it will be sold near all the regular fever thermometers.

A basal thermometer  is specially designed to read only temperatures within a certain range, below the temperatures you might see with a fever, but a fever thermometer can be used if you don’t have a basal thermometer. They are not expensive, however, and may be more effective because they are calibrated to be more precise; many are made to read temperatures to within a hundredth of a degree. It’s also helpful to find one with a built-in light, because you’ll probably be reading your temperature early in the morning while it’s still dark in your bedroom.

The key to using your basal temperature to understand your fertility is this: after you have ovulated, your temperature will rise noticeably. Basal temps will vary from one woman to another, but what you’re looking for is a rise in temperature that is sustained over at least three mornings; it’s normal for pre-ovulatory temps to be pretty low, in the 97-degree range, with post-ovulatory temps being 98 degrees or higher. The change is not large (sometimes only half a degree or so), but you will notice it. It’s important to take your temperature at the same time every day. Taking it later or earlier than normal can affect the reading, so you may want to set an alarm to be sure you’re waking up at the same time every morning.

Many woman use a temperature chart to keep track of their daily basal temps, so that they can see the trend at a glance. You can make your own chart with graph paper, or download one from the internet; there are lots of resources online. Many people refer to this birth control method as, simply, “charting,” and you may read online that there are women using it to achieve pregnancy, too. For our purposes, the focus is on preventing pregnancy, but it is true that this method can help women get pregnant as well.

The second main sign you need to observe when using the Fertility Awareness Method of NFP is your cervical mucus. Did you know that your body produces different types of mucus, found in your vagina and made by your cervix (the lower part of your uterus), and that it changes depending on where you are in your cycle? It’s true: cervical mucus is a really interesting substance and it can tell you a lot about your body. Right after your period, your body will begin to produce mucus which will gradually change from sticky, tacky stuff like rubber cement, to lotiony, wet, and creamy, and finally, to clear and stretchy, like egg whites, as you approach ovulation.

Cervical mucus serves a very important purpose: to help sperm reach your egg. The wetter and more stretchy the mucus (in fact, the more like semen it is), the easier the sperms’ journey will be through your reproductive tract. That’s why the mucus becomes more copious and fluid the closer you get to ovulation; it helps sperm travel through your cervix to your uterus, where it will continue to swim toward your Fallopian tubes to wait for an egg to be released. Watching your cervical mucus can tell you a lot about where you are in your cycle, and can help you prevent pregnancy by avoiding vaginal intercourse or using a barrier method.

Beginning as soon as your period is over, you will need to check your cervical mucus every time you go to the bathroom. This seems like a hassle at first, but with experience, you’ll get used to it. Some women find it easier to do this in a squatting position on the floor, others do it while sitting on the toilet. Take your index finger and middle finger and insert them together into your vagina, and reach up until you hit something that feels like it’s hanging down inside your body. That’s your cervix. It’s the lower portion of your uterus. When you are not fertile, your cervix will feel hard, like the tip of your nose, and will be at its lowest position in your vagina. When you are fertile, it will feel softer, and will be very high up, sometimes almost too high for you to reach.

You will also notice what feels like a small hole on the tip of your cervix. This is called the os, and it’s the opening from which your menstrual blood flows out of your uterus; it’s also the part of the uterus which will stretch, or dilate, when you are in labor and delivering a baby. During the fertile phase of your cycle, this opening will enlarge, to allow sperm to swim inside more easily. A fertile cervix is high, soft and open, while an infertile-phase cervix will be low, firm and closed. Cervical texture and openness are two optional signs when using FAM/NFP.

When using NFP, you will want to retrieve cervical mucus from the cervix itself, where it will be freshest and most recently produced; this is important because it can change fairly quickly in the few days before ovulation, and you want the best accuracy when determining your fertility. Using your fingers, “squeeze” your cervix and, holding your fingers together, take them out and have a look. Try spreading your fingers to see if the mucus is stretchy at all. Infertile mucus will be pasty, gluey, white, not stretchy. Or you may see lotiony, creamy mucus, which is also probably infertile, but most people using NFP treat it like it’s possibly fertile, and will abstain or use condoms when they see it.

Stretchy, clear mucus is the most fertile kind, and unprotected sex while you have this kind of mucus is likely to result in pregnancy. Because mucus can change quickly, you will want to start abstaining or using a condom (or other barrier method) BEFORE you see the change to clear or “egg white” mucus. This is why it’s so important to check your mucus numerous times a day, especially while you’re still learning about your own body’s patterns, and getting used to observing your signs.

So let’s put it together: you have basal body temperatures, and you have cervical mucus. Low temperatures and sticky mucus are usually indicative of an infertile time in your cycle, and you will usually see both right after your period ends. As you approach ovulation, your temperature will stay in the low range (whatever is low for you, after you’ve had a chance to observe it for awhile), but your cervical mucus will be getting wetter, slipperier, and clearer, more like egg whites, in the days before you actually ovulate.

During the pre-ovulatory phase, you’ll first experience dry days, where you have no mucus, are considered safe for unprotected sex, but they usually happen early, right after your period ends. Next will be sticky mucus days, which are also usually safe, but you need to watch your cycle carefully for awhile to see how many you are getting; if you ovulate early in your cycle, you will want to use a condom or abstain sooner (many women choose to chart several cycles before ditching the condoms or other barrier methods, just to get a feel for everything before relying on FAM/NFP as the primary for of birth control). Sticky mucus will transition to creamy mucus, which should be treated as potentially fertile, and next will come egg white mucus which the most fertile type you will have, and happens in the few days preceding ovulation, also known as the ovulatory phase.

The day after you ovulate, your basal temperature will be higher than it had been (“high” is subjective; you will need to do this for a few months to get a feel for what “low” and “high” mean for your individual cycle), and it will stay elevated for at least three mornings to tell you that ovulation has occurred. You are safe to have unprotected sex on the night of your third morning of high temperatures, because you can assume that you have ovulated, and that it is too late for sperm to reach your egg to fertilize them.

Around the same time, your cervical mucus will be drying up, and going back to the sticky, or possibly somewhat creamy, state it was in at the beginning of your cycle, after your period ended. Now you are in your luteal phase, which is when the fertilized egg would implant, or if you weren’t pregnant, the unfertilized egg would eventually die, and you’d get your period, and the whole thing would start over again with a new cycle.

Breastfeeding mothers can also use this method, even if their periods have not yet returned post-partum. The principle is the same: you would watch your cervical mucus daily to observe changes that seemed to be heading toward a fertile phase. Every woman is different, and the return to fertility varies from one woman to another, and the same woman can have different experiences with each baby, too.

The return to fertility depends a lot on frequency of nursing, as well as what time of day the nursing is happening; many women find they begin ovulating again when their baby starts sleeping through the night (i.e., going more than 5 hours without waking to nurse), because nighttime nursing seems to have a greater inhibitory effect on the hormones of fertility. Women who want to use NFP while nursing will need to be vigilant about checking their cervical mucus, and may wish to consider temping too, but that can be more difficult with a young baby and an unpredictable sleeping schedule. Many women choose to use condoms or other barrier method until their periods return and cervical mucus observation and temping can be done more reliably.

Besides being drug- and chemical-free and affordable, another reason women choose NFP is because it doesn’t rely on having a regular or even an especially predictable cycle. Some other methods (like the so-called “rhythm method,” which is unreliable and not recommended) hinge on the premise that a woman has perfectly timed cycles, getting her period every 28 days and ovulating on cycle day 14. Most women don’t have cycles like this. They may have cycles which are longer or shorter, and they may ovulate on any other day of their cycle, all of which is NORMAL. Our bodies are not machines, and we will not usually see everything happening in a perfectly-timed fashion. That’s why FAM/NFP is  great for ALL women; you’re observing your OWN body’s fertility signs and changes, and not relying on a calendar or someone else’s idea of what your cycle is supposed to be like. You can safely use NFP no matter what your cycle is like, even if you’re only getting a few periods a year.

Another great thing about this method is that it can help you spot potential problems and bring them to the attention of your healthcare provider. For instance, you will be able to tell whether you are ovulating or not; if you get consistent cycles that don’t seem to show an ovulatory pattern (based on temperature and mucus), you may want to discuss this with a professional who can test you to make sure your hormones are in proper balance.

Another interesting (and beneficial) feature is that you can figure out how long your luteal phase (between ovulation and your period) usually is; this may become important later on if you want to become pregnant, because the luteal phase needs to be long enough to support implantation of a fertilized embryo. A healthy luteal phase is one that lasts at least 10 days; most women have a luteal phase of 10-14 days. The luteal phase, by the way, is the only part of your cycle that is somewhat fixed; from woman to woman, the luteal phase length may vary, but in an individual woman, you will usually find that yours is about the same length every cycle. This means that your ovulation date determines the length of your cycle: you may ovulate on the same exact cycle day every cycle, or you may not. Many women find their ovulation date varies a bit, or maybe even a lot, from one cycle to another, but their luteal phase is usually about the same every cycle, give or take a day.

There are some great resources at the end of this post, to help you explore this method further, and see some visuals to hopefully make it seem more understandable. It seems like a lot to digest all at once, so further reading would definitely be encouraged. You may also want to discuss this method with a midwife or gynecologist, but don’t be surprised if they don’t have a lot of info for you. Many practitioners will be more inclined to recommend birth control methods which rely on drugs or devices, and some will be uninformed about FAM/NFP altogether. This is a method which often requires women to take responsibility for their own education. But those who use it find that they prefer over other methods because of its safety, effectiveness and reversibility, as well as its low cost; the only thing you really need to have is a thermometer.

Also, you should be cautious when you’re researching this method online because there are many websites devoted to helping women ACHIEVE pregnancy, as opposed to avoiding it, and the techniques and advice are slightly different for each situation, so you will want to read carefully, to make sure you are getting good tips and information for using FAM/NFP as birth control.

Taking Charge of Your Fertility, by Toni Weschler, is a very informative book and an excellent resource for learning how to “chart” for both pregnancy avoidance (contraception, or birth control), and pregnancy achievement. You can find this book in bookstores, or order it online. She also has a great website where you can learn more about FAM/NFP, and download software to help you create your own charts. Her website: http://www.tcoyf.com/

Weschler, Toni. Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health. New York: Quill, 2002.

Planned Parenthood’s website has some good information about FAM/NFP, and your local center can even help you learn to chart in person with a qualified health educator. http://www.plannedparenthood.org/health-topics/birth-control/fertility-awareness-4217.htm

The Feminist Women’s Health Center has a very good online resource for reading and learning about FAM/NFP, with good graphics. http://www.fwhc.org/birth-control/fam.htm


(c) Jennifer Hays. All rights reserved




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