A very specific NFP query (breastfeeding related)

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The_Bucket

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Ok, so since I have failed to get in contact with the NFP teachers that are listed for my area at the CCL, I thought perhaps CAF would have some experts or at least contacts with experts for a pretty specific NFP question I have. I know that a man asking these questions on the forums is not usual, so I hope you’ll bear with me.

We’re at 7+ months post partum with our daughter and my wife definitely needs to avoid pregnancy for some time, think years, due to really bad complications that resulted in a very premature birth of our first (born at 25.5 weeks and in the hospital for more than 4 months but he’s fine now, praise God! Walking, talking and generally being a normal 20 mo. old except for his height) and health problems for her with our second. Serious ones too; and I’m thankful that we’re Catholic and never had cause to touch BCP because she likely would have developed worse pulmonary embolisms than she had with pregnancy and possibly died from them.

So back to us. LAM worked great for what it was supposed to do and while she’s not following all of the ecological BF protocol, it’s still pretty close to the guidelines for a child after six months. She nurses probably 5-6 times a day at minimum in addition to baby food as well as gets up once at night to nurse.

But here’s the issue: we’ve been charting for the last month to try and get a handle on everything but the signs are all over the map. No consistent pattern whatsoever; I’m talking about one dry day, then a few non-fertile mucus days, then a day or two of what looks like more fertile and so on. Basically we can’t find a BIP with mucus or without. Temps are not a ton of help either; they’re all lower as you might imagine and are a bit jumpy but not haphazard.

My question(s) is pretty simple for someone who knows a lot about this stuff (and we don’t for postpartum): What are the “rules” for a BFing (not strictly ecological but also not cultural) mother that has not had her first postpartum period after the six months of LAM? How do you detect a pattern if the signs are very ambiguous or are we just going to have to deal with possibly many months of abstinence?

Once the first postpartum period appears, whenever that is, we’re hopeful that we can get a better handle on all of this. I fully expect to have to deal with being extremely conservative in the future, tough with a woman that has very long cycles anyway, but that’s perfectly OK especially when health and possibly lives are at stake.

Any help you folks can provide with an answer or simply giving me an email address for someone with more expertise and will actually reply would be greatly appreciated. I know this is pretty random, but I’m hoping someone on CAF would have a better hookup than I do on this!

Thanks and God Bless.
 
I don’t have any expert advice for you, but for myself, I got pregnant at three months postpartum, while exclusively and only, and on-demand nursing, and while charting and paying attention to temps and cervical changes. I thought I was in the clear, we had unprotected sex and then the next day I had the most fertile of fertile CM I’ve ever had, completely out of nowhere.

NFP while breastfeeding, especially when there’s been no postpartum period to go off of, is very hard. The good news is that a lot of women don’t ovulate until after their first PP period, and that first one is kind of a warning sign. Also good is the fact that ecological breastfeeding is actually quite effective as birth control. The bad news is that there are many many women like myself out there who are those 1 in a hundred.

Would ovulation test kits work in this instance?
 
nfpandmore.org has an online manual that might help.

nfp.marquette.edu/ also has an online manual and forum–this form of nfp uses a fertility monitor

I’d also make a greater effort to find an NFP instructor to meet with. Most offer a postpartum class. This is the most difficult time for doing nfp. For me, after 6 children, the most reliable sign of returning fertility is mucous and then I rely on temps to see that an ovulation event has occured. Many women don’t have such clear signs and I would think adding the fertility monitor would be good in these cases. I know it’s no fun, but if your wife has serious health needs to avoid pregnancy, abstaining for now is the only safe option for her, until you can figure out her signs (and maybe even until her first postpartem period–I know that sounds like forever, but if her life is in danger, it’s a small price to pay) Many prayers for clear signs and improved health!:signofcross:
 
I’m not an expert. I would suggest that you email CCLI , www.ccli.org . They may be able to help you.

Now, I do have a question. Has your wife been checked for PCOS? I ask this because of your comment on weight and long cycles. No doctors checked me for this until I had a miscarriage. But, I had been showing symptoms for years. Once they got me on the right medication, not BCPs which is what they try to get you to do because it is easier for them, I had normal 28 to 30 day cycles for the 1st time in my life.

Now, my take on what could be going on. If your wife started solids, it could be throwing off her cycles because of the change with the feedings. I got pregnant with my 2nd child 1 month after I started solids with my oldest. Let me tell you, the next time, I held off on starting solids for a couple of more months! 😃 Now, I started having periods 5 weeks after the 1st was born and every 5 weeks thereafter, but that was because she was not a heavy eater. The 2nd child, I didn’t have a period until about 9 months postpartum. He ATE. The feeding situation definately had an affect on how my cycles went and they might be having an affect on your wife as well. As I said, try CCLI and see if they can give you a better idea of what to do.
 
Jennifer_J said:
nfpandmore.org has an online manual that might help.

nfp.marquette.edu/ also has an online manual and forum–this form of nfp uses a fertility monitor

I’d also make a greater effort to find an NFP instructor to meet with. Most offer a postpartum class. This is the most difficult time for doing nfp. For me, after 6 children, the most reliable sign of returning fertility is mucous and then I rely on temps to see that an ovulation event has occured. Many women don’t have such clear signs and I would think adding the fertility monitor would be good in these cases. I know it’s no fun, but if your wife has serious health needs to avoid pregnancy, abstaining for now is the only safe option for her, until you can figure out her signs (and maybe even until her first postpartem period–I know that sounds like forever, but if her life is in danger, it’s a small price to pay) Many prayers for clear signs and improved health!:signofcross:
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Yeah I checked out Marquette; I just don’t have the money to use the monitor. I find it aggravating that insurance covers BCP but if you use any form of natural family planning, hey, you’re on your own because it’s not drugs or surgery! Ugh.

I figured that the CM returning was a sign that she’s at least reaching that “transitional” stage, but who knows how long that lasts. Since her health is definitely at risk, obviously I’m not going to mess with it but I’m not going to lie and say it isn’t extremely frustrating.

Cathh(name removed by moderator): As for PCOS, it’s an interesting suggestion but I very much doubt it. She DOES have cysts as seen by several ultrasounds and even a CAT scan (when they were checking for potential causes of the nasty lung pain she had and trying to rule out metastatic cancer from her ovaries… and yes that was ruled out. She just has a genetic defect that makes her have major clotting problems when she’s pregnant meaning she goes on injected blood thinners when she is. Side effect of course is those thinners combined with c-sections have made her uterus weaker over time and more dangerous for her and a future baby). But they are larger cysts on the outside of the ovary and she doesn’t have any of the other PCOS symptoms. She’s very fit and thin for one, she has no acne, no voice deepening and no anovulation; just cycles that last anywhere between 30-49 days and vary greatly. And, of course, no fertility problems since we have two kids in less than three years of marriage!

Now I do suppose she could have oligomenorrhea since she’s always been thin (not unhealthy, she gained appropriate weight for our babies when pregnant and they grew fine postpartum from nursing) and athletic since she was a teenager. She also has a very high natural metabolism which I suppose could lead to that too. But we’ll address some of those concerns, if they are significant, with her doctor once her cycles start up again.

In the interim I suppose I’ll just try again to contact CCL with this question and look for a reliable BIP.
 
I imagine that without the computer there would be more “invalid” or unsure results with those tests, right? And it wouldn’t have a “peak” result. Even so, I could live with that just fine. When paired with CM and BBT charting I imagine I wouldn’t need a computer to show peak. Might be a good system for when she starts her cycles up again; I know CCL’s book says not to have an insane amount of cross-checking because that can make it overly complicated, but I’m pretty sure that’s because they’re talking about people who are looking to shave off abstinent days and not people who want to be as absolutely conservative as possible while not going entirely without sex for months on end.
 
The_Bucket said:
Cathh(name removed by moderator): As for PCOS, it’s an interesting suggestion but I very much doubt it. She DOES have cysts as seen by several ultrasounds and even a CAT scan (when they were checking for potential causes of the nasty lung pain she had and trying to rule out metastatic cancer from her ovaries… and yes that was ruled out. She just has a genetic defect that makes her have major clotting problems when she’s pregnant meaning she goes on injected blood thinners when she is. Side effect of course is those thinners combined with c-sections have made her uterus weaker over time and more dangerous for her and a future baby). But they are larger cysts on the outside of the ovary and she doesn’t have any of the other PCOS symptoms. She’s very fit and thin for one, she has no acne, no voice deepening and no anovulation; just cycles that last anywhere between 30-49 days and vary greatly. And, of course, no fertility problems since we have two kids in less than three years of marriage!
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Just a FYI, not every woman with PCOS has all of the symptoms. I have 4 kids to prove that you can have kids and still have PCOS. I had 3 of those kids before I had the miscarriage. Some women with PCOS are skinny, granted they are not the majority of the women with it. The cycsts are a big indicator and the long cycles.

BTW, don’t forget to have them check the thyroid if the temps are low, like really low, ie in the 96’s, low 97’s.
 
Might check out PCOS possibility at her next doc checkup since she has had some very low temps both now and in the past. We’ve done the thyroid tests because of her other health issues; it’s very slightly overactive and has some benign cysts on them but no big deal according to her docs. She needs annual checkups on those cysts on her thyroid but the CAT scans, blood test and biopsy indicate that there’s no problem.

For now we’re adding Marquette style check to CM and BBT; got ovulation test kits as a triple check and to help determine the BIP.
 
Hi TheBucket,

I am not an expert, and pretty new to NFP myself, although I have taken the regular NFP class through the Couple to Couple League and also took the postpartum NFP class. I own both Student Guides.

I am in a similar boat in terms of breastfeeding and trying to avoid pregnancy (but for me the need is not as dire), so I understand that you need some “rules” to work with during this time of breastfeeding and fertility signs that are all over the map.

Anyway, I think you would find a book called The Art of Natural Family Planning, PostPartum Student Guide VERY helpful (2nd book down): ccli.org/shop/onlineshopping.php?criteria=category&f_cat=books&ind=1&order_by=name

It is very clear and easy to understand and tells you the rules for avoiding pregnancy during this time. To put it in a major nutshell, the main rule for breastfeeding is the “Mucus Patch Rule” (mucus patch being "one or more days of mucus sensations or characteristics followed by dry/nothing days, without a thermal shift). The Mucus Patch Rule is: Phase I infertility returns* on the evening of the fourth day* (meaning you can have sex;)) of no mucus sensations or characteristics after Peak Day. “Peak Day,” in the postpartum time is defined as the last day of a mucus patch or breakthrough bleeding. Phase I infertility means that after that 4th dry day evening, as long as she is still having dry/nothing days, you can have sex every other day, only in the evenings. (This is so that she can tell seminal residue apart from actual mucus on the days in between. Only evenings is because she will have all day long to determine whether she notices any mucus or not.)

It is important to note that if the temperatures begin to rise, the Mucus Patch Rule does NOT apply. Wait for the start of Phase III infertility according to the Sympto-Thermal rule.

That’s almost straight out of the book (which I own). Depending on how many mucus days your wife has, you may find that this requires a LOT of abstaining, but if you need to be very careful, you may have to bite the bullet. At least you will have some rules to work with, though.

The exception to all this is if you can determine a Basic Infertile Pattern in her mucus pattern. According to CCL, a BIP is defined by mucus every single day and the SAME kind of mucus every single day for 2 weeks. The key is it has to be unchanging. In that case, you can ignore the mucus and need not abstain. But you can only establish this after observing the same exact mucus for 2 weeks straight. Any change after that (a dry day, a day of wet sensation, etc.) and you go back to the Mucus Patch Rule. Determine Peak Day, then count 1,2,3, 4 dry days and on the evening of the 4th day she is considered infertile and you can have sex that evening.

Hope this helps, or gets you through for the time being. If you need further clarification (I’m not sure if you’re familiar with Phases I, II, and III terminology as I learned them from the Couple to Couple League), let me know and I can try to help.

I suggest you definitely order that book asap because I think you will find it addresses a lot of concerns about infant feeding, postpartum bleeding, temps, mucus patches, etc. It has example charts that I found very reassuring as they looked a lot like mine.

I would not worry about your wife’s low temps as the production of prolactin from breastfeeding keeps the temps quite low (sometimes off the chart). Everyone always thinks they have some thyroid problem or something 😉 but it’s totally normal if you’re breastfeeding and simply suggestive of suppressed fertility. I highly doubt your wife has pcos, personally, because she has none of the classic symptoms. If your doctor wasn’t worried about the cysts, I wouldn’t be either, but that’s just my opinion.

Sorry this so long. Hope this helps!

Also, you can search for an NFP “teaching couple” near you here : ccli.org/learn/tcsearch.php
 
Yeah the biggest problem is the “background mucus” and sometimes it’s really tough to tell. She hardly ever has “dry days” but that was the case for her before pregnancy and breastfeeding. Looking back at some of the charts it is quite easy to tell the difference between her fertile and infertile times. Temps were not consistent but the fertile window had six straight says of “Stretchy and clear/cloudy” CM. In the infertile times, even after ovulation, she had some CM but nothing like that.

So we’ve hit upon a kind of hybrid that helps make sure everything is kosher. Anytime she sees anything that isn’t BIP or she’s “not sure”, we need four days of her BIP CM plus confirmation with ovulation test kits (using the rule you were referring to). Basically we’re following the Marquette protocol only with BBT as well. I doubt the BBT will be helpful for awhile, but it’s always good to have more information rather than less when you’re being very conservative. If you’re not being quite as conservative, then it just gets confusing.

As you might imagine, this will likely not provide many, if any, as some put it “green light” days for quite some time. But hey, that’s life and at least we’ve got a decent handle on what’s going on even if mother nature is not as cooperative as I’d like.
 
Oh OK. I’m not really familiar with the Marquette model, but I’m glad to hear you have a method to work with. The BBT definitely helps because, like I’ve experienced recently, sometimes you “could’ve sworn” ovulation already occurred, but then there is a lack of temp shift and you know it has yet to happen. That’s really good info to have.

Also, cervix checks help a lot as just one more line of evidence. I would often find that while breastfeeding I might have some seeming fertile mucus, but my cervix was very low and not soft at all, so the cervix check really helped put whatever mucus I found into perspective. As with everything else, though, I found that my cervix was up, down, and all over the place with no pattern for a long time. When all the signs start “lining up,” though, then it becomes more obvious.

Anyhoo, good luck to you.
 
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