Natural Family Planning

Let me start by stating that I recognize that this is a touchy subject, especially for those of you who are on birth control. My intentions are not to condemn anyone for their use of chemical contraceptives, but rather to shed some light on an issue that seems to be tucked away in the darkness. My prayer is that this would be read with both an open heart and an open mind, and that selfish desires and ungodly insecurities would be recognized and put to death. May we seek to be imitators of Christ in all we do, no matter how uncomfortable the decision.  

The Journey

My husband and I first started looking into different methods of birth control after becoming engaged this past summer. We are both in school full time so we thought it would be best to wait a few years before having children. Most of the married couples we knew were on some form of chemical birth control and we assumed we would be eventually as well. The pill seemed like the best option since it has one of the lowest failure rates out of all contraceptive methods. As I began to research possible side effects of chemical contraceptives I already knew they could cause moodiness, weight gain and lowered libido, but I had also heard stories from my mother about women she knew who had died from pill related blood clots. I tried to brush the more severe side effects aside since they only affect a small percentage of women, but I still wasn't very comfortable with the idea of pumping my body full of synthetic hormones on a daily basis. 

I was still trying to talk myself into taking the pill for the sake of marital "happiness" when I came across something that was even more disturbing than the risky side effects—an "ethical considerations" link on the website of the American Pregnancy Association (an impartial non-profit organization not associated with any religious, political, or activist groups). The warning explained that the pill (along with all other forms of chemical birth control) does not merely prevent ovulation (and thereby prevent fertilization) but also works by thickening the woman’s cervical mucus and thinning the lining of the woman’s uterus, thus making it hard for a fertilized egg to implant. This means that, if there is a breakthrough ovulation (which doctors suggest happens 3-9% of the time) and a couple does conceive, the zygote (baby) will not be able to implant on the mother's endometrium where it continues to grow; instead it will be flushed out of the woman's body due to the hostile environment created by the hormonal contraceptive. 

I spent the next several days digging around on the FDA website and searching through the package inserts for various chemical contraceptive methods in hopes of finding something to counter what I had read on the APA website. To my dismay, the same description was plainly stated on the packaging: “It may thicken your cervical mucus, thin the lining of your uterus, inhibit sperm movement and reduce sperm survival. [It] may stop release of your egg from your ovary, but this is not the way it works in most cases" (This is from the Mirena IUD insert. The IUD's main function is to prevent implantation, not ovulation).  After expressing my concerns to my own OB/GYN (who is pro-choice) she responded by saying, "Yes, the birth control pill can prevent implantation, but it's okay because a fertilized egg is not a life, so you have nothing to worry about." She went on to pressure me to get on the pill so that I wouldn't ruin my life by getting pregnant or have to face the possibility of choosing an abortion. Whether she agreed with me or not, my doctor was clearly unconcerned with my religious and moral convictions about when life begins. I have found that both pro-life and pro-choice MDs tend to agree on what some chemical birth control pills do (e.g., cause the miscarriage of the zygote by altering the endometrium), the issue is, rather, whether or not the conceived zygote qualifies as a human person.

If you don’t believe that life starts at conception then miscarrying a zygote is probably a nonissue, but for those who believe that life starts at conception this isn’t something that can just be pushed aside.  This is a big deal — a really big deal. Taking chemical birth control would mean gambling with human life.  As I’m sure one can imagine, I was a little distraught. Mark and I were not ready to have children and seeing as condoms have nearly a 15-18% failure rate we didn’t see that as a very “safe” method. I am ashamed to say it now, but I found myself wishing there was a way to temporarily turn off my fertility for a few years (because being fertile is such a curse, you know). Thankfully, one of my husband's ethics books mentioned something called “Natural Family Planning” as a healthier and safer alternative to birth control. Mark and I were both skeptical assuming that NFP was nothing more than counting days like the "rhythm method," but we were also unwilling to compromise our moral convictions, especially if it meant knowingly taking a medication that may cause me to miscarry a child we had conceived.   

Since NFP seemed like the only option we had left, Mark and I decided to visit a free training class I found for us on this website with the Catholic Social Services.  The class consisted almost entirely of engaged and married couples. It was really interesting, and at times humorous, to see all the men actively engaging in the class and asking questions about their wife's reproductive system and what they could could do to help her track her fertility. It caught me a little off guard, but in a good way.  

To our surprise, our instructor began to explain that NFP has the same success rate as the pill— 97-99% (Here are some of the studies found in a leading European medical journal called Human Reproduction Today and others conducted by Marquette University). Petra Frank- Herrmann, who is the managing director of the natural fertility section of the Department of Gynecological Endocrinology at the University of Heidelberg, Germany, has stated, "The pregnancy rate for women who used the STM [sympto-thermal method] method correctly in our study was 0.4%, which can be interpreted as one pregnancy occurring per 250 women per year. Therefore, we maintain that the effectiveness of STM is comparable to the effectiveness of modern contraceptive methods such as oral contraceptives, and is an effective and acceptable method of family planning.” This is because, much to our surprise again, Natural Family Planning is very scientific and is much more advanced than the old-school "rhythm method."

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How It Works

In short, NFP works by monitoring just a few simple signs: cervical mucus, the Luteinizing hormone (LH), and waking body temperature (also called basal body temperature). While it's hard to predict ovulation, monitoring these signs will allow you to pinpoint the fertile time of each cycle. To avoid pregnancy couples should abstain (or use non-chemical barrier contraceptives like condoms or diaphragms if desired) during this fertile window of  5-7 days. 

Cervical Mucus

Cervical mucus starts to appear on the days leading up to ovulation. As soon as mucus is present the fertile window has begun. Though ovulation will not occur for a few more days, the cervical mucus is what keeps the sperm alive and healthy while it waits for the release of the egg during ovulation. The days right before ovulation are the most fertile days, so couples should start to abstain as soon as the cervical mucus appears.  
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LH

Another way to predict ovulation is by observing the LH hormone. This is a hormone that is released 24-48 hours before ovulation and can be tested using an ovulation kit or fertility monitor. When LH is present, a woman can be sure that she will ovulate within the next day or so. This isn't necessary for all women (most women do fine by just observing cervical mucus), but a fertility monitor can be used as an extra precautionary to determine the fertile days. 

Notice the extreme jump in temperature?

BBT

After ovulation the body produces the hormone progesterone, which causes a rise in body temperature. Women should take and record their waking body temperature every morning; the day after ovulation there will be a significant rise in temperature allowing women to pinpoint when ovulation has occurred (see image). Since the egg released during ovulation usually only survives for 24 hours (48 at most) couples should consider the three days following ovulation to be fertile days. Waiting for three days also takes into consideration the possibility of the woman’s ovary releasing a second egg. This is rare, but waiting the entire three days ensures that there is no chance of conceiving.

(For more on how to chart and observe fertility signs click here.) 

Sound like a lot of work? It's not, really; my daily NFP routine is actually quite easy. I take my temperature (orally!) every morning around the same time while lying in bed and then go straight back to sleep. Later I record my temperature on this (free) NFP app my doctor recommended. I also use the app to record all my other fertility signs that may be present throughout the day. There are only 3-4 days a month in which I test my LH levels with the help of my fertility monitor which takes all of 60 seconds. I input all the information on my iPod and let the app do all the charting for me. I can't imagine that doing any of this is any more inconvenient than remembering to take a pill. And even if it is, the benefits of using NFP rather than a hormonal contraceptive far outweigh what some might consider to be a slight inconvenience. 
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Mark and I have been practicing NFP for over a year now and love everything about it. I could go on and on about how great this decision has been for us as a couple, but for the sake of brevity I will just explain a couple of ways it has benefited us.
Aside from the most important benefit—avoiding abortifacients—NFP has really helped me maintain my overall health. Because I can physically see on my chart when I am under stress or dehydrated, I’ve been a lot more proactive about working out, eating right, and getting to bed at a decent hour because I can see how failing to do these things affects my cycle.

To my surprise, NFP has also helped me be a better steward of my time. During the week that I am fertile I spend more time studying, working and maintaining our home. I also try to let Mark work late these nights if he needs to. In fact, we both push ourselves a little harder during this time because being productive creates more free time to be with each other in the weeks to follow. We also spend more time with our friends during this week—I’ll get coffee with my girl friends and Mark gets to go out with the guys. NFP has definitely helped me manage our busy schedule.

A lot of people assume that couples that practice NFP have less sex than couples that use birth control. I can’t say for certain because I have never been on birth control, but there are several reasons why I think this is probably not the case. First, I know that charting makes me very aware of when and how often Mark and I are intimate. If we haven’t been together in a while, I know it because it’s on my chart and I see it every morning. Time flies for everyone, but it doesn’t seem to get away from us as much in this area. Charting has helped me to be more proactive about keeping things regular and often. Second, with NFP we are able to experience a “honeymoon” every month after our week of abstinence. Sometimes abstaining can be difficult, but we quickly learned that it is worth the wait.
There are also several great relational benefits to NFP, perhaps the biggest being better communication. Because pregnancy is a real possibility each month—not just some distant future idea—we discuss things like our finances, job insecurities, future goals, and fears quite often.
 
There are plenty of other benefits I could discuss. I could go on about how NFP has taught me that, opposed to what our culture has conditioned us to believe, it is possible for us to control our sexual desires. I could explain how NFP has taught me self-discipline, to love my husband better, and to be less selfish. It has helped me see how deeply Mark loves and respects me and has provided me with a way to do the same for him. It has changed the way I view marriage and children and has taught me to trust God more. For us, NFP has been about far more than avoiding dangerous chemicals; it’s been about loving each other better and growing in virtue. The relational, emotional, spiritual, and health benefits of NFP have been such a blessing to both of us that I can only hope others will soon catch on to what has been a life-changing decision.

Additional Resources:
Embryo: A Defense of Human Life by Robert P. George and Christopher Tollefsen
Does The Birth Control Pill Cause Abortions? by Randy Alcorn
Defending Life by Francis Beckwith
Ethics For a Brave New World by Feinberg and Feinberg
Biomedicine & Beatitude by Nicanor Pier Giorgio Austriaco, O.P.
http://onemoresoul.com/
http://www.ccli.org/
http://www.fertilityfriend.com/
http://nfp.marquette.edu/
Find an NFP training class- http://register.ccli.org/