Archive for October, 2020

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Natural Family Planning and Spacing Effectiveness of Breastfeeding

Sunday, October 25th, 2020

Your Right to Know: Spacing Effectiveness of Breastfeeding

You certainly have a God-given right to know the spacing effectiveness of breastfeeding, and you also need to know the differences between the different forms of breastfeeding.

Cultural breastfeeding has almost no effect on the return of fertility. In other words, fertility returns almost as fast as it does with bottlefeeding. That’s because Westernized cultural breastfeeding generally entails nursing according to a schedule, regularly using pacifiers and bottles, leaving the baby in the care of others, and trying to get the baby to sleep through the night as soon as possible. All of these practices reduce the frequency and the amount of nursing, the length of nursing sessions, and generally the months of breastfeeding. This form of breastfeeding certainly provides some benefits to baby and mother alike, but it should not be expected to delay the return of fertility.

Exclusive breastfeeding is also called the Lactational Amenorrhea Method (LAM). This form of breastfeeding can have a very high spacing effectiveness for the first six months postpartum if three Standards are followed. 1.The baby is exclusively breastfed. The baby receives only his mother’s milk directly from her breasts for his nourishment. He does not receive any other food or liquid. His mother’s milk is his only food and liquid. Exclusive really does mean exclusive. 2.The mother has no menstrual bleeding after the first 8 weeks postpartum. 3.The baby must be younger than 6 months of age. Thus the LAM applies only for six months.

Research has shown that the LAM has a 98% spacing effectiveness during the first 6 months. During the first 8 weeks postpartum, any bleeding may be ignored as a sign of fertility according to the LAM research.

A problem with LAM is that only about half the mothers doing exclusive breastfeeding will experience natural infertility for six months. That is, they will have a period before six months. That’s because many mothers doing LAM do not nurse frequently enough.

Ecological breastfeeding (EBF) means breastfeeding according to the Seven Standards of ecological breastfeeding as follows: 1.Breastfeed exclusively for the first six months of life as in LAM above. 2.Pacify or comfort your baby at your breasts. 3.Don’t use bottles and don’t use pacifiers. 4.Sleep with your baby for night feedings. 5.Sleep with your baby for a daily-nap feeding. 6.Nurse frequently day and night and avoid schedules. 7.Avoid any practice that restricts nursing or separates you from your baby.

Mothers who care for their babies according to the Seven Standards will experience, as a group, an average of 14 to 15 months of breastfeeding amenorrhea (no periods). The return of menses with EBF follows a normal distribution curve. In our two studies— • 7% had a first period before 6 months, • 56% were without menstruation at 12 months, • 34% were still in amenorrhea at 18 months. • The average duration of amenorrhea was 14.5 months.

Research by Doctors Remfry (1895) and Prem (1971) showed that only 6% of nursing mothers actually became pregnant before they had their first period, and those studies occurred before women had learned to identify the return of fertility from the presence of cervical mucus and/or changes in the cervix.

Besides the natural baby spacing benefit, the other great blessing of ecological breastfeeding is that its frequent suckling maintains the milk supply and thus maximizes the many health benefits of breastfeeding for both mother and baby. For a list of the 21 benefits to babies and 8 benefits to mothers, see pages 103-104 of Natural Family Planning: The Complete Approach. And the full list of benefits grows every year.

Because of both the spacing benefits and the health benefits, we think it is highly appropriate to refer to ecological breastfeeding as God’s own plan for spacing and baby care. It is difficult to understand why anyone who is interested in the welfare of babies and mothers is not making every reasonable effort to promote and teach ecological breastfeeding.

John F. Kippley

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Natural Family Planning and Relative Effectiveness

Sunday, October 18th, 2020

Your Right to Know: Relative Effectiveness

As mentioned previously in my comments about cervical mucus, the US Bishops established the Human Life Foundation in 1968 to support Humanae Vitae and to promote natural family planning. In the Seventies there was considerable debate about the relative effectiveness of the mucus-only “Ovulation Method” (OM) and the cross-checking “Sympto-Thermal Method” (STM) which uses mucus, temperature and previous cycle history. The Foundation persuaded the National Institutes of Health to run a scientifically sound study in 1976-1978 to compare the use-effectiveness of the OM and STM.

In the formal study, the investigators found an OM imperfect-use rate of 39.7 and an STM imperfect-use rate of 13.7 pregnancies per 100 years of use. In other words, the OM had an imperfect-use “avoiding” effectiveness rate of 60.3% and the STM had an imperfect-use “avoiding” rate of 86.3%. The OM group experienced six perfect-use pregnancies; the STM group experienced zero perfect-use pregnancies. In the words of the final report, “Results of this study show the STM to be superior to the OM of NFP in terms of use-effectiveness.” (Wade et al., “A randomized prospective study of the use-effectiveness of two methods of natural family planning,” Am. J. Obstet. Gynecol. 141:368, 1981, p.375)

Toward the end of the final report, the authors wrote: “It is of interest that after couples were informed in August, 1978, that a statistically significant trend in the pregnancy rate between the OM and STM groups had been found, almost all of the STM volunteers continued in training, and virtually all of the OM volunteers requested to be, and were, thoroughly trained in STM” (376).

In brief, when the relative effectiveness of the mucus-only “Ovulation Method” and the cross-checking “Sympto-Thermal Method” was hotly contested, the US Bishops sponsored a study which found that the STM approach was superior to the OM approach. You have a right to know these things.

Still, some or many dioceses seem to ignore that part of the science of NFP and continue to promote the mucus-only approach as if there is no difference.

Another comparison. In the effectiveness comparisons, not much attention has been paid publicly to the differences in the computation of effectiveness rates, and there is a big difference. The question is this: “How should we count pregnancies that result from not following the rules?”

The terminology has evolved over the years. In current terminology, “perfect-use” pregnancies refer to pregnancies of couples who became pregnant while following the rules. “Imperfect-use” pregnancies refer to pregnancies of couples who became pregnant while not following the rules. That seems rather straightforward, and most people in the NFP movement have accepted that standard.

Most is not all. Dr. Thomas Hilgers, author of the mucus-only “Creighton Model” and “FertilityCareTM” does not accept that standard. He argues that when a couple engages in the marriage act at a time defined as fertile or possibly fertile according to the rules, the spouses are engaging in “pregnancy-achieving behavior.” Well, certainly, but that is true for every method. The rest of the NFP movement counts such pregnancies as “imperfect-use” pregnancies, but Dr. Hilgers does not. The result is that there are relatively few “imperfect-use” pregnancies in his calculations, and that makes his system appear to be much more effective than it would be if he used the standard accepted by the rest of the NFP movement.

How can we tell? In 1985, Joanne Doud, a teacher of the Hilgers system, reported a study in which she claimed a very high imperfect-use rate of 96.2%. Fortunately, she also listed the number of pregnancies that the couples themselves regarded as unplanned. Using those numbers, the imperfect-use effectiveness was only 67% (Joanne Doud, “Use-effectiveness of the Creighton Model of NFP,” International Review of Natural Family Planning, Vol IX, No.1, Spring 1985). You have a right to know these things.

For purposes of comparing apples with apples and for credibility, the rest of the NFP movement accepts the statistical method used by the contraceptive birth control movement. Few in diocesan administration, however, seem to pay attention to the fact that the Hilgers system calculates its user-effectiveness rates in a way that is not accepted or practiced by anybody else in the NFP movement. Dioceses have paid thousands of dollars to have a single teacher trained in the Hilgers version of mucus-only without any comparative indication that his system is any better than the original Billings system or the cross-checking Sympto-Thermal Method.

What about seeking pregnancy? There have been no comparative studies about couples using different NFP systems to achieve pregnancy, and thus there is no evidence that any system of observing and recording the mucus sign is any better for achieving pregnancy than that used in any other system. Fertile mucus is fertile mucus, no matter how observed and recorded. Further, certain types of impaired fertility may be successfully resolved simply by improvements in nutrition and lifestyle.

On the other hand, when there is a case of difficult infertility, it is good to know that Hilgers-trained doctors may be able to treat certain defects with surgery or other medical techniques in what he calls NaProTechnology. It is also important to know that there are some couples in which one or both spouses are infertile and whose only morally sound hope for a child is the adoption of a baby who needs their loving care.

John F. Kippley

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Natural Family Planning and the Covenant Theology

Sunday, October 11th, 2020

Your Right to Know: Covenant Theology

The most basic framework of God’s relationship with man is the covenant. The first was God’s covenant with Noah and every living creature—“never again shall there be a flood to destroy the earth” (Gen 9:11). The second covenant was with Abram (Gen 15:18) and then renewed when his name was changed to Abraham (Gen 17:9-14). The third covenant was with Moses and was sealed with the blood of the oxen that had been sacrificed as Moses said, “Behold the blood of the covenant which the Lord has made with you in accordance with all these words,” and the people committed themselves to living by the Covenant (Ex 24:8). The final covenant of the Old Covenant was made with David, the promise of God that a son of David would establish an everlasting kingdom (2 Sam 7:12-13). Finally, the work of the Old Covenant was completed and the Lord Jesus, the Son of David, established the New Covenant as He gave himself up for us. “This cup which is poured out for you is the new covenant in my blood” (Luke 22:20).

A covenant is a promise that cannot be broken and it covers everything. A contract stipulates only certain things on which the parties agree and generally will also state the conditions under which the parties agree to void the contract. In the first two covenants, God makes unilateral promises. In the covenant with David, he also promises to punish those descendant kings who violate the covenant, and the sorry record of the king-sons of David is so bad that only two or three of them receive favorable comment by the authors of the Old Testament books. But the promise held.

Marriage is also a covenant. When Jesus was challenged by the Pharisees about marriage and divorce, he surprised his questioners. The Jews of that time took it for granted that a man could divorce his wife and remarry. The dispute among them was whether a man needed a serious reason (e.g., adultery), or “for any cause” (e.g., being a lousy cook) as the question was phrased in Matthew 19:3. Jesus asked them what they had from Moses, and they replied, “Moses allowed a man to write a certificate of divorce and to put her away.” (This proof of divorce at least protected a woman from being treated like a yo-yo.) But Jesus replied, “For your hardness of heart he wrote you this commandment. But from the beginning of creation, ‘God made them male and female.’ ‘For this reason a man shall leave his father and mother and be joined to his wife, and the two shall become one.’ What therefore God has joined together, let not man put asunder” (Mark 10:2-9).

In brief, the men of his time wanted to treat marriage as a contract, but Jesus went back to the very order of creation and taught that marriage is a covenant, something that covers everything and lasts until death separates the spouses.

The rainbow was the sign of the covenant with Noah. Beginning with the covenant with Abraham, the sign of the Old Covenant was circumcision of the men. Beginning with Jesus, the sign of the New Covenant is his own Body and Blood in the Eucharist. Each Mass provides us with the opportunity to renew this covenant with the Lord. As St Paul wrote; “…The Lord Jesus on the night when he was betrayed took bread, and when he had given thanks, he broke it, and said, ‘This is my body which is for you. Do this in remembrance of me.’ In the same way also the cup, after supper, saying, ‘This cup is the new covenant in my blood. Do this, as often as you drink it, in remembrance of me.’ For as often as you eat this bread and drink the cup, you proclaim the Lord’s death until he comes” (1 Cor 11:23-26).

In marriage, the sign of the covenant is the marriage act, the sexual union of male husband and female wife. This is a God-given act that by its very nature is oriented toward the co-creation of children and the bonding of the spouses. The marriage act is intended by God to be a renewal of the marriage covenant.

But the renewal of the covenant is not automatic. St. Paul warns us that we can sin by defrauding the New Covenant. “Whoever, therefore, eats the bread or drinks the cup of the Lord in an unworthy manner will be guilty of profaning the body and blood of the Lord. Let a man examine himself, and so eat of the bread and drink of the cup. For any one who eats and drinks without discerning the body eats and drinks judgment upon himself” (1 Cor 11: 27-29). This is why the Church teaches that if you are conscious of having committed a mortal sin, you need to repent and receive the sacrament of Penance before receiving Holy Communion.

What makes the marriage act morally different from the same physical act between two people who are not married? It’s the same anatomical act, but there is a world of difference. Sacred Scripture and Tradition describe as seriously immoral all those sexual acts that do not occur within marriage. In other words, in God’s plan, sexual intercourse is intended to be exclusively a marriage act, and within marriage those acts ought to be at least implicitly an authentic renewal of the marriage covenant, that is, at least not contradicting it in any way.

It sometimes helps to remember just what a man and woman do when they “commit marriage.” They promise to love each other, and that entails caring love, not just romantic love. They promise to be faithful to each other. They vow to love and be faithful for better and for worse, knowing full well that there will be difficult times as well as the best of times. And they vow to keep this commitment until death do they part.

Wow! How can those who recognize their own weaknesses and sins write such a blank check to the other person before God? Millions do so every year because they believe that this is God’s plan for love and sexuality and that He will provide all the graces they need to persevere through whatever marital difficulties they will encounter.

The marriage act can also be defrauded, and in more ways than one. There is such a thing as marital rape, and that is certainly not a renewal of the marriage covenant. If you keep in mind that the marriage act ought to be a renewal of the commitment, the caring love, and the for-better-and-for worse of the marriage covenant, then it is not difficult to see that contraception is not a renewal of the marriage covenant. Marital contraception says, “I take you for better but positively not for the imagined worse of possible pregnancy.” It contradicts the “for better and for worse” of the marriage covenant. It pretends to be what it isn’t. It is dishonest and therefore immoral.

The concept is simple: Sexual intercourse is intended by God to be at least implicitly a renewal of the marriage covenant. What I have tried to do in this article is to place that concept in the context of the Commandments, the biblical covenant, and marriage itself.

For more on the analogy between the Eucharistic and marital communions, see http://www.nfpandmore.org/Holy%20Communion%20-%20Eucharistic%20and%20Marital.pdf .

John F. Kippley

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