NATURAL FAMILY PLANNING

Definition -WHO 1982: Methods for planning or preventing pregnancies by observation of naturally occurring signs and symptoms of fertile and unfertile phases of the menstrual cycle. -Couple abstains from coitus during fertile phases (especially when conception is an undesired effect) -Equally effective to artificial birth control when correctly practiced 2

Goals Ultimate goal is to improve the quality of life Birth spacing Birth limitation Assist infertile couples to have children 3

TYPES OF NATURAL FAMILY PLANNING A.Basal Body Temperature B.Sympothermal Method C.Ovulation or Cervical Mucus Method D.Calendar Method E.Standard Days Method F.Lactational Amenorrhea 4

A. BASAL BODY TEMPERATURE PRINCIPLE: slight increase in body temperature, by 0.5-1˚C right after ovulation (thermogenic effect of progesterone) Increase in temperature is maintained until the next menstruation Ovulation assumed when there is rise in temperature is sustained for at least three consecutive days 5

Take temperature every morning before any activity is done Refrain from intercourse from end of menstruation up to 3 days after increase in temperature Biphasic curve THERMAL SHIFT: 6

B. SYMPOTHERMAL Most effective Identify fertile and infertile days using: changes in basal body temperature signs and symptoms of ovulation o slippery and transparent mucus in the genital area o Swelling, tenderness, sensitivity of the breasts o Dull pain the lower abdomen (Mittlschmerz) o Midcycle spotting (Klein Regal) 7

Identify the first day of fertile period by calendar method or cervical mucus method Advantages: permits sexual relations during the early dry days shortens the period of abstinence necessary for complete protection when using the temperature method alone 8

Ovulation / Cervical Mucus Method Billing’s Method After menstruation – Cervical mucus is opaque, thick & sticky – dry days Ovulation – Mucus is slippery, lubricative, transparent & watery discharge – “raw egg white” – peak of ovulation 10

Klein Regal – During peak day spotting may appear – “Days of bleeding” Ovulation / Cervical Mucus Method 11

Recap Colour Consistency How stretchy it is 12

Early day Rule ( From menses to peak) COITUS IS AVOIDED ON DAYS OF BLEEDING!! Ovulation / Cervical Mucus Method Intercourse during dry days of unchanging discharge Avoid contact on succeeding days Avoid sexual liberty on any day where there is change from basic infertile pattern Peak Rule- late day of cycle from peak till the next menses 13

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Three types of mucus -Odeblad G- Type made up of purely proteins and fibers opposes the sperm L-Type thick, clumpy texture “ flower like” Maintains capacity of sperm to fertilize S- Type predominates in ovulation 15

Calendar Method a.k.a Rhythm Method – estimating a woman's likelihood of fertility – Basing on the past menstrual cycle for at least 6 months – Unique nature of woman’s cycle ( irregular periods or unusual length) 16

How to Calculate D1 (1 ST day of menstrual cycle)  next menstrual cycle Normal: 28 days ( days) Fertile D5- D25 To Calculate Fertile phase: subtract 18 from shortest cycle and 11 from the longest * Shortest cycle: = 5 (infertile phase) * Longest cycle: = 25 (post-ovulatory infertile phase) 17

EXAMPLE Bechay 22y/o regular menstrual period LMP: June 15’09 June 29 – ovulation period (add 14) +/- 5 days = SAFE/ NON FERTILE 18

STANDARD DAYS METHOD 95 % effective Tracking of days to avoid sex to prevent pregnancy Beads represent the menstrual cycle Woman can use this method if her cycles last between days. 19

Each bead is a day of cycle. Red = 1 st day of the period White = woman can get pregnant Brown = Pregnancy is unlikely 20

TWO DAY METHOD Did I note any secretions today? Yesterday? Monitoring of each day for the presence or absence of secretions. Monitor secretions in the afternoon and in the evening by sensation or observation. Consult if secretions happens for more than 14 consecutive days. 21

LACTATIONAL AMENORRHEA Depends on the hormones and on the act of breastfeeding. 22

Prerequisites: 1.Mother must feed the baby nothing but her milk 2.Breastfeeding intervals should not be longer than 4 hours during the day and 6 hrs at night. 3.The baby is also fed on demand. 4. Milk can be given as a support 23

Caution: A woman might ovulate even without menstruation. This method is most effective during the first 6 months of exclusive breastfeeding. Works better in older participants. 2 % of failure in the 1 st 6 months. If bleeding occurs the risk of failure becomes higher. 24

ADVANTAGES OF NFP Safe-no interference with body processes, no artificila devices used, no medical effects or allergic reactions Inexpensive helps women get to know their bodies and it empowers them to cooperate with their male partners in avoiding unwanted pregnancies; Improves mutual relationship of couples Allows sexual intimacy w/o interference during safe days Allows couples especially Catholics to remain faithful to their religious and ethical beliefs 25

DISADVANTAGES OF NFP They rely heavily on your ability to accurately work out your fertile periods each month. They are not suitable for women with irregular periods. Your body signs may be difficult to interpret if you are tired, stressed or ill They do not protect you or your partner against sexually transmitted infections, 26

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