3 NATURAL METHODS OF BIRTH CONTROL
Natural family planning is a general term used to describe several methods of birth control that do not depend on using hormones (as in the pills) or mechanical barriers (condoms, for example). The rhythm method is the best known natural birth control method, but the cervical mucus method (also known as the Billings method after its originator, Dr J. Billings) is gaining in popularity. Natural family planning methods are based on the premise that if a couple understand how the woman's body functions and know what to look for they will know when they can have intercourse with no risk of pregnancy. They will also know when the fertile times are if they wish to have a baby. A crucial aspect of choosing any natural family planning method is to receive advice and instruction from a qualified physician or teacher on how natural methods work. Natural family planning programs exist in all states of the U.S. and in most European countries. The Catholic Church in each area has a listing of such programs. Family planning centers and clinics and many physicians can also give advice.
RHYTHM METHOD
The rhythm method requires periodic abstinence from intercourse. Obviously thi sis a method that can best be used by couples in long term sexual relationships. The goal is to avoid intercourse when ovulation is likely, and to resume intercourse when the woman is not fertile. The two ways that a couple can determine when to abstain and when it is safe to have intercourse are the calendar method and the temperature method (also called the basal body temperature method). They may be used alone or in combination. The calendar method is the least effective and least scientific natural technique. It requires the woman to keep an accurate record of her menstrual cycles for at least eight to 12 months before starting to use it. This record is designed to enable the woman to predict her menstrual cycle each month. Using the beginning of her menstruation as day one and the day before her menstruation as the last day of her cycle, the couple then uses a simple arithmetical formula to determine when they can have intercourse and when they should abstain. Ovulation generally occurs (with slight variation) 14 days before the onset of the next menstrual flow, so if a woman regularly has a 28-day cycle she is likely to ovulate on day 14. Since sperm can remain alive and be active for up to three days and the egg remains viable for a day, abstinence would be in order for several days before and a couple of days after ovulation. Computations for cycles of different lengths can be learned with proper instruction. However, it is often not as straightforward as this in practice because women rarely have such regular cycles: illness, stress, weight loss or gain and environmental factors change the calendar. Other couples find it too intrusive - they feel it limits their spontaneity; although other sexual acts can be fulfilling, intercourse still remains the most desirable for most couples. You can get advice on what are the best sex positions for lovemaking here.
The calendar month can be supplemented by the temperature or basal body temperature (bbt) method, or the bbt method can be used alone. In this approach the woman records her temperature each morning before getting out of bed. A special bbt thermometer purchased at a pharmacy or family planning clinic should be used because it is easier to read than regular fever thermometers. Temperature can be taken orally, rectally or vaginally but it must be taken the same way for several months each day before getting out of bed. The temperature is recorded on special graph paper which comes with the thermometer. The pattern that appears on the chart is one which usually shows the temperature about the same each day until the time of ovulation, when there is a slight drop and then a rise in temperature for about three days. The rise in temperature (due to increased quantities of progesterone) is small, but a careful reading and marking of the graph will indicate it. The woman is fertile while her temperature is up. Some couples who do not want a child remain abstinent temperature through the first part of the cycle until the temperature has been elevated at least three full days.
It is clear that each woman needs to plot a chart for several months before using the method in order to learn the particular pattern of her body. Some women have a great deal of difficulty in learning the pattern, which anyway can easily be thrown off by a fever or other illness. The reading can be distorted by having to get out of bed quickly and taking the temperature later on. Having to take a reading at the same time each day is a bother for many women. Some couples who wait until after ovulation to have orgasm intercourse, which is the safest application of this method, complain that they have only 12 to 14 days for intercourse before the next cycle begins.
(Billings Method) This method is based on the fact that from the end of menstruation one month to the first day of the next flow the natural mucus produced by the cervix changes. The presence of a certain kind of mucus indicates ovulation is imminent. Since it is not possible under ordinary circumstances to detect the nature of the cervical mucus during the menstrual flow, those days in this method are considered potentially fertile. Instruction from a trained couple or physician from a natural planning program is absolutely necessary to learn how to make this method effective. The basic principles involved in this approach are: for a few days after menstruation the cervix produces no mucus or very small amounts, making this a relatively safe time for intercourse. When the level of estrogen rises, the cervix begins to produce a mucus that is clear, stretchy and rather like raw egg-white. This type of mucus is produced for several days and marks a fertile period. It is followed by thicker, sticky, cloudy mucus. The first day of the change to clearer mucus indicates ovulation will occur in a day or so; these days and three or four days after are fertile, and intercourse should be avoided. In the remaining days of the cycle the thickness and cloudiness of the mucus indicate a safe, infertile period.
Some couples find this is a complicated method as it requires continual monitoring of the mucus (this is done by using toilet tissue several times a day to determine the presence and nature of the discharge), and they also find it unappealing and embarrassing. The method must be practiced for a month or two before depending on it. Charting the kind of mucus observed is important to develop a recognizable pattern. Stress may affect ovulation and therefore change usual patterns, and infections, drugs, sprays and even colored undergarments may produce a discharge that interferes with accurate recognition of the state of the mucus. People using the mucus method also have to learn to distinguish semen remaining in the vagina from cervical mucus.
Q. "It appears that using natural family planning methods is a complicated task for a couple. Why use them, with so many other methods available?"
A: "There are several reasons. Many couples who choose natural family planning do so because of their religion. Some religions, notably the Catholic Church and Orthodox Judaism, officially require their believers to use natural methods only. Chemical or mechanical barrier methods are banned. Couples may not be able to use the more common family planning methods for medical reasons. Some couples want to learn how to plan a pregnancy using the body's natural clocks and timetable and these methods help them learn. Other couples value natural methods because they are without side effects of any kind. Then, although it is unlikely to be the deciding factor, whoever you are, natural family planning costs nothing."
Q. "Which is the best natural family planning method?"
A: "From an effectiveness standpoint, the temperature or bbt method with intercourse only after ovulation occurs; it shows success rates in some studies of around 98-99 percent - similar to those of oral contraceptives. Effectiveness rates for the calendar method alone have not been widely tested, but are likely to be around 70 percent. Rates reported for the cervical mucus method vary from 70 percent to the high 90s. Not enough studies have been done to give us a properly accurate picture of the effectiveness of any of the natural methods. Perhaps because of this - and perhaps because of their political and social motives as well - family planning practitioners are not on the whole enthusiastic about natural methods."
RELATIONSHIPS When a couple master a natural family planning method it seems to be successful not only in controlling pregnancies but helping the relationship.
"Since we started using the ovulation method of family planning I think our relationship is better. We are much more relaxed about the health factors than we were before, and it is exciting to be learning about how wonderfully the body works and to be able to use that to our advantage. The fact that this method is in line with our religious teachings is also important to us, as the guilt we once felt in the past is now gone."
"Maybe we are weird but we have learned to be close and sexual without having to have intercourse and that has been exciting to us and has added another dimension to our relationship. Sometimes I have to bite my tongue because I want to tell our friends about it. That should be important for other couples too, whether they use natural family planning or not. It sounds like the harmony in our relationship is an inducement to others of like mind to try such a method."
Q. "We are Catholic and have been trying the various natural methods without much success. We are at a point now where having another baby will hurt us financially and emotionally. What can we do?"
A: "You and your husband can go see your parish priest and explain your situation to him, emphasizing your honest efforts in the past and the results. Indicate that your ability to be loving parents in a stable home environment will be seriously impaired if you have another child. Some priests will understand and will support you if you make a decision, based on an honest examination of your con sciences, to use another method of birth control. However, it is just as likely that your priest will repeat the Church's traditional position, banning artificial birth control. He might suggest further study of the proper use of natural methods or counseling. Changing to an artificial method is not an easy decision to make, for it requires you to reflect thoroughly both on your relationship and on your beliefs. A great many Catholics have come to the view that it is possible to use artificial methods and still be a good Catholic, but that is a private decision for each couple."
General Issues Around Contraception