00:01
Now, let's think about some other
non-pharmacologic methods
that we could use that don't require hormones.
00:07
We're going to talk about natural family
planning and fertility awareness
and talk about some methods around that.
00:13
There are going to be some clients who preferred
not to use any sort of barrier method
maybe for religious reasons
or personal preference.
00:20
They may not be a candidate
for hormonal methods,
that we'll talk about later, so they
may choose to go a more natural route.
00:27
This is definitely birth control.
00:29
So, let's look at some of the
options someone would have.
00:32
The first one is a calendar method.
We'll also talk about tracking symptoms,
we'll look at basal body temperature,
and then finally breastfeeding
or lactational amenorrheic method,
so that actually is a method.
We'll talk about that.
00:49
So, let's first look at fertility awareness
because that's sort of the basis of all of these.
00:54
So, when we think about fertility pattern,
it's being able to really pick out the days
of the month when someone is able
to conceive or get pregnant.
01:02
There are about 9 days or maybe a few more
for a client with a regular menstrual cycle.
01:08
I hope you're picking up on that.
01:10
Having a regular menstrual cycle is absolutely
required for trying to determine
which one of those days is fertile,
is going to be really, really difficult.
01:20
Typical failure rate for fertility awareness is
anywhere from 2% which is not too shabby,
all the way to 23%. Why the variability?
Because we have to be really careful
and monitor everyday all of our symptoms.
01:35
And again, we're human, some of us are not
that great in keeping up with records that way.
01:41
The other thing is our body changes,
so we may be sick or ill or stressed,
and that can cause changes to our menstrual cycle
and that can affect our fertile days.
01:51
Let's look at the calendar method.
This is also known as the rhythm method.
01:55
It has nothing to do with music, but it has to do
with the rhythm of the menstrual cycle.
02:01
So, you can see in this graphic a calendar
so it represents a 28-day menstrual cycle.
02:05
You have low risk days which are
at the beginning of the cycle
so you can see that,
that's usually when you bleed,
so remember that when we talk about our
menstrual period we start with the day of bleeding.
02:16
So, we have low risk days and then we
move in to potentially unsafe days.
02:21
Now, why do we have unsafe days that
are so far away from ovulation?
Well, sperm, they are really strong sometimes
and they will lie and wait for an egg.
02:34
And they can lie and wait for an egg
for up to a week, just waiting.
02:38
So, we want to make sure that we protect
on those potentially unsafe days.
02:43
So, you'll see that coming up
into those 9 fertile days.
02:46
So, the unsafe days are the days
we know you can get pregnant.
02:50
You've got some potentially unsafe
days on the other end
because maybe we didn't quite get
that ovulation day exactly right
and then we go back to the low
risk days at the end.
03:00
So, what you might notice with this rhythm
method is their truly safe days are fairly limited,
which maybe why someone might
choose not to use this method.
03:09
Now, let's begin our discussion about symptoms
that may indicate where we are in our menstrual cycle.
03:14
So, again, this is about fertility awareness.
03:17
What are those unsafe days?
When are we ovulating?
Cervical mucus lets us know
how close we are to ovulation
and we're specifically discussing the
consistency of the cervical mucus during the cycle.
03:32
So, at the beginning of the cycle,
so this is right after menstruation,
then the cervical mucus is pretty dry,
it's not very stretchy, it's very thick.
03:41
As we get to day 4 to 6, hopefully what you notice in this graphic
is that our cervical mucus gets a little more sticky.
03:50
So, we're still not fertile, but we notice
the change in the cervical mucus.
03:55
Once we get to 7 to 8, then we find that the
cervical mucus gets a little more creamy in consistency
and then once we get to day 10 to 14, hopefully
this is coinciding in your mind with ovulation,
then we find that the cervical mucus
gets stretchy and clear.
04:13
And why is that great? Because that
creates a highway for the sperm to travel.
04:18
So, highway to the cervix
and hopefully to the egg.
04:22
So, that physiologically is a way
that we support fertility,
but we could also use this as a way to determine
when we are fertile and avoid pregnancy.
04:32
So, this stretchiness
is called spinnbarkeit.
04:36
Remember I said that lactation is actually
a birth control method, and it is.
04:42
Let's talk about what that looks like.
04:44
So, right after the baby is born when the baby
is at the breast and they're suckling,
that action actually not only releases
oxytocin but it suppresses ovulation.
04:55
It changes the HPO access.
04:58
And once it does that,
it changes the ovarian function.
05:01
And once it does that, it causes amenorrhea
and that means that we're not having ovulation.
05:08
Now in order for this method to work,
several factors must be in play.
05:12
Number 1, the client must be
exclusively breastfeeding.
05:16
So, if they're breastfeeding and then
supplementing with bottle or they're pumping,
this method doesn't work. Also, the baby
must be eating at least every 6 hours.
05:28
If they're going longer than 6 hours,
it's too long and that system will start up
in terms of ovulation and this will not work.
05:36
So, usually this only works about the first
6 months because after 6 months the baby
is going to start eating food
that's not at the breast
and so likely they're not going to
meet the 6-hour rule
and they're not going to be
exclusively breastfeeding.
05:51
Let's get back to our symptom methods.
So, thinking about basal body temperature.
05:55
Maybe you remember from our
discussion of the menstrual cycle
that after ovulation the temperature goes up.
So, progesterone causes an increase in temperature.
06:05
If we track that temperature,
then we're able to determine when you ovulate.
06:09
So, in order to use this method,
you must use a basal body thermometer.
06:14
The regular ones that you get at the store,
they're not specific enough for this purpose.
06:18
So it specifically has to say
basal body thermometer.
06:22
The temperature has to be taken every
morning before the person gets out of bed
because once you start moving around, you
generate some heat and that changes the temperature.
06:31
So, make sure when you get up, you take
your temperature before you get out of bed.
06:37
This is what the graphic looks like.
06:39
So, what the person would do is that they would
track their temperature over the course of the month.
06:44
And what you'll notice at the beginning of the cycle
is we've got some fluctuations in the temperature,
but it stays low but right before
ovulation and definitely after ovulation
the progesterone levels start to go up
which means that we have ovulation.
07:01
Exactly. And so through the second half of the
cycle, the temperature remains elevated,
but if there's no pregnancy progesterone
levels go with the disintegration
of the corpus luteum and then the
temperature drops back down.
07:14
So, what the person would do would be
track when that temperature goes up
and then have intercourse
several days after ovulation.
07:24
Now, we would be remissed if we didn't
leave out the withdrawal method.
07:30
So, with the withdrawal method, there is intercourse and then
right before ejaculation the penis is removed from the vagina.
07:39
The problem with the withdrawal method
is that there are pre-ejaculates
and inside the pre-ejaculate there is sperm
and there can be millions of sperm
that are released well before ejaculation.
So, it doesn't always work so well.
07:54
So, with perfect use, it would be around
4% which is not so bad,
but that would require everybody to be onboard
and for someone to withdraw everytime
and well before ejaculation
which doesn't always happen.
08:10
So, typical failure rate
is going to be around 22%.
08:14
So, does it work better than nothing?
Yes, but definitely not the most reliable method.