Birth control, the natural way

The article concludes a two-part series on natural family planning methods.

In my last article, I described two approaches to natural family planning, which were the ovulation method and the basal body temperature method.

As I had mentioned, some women and men prefer methods of family planning that do not involve medications, devices or surgical procedures, perhaps due to religious or personal reasons.

While natural family planning methods are safe and do not cause side effects, women and their partners should be aware that they need to be followed strictly in order to be effective. Natural family planning also does not protect against sexually transmitted diseases.

In this article, I will elaborate on a few more methods.

Withdrawal method

This method is exactly what it sounds like, where a man withdraws, or pulls out, his penis from the woman's vagina and ejaculates outside of her body.

The key aspect of this method is that the man's semen should not enter her vagina or come into contact with her external genitals, so that no sperm is able to fertilise the egg.

The greatest disadvantage of the withdrawal method is that the man needs to have very good self-control because he has to be conscious of the right moment to withdraw, right at the peak of his excitement.

There is also the possibility that pre-ejaculation fluid, which can leak out before the man withdraws, may contain sperm. If the man is prone to premature ejaculation, this method will probably not work as he will not be able to control his ejaculation.

Apart from timing his withdrawal properly, the man also has to take precautions if he plans to have sex again within a short period of time. He should urinate and clean off the tip of his penis, which will help to remove any remaining sperm from his previous ejaculation.

The withdrawal method is about 73 per cent effective if used correctly.

Calendar and Breastfeeding methods

Calendar method

This method, also called the rhythm method, is the most widely used natural family planning approach.

It works by calculating your menstrual cycle, so that you can predict your fertile and infertile phases. In order to use this method, you should first record the number of days in your menstrual cycle for at least six to eight months, so that you become familiar with your cycle.

Pick the shortest cycle out of these six to eight months, and subtract 18 from the total number of days. This number represents the first fertile day of your cycle. For example, if your shortest cycle lasts for 24 days, subtract 18 from 24 and you will get six. That means the sixth day of your cycle is your first fertile day.

Then subtract 11 from the number of days in your longest cycle, and this number represents the last fertile day of your cycle (eg, it could be the 19th or 21st day of your cycle). This means that if you have sex from the first fertile day to the last, you are likely to conceive. You can avoid or choose to have intercourse accordingly.

It is not easy to learn the calendar method, and it takes more than six months before you can use it properly. However, this method is 95 per cent effective if used well.

Breastfeeding method

Breastfeeding is an accepted method for natural family planning. It is also known as the lactational amenorrhoea method (LAM).

When a mother breastfeeds, her baby's suckling of her nipple sends a message to her brain to produce a hormone called prolactin. This hormone stimulates the breast to produce milk, which is why the baby's suckling automatically produces milk.

At the same time, the secretion of prolactin sends a message to the body not to produce follicle stimulating hormone (FSH) or luteinising hormone (LH). Without these two hormones, she will not ovulate.

For breastfeeding to be fully effective as a birth control method, the mother must breastfeed her baby exclusively - meaning she does not give the baby any food or fluids other than breast milk. This can only be done when the baby is below six months, because complementary foods are introduced from that age onwards.

She should use both breasts to nurse her baby on demand, with less than four hours between each feed in the day, and less than six hours between each feed at night.

When a woman breastfeeds less, the reduction in the suckling action causes less prolactin to be produced, while FSH and LH start to kick back into production. This will result in ovulation and menstruation returning.

Even during the first six months, if the mother is exclusively breastfeeding, she should be aware that other factors may cause prolactin levels to dip. For instance, if she is under a lot of stress, is sick (or if the baby is sick), cuts down on the number of feeds, has long intervals between feeds, or is feeding the baby with supplementary milk for any reason, this could cause the LAM method to be less effective.

It is safe to say that LAM can be used as a pretty effective form of contraception in the first six months after your baby is born, barring any extraordinary circumstances that may cause you to breastfeed less.

However, after six months, you should ask your doctor about a non-hormonal method of family planning, otherwise you may become pregnant again before your body is fully healed.

All these natural family planning methods are free, do not cause hormonal side effects, and do not require any surgical procedures. But in order to enjoy these advantages, you have to be disciplined and follow the methods strictly.

Always talk to your gynaecologist to get advice about the proper method before attempting it on your own.

Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK).

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