Natural Family Planning International

“…no one even mentioned the temperature method or breastfeeding. I had to kick and scream and cry (of course) just to have them admit there were other options. Other options they were completely unwilling to teach.”

The quotation is from a woman who was in a bit of a panic.  She was about three months postpartum after a difficult delivery and wanted to postpone her next pregnancy.  She went to a well regarded center where she talked with someone who teaches a mucus-only system, and she was not happy with their conversation.  After her next pregnancy and difficult delivery, she was again in a panic mood.  She and her husband had engaged in the marriage act during an early postpartum mucus patch, and now she was thinking that she would have to endure uncertainty for another three weeks before she could have a valid pregnancy test.  This time she went to the internet and somehow found us and sent an anguished email.  I told her that if she took her temps every morning for five days, I might be able to give her some certitude about her situation.  She did so and with great relief announced to me some days later that she now knew she wasn’t pregnant.

The obvious question is this: why didn’t the well paid professional to whom she first turned tell her the same thing?  Why do many of the well paid professionals who teach one of the mucus-only systems ignore the temperature sign?  Even worse, why do some of them tell women that the temperature is unnecessary (whatever that means) or even that they shouldn’t use it?  Or that temperatures are irregular, whatever that means?  Or tell them the mistaken idea that the mucus sign is the best indicator of ovulation?

Is that fair to individual women and their spouses?  Is that fair to sponsoring hospitals, dioceses and parishes?  Who is the real professional—the well trained volunteer who teaches spouses all the common signs of fertility so that they can make their own choices or the well paid promoter of one system using one sign who refuses to tell spouses about other valid common signs and systems?  You expect such a narrow approach from a hack salesman but not from someone who wants to be considered a professional.  After all, professionals would like us to think that they are something more than mercenary.

The one-sign heresy.  Every heresy starts with the affirmation of one truth but then falls into the error of denying other truths.  With regard to NFP, this goes way back.  One of the early medical promoters of the Calendar Rhythm system strongly believed that the rhythm calculations were self-sufficient and denied that they would be helped by the cross-check of the temperature sign which became available in the latter 1930s.  In the late 1960s or early 1970s, a medical proponent of a temperature-only system denied the value of the mucus sign that was just then coming into prominence.  And in the early 1970s, the originator of the Billings Ovulation Method discarded the cross-checking temperature sign in favor of a mucus-only system.  Interestingly, Dr. John Billings didn’t say the temperature sign was too difficult to use.  On the contrary, he said it was so easy to use that women would ignore giving proper attention to their cervical mucus signs.  Dr. Billings, of course, had another reason for emphasizing only the mucus sign.  He was trying to get this form of NFP into Third World countries where thermometers would be difficult to obtain, and I admire him for that effort and empathize completely with his stand for those in the Third World.

My concern in this blog is for women in First World countries where thermometers are almost universally available.  (They are increasingly available also in developing countries.)  I have to wonder if the ease of using the temperature sign is not behind the objections raised by some of the well paid professionals against it.  If its use makes NFP too easy, the demand for their follow-up services might be reduced considerably.
Let’s take a look at these allegations and objections.

Is mucus the best indicator of ovulation?  No.  Cervical mucus is certainly a great indicator of fertility, but so is an open and elevated cervix.  Peak day (the last day of more-fertile mucus before the drying-up begins) is usually associated with ovulation, but not always.  Double-mucus-peak cycles provide a problem because in such cycles because ovulation does not occur around the first Peak day but with a later mucus patch and Peak day.  Thus some mucus-only proponents tell women that they need to keep monitoring their mucus every day during Phase 3.  Does that sound as if they really believe that Peak day is the best sign that ovulation has already occurred?  Here we see the value of the temperature sign.  The temperatures remain low after the first non-ovulatory Peak day and then rise in conjunction with the Peak day that is associated with ovulation.  Furthermore, according to Dr. Konald Prem’s professional opinion stated in a medical journal, the temperature sign is the single best indicator of a baby’s gestational age.  By the way, Dr. Prem is the only doctor associated with the NFP movement who has headed up a department of Obstetrics and Gynecology at a secular medical school.

My wife and I have taught the cervix sign since the early 1970s because breastfeeding mothers found this sign more helpful than the mucus sign during amenorrhea and the sometimes ambiguous return of fertility.

Irregular temperatures?  If you are ever told that temperatures are irregular, ask what is meant by “irregular.”  Of course you—man or woman—will have slight daily variations in your waking temperatures.  That’s the way God made you.  That’s why we do not rely on just one or two temps but on the overall levels during and after the mucus patch.  The important reality is that God made woman in such a way that post-ovulation progesterone causes her temperature to rise enough so that it can definitely be charted and interpreted.

Special values.  A significant value of the temperature sign is that low levels indicate non-pregnancy while high levels indicate post-ovulation progesterone, and 21 days of elevated temps give about a 99% certainty of being pregnant.  Postpartum, couples sometimes ignore some mucus patches and then wonder if they have become pregnant.  Continued low temperatures assure them of non-pregnancy.

Choice.  Choice is not a dirty word.  Giving couples a real choice among morally valid systems of systematic NFP treats couples as adults capable of making choices best in line with their own needs and personal preferences.  That’s why we teach both external and internal observations of cervical mucus plus physical changes in the cervix.  That’s why we teach the what, why and how of ecological breastfeeding; this allows couples to make choices in terms of what is truly best for mother and baby.  That’s why eco-breastfeeding as well as all the common signs of fertility should be included in every sort of NFP instruction.  Unfortunately, that is simply not the case, and real choice is systematically denied.  Is that fair?

John F. Kippley
Battle-Scarred: Justice Can Be Elusive  This book is 20% off at lulu.com with an additional 15% off on one lulu order through Sept. 21—using the code PIRATA.
Sex and the Marriage Covenant: A Basis for Morality

In late December 2010, someone asked NFPI to help recruit people to become involved with a study on the Creighton Method (CrM).

We declined the invitation because we have some serious reservations about the Creighton Model as a system of natural family planning.  We recognize that it can be very helpful for couples with infertility problems so serious that they may require medical intervention, but we cannot recommend it as a system for postponing or avoiding pregnancy.

First, every comparative study has demonstrated that cross-checking systems provide better effectiveness rates than mucus-only systems.  We think it is a disservice to women and to couples to promote any mucus-only system as equal to or better than a crosschecking system for purposes of avoiding conception.  In addition, the crosschecking signs of the Sympto-Thermal Method (STM) enable most women to learn the system without intensive instruction or hand-holding.

Second, mucus-only systems, including the Creighton Model, do not include the teaching of the value of the temperature sign as a routine part of their education.  The reality is that God made woman in such a way that her basal body temperature rises sufficiently after ovulation that it can be used as a positive sign of post-ovulation infertility, either independently or as a cross-check on the drying up of the mucus sign.  Every woman and married couple has a right to know this part of the Divine Plan.  To systematically ignore the value of the temperature sign, certainly a valuable biomarker in the fertility cycle, or to keep it as a secret only to be used when the mucus sign is practically worthless is to systematically deny this knowledge to people who have a right to know it.  That’s not right.

And what does the Creighton model teach about ecological breastfeeding?  Every mother and her husband have a God-given right to know about the kind of breastfeeding that truly DOES provide an extended time of postpartum infertility.  Information on ecological breastfeeding is easily available, but it appears to be systematically ignored by most NFP programs.  That’s not right.

Another reason we could not help recruit couples for a CrM study is that we have not been informed about its teaching of sexual morality.  It is our understanding that most NFP programs fail to teach specifically against recourse to masturbation and marital sodomy during the fertile time.

We understand that the CrM teaches women to do Kegel exercises to expel as much semen as they can shortly after the marriage act.  We find this morally ambiguous.  While the intention is probably not  contraceptive, the action itself is too close to the action of a post-coital tap-water douche.  That is, the action itself may have contraceptive effects.

Lastly, it is our understanding that the complete CrM course is typically much more expensive than a typical STM course.  Thus it seems to us that when compared to the course we teach, the CrM course costs more and delivers much less.

John and Sheila Kippley

Natural Family Planning: The Complete Approach

PS: We have received several comments that were a combination of a reply and standard Creighton model advertising.  We post only those comments which provide facts and specific information relevant to our blogs.  We have chosen not to post these comments, but we will address the relevant issues.

MCP noted that she had several friends who did “all the steps for ecological breastfeeding and have had an ‘early’ return of fertility.”  She did not respond to our question, “What does the Creighton model teach about ecological breastfeeding?”  First, our experience is that some women who claim they were doing EBF were in fact not following all seven standards.  Second, whenever there is an average experience, there will be those below that average and those above that average.  Our research showed that only 7% of mothers doing EBF had a first menses in the first six months.  The average experience was 14.5 months of breastfeeding amenorrhea.  Thirty-one percent had at least 17 months of amenorrhea.  Our point is that ecological breastfeeding truly is a natural form of spacing babies and that every NFP program should be teaching this information.  But they don’t.

MCP also defended the CrM teaching about behaviors during the fertile time.  “Creighton materials clearly state that genital contact during the fertile time may lead to pregnancy and the use of such practices [masturbation and anal intercourse] clearly is not part of their system.”  MCP again misses the point.  We recognize that every NFP organization teaches against genital-genital contact during the fertile time.  That is a practical matter of avoiding sperm transmission.  And we have not said that CrM or any other Catholic-oriented program actually recommends masturbation or marital sodomy.  What we did say is this: “It is our understanding that most NFP programs fail to teach specifically against recourse to masturbation and marital sodomy during the fertile time.”  MCP does not address that issue.  We will be happy to publish a clarification once we see the CrM user manual and find a teaching against these immoral practices.

“Heather” is happy with the CrM and wrote several glittering generalities, but she also made one statement of alleged fact.  “The Creighton Model has far surpassed the other methods in its ability to standardize the observation of a woman’s biomarkers of fertility and has gained acceptance by physicians all over the globe.  The Creighton Model has been shown to be a useful tool in a medical practice.  This just cannot be argued with.”  On the contrary, we would argue that any system that ignores two important biomarkers of fertility – physical changes in the cervix and changes in basal body temperatures — certainly does NOT surpass those systems that use these signs in a cross-checking way.

Heather then asked, “[H]ow does an ongoing ‘competition’ between methods that have all been proved to be beneficial, reliable and morally acceptable helping to promote a ‘Culture of Life’ and promoting the truth about NFP?”  Is not the previous quotation about the CrM surpassing the other methods a competitive statement?  Again the research shows that the cross-checking systems are more effective than the mucus-only methods.

As far as the truth is concerned, I think it is safe to say that the rest of the NFP leadership would like CrM studies to state effectiveness in the same terminology that is used by the rest of the movement instead of the current CrM statistical system that makes its results appear much better than they would appear if stated in the standard manner.  At least such studies should state the effectiveness in both ways.  For example, the 1985 Doud study of the CrM claimed an effectiveness of 96.2% based on the unique Hilgers method of doing statistics.  Fortunately, she also provided raw data that allowed the application of standard statistics that yielded an imperfect-use effectiveness rate of 67%.  The point here is not the low imperfect-use rate but the discrepancy between the different methods of analysis.

“Patty” wrote about her enthusiasm for the CrM.  She is glad that her Archdiocese required her to take a CrM class as part of preparation for marriage, and the couple was delighted they conceived in their very first cycle of seeking pregnancy using the CrM.
Every system has its enthusiasts.  Very early in our marriage we heard a very enthusiastic endorsement of the Ogino-Knaus Calendar Rhythm system from a couple who had used it with 100% success to have three children and then no more.  Our question here would be, “Did the Archdiocese give couples the freedom to attend NFP courses offered by different providers?  And if not, why not?”
Patty also assured us that the instructor did not “teach us anything contrary to the faith…”, but she failed to state whether the instructor taught specifically against masturbation and marital sodomy.  There is a huge difference between not teaching moral heresy and positively teaching against common temptations.

PS#2: In a comment dated Saturday, March 19, 12:45 AM, a CrM user who identified herself only with a first name offered her opinion on our blog of March 13, but most of her two pages was simply propaganda for the CrM.

First, she criticized us for not having read the CrM users’ manual before posting the blog.  She has a point, but in the comments we have received, there has been nothing to indicate any error in our blog.  After all, there is common knowledge about it.  Secondly, this week I did check with someone who has a copy and I found nothing wrong with our previous statements.

Before that consultation, I called the Pope Paul VI Institute to attempt to purchase a copy.  A staffer told me that only Dr. Hilgers could authorize a sale to someone not taking the course through one of his teachers.  The next day the staffer called to tell me that Dr. Hilgers had said they would not sell me a copy.  The rationale provided was that some folks have used that information to try to copy his system.  I can assure any reader that Dr. Hilgers knows me and that he also knows full well that I would not be using the information to copy his system.  The next day the staffer called me to give me Dr. Hilgers email address so that if I have any questions, I can write him.

This secrecy seems to me to be much more about marketing than science.  The general propaganda for the CrM is that it is easy to understand and use.  So if it is so easy, certainly it can be described in sentences that are intelligible to ordinary people.  So maybe it’s not so easy.  Maybe it really does require a number of follow-ups and hand-holding for ordinary people to understand it.  But in the current system, the information is to be available only through paid providers, assuming they are available.  Independent evaluators and potential critics are not to be allowed to see what the CrM users are told.  Such secrecy does not add to the credibility of the system.  To put it succinctly, secrecy stinks.

By contrast, we learned the Sympto-Thermal method simply by reading one article and one book that was considerably less complete than those that we have written.  No doctors.  No meetings.  No follow-ups.  No hand-holding.  It’s just that cross-checking signs add clarity and confidence.

My critic also launched into a hearsay criticism of the value of the temperature sign.  In our manual, we offer a whole page of such excuses and our responses to them.

Her support of what the CrM teaches about breastfeeding only confirmed what I had written.  She did not make correct distinctions on the types of breastfeeding.  She mentioned ecological breastfeeding, but then gave specifics of exclusive breastfeeding.  Many folks do this.  They confuse ecological breastfeeding with exclusive breastfeeding.

Her effort to defend the Kegel exercise to expel semen added strength to my previous statement that it is morally ambiguous.

She criticized us for blocking or editing comments.  We publish comments that actually clarify an issue.  We do not publish comments that are simply propaganda.

Her comments on past research indicate that she is uninformed.  She also claims that the new study of the CrM will get new statistics which can then be compared with other systems.  If the researchers in the new study want valid comparisons, they should be doing a comparative study in which couples use different systems but in which everything else is held as comparable as possible.  Such studies are difficult and expensive.  But they provide credible results.  In a major study done in 1976-1978 of the overall effectiveness of the STM and the OM, the evidence was so much in favor of the STM that the study was shut down early.  The principal investigator believed that he could not ethically assign couples to a system that had already been shown to be much less effective.  Statistics from the new non-comparative study will be helpful only if the researchers provide the raw data so that standard statistical methods can be applied, but I am unaware of any prior commitment to do so.