RE: RE: simple versus complex NFP

December 22, 2004

I agree with Dr. Stanford. When I

give public talks on NFP, invariably, someone comes up to me to introduce me to

their “NFP baby” or to show me a photo of same. With brief digging,

all have been sefl-taught (often old Rhythm method) out of a book or have

picked it up “along the way” (??); none has ever been trained

by a instructor. I have also had many patients in tears of frustration

come to me after not being able to really “get it” from a

book. My best friend in med school gave up and suffered some strain in

his marriage, after 2 months of trying to learn STM from a book. Just 2

hours of chat by our local CCL instructor, and he and his wife were right on

track. I’m the godfather to another “NFP baby.”

Again, no instruction. Nothing can replace a trained instructor, and 10

mins cannot do it justice, except to introduce the concepts. The

perspective/conceptual shift about fertility appreciation that occurs is

difficult to achieve without a relationship with a trained instructor. I

warn the residents here that when I teach them the basics, they are by no means

experts.

As an aside: Dr Phil Boyle in Ireland is

reported to have significant success in helping couples achieve pregnancy just

with Creighton Model fertility focused intercourse, in couples who have failed

IVF !

However, I’m intrigued by Dr Fehring’s

concept of gradual introduction of the teaching process. I have tried

something similar by mentioning that Jr.High girls can be taught to recognize

their fertile mucus days within a couple of cycles (TeenSTAR program of Dr. Hanna

Klaus).

, MD

VCU/Shenandoah Valley Family Practice

Residency

Winchester and Front Royal, VA

From: ph B.

Stanford

Sent: Wednesday, December 22, 2004

12:26 AM

To: nfpprofessionals

Subject: RE:

simple versus complex NFP

Dear Dr. Fehring (),

I think there is a place for simple methods that can " be taught in

10 minutes. " I don't mean " better than nothing " as a

negative statement, but as a relatively positive one, depending on the

setting. But there are some issues to consider-

NFP requires behavioral change, especially if it is to be NFP rather

than BAFT (barriers at fertile time), etc. Behavioral change will usually

be easier to effect in the context of an ongoing relationship with an NFP

teacher than in one or two 10 minute office visits (in my observation is this

is usually the case).

Couples with more complex issues (such as infertility or gynecologic

problems) who want to use NFP data to help manage their condition do better

with more detailed instruction in more detailed methods, in my clinical

experience.

I have had the experience on quite a few occasions of both patients and

colleagues getting " 10 minute " instruction in one method or another,

assuming it would be adequate, and then being surprised and totally negative

thereafter when the method " didn't work " . A lot of complex

issues here, but not a good outcome when they decide all NFP doesn't work based

on these experiences.

If a simple method is relatively good but not optimumly effective, that

trade-off needs to be made extremely clear to the user. Do they prefer

simplicity at the expense of some margin of effectiveness?

I don't think it is optimum medicine for diabetics for me to try to do

complete diabetic teaching in a 10 minute office visit. Likewise I don't

think it is optimum reproductive medicine for me to try to teach NFP in a 10

minute office visit. That's my perspective.

But these are issues that can be studied with data, not just

opinions. I look forward to future studies that can address how much

teaching is really needed for optimum use by specific couples in specific

situations.

Joe

Stanford quote: " Yes

there are methods of NFP that can be taught 5 or 10 minutes (and they may be better

than nothing), but I believe that the best NFP instruction will not generally

fit into office visits, but should be done as a separate service. It

helps to have the NFP instructor available in the same office or very

accessible close by. "

Dear Dr. Stanford (i.e., Joe):

Thank you for your perspectives on short

NFP methods, but for the sake of conversation (on this NFP discussion list) -

what standards or criteria would you use to define " the best NFP

instruction " -- and why do NFP methods that would only require a short 5 -

10 minutes be only " better than nothing " ?

For the most part we are competing with

birth control methods that can be provided in a short office visits - e.g.,

hormonal pills; condoms; depo shots - methods that do not require a lot of

behavioral change.

When Sandrock, CNM mentioned that

the TwoDay method was a " no brainer " , I thought that is a good

criterion for a method of birth control i.e., " simple to use " and I

would add " simple to teach " and according to the latest study - it is

effective in helping couples avoid pregnancy. If the method is effective

in helping couples to achieve their goal of avoiding pregnancy, it is simple to

use, and it does not separate the unitive from the procreation act, is that not

a good method? You can reach many people with simple non-complex

methods. Not always easy to do with complex methods - that require

extensive training of teachers and of the couple users. And I am not

saying that easy is always the best.

I would also add that changing behaviors

will occur faster when we can reduce behavior hurdles - like learning complex

methods of NFP and requiring extensive group teaching and/or follow-up. I

believe that Larry Severy, PhD (psychology professor at the University of Florida)

mentioned at the Marquette

conference in 2002 - couples would prefer to use nothing --- but if they have

to use something - it needs to be simple and accurate. Furthermore, if

health professionals could incorporate teaching a NFP method into their busy office

practice - then maybe more health professionals would and could provide it.

Your thoughts?

Hope all is well.

J. Fehring

Professor

Marquette University

PS - please do not take this as an

attack on any one method of NFP --- it is a general comment on modern methods

of NFP (OM, STM, etc) - including the

Marquette Model. We have a hard time getting couples to come to one group

session and a follow-up.

--

______________________________

ph B. Stanford, MD, MSPH

Health Research Center

Dept. Family & Prev. Med.

University of Utah

jstanford@...

December 22, 2004

From my pre-NFP days, I have told patients about my diaphragm baby, my pill baby, my foam and condoms baby, and my perforated uterus from an IUD (no baby, but afterwards I wondered if I would ever be able to have another baby! - especially since the next 2 pregnancies miscarried). I also tried to learn STM from a book and never could - but learning a mucous only method from a good instructor has been a Godsend and a real revelation, and I honestly think that all young adults should be taught how to recognize and respect their fertility early in their reproductive years.

My biggest regret is that I didn't get off the dime earlier.

Giving basics in marriage prep is important, but is way too late for the majority of persons in our highly dysfunctional and over-sexualized culture. I think that this information needs to be introduced in High School (or even maybe Middle School) health classes - not as a family planning method but simply as "this is how your body was fearfully and wondrously made".

alicia cnm RE: RE: simple versus complex NFP

I agree with Dr. Stanford. When I give public talks on NFP, invariably, someone comes up to me to introduce me to their “NFP baby” or to show me a photo of same.

December 22, 2004

Regarding marriage prep and NFP, I think

that II is correct in Familiaris Consortio (http://www.vatican.va/holy_father/john_paul_ii/apost_exhortations/documents/hf_jp-ii_exh_19811122_familiaris-consortio_en.html)

no. 60, where he divides “marriage preparation” into “remote”

(which “begins in early childhood”), “proximate,” and “immediate”

(“in the months and weeks immediately preceding the wedding”)

phases. He seems pretty clearly to

suggest that NFP information belongs in the “proximate” phase –

i.e. that providing it shouldn’t be delayed

until the “immediate” phase, as I gather tends to be the case in

the “marriage prep” model that many Catholics seem to assume. Specifically, he says that “the

proximate preparation” “will encourage those concerned to study the

nature of conjugal sexuality and responsible parenthood, with the essential

medical and biological knowledge connected with it.”

I think the challenge for us is: How can

we make that happen?

Franciscan Univ. of Steubenville

RE: RE: simple versus complex NFP

I

agree with Dr. Stanford. When I give public talks on NFP, invariably,

someone comes up to me to introduce me to their “NFP baby” or to

show me a photo of same.

December 22, 2004

How to effectively teach fertility

appreciation in the proximate stage is already set up in the TeenSTAR program,

with gradual instruction in Jr. High, then High School, and then College age

curricula.

It “addresses the central problem of

our time, centrally.” www.teenstar.org.

One need not start from scratch. It is used around the world in

many Catholic high schools, some public schools, and in church youth groups and

colleges.

, MD

VCU/Shenandoah Valley Family Practice

Residency

Front Royal, VA

From: E.

Sent: Wednesday, December 22, 2004

10:12 AM

To: nfpprofessionals

Subject: RE:

RE: simple versus complex NFP

Regarding marriage prep and NFP, I think

that II is correct in Familiaris

Consortio (http://www.vatican.va/holy_father/john_paul_ii/apost_exhortations/documents/hf_jp-ii_exh_19811122_familiaris-consortio_en.html)

no. 60, where he divides “marriage preparation” into

“remote” (which “begins in early childhood”),

“proximate,” and “immediate” (“in the months and

weeks immediately preceding the wedding”) phases. He seems pretty

clearly to suggest that NFP information belongs in the “proximate”

phase – i.e. that providing it shouldn’t be delayed until the

“immediate” phase, as I gather tends to be the case in the

“marriage prep” model that many Catholics seem to assume.

Specifically, he says that “the proximate preparation” “will

encourage those concerned to study the nature of conjugal sexuality and

responsible parenthood, with the essential medical and biological knowledge

connected with it.”

I think the challenge for us is: How can

we make that happen?

Franciscan Univ. of Steubenville

RE: RE: simple versus complex NFP

I

agree with Dr. Stanford. When I give public talks on NFP, invariably,

someone comes up to me to introduce me to their “NFP baby” or to

show me a photo of same.

December 22, 2004

Yes – from what I know of Dr. Hanna

Klaus’s work – I am a fan of it! My concern is that I suspect that only a

fairly small minority (even of Catholics – let alone of the general

population) are exposed to it or something like it. I’m not so much talking about the

need to invent methods – as about the need to implement them more broadly

in our culture.

RE: RE: simple versus complex NFP

I

agree with Dr. Stanford. When I give public talks on NFP, invariably,

someone comes up to me to introduce me to their “NFP baby” or to

show me a photo of same.

December 22, 2004

I think you make a good point, Joe, that

NFP is a behavioral change, much like losing weight or quitting smoking.

I tried to convince a woman once that NFP was better for her body (she had no

moral convictions of any sort) and her reply was “I have trouble just remembering

to take my pill every day…there’s no way I’ll remember to do

all THAT.” Obviously if she wanted to bad enough, she could

remember to do it all, but most smokers don’t think they can really quit

either...

I think we all agree that extensive

instruction is necessary for NFP in any form to be very effective, for either

achieving or avoiding. As physicians, I think that 10 minutes might be

better spent truly and thoroughly convincing the woman to change her lifestyle.

Make it known that it IS a lifestyle change, for both man and woman, and not a

quick-fix. Then refer her to a teaching couple for instruction.

Sending her home with pamphlets and names/phone numbers is a GREAT idea, to “bring

home” the concept and make it “real” for the woman. I

would notate the chart, and at future visits ask immediately and poignantly

about it.

RE:

simple versus complex NFP

Dear Dr. Fehring (),

I think there is a place for simple methods that can

" be taught in 10 minutes. " I don't mean " better than

nothing " as a negative statement, but as a relatively positive one,

depending on the setting. But there are some issues to consider-

NFP requires behavioral change, especially if it is to

be NFP rather than BAFT (barriers at fertile time), etc. Behavioral

change will usually be easier to effect in the context of an ongoing

relationship with an NFP teacher than in one or two 10 minute office visits (in

my observation is this is usually the case).

Couples with more complex issues (such as infertility

or gynecologic problems) who want to use NFP data to help manage their

condition do better with more detailed instruction in more detailed methods, in

my clinical experience.

I have had the experience on quite a few occasions of

both patients and colleagues getting " 10 minute " instruction in one

method or another, assuming it would be adequate, and then being surprised and

totally negative thereafter when the method " didn't work " . A

lot of complex issues here, but not a good outcome when they decide all NFP

doesn't work based on these experiences.

If a simple method is relatively good but not optimumly

effective, that trade-off needs to be made extremely clear to the user.

Do they prefer simplicity at the expense of some margin of effectiveness?

I don't think it is optimum medicine for diabetics for

me to try to do complete diabetic teaching in a 10 minute office visit.

Likewise I don't think it is optimum reproductive medicine for me to try to

teach NFP in a 10 minute office visit. That's my perspective.

But these are issues that can be studied with data,

not just opinions. I look forward to future studies that can address how

much teaching is really needed for optimum use by specific couples in specific

situations.

Joe

Stanford quote:

" Yes there are methods of NFP that can be taught 5 or

10 minutes (and they may be better than nothing), but I believe that the best

NFP instruction will not generally fit into office visits, but should be done

as a separate service. It helps to have the NFP instructor available in

the same office or very accessible close by. "

Dear Dr. Stanford (i.e.,

Joe):

Thank you for your

perspectives on short NFP methods, but for the sake of conversation (on this

NFP discussion list) - what standards or criteria would you use to define

" the best NFP instruction " -- and why do NFP methods that would only

require a short 5 - 10 minutes be only " better than nothing " ?

For the most part we are

competing with birth control methods that can be provided in a short office

visits - e.g., hormonal pills; condoms; depo shots - methods that do not

require a lot of behavioral change.

When Sandrock, CNM

mentioned that the TwoDay method was a " no brainer " , I thought that

is a good criterion for a method of birth control i.e., " simple to

use " and I would add " simple to teach " and according to the latest

study - it is effective in helping couples avoid pregnancy. If the method

is effective in helping couples to achieve their goal of avoiding pregnancy, it

is simple to use, and it does not separate the unitive from the procreation

act, is that not a good method? You can reach many people with simple

non-complex methods. Not always easy to do with complex methods - that

require extensive training of teachers and of the couple users. And I am

not saying that easy is always the best.

I would also add that

changing behaviors will occur faster when we can reduce behavior hurdles - like

learning complex methods of NFP and requiring extensive group teaching and/or

follow-up. I believe that Larry Severy, PhD (psychology professor at the

University of Florida) mentioned at the Marquette conference in 2002 - couples

would prefer to use nothing --- but if they have to use something - it needs to

be simple and accurate. Furthermore, if health professionals could

incorporate teaching a NFP method into their busy office practice - then maybe

more health professionals would and could provide it.

Your thoughts?

Hope all is well.

J. Fehring

Professor

Marquette University

PS - please do not

take this as an attack on any one method of NFP --- it is a general comment on

modern methods of NFP (OM, STM, etc) - including the Marquette Model. We

have a hard time getting couples to come to one group session and a

follow-up.

--

______________________________

ph B. Stanford, MD, MSPH

Health Research Center

Dept. Family & Prev. Med.

University of Utah

jstanford@...

December 22, 2004

+ As we all agree, instruction by a knowledgeable instructor is key. We've all experienced the "Eureka!" moment when the most recalcitrant of our clients gets the point and ceases doubting and fighting us, themselves, the Church teachings and God. I get many clients who've tried to learn on their own and become dismayed as well. We tried (in good faith) something this passed year with Engaged Encounter that I believe probably accounts for a dramatic decline in Catholic clients. It was referred to throughout--giving just enough information without instruction. We began distributing the wonderful blue booklet created by members of various disciplines to give an overall picture of NFP along with the Janet tape. After this discussion, I wonder if the problem may not be that folks are getting just enough info from the pamphlet and yet not enough, so they try and fail, or become discouraged with not being able to "get it." (I've long suspected that the "failure rate" in our parents' generation likely had more to do with self-instruction than with Dr. Latz's science.) Of course, our names (instructors) and contact info are included, but potential clients may not realize that they need us. Coincidentally, the clients I'm getting are protestants who probably never saw this material and come to classes with a clear slate. The Catholics who do call have a priest/councilor who requires the entire course.

God bless, Rosko, BSN RN

Marquette Method

Birmingham, AL

"...love goes beyond what justice can achieve." Gaudium et spes (The Church in the Modern World)Ph: fax:

RE: RE: simple versus complex NFP

I think you make a good point, Joe, that NFP is a behavioral change, much like losing weight or quitting smoking. I tried to convince a woman once that NFP was better for her body (she had no moral convictions of any sort) and her reply was “I have trouble just remembering to take my pill every day…there’s no way I’ll remember to do all THAT.” Obviously if she wanted to bad enough, she could remember to do it all, but most smokers don’t think they can really quit either...

I think we all agree that extensive instruction is necessary for NFP in any form to be very effective, for either achieving or avoiding. As physicians, I think that 10 minutes might be better spent truly and thoroughly convincing the woman to change her lifestyle. Make it known that it IS a lifestyle change, for both man and woman, and not a quick-fix. Then refer her to a teaching couple for instruction. Sending her home with pamphlets and names/phone numbers is a GREAT idea, to “bring home” the concept and make it “real” for the woman. I would notate the chart, and at future visits ask immediately and poignantly about it.

-----Original Message-----From: ph B. Stanford Sent: Tuesday, December 21, 2004 11:26 PMTo: nfpprofessionals Subject: RE: simple versus complex NFP

Dear Dr. Fehring (),

I think there is a place for simple methods that can "be taught in 10 minutes." I don't mean "better than nothing" as a negative statement, but as a relatively positive one, depending on the setting. But there are some issues to consider-

NFP requires behavioral change, especially if it is to be NFP rather than BAFT (barriers at fertile time), etc. Behavioral change will usually be easier to effect in the context of an ongoing relationship with an NFP teacher than in one or two 10 minute office visits (in my observation is this is usually the case).

Couples with more complex issues (such as infertility or gynecologic problems) who want to use NFP data to help manage their condition do better with more detailed instruction in more detailed methods, in my clinical experience.

I have had the experience on quite a few occasions of both patients and colleagues getting "10 minute" instruction in one method or another, assuming it would be adequate, and then being surprised and totally negative thereafter when the method "didn't work". A lot of complex issues here, but not a good outcome when they decide all NFP doesn't work based on these experiences.

If a simple method is relatively good but not optimumly effective, that trade-off needs to be made extremely clear to the user. Do they prefer simplicity at the expense of some margin of effectiveness?

I don't think it is optimum medicine for diabetics for me to try to do complete diabetic teaching in a 10 minute office visit. Likewise I don't think it is optimum reproductive medicine for me to try to teach NFP in a 10 minute office visit. That's my perspective.

But these are issues that can be studied with data, not just opinions. I look forward to future studies that can address how much teaching is really needed for optimum use by specific couples in specific situations.

Joe

Stanford quote: "Yes there are methods of NFP that can be taught 5 or 10 minutes (and they may be better than nothing), but I believe that the best NFP instruction will not generally fit into office visits, but should be done as a separate service. It helps to have the NFP instructor available in the same office or very accessible close by."

Dear Dr. Stanford (i.e., Joe):

Thank you for your perspectives on short NFP methods, but for the sake of conversation (on this NFP discussion list) - what standards or criteria would you use to define "the best NFP instruction" -- and why do NFP methods that would only require a short 5 - 10 minutes be only "better than nothing"?

For the most part we are competing with birth control methods that can be provided in a short office visits - e.g., hormonal pills; condoms; depo shots - methods that do not require a lot of behavioral change.

When Sandrock, CNM mentioned that the TwoDay method was a "no brainer", I thought that is a good criterion for a method of birth control i.e., "simple to use" and I would add "simple to teach" and according to the latest study - it is effective in helping couples avoid pregnancy. If the method is effective in helping couples to achieve their goal of avoiding pregnancy, it is simple to use, and it does not separate the unitive from the procreation act, is that not a good method? You can reach many people with simple non-complex methods. Not always easy to do with complex methods - that require extensive training of teachers and of the couple users. And I am not saying that easy is always the best.

I would also add that changing behaviors will occur faster when we can reduce behavior hurdles - like learning complex methods of NFP and requiring extensive group teaching and/or follow-up. I believe that Larry Severy, PhD (psychology professor at the University of Florida) mentioned at the Marquette conference in 2002 - couples would prefer to use nothing --- but if they have to use something - it needs to be simple and accurate. Furthermore, if health professionals could incorporate teaching a NFP method into their busy office practice - then maybe more health professionals would and could provide it.

Your thoughts?

Hope all is well.

J. Fehring

Professor

Marquette University

PS - please do not take this as an attack on any one method of NFP --- it is a general comment on modern methods of NFP (OM, STM, etc) - including the Marquette Model. We have a hard time getting couples to come to one group session and a follow-up.

--

______________________________ph B. Stanford, MD, MSPHHealth Research CenterDept. Family & Prev. Med.University of Utahjstanford@...

December 22, 2004

, I didn't find what you were referring to in 60, did you mean #65?

Also a good document is Educational Guidance in Human Love

http://www.vatican.va/roman_curia/congregations/ccatheduc/documents/rc_con_ccath\

educ_doc_19831101_sexual-education_en.html

The points I've been reading in recent posts are well taken. Chastity

(the power to place one's sexual desires at the service of true love) is

a virtue, knowledge is essential, but insufficient by itself.

Re learning NFP, I might add that I had the opposite experience -- I

learned NFP better by reading a book, namely the Kippley's early Art of

NFP! There's one in every crowd...

a Johannes

E. wrote:

> Regarding marriage prep and NFP, I think that II is correct in

> Familiaris Consortio

>

(http://www.vatican.va/holy_father/john_paul_ii/apost_exhortations/documents/hf_\

jp-ii_exh_19811122_familiaris-consortio_en.html)

> no. 60, where he divides “marriage preparation” into “remote” (which

> “begins in early childhood”), “proximate,” and “immediate” (“in the

> months and weeks immediately preceding the wedding”) phases. He seems

> pretty clearly to suggest that NFP information belongs in the

> “proximate” phase – i.e. that providing it shouldn’t be delayed until

> the “immediate” phase, as I gather tends to be the case in the “marriage

> prep” model that many Catholics seem to assume. Specifically, he says

> that “the proximate preparation” “will encourage those concerned to

> study the nature of conjugal sexuality and responsible parenthood, with

> the essential medical and biological knowledge connected with it.”

>

> I think the challenge for us is: How can we make that happen?

>

> Franciscan Univ. of Steubenville

>

> RE: RE: simple versus complex NFP

>

> < agree with Dr. Stanford. When I give public talks on NFP, invariably,

> someone comes up to me to introduce me to their “NFP baby” or to show me

> a photo of same.

>

December 22, 2004

That is exactly the book I tried to learn from! To be just, I am one of those

people who just does not have a BBT - I have never had regular sleep/wake cycles

from childhood on (ADD), and I was trying to learn BBT with a houseful of

children and a husband who regularly got phone calls from work in the middle of

the night. I was also unable to learn Billings from the book that we were given

as part of marriage prep.

If our priest 30+ years ago had required a full course in any method, we would

have gone. I really think that it should be mandatory to have at least 4 hours

of practical NFP instruction prior to marriage, even if the couple doesn't ever

plan to use it.

alicia

-----Original Message-----

Re learning NFP, I might add that I had the opposite experience -- I

learned NFP better by reading a book, namely the Kippley's early Art of

NFP! There's one in every crowd...

a Johannes

> -----Original Message-----

> From: alicia

I

> also tried to learn STM from a book and never could - but learning a

> mucous only method from a good instructor has been a Godsend and a real

> revelation, and I honestly think that all young adults should be taught

> how to recognize and respect their fertility early in their reproductive

> years.

December 22, 2004

Whoops! What I actually meant is #66.

> RE: RE: simple versus complex NFP

> >

> > < agree with Dr. Stanford. When I give public talks on NFP,

invariably,

> > someone comes up to me to introduce me to their " NFP baby " or to

show me

> > a photo of same.

> >

December 22, 2004

Dear Joe (Dr. Stanford):

Thanks for the response – obviously

your response stimulated a good discussion on this list about NFP!

Some of my observations:

I think that most of us can tell

stories about some couple telling us how they became pregnant with some NFP

method or another.

I don’t think one NFP

methods fits all situations. I think that a health professional that is

providing NFP services should be able to help discern with the

woman/couple or groups or communities what is the best approach. (e.g., Spanish

speaking migrant workers or Hmong immigrants with little or no reading ability

might not be able to master some of our more complex NFP methods or systems;

or needing to teach a large number of couples when you are the only NFP teacher).

Maybe some of the more complex NFP systems are more appropriate for certain

medical situations or behavioral situations – that needs to be

determined.

Non-complex NFP methods like the

SDM or TwoDay have been determined in well designed well conducted and

peer reviewed studies to be effective in helping diverse groups of people

to avoid pregnancy. The effectiveness rates are comparable or better than

current OM or STM methods. However, we really

do not know if they are “just as” or more effective unless a randomized

comparison study is conducted.

We need to look at how cost

effective the more complex methods are in professional time and money and

for the couple. And how many couples we can reach with more complex

methods. If only 1-2% of couples are using STM or OM

methods in the United States –

an increase of 1-2% would overwhelm our current teaching systems.

A “ten minute”

method that is effective – would leave more time for the health

professional to deal with behavioral, physical, and if appropriate spiritual

issues.

I agree 100% with your statement

that I cut and pasted below:

“But these are issues that can be studied with

data, not just opinions. I look forward to future studies that can

address how much teaching is really needed for optimum use by specific couples

in specific situations.”

Blessed Christmas to all!