Apples and Fugu

I bet the Pill prevents pregnancy-induced insomnia.  I never have trouble sleeping, except during the last weeks of pregnancy.  I have been tossing and turning and thinking about an exasperating exchange with another blogger, and I have given up trying to sleep.

I read a variety of blogs, written by women with a variety of different views.  Usually I am content to listen to their opinions even if I disagree with them, but occasionally I'll jump in and comment.  Last night I ran across a paean to the Pill.  Did you know it prevents ectopic pregnancy?  Of course it does so in the same way that any form of birth control does:  if you don't conceive, you can't have an ectopic pregnancy.  By that logic, the Pill also protects against placenta percreta, pre-eclampsia, and postpartum hemorrhage, as well as the pregnancy-induced insomnia that has me awake and writing this grumpy post.

It didn't start out as a grumpy post, though.  I left what I thought was a courteous comment last night saying that it was incomplete to list benefits of the Pill without also listing its risks.  I provided links to mainstream documentation of what I acknowledged were low-incidence complications.  And the blogger wrote back to say, "Hi, Jamie! Thank you for your thoughtful comment. For some women, the risks of the Pill do outweigh the benefits, although I personally think the Pill is great." 

Okay, actually, she didn't say anything remotely like that.  But I have this silly hope that people who disagree can have civil conversations and acknowledge their common ground, and I am frustrated by the elusiveness of what seems like a modest goal.

I have long been frustrated by the way the risks of the Pill are presented.  Articles that say, "Although the Pill may have undesirable side effects, it is safer than pregnancy" -- they drive me up the wall.  I have read that such comparisons are statistically invalid, because the studies available at the time I was reading about it compared morbidity and mortality for populations of pregnant women and populations of Pill users -- without correcting for the fact that Pill users tend to be young, healthy women with access to health care.  No doctor who valued his license would prescribe the Pill to a 42-year-old brittle diabetic smoker with uncontrolled high blood pressure, but she is free to become pregnant.  Obviously, her risk of health problems is far higher than that of a 19-year-old healthy nonsmoker.  (I have to think that there are better studies available now, but I don't keep up on the literature at all -- Alicia? anybody know?)

But the larger issue is the false dichotomy:  either you take the Pill or you get pregnant, so make your decisions based on those two options.  I used to say it was like comparing apples and oranges, but that doesn't quite get it.  Oranges are cheap, nutritious, and tasty -- much like apples.  Here in my insomniac grumpy state I'm going to say it's like comparing apples and fugu, the expensive and occasionally deadly Japanese fish whose popularity leaves me scratching my head.

Fifteen years ago I would have found that a preposterous analogy.  I grew up in a mainline Protestant denomination, in a family that viewed contraception as normal and responsible.  When I heard that there were some people who didn't use contraception, I thought, "What's the matter with them?"

In the year after I finished college, I found myself unexpectedly drawn to the Catholic Church.  I didn't understand the teaching against contraception, but I was willing to follow it.  My mother has seldom been so angry.  In her view I was waving my hand in the air, calling, "Oh, boot heel of the patriarchy?  Come on over and grind me into the mud, please!"

What I have never been able to explain satisfactorily to my mother is that NFP is empowering.  For my college friends and me, our fertility was something capricious if not downright malicious -- something lurking in the corner until it could smack us upside the uterus with a pregnancy.  It wasn't until I took an NFP class that I realized my fertility is a gift, whether or not I am in a position to get pregnant in a given cycle or a given year.  NFP showed me that I could live in harmony with my fertility instead of bludgeoning it into not-quite-submission. 

One criticism of NFP is that it takes some learning, and that's true enough.  You can learn how to use the Pill in one visit to your doctor, but it can take months to get comfortable identifying changes in your cervix.  Once you have the knowledge, though, it's yours forever.  You don't have to wonder if you're pregnant or just late.  You don't have to wonder what's going on when you're nursing a baby.  You don't have to be afraid that you only have two unappealing choices:  either synthetic hormones or perpetual pregnancy.

When we were engaged, I was really stressed about NFP.  I envisioned long years of abstinence and anxiety.  The reality has been something else entirely.  If I follow my previous pattern after the birth of this baby, I will have had a total of five periods in the eight years between January of 1999 and January of 2007.  (I do love breastfeeding.)  In only one cycle since January 1999, the one immediately following my miscarriage last year, have we sought to avoid pregnancy.  A couple of times when my youngest was a toddler and I was unsure how working would affect my fertility, I said, "Talk to me in a day or two; I'm not quite sure what's going on today."  And that's it:  we've had no worries about surprise pregnancies, no doctor visits to discuss birth control, no side effects from synthetic hormones, no pharmacy bills, no "oops I forgot to stop at the drugstore" moments.  Somebody should market that!  Except -- wait -- it's free.  And it's way too uncomplicated for a technophilic culture like ours.

All right, I'm back after a shower and a cup of coffee, and I'm feeling more measured.  A couple of disclaimers are in order:  I know the Pill is safer than fugu; I know that our practice of NFP has been made easier by my longer-than-average stretch of postpartum amenorrhea; I know that my situation as a married Catholic woman with a faithful husband is different from the reality many women face.  I know there are lots of happy fugu eaters out there.  Although some NFP advocates call for a return to the Comstock laws, I'm not looking for a fugu ban.  I'm just saying we should have more apples in the grocery store.

I still think it's a little odd that the Pill is so widely accepted.  Is any other normal body function routinely suppressed in healthy women?  Is there any other case in which we blithely use synthetic hormones to interrupt the conversation of hypothalamus and pituitary, to squelch normal organ function?  Absolutely, the risk of complications like liver tumors, stroke, heart attack, gallbladder disease, retinal thrombosis, and death in Pill users is tiny.  But every single case -- as well as every case of nausea, headaches, mood swings, and the other less alarming but far more common side effects -- every single one is iatrogenic, caused by medical intervention that interrupted a normal physiological process.  If I were a doctor who had pledged "first do no harm," that would give me pause.

Very few doctors seem to agree with me, though.  I am not the poster woman for successful NFP use, because I had severely irregular cycles in my teens and twenties.  Every doctor I asked about it offered me the Pill.  I don't want to take the Pill, I told them.  As soon as I said that, the conversation was over.  The bag of tricks was empty.

And yet the solution (discovered when my NFP teacher sent me for help) was so simple:  I gained five pounds and implemented some stress reduction strategies.  Hey presto -- the improvement was remarkable.  I will never have ovaries you could set your watch by (especially not now, while they're on the biennial plan), but I have no complaints.

No complaints, that is, except about the difficulty of getting to this point.  In the pre-Web days when I was trying to get started with NFP, good information was absurdly hard to find -- even from a doctor.  Not enough has changed on that front.

Some of my girlfriends who took the Pill in their twenties have said things like, "I'm never taking the Pill again," and, "I told my doctor I was unhappy with the Pill, but he said it was better than getting pregnant."  Sometimes I hear it from women at breastfeeding support groups, too:  they don't like the spotting, or the mood swings, or the sudden drop in milk supply.  One woman's doctor told her that it was better to supplement with formula than to get pregnant at three months postpartum.  (Excuse me.  The memory causes me to stop and -- pound pound pound -- beat my head on my desk for a minute.  I'll stop now, though.)  Why doesn't he know that LAM is more effective than the mini-pill?

Women are going to their doctors and saying, "I'm looking for something sweet and crisp and vegetarian that starts with A.  Can you help me?"  And in response too many of them are hearing, "Well, today we have fugu sashimi and fugu soup..."

I am thinking about all the delicious apples in the world -- Braeburns and Fujis and Galas and Honeycrisps, versatile and inexpensive and good for you.  Calendar rhythm is the Red Delicious in this analogy:  nearly worthless but still mysteriously ubiquitous, held up as an object of ridicule whenever apples are on the table.  And did anybody else ever see that book on astrological birth control?  If you're a Scorpio and he's a Leo, you can groove on the 3rd, the 5th, the 7th through the 13th, and from the 18th to the end of the month.  I wish I had bought it when I saw it in a used bookstore; the memory makes me laugh.  Maybe that one is like a crabapple:  unfit for use unless modified beyond recognition.

The birth control issue can be a litmus test for both Catholics and non-Catholics.  For some Catholics, the degree of a person's opposition to birth control is a measure of her allegiance to Rome; for some advocates of reproductive freedom it is a handy gauge when evaluating for wingnut-fruitcakeness.  I disagree with both points of view.

We are closing in on twelve years of marriage, in which we have never used contraception.  I cannot offer it as evidence of personal piety, though.  If all I had to do to get to heaven was stay away from contraception, you could plan my canonization Mass now.  Unfortunately, that "love thy neighbor" business still kicks my butt.

I would also dispute the opposing conclusion, that a woman who says "I will not use contraception" is a rabid militant hyperzealous far-right-winger ill-equipped for life in this millennium.  I am none of those things, but I'll still say no thanks to fugu.

For a while now I've been kicking around ideas for an NFP post.  At first I was going to say that I had decided to give up teaching NFP because my heart wasn't in it anymore.  Then I was going to say that one of the things I like about PCT is that it's in a diocese with an excellent (and less politically charged) NFP program, and maybe I wouldn't give it up after all.  As I have been thinking about these issues, remembering how glad I was as an engaged woman to hear a friendly voice on the phone saying, "Yes, I used to have trouble finding my cervix, too," I am feeling an obligation to keep teaching.

Not everybody wants an apple.  It may be that I hear so many women complaining about the fish of the day because my own sympathies lie that way.  But my hope is that reliable information about reliable natural methods of family planning will become as mainstream as apples in the produce aisle.  Maybe I can help to make that happen.

If I put a pot on my head, will you call me Jamie Appleseed?

Comments

[Elizabeth]

I'll call you Jamie Appleseed, even without the pot. And I love this post.

[Amie]

Very good post! Your so right about the the pill being all dr.'s know to offer. I'm SO tired of explaining to my OB why I don't want the pill.

[Summer]

I read half of this post, then was told by my husband that our son was headed downstairs to the kitchen in search of dinner, and perhaps I should head that way myself. While our pasta boiled, I flipped through the latest copy of SELF magazine. Lo and behold: an article on contraception, which I did not read, and a full-page chart titled "Find the no-worry birth control that's right for you!" The chart was divided into new technologies (the Pill patch, the NuvaRing) and "old standbys". In the old standby category: the Pill, condoms, vasectomies and tubal ligations. Nowhere was there a mention of NFP. Hello? This magazine would rather have me consider STERILIZATION than ovulation awareness? On what planet is an IUD "no-worry"? (It occurs to me that perhaps I should be writing to the editor of the magazine, rather than you, but at least I know you'd agree with me.)

I've been practicing NFP for longer than I've been a Catholic. Eleven years now, without a single pregnancy scare. For me, at least, it's easy. My cycles are regular, regular enough that I could use the calendar method, but I don't even make that much effort. I just check the toilet paper, and if there's lots of mucus, I know that's not the best day to get it on unless I want to make a baby. I know that many women have to put more work into NFP, but how many other women would have as easy a time of it as I do, and just don't have that little bit of knowledge they'd need to use it? Lots, I bet. Lots and lots.

Another scary thing I've read about in women's magazines recently is the trend towards keeping women on active birth control pills so they only have their period four times a year, or even less often. The logic behind this, if I'm remembering it correctly, is that ovarian cancer has become far more common than it ever was, and researchers think it might be because modern women ovulate too many times in their lifetime. Since modern women are having fewer children and breastfeeding those children for a far shorter time, a hypothetical modern woman will have two or three times more ovulations than her counterpart 200 years ago. So the solution, obviously, is to stuff women full of synthetic hormones and chemicals to stall her natural cycle. Am I the only one this disturbs?

And breastfeeding, oh breastfeeding, what a wonderful thing it is. Not only did breastfeeding give me a full year of no periods, but it made me as skinny as I was in high school.

[Laurie]

Jamie, I'm interested to hear your opinion on reproductive techonologies. Especially as my DH and I have just celebrated our 10 year anniversary, have not used BC since our honeymoon, and I have never been pregnant. And yes, we know what the problem is .
I think that NFP is percieved as being too granola and unreliable, and you know americans love their high-tech stuff!

[Sierra]

I was a victim of ignorance before I started trying to get pregnant. I spent years on the pill and only started to learn about my body when I had a hard time conceiving. I will never have to use any other form of birth control other than NFP ever again! People have a hard time digesting my refusal to take the pill. I love knowing more about my body and I love the convenience. I don't understand why more women don't seek this.

For the record, I started having periods again when Aidan was only 3mo, and I never supplemented and he didn't have any solids until 6.5mo (and I was a major pacifier for him, and he nurses frequently during the night). Not everyone gets to enjoy an absence of periods. I would like to get pg again soon, but I'm a little worried about trying/getting pregnant while breastfeeding (Aidan is 9mo). Do you have any thoughts here? Or a direction you can point me in for some thoughts?

Great post!

[Claire Gee]

Forgive my ignorance, but what does NFP stand for - it may be called something else here in Australia?
When I was in high school (Catholic Girls School) we were taught about "The Billings method" which involved observing mucus and charting your cycle. I don't quite trust it, as my daughter was conceived very late in my cycle when we thought it was "safe". We were thrilled to have her, but our health insurance didn't kick in until 2 months after she was born, so she was created slightly before we were going to start "trying". Turns out Hubby and I don't really need to try (we are very lucky) and I am currently carrying number 3, also conceived v late in my cycle.

I wonder if you know anything about a study I heard about late last year (heard on the radio while driving - don't know details of study, but it was Canadian), where women with v regular cycles were tested daily (i think by ultrasound) to determine when exactly they ovulated. Those doing the study were amazed to find that quite a large proportion of the women in the study ovulated twice, and some even three times, spred across their cycle.

As I am a fraternal twin, my mother obviously ovulated twice at once, I wonder if I might ovulated twice at different times.

Curious to hear your thoughts as I do not take the pill either, but don't really want 7 children like my MIL :-) (if we ended up with 7, we would cope, and love and cherish them though)

[Jane L]

I've used NFP since I was 18 and needed to know whether I was going to have a 22 day cycle or a 90 day cycle. I've used NFP for fertility regulation since getting married nine years ago, and like Sierra, my periods resumed at 3 months postpartum with my firstborn despite full ecological breastfeeding. It hasn't always been easy, but I like doing it and it's gotten to the point where I don't have to think about things. (Plus, I had 20 months of postpartum infertility after my daughter and I'm on 12 months now with my son, so apparently I was just too stressed after my firstborn.)

It irritates me when people claim that NFP has a 78% success rate (no, that's calendar rhythm) but the Pill is foolproof. I know many women who got pregnant while on the Pill. But this is the result of a culture that values control over everything else, and in which children are a thing to be hated and feared because they detract from the things we can give ourselves.

I ended up at a doctor for severe bleeding just after we got married (apparently some hymens break in a bad way) and that doctor said, "So you must really want children quickly," when I told him we used NFP; the doctor who delivered baby #1 and whom I would love to run down with my car openly sneered at using NFP and said, "You'll be back here pregnant in six weeks." (Note: I wasn't, and if I had become pregnant, I'd have sooner delivered in a taxi cab than in the hospital if he was on duty.)

Thanks for your post. I don't know how to get doctors to give honest choices to women, but if you figure it out, I'll help. :-)

[Anne Basso]

I also grew up in a mainline protestant denomination. I have the same difficulty explaining to my mother why we aren't going to use birth control or be sterilized. I'm currently carrying baby number 4 who was concieved while breastfeeding exclusively a seven-month old. I thought I'd have a warning period, and I didn't. This time I'll start charting a couple of months sooner. But I'd still take NFP over anything else. And if my mom can't understand that, it's just too bad. Thanks for the great post!

[Jamie]

Thank you, everybody, for reading my screed. Anne, you just left the 500th comment on this blog -- if you want to email me your address, I'll send you some chocolate.

Claire, NFP stands for natural family planning. I should probably go back and put that in somewhere. The Billings method is one form of NFP; some women also use basal body temperature and cervical changes to determine whether or not they're fertile on a given day.

I hadn't heard a word about that Canadian study (here's a summary), but in googling a little further I also found some responses (pretty far down the page) which make more sense to me. Apparently the researchers saw a second or third wave of follicular development, but not actual ovulations. One of the effects of progesterone (secreted after ovulation) is to suppress further ovulation, so I was surprised when I saw the first report. Progesterone also dries up cervical mucus, so even if there could be additional breakthrough ovulations, it would be tough for sperm to meet egg.

Oh, argh, my sons are not excited about my finishing this comment. Laurie and Sierra, I'll be back.

[Elena]

Great post Jamie!! I can't add anything much except to say that if NFP became mainstream- Planned Parenthood would lose a lot of business!! Which is probably why they don't promote it much.

[Mary Poppins NOT (Renee)]

Oh, how I wish your NFP experience was mine. I have a 6-7 month break post partum, but no matter how diligently I follow ecological guidelines, I never get longer than that. Then because baby is still a vigorous nurser, my "signals" are iffy - temps up and down, mucus constant. My husband says, "You can't be fertile all month!". So we try, and we try,and 3 times have conceived on a "safe" day. I don't regret any of the children we have received due to my confusing signs BUT, I am never sure if I am late or pregnant. I am currently undergoing a "scare" and my baby is only 8 months old. Doesn't seem right, somehow. I feel my choice is either alot of abstinance, or alot of pregnancy. Maybe if I immersed myself in studying and getting more help from CCLI, I might feel more confident, but I truly don't know when I would do that. OF course, contraception isn't an option, not just because of my religious convictions, but now because of philisophical and biological ones as well.

Once we were invited to a NFP class at our friends' house. We were going to go, as they offered to let us bring the children. As the time to depart got closer, the little kids got tired, hungry, etc, and I felt unsure about having the older kids have to watch the little ones at a different house. I could only imagine the huge number of interruptions we would incur. Anyway, we called our friends, and said, "We have too many kids to come to the NFP class." That is the story of my life!

[Linda]

Jamie, I came to your blog kind of randomly (googling for Laurie Colwin's brownie recipe--happy to discuss her w/you any day!) and am amazed by how different yet alike we are. I, for example, am completely lacking whatever features enable people to experience spiritual feelings, and I also have never experienced a desire to have children. (I never used to assume that I'd NEVER want them, but I'm pushing 39 and it hasn't happened yet.) But I still feel we are sisters in sensibility in a way that I can't really articulate.

I don't especially disagree with your position on the pill and NFP. I do think doctors seem excessively eager to put women on the pill, and that it possibly reflects a general inclination to medicalize and pathologize the whole condition of being female. I get suspicious of all the you-go-girl magazine articles claiming that the pill is GOOD for your health in ways other than preventing pregnancy. I've never used the pill because my body has usually seemed to work pretty well and I'm just scared of rocking the boat.

Also, you make a very good case that NFP is empowering. Clearly it is working well for you, and many women, as a means of birth control. But it IS birth control, isn't it? You ARE controlling your fertility--not in a 100% reliable way, but then who is? It's the "Who am I to try exert the least control in this one particular area of my life" position that bothers me--and, much more, the "Who are YOU to try exert the least control in this one particular area of YOUR life" position. Again, I understand that you are not taking either of these positions, but the fact that they're out there is what sets people off.

I agree that it would be wonderful if more people had more, and less politically/religiously charged, info about NFP, though an awful lot of women, especially very young women, are probably not great candidates for it.

This is a particularly random post for me to respond to, but perhaps that's fitting...

[Angel]

Thank you.

[Moxie]

NFP isn't popular because people don't have to pay for it.

When we use it (when I'm not pregnant), we call it FAM, because I'm Protestant, fine with birth control, and use condoms during the "unsafe" days. But it's the same method. Finding out about it was, well, like being given a drink of nice cool water after a long hot walk. I first read about it in TCOYF, which I then forced my mom to read ("Why didn't anyone ever tell me this?!").

I got into a whale of a discussion about FAM/NFP vs. the Pill for women in developing countries with an older (late 40s) friend of mine. She was inistent that giving women in thrid-world countries the Pill was the only way to give them control over their reproductive lives. After all, they couldn't be expected to learn the complicated rules of NFP: they'd have to know what day it was, and be able to count, and stuff like that. The very idea that it was more practical for them to be consuming chemicals they'd have to have shipped in from the outside world than to teach each other NFP (and maybe they could make cool beaded bracelets out of local materials to help keep track of days) just boggled my mind. But this is what my friend was insisting.

Why use something free when you can pay for something inferior?

[Jamie]

Sierra, are you concerned that Aidan still needs to nurse, or concerned that it will be harder to conceive and sustain a pregnancy while you're nursing? For some women, nursing interferes with conception even after the return of regular cycles (although no one who wants to avoid pregnancy should count on that!), but many women find they can conceive healthy babies while still nursing frequently. If Aidan is your concern, you have the option of continuing to nurse him through or beyond a second pregnancy if you want to go that route.

My very most favorite book about older nurslings is Mothering Your Nursing Toddler. There's also some good stuff in Sheila Kippley's Breastfeeding and Natural Child Spacing. LLL has a newish book called Adventures in Tandem Nursing that you might find helpful, too. Email me if you want to talk more.

Laurie, I can only give a humble opinion on reproductive technologies because I have never gone down that road. The most important thing I want to say about your comment is that I am sorry to hear you find yourself in this spot, and I will pray for you and your husband. Since you asked, I'll answer: I am a Catholic, and the Church's teachings on ART make sense to me. I have also observed, from friends' lives and from many bloggers' stories, that ART seems to be a uniquely soul-sucking process for many couples (though I understand infertility is soul-sucking in its own way). I wish you the best.

[Jamie]

Moxie, are you familiar with the 1993 BMJ paper on NFP in the developing world? A researcher named Ryder found NFP was as effective as the Pill among Calcutta women (mostly poor, and many illiterate if memory serves). Love the story about making your mom read TCOYF -- wonder if my mom would have been less flipped out with better information.

Renee, sympathy to you on your return of fertility situation. If I could spread breastfeeding infertility around in your direction, I would. Does the cervix sign help you at all? I would be lost without it myself.

Linda, thanks for your comment -- nice to hear from someone who appreciates good brownies and Laurie Colwin! Yes, NFP is birth control. Catholics make a distinction between birth control and contraception, labeling methods that work to stop sperm from getting from the right neighborhood to the right address as contraception, and distinguishing them from natural approaches that keep sperm in their own zip code until the egg has left the building. One of the most frequent criticisms of Catholic teaching on birth control is that this is a meaningless distinction, but I disagree. Subtle, yes, but important.

Catholics are called to steer a middle course between providentialism (the "Who am I to exercise the least control?" position you were describing) and control-freakitude (which has a better name that is just not springing to my sleepy brain) -- being generous in response to God and also being prudent in light of the resources they have. NFP is not a magic bullet, because it can be used in a control-freakitudinous way. And I had a concluding thought but I am falling asleep at the keyboard so I will see if it floats back into my head overnight. Good night, all.

[alicia]

Jamie - the following is from a letter I sent to my Theology of the Body listserv - I thought it would be applicable here and maybe give you a little hope. alicia
******
A patient came in to me for a consultation, put in there at random by the staff at the health center where I work. She was married, with one child, had been put on the depo shot after
childbirth by her previous provider, and was very unhappy with how it made her feel.
Not Catholic, but Christian and pro-life. I sat down with her and talked about
the post-fertilization effects of hormonal contraception. We talked about the unknown
mechanism of IUDs, but that once again there is probably a post-fertilization effect.
We talked about the effectiveness rates and psychological effects of barrier contraception
(which she had also used). Then I asked her if she had ever heard of NFP. She had
never heard of it, had never even heard of rhythm, (she's 21), had no clue that
there was any way to prevent pregnancy that worked with her body instead of against
it.
This was back in the fall, and I gave her a brief description, asked her if she
thought her husband would be supportive, and sent her off to my local teacher for
classes.
She came in earlier this week for a followup visit with me, and told me that she
was so very happy to be learning how her body works, and that her marriage was better
than she thought it could ever have gotten, because she and her husband are communicating
about their sexuality and their fertility. She got tearful about how empowered
they both felt that they could make a choice and not be under the control of lust.
This, to me, is the playing out of TOTB in action.
Right now, they have one infant, very strained financial circumstances, and another
baby would create a lot of hardship. Her body is also still recovering from the
Depo so avoiding pregnancy is a good idea for her at this time. She was marvelling
at how the pheromones of desire are highest at her fertile times, something she
had never noticed before, so I reminded her that God created sex for babies, not
just for bonding. She told me that she has been saying "not now, I'm fertile"
and I suggested maybe saying something more along the lines of "If now, are
we ready to have another baby?". Kind of changing the focus from denial to
acceptance - and I could see her brain clicking along that thought process.
I was just in awe - I don't get to see that too terribly often in my work setting.
Mostly I am dealing with the fallout of the sexual revolution. Most of my prenatal
patients are not married, many of them have questions about their child's paternity,
some of them have several children by several men, I have 20 year olds asking to
be sterilized because they have 3 children and no one to help raise them. We need
to evangelize the culture, and most days it is so easy to sink into despair.

[alicia]

OH, and would you send me an email with the specific research question that you have?
NFP - there are many different methods for determining the fertile and infertile days, and if one of them doesn't work for you, try to learn another. Me, I don't HAVE a BBT to determine, too many years of disturbed sleep etc. (My proegesterones are also all over the place - probably why I have miscarried at least 40% of my pregnancies). My cervix is almost unreachable (severely retroverted uterus). But I have had great success with using Mucous only methods (Creighton model). Billings and Creighton are both mucous only, but women who have a continuous mucous discharge and who cannot identify a 'point of change' in their mucous (need to consult with an experienced teacher!) may need to supplement that sign either with BBT readings (STM) or with urinary FSH levels (Marquette model). Probably 70% of women can reasonably use a calendar method, and the standard days method (Cyclebeads) may be a reasonable option for them - my big complaint about that is that the period of abstinence is so much longer than it needs to be. NFP can be as high tech as an ovulation monitor and urine dip sticks, or it can be as low-tech as toilet paper. Hey, there are close to 30 different formulations of birth control pills, so why the heck not have as much choice and individualization in NFP?
ABout ART - I strogly suggest that anyone considering that also consider first getting a consult with Dr. Thomas Hilgers (Pope Paul VI Institute) or with a doc trained by him. They have succeeded in helping women conceive who have failed IVF. Dr. Hilgers just published a 1264 page textbook -if you want you can buy it for around $200 and read his research and techniques before investing in a trip to Omaha. His methodology is based upon first identifying problems areas using Creighton model NFP charting, so finding a Fertility Care Practitioner (Creighton model teacher) is a good first step. I also have found that Marilyn SHannon's advice in "Fertility, Cycles, and Nutrition" is excellent. If there is a male problem, the best thing may be to enhance the woman's cervical mucous so that what few healthy sperm there are can get there at the best time. A lot of people have this weird idea that fertility is two seperate people's issue, not an interactive one, and the ART mentality does not help there.

[Laurie]

Alicia, ART is a lot more than just IVF. And there is a minimum number of sperm needed for conception, so if the male only has a few hundred thousand all the EWCM in the world ain't gonna get the little swimmers there. Believe me, we have tried all the low tech (and some not-so-low tech like Clomid) methods that we could. In our case conception is just not going to happen without either some type of ART medical intervention or a Elizabeth-and-Joachim-type intervention ;)
Jamie, infertility and ART are two sides of the same soul-sucking coin. I was raised Catholic, and although I no longer practice any sort of religion I'm pretty up-to-date on the Church's stance on ART. My opinion is that anything that helps a loving couple have a much-wanted child cannot be wrong, and if I do concieve a child with insemination or IVF my child WILL have a soul (A priest at our Pre-Cana class told us that a child concieved with ART would have no soul!). And I cannot imgaine a loving God punishing a child for its parents' transgressions. Would I prefer my child be concieved through an act of love rather than one of science? Of course! No one does ART if they don't have to. But our preference as a couple is to exhaust all possible ways to have a biological child before we move on to adoption.
And thank you for your prayers. As my grandmother used to say, from your lips to God's ear.

[Anne Basso]

My concerns with IVF etc. are 1) on a spiritual level the disconnection between conception and the marital act 2) on an ethical level it is being misused by over-producing embryos, over-impregnanting women and leaving frozen babies or too many babies in a woman that can be in danger (or endanger their mother) should they all implant. I'm afraid our ethics haven't caught up with our technology. But I agree with the last commenter about the baby. I'm sure that the babies have souls (what an odd thing for a priest to say!) and that God loves them very much!

Jamie, be careful about offering a pregnant woman chocolate. It could be dangerous! :-)

[Laurie]

Anne, I think more women undergoing ART need to educate themselves about the whole overstimulation/overproduction issue. Maybe it is different for me because I am a scientist, but most women I've know just kind of blindly follow what the doctor tells them, trusting that he has their best interests in mind (hah!). The thought of frozen embryos doesn't bother me personally, but I am going to do my damnest, and make sure the docs do the same, to avoid higher-order multiples. There are ways to do it- it might drag out the process a bit and lower the clinic's stats (the horror!) but my health and the health of my future children is more important to me, and I'm both the body and the wallet ;)
You could have knocked me over with a feather when the priest said that! We didn't know about our problems at the time (obviously, or we would not have been able to marry in the Church, and that's a whole other issue) but I thought that was totally wrong and incredibly insensitive thing to say. Even beyond the fact that a celibate priest was teaching NPF to a room full of engaged Catholics!

[r o]

Laurie, if you mean that infertility is a bar to marriage in the Church, that's not true.

[alicia]

Laurie, I do know that ART has a whole lot more than IVF to offer. I am in the health care field after all, and even at the so called "mid-level provider" we learn about that stuff. What bothers me is that so many reporductive endocrinologists are so cavalier about the side effects of their technologies, and I am speaking not just physical but also emotional and spiritual. The human aspects of fertility are so intertwined that sometimes I think it is a miracle that I see so many people with totally unplanned and partially unwanted pregnancies.
I am also puzzled that you say that your problems would have been a barrier to marriage in the church - where did you get that idea? You have to be open to the idea of having children, but you don't have to be physically capable. Women after menopause or who have had hysterectomies are barred from marriage in the church just because they can no longer physically concieve.

[Laurie]

r o and Alicia, I don't have time right now for a full comment, but we were told by our priest that if either of us knew that we could not have children that he could not marry us. Any known inability to conceive and carry a pregnancy- congentital, natural or surgical- would have been unacceptable. So, say if I knew I was a DES duaghter (I'm not) and could not carry a pregnancy to term, I would not have been permitted to get married in the church.

[Jane L]

Laurie, I was told that if a person was physically "incomplete" and incapable of actually having intercourse, that would be a barrier. (Like, for example, a man who had the whole works removed due to penile cancer). But since "infertility" is such a delicate area and some "completely infertile" couples have conceived spontaneously, that would not be a barrier to marriage in the church.

[Jamie]

Laurie, canon law says "sterility neither prohibits nor invalidates marriage" (1084.3). You can't lie to your betrothed about being infertile if you know that it's an issue, but in that case it's the lying that's the problem and not the infertility.

And that priest who said babies conceived via IVF don't have souls -- he's saying there are people walking around in human bodies who don't have human souls? That's closer to Robert Heinlein (I'm thinking of Friday) than it is to any Catholic teaching I've ever heard.

[Jen]

So I stumbled across this blog from Julie's site... it's very interesting, actually, because one would think that looking at my usual tendencies I would be very skeptical about NFP. I am currently on Evra (the patch) and while I'm happy that it is available, if I were for example married I would prefer to use NFP for many of the reasons Jamie mentioned.

I have kept track of my cycle for a long time (and not because I was having sex, just because I liked knowing when I would be on my period, PMSing, etc. etc.) and it was never difficult to tell when things were going on in my body. NFP seems quite logical, easy to follow, and I agree that it sounds empowering and frankly, much healthier.

[Laurie]

It all just sort of underscores the fact that priests are fallible humans also, doesn't it? Jamie, glad to see you've read that book as that was the first thing I thought of when the priest said that.

[Jane L]

There was a "mystic" who was seeing "visions" of Our Lady in Bayside, Queens. She has been discredited by the church pretty much every time she opens her mouth, but one of the things she claimed was that demons were animating children born through IVF. (And the Church said, "Like fun they are.") So the next time some woman says her kid was "a little demon," it's worth an eye-roll.

I looked up the Church's teaching on IVF and it explicitly says that the children born of IVF procedures are no different and are to be treated no differently than children born any other way.

[Mab]

Thanks for this post Jamie. I finally got off my butt and went looking for a thermometer and a teacher. Doing NFP was something that I had been pondering for a while and this was the clarion call. I definately do not want a pregnancy at this point in my life (studing, flatting and in a committed relationship), but I need some more security than the old condom roulette. I have never taken the pill, simply because messing around with hormones sets alarm bells ringing in my head. And knowing how my body works and the signs it gives off is something I wouldn't want to trade. So thanks for the trumpeting.

[Melissa]

A very timely post for me. After 13 years on the Pill I am off and using the methods in TCOYF to hopefully prevent pregnancy for a few more months before we try to conceive. I do agree that the fact that FAM and NFP are overlooked and ridiculed is problematic and within the medical community, it is pathetic.

However, the Pill has its place in our culture and it's not people that hate babies that are taking it. This excerpt from a comment above drives the point home:

"I don't regret any of the children we have received due to my confusing signs BUT, I am never sure if I am late or pregnant. I am currently undergoing a "scare" and my baby is only 8 months old. Doesn't seem right, somehow. I feel my choice is either alot of abstinance, or alot of pregnancy. Maybe if I immersed myself in studying and getting more help from CCLI, I might feel more confident, but I truly don't know when I would do that."

When the Pill was introduced to American women the above experience was the norm. I don't mean to put word in the poster's mouth, but I can hear her desperation from afar. And her answer to the issue of her unpredictable cycle? It's her fault for not studying enough or being dedicated enough. I don't find that to be a healthy disposition.

Whoever mentioned the Pill as a device to clinicize women's fertility is flat-out wrong. Women were desperate for a method to prevent pregnancy and eagerly embraced the Pill. the fact is that the Pill is extremely effective and extremely safe and is a good option for younger women that simply aren't ready to take on the duties of motherhood.

I haven't been charting and observing my signs for very long now, but there was no way I could have been consistent in this to prevent pregnancy until this time in my life when I am more settled and my signs are likely to be somewhat consistent.

All that said, I still agree with the basic premise that NFP and/or FAM should be treated as legitimate birth control methods and promoted as such by our health care providers.

[Anne Basso]

I hear what you're saying, Melissa, and I admit I look at life through Catholic lenses. But if a woman isn't responsible enough to track her cycles (I also believe she should be married, but one issue at a time) what makes you think she's responsible enough to be in a sexual relationship?

I'm really sick (sorry this is slightly off topic) of sex being just this animal act that people can hardly control, or should be allowed to do anytime because it feels good. Chocolate is really great for me, but if I don't watch it I'll gain 100 lbs.!

I love the beautiful sexual relationship that I have with my husband. I wish someone had explained it all better to me years ago. No pre-marital contracepted sex act can begin to compare with the beautiful sexual relationship I have in my marriage, and with NFP.

[Laurie]

...No pre-marital contracepted sex act can begin to compare with the beautiful sexual relationship I have in my marriage...

Anne, I have to disagree with you here. The spirituality of a sexual relationship does not depend on marital or contraceptive status, but the persons involved.
And yes, sometimes sex is a wonderful, spiritual act of love that brings two people even closer together. But sometimes it's just hot sweaty monkey sex. Both have their place in a relationship. I've had sex and I've made love, all with the same man in the same relationship both before and after marriage.

[Anne Basso]

Laurie, you're free to disagree with me till the cows come home, but when it comes to which I'm going to encourage my children to wait for, I'm going with the deep spiritual sexual connection of marriage. Call me crazy, but I want better for them than just some pre-marital monkey sex, with all of it's risks.

[Laurie]

But my point is that marriage does not automatically equal deep spiritual sex. And premarital sex does not have to be just sweaty monkey love.
I know more than a few marriages where I seriously suspect, and in some cases know for sure, that there no deep spiritual connection on any level, not just sexual. And my DH and I had that connection before marriage and before pre-marital sex. A wedding ring is not a magic ring that automatically binds two souls together- that can happen at any time, or not at all. I want my children (if I am fortunate enough to have them) to have deep, fulfilling spiritual relationships. Marriage is not essential to that IMO. Marriage is wonderful, but it can't fix what's broken or doesn't exist in the first place.