Natural Family Planning (Nursing)

by Jacquelyn McMillian-Bohler

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

    About the Lecture

    The lecture Natural Family Planning (Nursing) by Jacquelyn McMillian-Bohler is from the course Contraception (Nursing).

    Included Quiz Questions

    1. Nine or more
    2. Four or more
    3. Fifteen or more
    4. Twenty-five or more
    1. “If you use the calendar method, it is essential to avoid having intercourse for the four days right before your menstrual period is about to start.”
    2. “You can use any thermometer you have at home to track your temperature if you use the basal body temperature method.”
    3. “Your menstrual cycle needs to be regular for the calendar method to be effective.”
    4. “If you use the basal body temperature method, you need to take your temperature every morning before you get out of bed.“
    1. "I make sure to pump if I know I can't breastfeed my baby within the feeding interval."
    2. “I make sure to breastfeed my baby at least every six hours.”
    3. “I know that I will have to use an alternative birth control method when my baby reaches six months of age.”
    4. “I have only been feeding my baby breast milk.”

    Author of lecture Natural Family Planning (Nursing)

     Jacquelyn McMillian-Bohler

    Jacquelyn McMillian-Bohler

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