NFP Uncensored: BSN and Charting

NFP Uncensored is a series of candid accounts of the way NFP informs every aspect of life. You can follow the posts by searching for “NFP Uncensored” here in the Living the Love blog (use the search bar on the right-hand side of this page), or by searching #NFPUncensored on social media.

In the past 50 years, birth control has become an almost unavoidable aspect of life as a medical professional. Whether it’s preventative methods that require prescriptions (such as hormone-altering medications and devices), non-prescription methods (such as condoms), or surgical procedures (such as vasectomies and “getting tubes tied”), artificial birth control methods are everywhere.

The background

The women I encounter most often use either the pill or a hormonal IUD — both of which alter the body’s natural hormone balance in order to negatively affect the body’s natural process of preparing for the potential conception of a baby. Pills are taken on a 28-day cycle. Twenty-one of the pills have artificial hormones which prevent the body from managing hormones on its own. The remaining seven days are placebo pills with no hormones at all. The sudden drop in hormone levels creates withdrawal bleeding, which patients often mistake as a period.

Other versions of birth control include hormonal implants that sit in different parts of the body and injections that provide time-release hormones. These options have been shown in studies to have potential complications with extended use, including but not limited to exaggerated hormonal imbalances, heart attacks, strokes and various cancers.

I’m fortunate to work for a Catholic hospital system that follows the Catholic tenet to avoid directly contributing to someone’s contraception use. We are exempt from the Affordable Care Act (which requires contraceptive coverage for employees).  Although, to my dismay, we will prescribe and fill certain prescription contraceptives for our patients (many of whom are not Catholic and hold varied views on contraception), providers make it a priority to discourage contraception and instead promote Natural Family Planning. This is reasonable from both a moral and a medical standpoint. NFP is the only family planning method proven to be effective, fully reversible, and without side effect to either party. We also refuse to perform any birth control surgeries, whether preventative – like vasectomy or tubal ligation (having one’s tubes tied) – or deadly, such as abortions.

Unfortunately, hospitals like mine are not the norm. In medical institutions that lack such vested interest in avoiding artificial hormonal therapies, natural family planning is often bypassed and overlooked. Patients who ask about NFP specifically receive an unfortunate variety of responses.

Nursing school

I recently graduated with my BSN, and the only time that I can recall NFP being mentioned was briefly in an obstetrics (OB) class. To my chagrin and dismay, birth control was talked about freely in most classes when the subject of pregnancy came up, and abortions were mentioned as an acceptable birth control method multiple times. My wife and I practice NFP in our own marriage, so I can attest to its efficacy from a personal standpoint as well as a medical one. When I mentioned NFP during a class poll, the atmosphere immediately became tense and the professor quickly brushed past the subject.

NFP is often overlooked and ignored due to misinformation about it that exists within the medical community. Doctors are busy, so they usually rely on outside sources for statistics and research. In this regard, the word of the national Center for Disease Control (CDC) is, by and large, the gold standard in information sourcing for the medical community. Sadly, sometimes the numbers can be misleading.

For example, when I was researching the success rates of NFP versus chemical contraception, I saw that chemical contraception was reported to be far more likely to prevent pregnancy than NFP. But when I looked deeper into the source of the numbers, I found that a case study had been used that included individuals (only women were studied) who did not adhere properly to the guidelines of NFP. As such, their data was skewed. This information was included in the published case study so that researchers could form their own opinions about the data, but the CDC failed to publish that note, presenting a low-quality study with skewed statistics.

Finding this information takes digging to discover — digging doctors don’t usually have time to do.

Don’t believe everything you hear

I know that there are many people who believe that since preventative birth control comes from medical professionals and NFP is by and large not promoted by them, that the former has a strong basis in science and the latter does not.

This could not be further from the truth.

While it is very true that hormone-based contraception does indeed have case studies and trials to back up its efficacy, there are many questions that remain unanswered as to potential problems and complications that have direct ties to its use.

NFP has none of these complications or questions.

NFP is based on a close monitoring of the woman’s temperature and other fertility markers, and these signs provide a solid indication of fertility status when understood properly. NFP does take more work on the user’s part than the pill, to be sure, but with an efficacy rate of 0.3-5 births per 100 participants (with full adherence) it rivals if not bypasses the 97 percent efficacy average of hormone-based contraception.

Second-rate reasons

Personally, I find it interesting that — in speaking to patients, colleagues, friends and family — the most common reason that women choose to take hormonal contraception is to improve negative cycle-related symptoms, not necessarily to control births. However, this doesn’t match the facts: the number of women using contraception for cycle-related symptoms normally stays under 15 percent of all users. (Further, in these instances, other therapies exist that do not have the contraceptive effects and potential side effects of birth control.) While this is a significant number itself (1.5 million in 2011), it is a small number compared to the overall population of birth control users and therefore can’t be considered the “primary reason” for taking the medication.

Some women use hormonal contraception over NFP because the former is easier to use. I would consider this a fair argument, but at the same time somewhat insulting from a healthcare provider perspective. It’s ludicrous to say that people should be pushed to simply take a pill every day because they can’t be trusted or expected be able to follow a more complex series of instructions to attain the same (and statistically more likely) result.
While I was in school, condoms were laughably pushed as well, though primarily as a supplemental form of control in that chemical means do not prevent the spread of sexually transmitted diseases as condoms do. Interestingly, delaying sexual activity until forming a lifelong commitment and holding to monogamy weren’t brought up in any lectures covering sexual health.

An inconsistent medical ethic

As nursing students we were taught how to educate people on everything from proper exercise, nutrition and hygiene to seemingly innocuous things as putting on lotion and trimming nails. But when it came to sexual health, we were told to simply “encourage them to use condoms to prevent spreading STIs” instead of a fostering an attitude about more complete sexual health.

In my view, it’s a very inconsistent attitude when the advice is: “Don’t teach patients about NFP because they can’t follow instructions and a pill is easier, but do teach them about diet and lifestyle changes that will likely be lifelong so that they aren’t on medication for X condition for the rest of their lives.”

Medicine should be focused on “treating and healing the entire person, not just the condition.” In many areas of health, we’ve come a long way in following this adage. But when it comes to non-pharmaceutical contraception, however, we still have a long way to go.

— Dave Bodinet is an operating room nurse at a Catholic hospital in St. Louis, Missouri. He lives in Highland, Illinois, with his wife Andrea and their three children; Camden (age 6), Emmett (age 4), and Isabel (age 2).