Skip to comments.Thanks Doc: More (and Younger) Doctors Support Natural Family Planning
Posted on 05/28/2003 1:26:55 PM PDT by Polycarp
More (and Younger) Doctors Support
Natural Family Planning
National Catholic Register
by TIM DRAKE
COLUMBUS, Ohio - Nancy Foley knows the value of a good natural family planning-only physician. Her physician, Dr. James Patterson, might very well have saved her life.
Foley (not her real name) had charted her signs of fertility for nearly 12 years, but the signs she was experiencing seemed anything but typical. Concerned, she approached her natural family planning-only physician with her symptoms. Pattersons (not his real name) knowledge, coupled with his patients, led to further tests and a final diagnosis of a precancerous condition that was successfully treated.
Because Foley used natural family planning, not only was she was in tune with her bodys signs but she was also able to identify an abnormality that led to an early diagnosis.
Im very thankful to have had a physician that recognizes and understands the medical applications behind natural family planning, she said.
It used to be that natural family planning-only physicians - physicians who understand modern, scientific methods of natural family planning and do not perform sterilizations or prescribe contraceptives - were difficult to locate. Thats less true today. Not only are there more natural family planning-only physicians than there were six years ago, but more and more are coming to the decision earlier in their careers.
Approximately six years ago, Steve Koob, director of the Dayton, Ohio-based apostolate One More Soul, created the countrys first directory of natural family planning-only physicians. It began with 45 doctors from a variety of specialties and has now grown to contain more than 450.
We get about three new NFP-only physicians each month, Koob said.
While Koob is happy to see the growth, hes disappointed that the number isnt larger. In 2000, I threw out the number 2,000 by the end of 2000, he said.
Hes convinced, however, that there will not be a dramatic leap in natural family planning-only physicians until clergy begin challenging doctors.
Very often, everyone in a community knows that a physician is doing tubal ligations, and yet they are treated like great Catholics, Koob said. They are on the parish council, they serve as Eucharistic ministers, they teach CCD. Thats a scandal.
Indeed, some of the very physicians contained in One More Souls directory came to be natural family planning-only at the admonition of clergy. That is certainly true for Dr. Michael Skoch of Lincoln, Neb.
I had been trained at a Catholic hospital in Wichita, Kan., and [contraception] was what we were taught, so I assumed that it must be okay for me to prescribe, Skoch said.
Eighteen months into his practice, Skoch found his professional life being addressed by his local priest.
He asked me if I knew what I was doing, Skoch said. When I told him that I was doing what I had been taught, he replied that if I continued doing what I was doing, he could no longer continue giving me holy Communion.
A year and a half later, Skoch finally stopped prescribing contraception.
In June 2000, Skoch left his five-physician family practice to launch the Moscati Health Center - a four-physician primary care medical practice incorporated with mental health services that does not compromise Skochs values.
While Skoch said he did lose some patients during the transition, he estimated that 90% of his 2,000 families stayed with him.
For Skoch the decision to become a natural family planning-only physician came in midcareer. However, an increasing number of physicians are embracing natural family planning during residency or before. Its a trend Skoch has noticed.
More and more young men and women have this figured out at a much earlier stage than I did, he said. Its an inspiration to me at this stage of my life. I firmly believe that the future is really bright and positive in this direction.
Dr. Richard Cash is among those who have gone in that direction. Cash became a natural family planning-only physician during his third and fourth years of medical school. At that time he received information he previously wasnt taught or had ignored about the abortifacient nature of oral contraceptives.
Cash was awarded the Minnesota Academy of Family Practice Resident of the Year award last year and is in his first year of family practice with the St. Cloud Medical Group. He serves as one of two natural family planning-only physicians in the 45-member practice.
When I made the decision to focus on NFP, I knew that the pill was used to treat the symptoms of a lot of different conditions, Cash said. I wanted the knowledge to be able to offer something more for my patients rather than saying, Im sorry, I dont deal with that.
Cash was recently certified as a natural family planning medical consultant by completing a six-month program through the Omaha, Neb.-based Pope Paul VI Institute.
That training will help me better treat some gynecologic conditions without using artificial hormones, Cash said. Its a disease-based approach, meaning that a lot of things that women have, such as infertility, painful menses and ovarian cysts, are symptoms of an underlying disease that is not often sought after by the medical community. They simply cover it up with contraceptives.
Cash said he has seen a trend among younger physicians embracing the Churchs teaching.
The majority of people in the medical-consultant program were students, residents or physicians early in their practice, he noted.
Another physician who has come to the decision early is third-year Ohio State University medical student Kyle Beiter. A biology major from Franciscan University of Steubenville, Ohio, Beiter hopes to bring a natural family planning-only approach to his work as an OB-GYN during his residence at Georgetown University. In his work he says he has already seen the failure of separating the unity of sexual intercourse from the procreative aspect.
In one week I saw three women who were pregnant and were 13-14 years old, Beiter said.
Beiter has found the support he needs along the way. He said he was fortunate to do his rotations with mentor Dr. Michael Parker, a natural family planning-only physician at Grant Hospital in Columbus, Ohio.
In addition, in preparation for his residency work, Beiter spoke with colleague Dr. Faith Daggs, a Camp Hill, Pa., OB-GYN.
She went to Georgetown [University], Beiter said, and was kind of anxious going into it. Yet her peers supported her decision. She has been out for five years and is doing well.
Clearly, the role of doctors in natural family planning is pivotal.
The doctors are huge on this issue, said Theresa Notare, assistant director of the U.S. Catholic bishops Diocesan Development Program for Natural Family Planning. Outside of the priest, if a couple is having trouble on this front they will go to their doctor and they will take what he says very seriously.
As important as the doctors are, the support of teaching couples and the Church is just as crucial. Notare described it as a trinity of support.
Whenever we survey the dioceses about the obstacles that stand in their way of getting the Churchs NFP message out to people, they include: priests not speaking about birth control and NFP, couples not coming forward to witness or teach other couples, and then, of course, the medical profession, she said.
Yet Notare is hopeful.
Im very encouraged when I see the young people that have somehow stumbled onto natural family planning and the theology of the body, she said. They are just jazzed about this. There is great hope out there.
Tim Drake writes
from St. Cloud, Minnesota.
Posted on 12/10/2001 10:49 PM EST by Dr. Brian Kopp
British Medical Journal, Sept 18, 1993 v307 n6906 p723(4)
"Natural family planning":
Effective Birth Control Supported by the Catholic Church
Natural family planning, when used by motivated couples, is a safe and cost-effective means of birth control. Natural family planning, which involves teaching women to recognize signs of ovulation and to avoid intercourse on fertile days, is the only method of birth control approved by the Catholic Church. A total of 869 women of diverse ethnic and economic backgrounds participated in a study conducted by the World Health Organization. Regardless of literacy and culture, 93% of the women were able to recognize the changes in their cervical mucus associated with ovulation. Other studies have emphasized the importance of good initial teaching and the motivation of the woman practicing the method. A failure rate of 0.2 pregnancies per 100 women was found in a study of 19,843 women in India.
[Full Text: COPYRIGHT 1993 British Medical Association]
During 20-22 September Manchester is to host the 1993 follow up to last year's "earth summit" in Rio de Janeiro. At that summit the threat posed by world overpopulation received considerable attention. Catholicism was perceived as opposed to birth control and therefore as a particular threat. This was based on the notion that the only method of birth control approved by the church--natural family planning--is unreliable, unacceptable, and ineffective.
In the 20 years since E L Billings and colleagues first described the cervical mucus symptoms associated with ovulation natural family planning has incorporated these symptoms and advanced considerably. Ultrasonography shows that the symptoms identify ovulation precisely. According to the World Health Organisation, 93% of women everywhere can identify the symptoms, which distinguish adequately between the fertile and infertile phases of the menstrual cycle. Most pregnancies during trials of natural family planning occur after intercourse at times recognised by couples as fertile. Thus pregnancy rates have depended on the motivation of couples. Increasingly studies show that rates equivalent to those with other contraceptive methods are readily achieved in the developed and developing worlds. Indeed, a study of 19 843 poor women in India had a pregnancy rate approaching zero. Natural family planning is cheap, effective, without side effects, and may be particularly acceptable to and efficacious among people in areas of poverty.
The 1993 follow up to last year's "earth summit" in Rio de Janeiro is to take place in Manchester during 20-22 September and is entitled "Partnerships for change." The Rio earth summit focused considerable attention on the expanding population of the world as an important issue in relation to resources, environment, and poverty. In the media the "opposition of the Catholic Church to birth control" was discussed (BBC Radio 4, Today Programme, 18 May 1992) and considered to be an important factor with the many millions of Catholics in the world, particularly the Third World, such as Brazil. In the medical press the "Pope's continuing opposition to birth control" was condemned and powerful Vatican opposition was considered likely to wreck hope of useful progress at the earth summit with regard to global overpopulation as a most urgent ecological hazard.
The widespread beliefs that the Catholic Church is opposed to birth control, that the urgent provision of artificial contraception within the Third World is the only answer to overpopulation, and that the Catholic Church is opposed to this all stem from the perception that the so called "natural methods of family planning," which are approved by the Catholic Church, are unreliable, unacceptable, and ineffective. Historically, this perception is based on the unreliability of the rhythm method of contraception ("Roman roulette"), which attempts to identify the fertile phase of the woman's cycle by calendar calculations. Is this perception as accurate today as it may have been in the past?
The ovum has a life span of not more than 24 hours and is fertilisable for only part of that time. The life span of the sperm may be measured in hours under adverse conditions. Under optimum conditions, however, sperms may remain viable for four or five days, and a life span of up to seven days has been postulated. Thus a woman is potentially fertile for no more than six to eight days of her cycle, probably less in most cases. To what extent can these potentially fertile days be accurately identified and avoided by most women as a method of birth control?
Cyclical changes in cervical mucus secretion
In 1972 Billings et al reported the characteristic changes in cervical mucus secretion which occur during the menstrual cycle. After menstruation there are a variable number of "dry" days with little or no mucus secretion and a feeling of dryness in the vaginal area. Then, as ovulation approaches under the influence of increasing oestrogen concentrations[3 5] the dry feeling ends and there is increasing secretion of cervical mucus, which at the time of ovulation becomes an abundant discharge of substance like the raw white of an egg. After ovulation the first secretion of progesterone abruptly reverses the effect of oestrogen on cervical mucus and causes it to become thick and rubbery, forming a plug in the cervix.[3 5] The fertile-type, "raw egg white" cervical mucus is of low viscosity and high threadability (spinnbarkeit) with glycoprotein fibrils in a micelle-like structure which aids sperm migration. It contains sugars and trace elements necessary for sperm survival, capacitation, and transport and it can maintain the sperm capable of fertilisation for several days.[3 5 6] By contrast, the thick, white, non-stretchy mucus which occurs at other times in the cycle is impenetrable by sperm and hostile to its survival.
Other symptoms have been described in association with ovulation, in particular periovulatory pain and the progesterone induced postovulatory rise in basal body temperature. Hormonal studies have confirmed the close relation of the various symptoms with ovulation,[4 7] and more recently ovarian ultrasonography has suggested that the day of most abundant secretion of fertile-type egg white mucus identifies the day of ovulation as precisely as does the luteinising hormone peak (see figure). Other symptoms associated with the cyclical changes in oestrogen and progesterone concentrations include changes in the cervix, breast tissue, skin, hair, libido, and moods.[3 5]
Pregnancy and contraception
Reported pregnancy rates (pregnancies per 100 woman years; Pearl index) in well motivated couples using the condom, diaphragm, intrauterine device, and progestogen only and combined oestrogen-progestogen oral contraception are 3.6, 1.9, 1.4, 1.2, and 0.18 respectively. Much higher rates have been recorded, particularly among less motivated couples--for example, pregnancy rates of 21 and 22 in condom users and 23 in diaphragm users. Pregnancy rates of 23 and 28 have also been reported in users of oral contraceptives in the developing world. As shown in Oxford, even the contraceptive pill may fail if the woman forgets to take it, runs out of tablets, or has diarrhoea and vomiting or other illness.
Early trials of birth control based on symptom observation[13-17] yielded pregnancy rates of 6.0 to 25.4. Most conceptions occurred because of intercourse on days designated by the family planning method as fertile. Controversy therefore ensued[18-21] between those who thought that all pregnancies occurring in trials should be considered as failures of the particular method[19 21] and those who thought that the method could not be blamed if couples had intercourse during a phase which they knew to be fertile.[18 20] It was also possible that initial scepticism about natural family planning methods led to a casual approach by couples.
Given a natural pregnancy rate--that is, the Pearl index without any birth control--estimated as 80, the cheapness of natural family planning, and the acceptability of natural family planning to many cultures and religions, the World Health Organisation undertook an international study.[23-27] A total of 869 women of proved fertility and widely varying cultural, educational, and economic backgrounds were studied in five centres (Auckland, Bangalore, Dublin, Manila, and San Miguel, El Salvador). Regardless of culture and education, 93% of the women recorded an interpretable ovulatory mucus pattern. Of the El Salvador women, 48.1% were illiterate and yet recognised the mucus symptoms.
Detailed analysis in the WHO study confirmed the potential effectiveness of mucus symptom observation as a means of family planning. The probability of conception from intercourse outside the period of fertility defined by cervical mucus observation was 0.004 (see table). Intercourse on days designated as fertile by cervical mucus observation resulted in conception with increasing frequency the nearer to ovulation that intercourse occurred, intercourse on the peak day of cervical mucus secretion resulting in a probability of conception of 0.667 (table). Thus it is clear that women of all cultures and educational backgrounds can learn to recognise when they ovulate and when they are potentially fertile and that if intercourse is avoided on potentially fertile days pregnancies will not occur.
[TABULAR DATA OMITTED]
Increased confidence in natural contraception
After the early studies,[13-17] increased confidence in and experience with natural family planning methods tended to lead to progressively lower overall pregnancy rates. The rates, however, remain variable, depending on the standard of teaching and the motivation to avoid pregnancy.[24 28-39] A study in Chile confirmed the importance of good initial natural family planning teaching, experienced teachers achieving a pregnancy rate of 4.7, inexperienced teachers achieving a rate of 16.8. Studies have underlined the importance of motivation, one international study finding a pregnancy rate of 4.13 in couples wishing to limit their families but a rate of 14.56 in couples wishing only to space their families. Studies suggest that methods combining several indicators of ovulation yield lower pregnancy rates. The cost issue has been addressed, studies from Liberia and Zambia showing pregnancy rates of 4.3 and 8.9 and user costs of $40 and $30 respectively. A study of natural family planning in general practice in the United Kingdom also found it to be by far the cheapest method.
The largest natural family planning study combined effective teaching with high motivation and showed that natural family planning can be extremely effective in the Third World. The study was of 19 843 predominantly poor women in Calcutta, 52% Hindu, 27% Muslim, and 21% Christian. Because of poverty motivation was high both among the users and among the well trained teachers of natural family planning. The failure rate was similar to that with the combined contraceptive pill--0.2 pregnancy/100 women users yearly. The result suggests that poverty as the motivation can greatly improve the effectiveness of natural family planning. A similar result, however, was achieved in Germany in a study with a pregnancy rate of 0.8.
An Italian study found an overall pregnancy rate of 3.6, all the pregnancies occurring in couples wishing to space but not limit their families. The pregnancy rate was zero in couples who wanted no more children. With other German studies finding pregnancy rates of 1.8 and 2.3, a study in general practice in the United Kingdom finding a rate of 2.7, and a study among 3003 illiterate and semiliterate women in India yielding a pregnancy rate of 2.04 the accumulating data confirm that natural family planning can be as effective as any method of family planning.
Implications for the Third World
In the WHO study most couples in the three developing countries who practised natural family planning were satisfied with the frequency of intercourse, whereas in the two developed countries one third of subjects and half of their partners who practised the method would have preferred more frequent intercourse. It might be argued that natural family planning being cheap, effective, without side effects, and potentially particularly effective and acceptable in areas of poverty may be the family planning method of choice for the Third World. The case for and against this may be argued and debated, but whatever the standpoint there is no doubt that it would be more efficient for the ongoing world debate on overpopulation, resources, environment, poverty, and health to be conducted against a background of truth rather than fallacy. It is therefore important that the misconception that Catholicism is synonymous with ineffective birth control[1 2] is laid to rest.
Understanding the simple facts about the signs of fertility confers considerable power to couples to control their fertility, for achieving as well as preventing conception. The widespread dissemination of these simple facts would be useful everywhere but might be of particular value in the Third World.
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There is a lot of disinformation on many threads on Free Republic on the issue of birth control and NFP, and the effectiveness of NFP. This article and this list is made available here as a starting point to clear up some of those misconceptions.
Be Good to Yourself - Don't Use Depo-Provera
Birth Control Pills and Young Women
Breast Cancer's Link to Abortion & the Pill
Contraceptive Imperialism versus Gospel of Life
Contraceptives and Informed Consent
My Advice To The Newlywed
Our Unexpected Date with the Culture of Death
(As usual, if you desire to be added to or removed from my "conservative Catholics" ping list, please send me a FReepmail. Thanks.)