By: Lee Ann Doerflinger
When my husband and I started using Natural Family Planning 23 years ago, we didn't anticipate it becoming a way of life. We thought of this as a private decision, but we ended up speaking to engaged couples (several thousand by our reckoning), writing articles, presenting at conferences, and teaching. So much for our privacy!
When we married in 1977, no one discussed the morality of birth control options with us. Instead of asking for help, we just started using oral contraceptives – as many other Catholic couples were doing – and, when that proved unsatisfactory, moved on to barrier methods.
In the late 1970s, we stumbled across Margaret Nofziger's book, A Cooperative Method of Natural Birth Control. She explained in very straightforward terms the hormonal basis of modern methods of NFP, and she made using the method sound appealing. In the spirit of scientific curiosity, we bought a basal thermometer – a mercury thermometer marked off in tenths of a degree Fahrenheit, from 95 to 100 degrees (the expanded scale made it more precise). We started recording my temperatures in a lab notebook left over from the days when we were both science majors. My first cycle was too complicated for beginners, but the second actually showed an ovulatory rise which was sustained for three days. I pointed out to my husband that I was no longer fertile in this cycle, and we would not have to use barriers. We have never looked back.
What happened to convince us that this was so much better? Why would a healthy young married couple embrace a family planning method that entails periodic abstinence? And why would a middle-aged couple stumbling toward menopause persist in using this method?
Initially it had a lot to do with the level of satisfaction we felt, physically and emotionally. The physical is rather obvious, but the emotional was an unexpected bonus. It turned out that making love without physical barriers between us meant making love without emotional barriers as well. It required a lot of trust in, and love for, each other that we had not had to exercise before.
As time went on, we also became aware that our marriage was growing in grace. We even found ourselves being looked upon by others as a model couple. A priest friend once commented that if we ever divorced it would destroy his concept of Christian marriage! Understandably, we found this remark rather frightening, but we also felt honored and challenged. We are absolutely not perfect, but we are committed to making our marriage as perfect as possible on this earth. Using NFP is almost a "freebie"– it is something we can do without a lot of effort that we are assured is in harmony with God's will. It has an effect on the way we treat each other and present ourselves to the world. Remarkably, a number of our friends and acquaintances learned NFP after learning that we used it, although we had made no particular effort to evangelize on its behalf.
Divorce rates among those who use natural family planning tend to be very low. I don't know if this is because NFP users are committed Catholics to begin with, or because the communication needed to use NFP successfully feeds those marriages. My experience and feeling is that it is a combination of commitment and communication that fosters happy marriages.
More than a year after we started using NFP, we started trying for our first child. Our decision to wait had been based on financial and medical concerns which finally receded when we had been married almost three years. Anna was born several weeks after our fourth wedding anniversary. Several months later, we realized that we needed more information if we were to go on using NFP successfully. Breastfeeding was suppressing my fertility somewhat, but we wanted to be able to tell where I was in my journey back to regular cycles. Unfortunately, in 1981 not much was known about the effects of nursing on fertility. We took a class in the sympto-thermal method – and while we found the class itself less helpful than we had hoped, it introduced us to the local NFP community. By 1984 when our second child was born, Dr. Evelyn Billings had published her book with Ann Westmore, The Billings Method, which gave a great deal more information about nursing and fertility.
In 1986 our third child was born. By now the impact of nursing on fertility had attracted the attention of the scientific community, and a study was begun on the return of fertility for nursing mothers. One of the study centers was at Georgetown University and I was fortunate to be recruited as a subject. This study eventually resulted in the Lactational Amenorrhea Method (LAM) which allows nursing mothers to rely on the natural infertility of breastfeeding for the first six months after a baby is born, as long as they meet certain conditions.
From that point we moved on to being a "witness couple" for several local marriage preparation programs. I went through teacher training in 1989.
After our fourth child was born in 1992, I was able to use the principles developed in the LAM study to avoid pregnancy. In all of these pregnancies, I was able to calculate accurately the due date for the baby because I was charting and could identify the day of ovulation.
What is Natural Family Planning anyway?
Fundamentally, NFP is a method of observing the signs and symptoms of a woman's recurring fertility and infertility in order to act on this information to either avoid or achieve pregnancy. It assumes that the husband will remain fertile throughout his life. The two major symptoms a woman observes are changes in her waking temperature and changes in her cervical mucus. Learning how to observe and chart these changes and interpret them can take three or four classes, including individual follow-up.
Several methods are available in the United States. The two most popular are the cervical mucus method (popularly known as the Ovulation Method or OM) and the sympto-thermal method (STM). OM involves learning about and charting a woman's cervical mucus. STM includes information about cervical mucus, the basal body temperature, and secondary signs of fertility such as breast tenderness and mid-cycle pain. Variations of these methods abound and have resulted in distinct NFP programs, many of which are available in the United States (see page four). Teachers are usually trained in only one method, and generally practice it in their own lives. They may volunteer to help teach for any NFP group, and they may be part of a diocesan program. In all these cases, they may also be certified by the Diocesan Development Program for Natural Family Planning, which assures the client that the teacher is well-trained in the scientific and theological basis for NFP.
Practical Effects of Learning Natural Family Planning
NFP classes are classes in fertility awareness, not sex education. Many couples learn for the first time that the woman ovulates only once per cycle and that the egg, once released, will survive for less than 24 hours. Most are surprised to learn that sperm can survive for up to five days under the right conditions. Obviously, understanding how to pinpoint the days of maximum fertility can help couples conceive. Less obviously, but just as truly, knowing the days when they should have conceived may lead infertile couples to seek help sooner. Having charted for many months, they are able to start diagnostic tests sooner rather than later, which can be important for couples in their late 30's who have less time to look for causes and solutions than their younger counterparts. When a couple achieves a pregnancy they are able to date it accurately from the day of conception, rather than the date of the last menstrual period which can be misleading.
For women avoiding pregnancy, the method can bring peace of mind. By becoming familiar with her cycles, any woman can learn when she is approaching ovulation and when ovulation has passed. Knowing this, she can predict the first day of her next cycle quite accurately.
Some doctors are skeptical about the effectiveness of NFP in avoiding pregnancy. Many studies, however, have shown it to be as effective as artificial methods. Some continue to associate NFP with the older "calendar rhythm" which had a pregnancy rate of about 20% – that is 20 women out of 100 could be expected to conceive in one year of use, compared to 85 out of 100 if they were doing nothing to avoid pregnancy.1 Couples closely following the method are rarely surprised by an unexpected pregnancy, though of course it does happen occasionally. Some couples follow closely, others will start "cutting corners" on the rules, especially if they are ambivalent about avoiding pregnancy. The only 100% effective method of avoiding pregnancy is total abstinence, since even sterilization has an associated pregnancy rate.2
The key difference between NFP and artificial contraception is not effectiveness but intention. Those who use NFP never deliberately intervene to shut down that power of fertility that is part of the gift spouses bestow on each other when they marry. Couples do take account of the fact that the woman's fertility is not always present; but can respect this gift in each other even when choosing at times not to embrace it. That seemingly small difference has meant a lot for our appreciation of each other and the special character of our married life.
Abstinence is the biggest obstacle for many people. Most couples will need to abstain 10 to 12 days in every cycle. There is no question that this can be difficult, and that sometimes the difficulty leads to a decision to go ahead and have a baby! Other times it may simply be frustrating. Although NFP teachers suggest finding non-genital ways to show love for each other, the reality is that any couple can tell the difference between emptying the dishwasher and making love. Strongly motivated couples remember that they are doing this for each other, and they move on. Even couples using contraception will have times when they must abstain – during illness or after childbirth, for instance, or when one spouse is traveling. Periodic abstinence can remind spouses of their love and desire for each other, leading sometimes to a "honeymoon effect" when it finally ends. But sometimes, the only recourse is to grit your teeth and wait for it to end!
Special Challenges ... and Rewards
For couples on the edges of fertility, such as breastfeeding and approaching menopause, NFP presents special challenges. For nursing mothers, the LAM guidelines can provide guidance for the first six months after a baby's birth. After those six months (or sooner if the nursing couple no longer meets the requirements of LAM), observing and charting will give ample warning of returning fertility. It's important for these mothers to consult with their NFP teacher, especially if this is their first postpartum experience. The pregnancy rate for LAM is under 2%.3
Though much more is now understood about the return of fertility while nursing a baby, the decline of fertility in the perimenopausal years is still largely unexplored. The perimenopausal time requires an even deeper commitment on the part of the couple, because lack of solid information and the very individual response of each woman to her decreasing hormone levels can make it more challenging to identify her fertile times. Conservative NFP rules may require long periods of abstinence which can be hard on marriages. Although pregnancy rates are low for women in their late 40's, nearly everyone can think of someone they know who had a baby at that age and this adds to the general feeling of insecurity when seeking to avoid pregnancy. And of course, the other changes of approaching menopause can make this even more difficult. Understanding where they are in the perimenopausal process will ease this passage, and with love and patience couples can go through this time gracefully.
Couples who choose to learn Natural Family Planning after they have been using hormonal contraception can find NFP particularly challenging, but they are frequently the most persistent about learning and practicing NFP. They understand the side effects of the medications they have been using – the weight gain, decreased libido, etc. – and appreciate the cost savings of about $360 a year. In addition, oral contraceptives (the Pill) can leave the cervical mucus either skimpy or confusing for several months after discontinued use. Ovulation may take several months to return after discontinuing of Depo-Provera injections, which may also disturb the cervical mucus. But these couples are very motivated to allow their bodies and their fertility to return to normal and they persist in their use of NFP.
The benefits of Natural Family Planning – self-knowledge, marital satisfaction, spiritual growth for both husband and wife – these make NFP unique. No one denies that unexpected pregnancies occasionally occur and that abstinence is sometimes difficult. But those who choose to live in accord with the Church's teaching on family planning and responsible parenthood find that their marriage and their families are a tremendous blessing, not only to themselves but to the friends and community surrounding them.
Lee Ann Doerflinger is a Natural Family Planning teacher for the Archdiocese of Washington.