Guidelines 2016 – Natural Family Planning
Guidelines for Nurse Practitioners in Gynecologic Settings 2016
I. DEFINITION
natural family planning (nfp) is an umbrella term for methods that use naturally occurring fertility signs to determine the fertile and infertile days of the menstrual cycle.
II. ETIOLOGY
effects of hormones on basal body temperature (BBt), cervical mucus, the position of the cervix, the cyclical nature of the ovulatory and endome- trial cycles, and the physical process of the release of an egg make possible knowledge of the occurrence of ovulation.
III. BACKGROUND FOR ELECTING THE METHOD
a. What the patient presents with
1. Motivation to learn natural signs and symptoms of ovulation for purposes of fertility regulation
2. often a history of previous use of other methods of family planning
3. failure, dissatisfaction, or lack of harmony in values with other methods
4. Cultural, ethnic, religious values, and personal beliefs harmonious with nfp
5. Medical contraindications to the use of one or more other methods
B. additional background information to be obtained from the patient
1. Medical/surgical history
2. obstetrical history
3. gynecologic history, including menstrual cycle history
4. family planning method currently used
5. patient’s knowledge about the female human body, especially the ovulation cycle
6. family history
IV. PHYSICAL EXAMINATION
a. Vital signs
1. temperature
2. pulse
3. Bp
B. Complete physical examination
C. external examination of genitalia
d. Vaginal examination using a speculum to observe position of cervix and mucus
e. Bimanual examination, noting
1. adnexal pain
2. Masses
3. tenderness
V. LABORATORY TEST
a. pap smear if none within past year; human papillomavirus (hpV) test, cultures, wet mount as appropriate or per protocol
B. Mammography as recommended
VI. DIFFERENTIAL DIAGNOSIS
a. preference for other methods
VII. TEACHING ABOUT NFP
a. fertility awareness
B. general introduction to nfp
C. Basic information about nfp and methods
1. Cervical mucus method
2. BBt method
3. symptothermal method
4. Keeping and interpreting a chart
d. interpersonal and intimate relationships and nfp methods
COMPLICATIONS
a. inability of patient to interpret signs and symptoms
B. lack of acceptability of method to partner
C. Unplanned pregnancy
VIII. CONSULTATION/REFERRAL
a. to specialist or program for teaching of nfp
IX. FOLLOW-UP
a. annual examination and pap smear per asCCp guidelines
B. evaluation of effectiveness of the method
C. evaluation of patient satisfaction
See Appendix I, handout for Natural Family Planning to Prevent or Achieve Pregnancy and Bibliographies.
Websites: www.cyclebeads.com; www.asccp.org
Fertility awareness methods (FAM) and NFP links to websites:
Billings Ovulation Method: www.thebillingsovulationmethod.org; www
.boma-usa.org; www.woombinternational.org (International site)
Online charting apps for Billings: NFP Charting Online and Fertility Pinpoint (both require certified teachers before using the app)
Creighton Model: www.creightonmodel.com
Academy that certifies practitioners, physicians, nurses, pharmacists, nurse practitioners, and physician assistants in Creighton Model and NaProTECHNOLOGY®: www.popepaulvi.com; American Academy of Fertility Care Professionals, www.aafcp.net
NaProTECHNOLOGY: www.fertilitycare.org; www.fertilitycare.com
.au (Australia); www.popepaulvi.com
Handheld apps in production at this time: check in the future at www
.fertilitycare.org
Sympto-Thermal Method
Couple-to-Couple League: ccli.org; www.cclgb.org.uk (Great Britain) SERENA: serena.ca/en/canada/index.php?lang=en (Canada)
Online Charting App for CCL: CycleGoPro Marquette Model: nfp.marquette.edu
Standard Days Method (Georgetown): www.cyclebeads.com;irh.org/ standard-days-method
Online App: iCycleBeads
Two-Day Method: irh.org/twoday-method