Ovulation method use during breastfeeding: Is there increased risk of unplanned pregnancy?

Labbok, Miriam H.; Stallings, Rebecca; Shah, Farida; Pérez, A.; Klaus, Hanna; Jacobson, M; Muruthi, T

doi:10.1016/s0002-9378(11)90574-2

Cited by 26 publications

(14 citation statements)

References 3 publications

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“…There are few studies that have investigated the e⁄cacy of using NFP methods to avoid pregnancy during the breastfeeding transition (Brown, Harrisson, & Smith, 1985;Hatherley, 1985;Labbok et al, 1991). Most have shown that NFP is not very e¡ective or that NFP even increases the unintended pregnancy rate.…”

Section: Discussionmentioning

confidence: 99%

Pilot Evaluation of an Internet‐Based Natural Family Planning Education and Service Program

Fehring

Schneider

Raviele³

2011

Journal of Obstetric, Gynecologic & Neonatal Nursing

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Objective: To evaluate the efficacy, knowledge of fertility, and acceptability of a web-based natural family planning (NFP) education and service program. Design: A 6-month repeated measure longitudinal evaluation pilot study. Setting: A university based online website. Participants: The website was piloted with 468 volunteer women seeking NFP services. Of these participants, 222 used the automatic online fertility charting system to avoid pregnancy. The 222 charting participants had a NOT THE PUBLISHED VERSION; this is the author's final, peer-reviewed manuscript. The published version may be accessed by following the link in the citation at the bottom of the page. Obstetric, Gynecologic, and Neonatal Nursing, Vol 40, No. 3 (May/June 2011): pg. 281-291. DOI. This article is © Wiley and permission has been granted for this version to appear in e-Publications@Marquette. Wiley does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from Wiley. Journal of2 mean age of 29.9 years (SD=5.6), 2.2 children (SD=1.9), 37% were postpartum, and 47% had regular menstrual cycle lengths. Intervention: Nurse-managed web-based NFP education and service program. Outcomes: Pregnancies were confirmed by an online self-assessed pregnancy evaluation form. A 10-item fertility quiz and 10-item acceptability survey was administered online. Results: Among the 222 users avoiding pregnancy, at 6 months of use, there were two correct-use unintended pregnancies that provided a pregnancy rate of 2% and seven total unintended pregnancies providing a typical use pregnancy rate of 7%. Mean knowledge of fertility increased significantly from time of registration (8.96, SD=1.10) to 1 month of use (9.46, SD=.10), t=4.60, p<.001). Acceptability increased nonsignificantly from 1 month of use (45.6; SD=8.98) to 6 months of use (48.4; SD=8.77). Conclusion:The nurse-managed online NFP system seems to provide adequate knowledge of fertility and help participants meet pregnancy intentions. Acceptability of such a system of NFP is still in question.Only 64,000 to 124,000 couples in the United States currently use modern natural family planning (NFP) methods to avoid pregnancy (Mosher, Martinez, Chandra, Abma, & Wilson, 2004;Mosher & Jones, 2010). Reasons for low usage of NFP include complexity of NFP methods, lack of access to qualified teachers, actual and perceived ineffectiveness, and lack of credibility of the methods among health professionals and the general public (Fehring, 2009;Fehring, Hanson, & Stanford, 2001). Current NFP delivery systems are teacher and user intensive (Arévalo, 1997;Fehring, 2009). Service delivery of NFP usually entails introductory sessions that last an hour or more, individual follow-up sessions at monthly intervals for up to 6 months (and sometimes longer), and complex charting and instructions (Fehring, 2004). In today's "fast-paced" information and technology age society, couples are often no longer willing or able to attend extensive educatio...

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Section: Discussionmentioning

confidence: 99%

Pilot Evaluation of an Internet‐Based Natural Family Planning Education and Service Program

Fehring

Schneider

Raviele³

2011

Journal of Obstetric, Gynecologic & Neonatal Nursing

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“…4 One study has suggested that breastfeeding women who adhered to the rules of the ovulation method (based on identifying when mucus becomes fertile) after menses returns may have a higher unintended pregnancy rate than those who were not lactating. 9 In addition, there is confusion among users about the interpretation of the natural signs of fertility during the breastfeeding transition, 10 especially if these women have had irregular cycles previously. 11 In studies that have investigated the efficacy of NFP during the breastfeeding transition, 4,6,[11][12][13][14][15][16][17][18] the pregnancy rates at 12 months have ranged from 11.1 13,15 to 24 per 100 women.…”

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confidence: 99%

Efficacy of a New Postpartum Transition Protocol for Avoiding Pregnancy

Bouchard

Fehring

Schneider

2013

The Journal of the American Board of Family Medicine

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Introduction:The postpartum period is a challenging time for family planning, especially for women who breastfeed. Breastfeeding delays the return of menses (lactational amenorrhea), but ovulation often occurs before first menses. For this reason, a protocol was developed to assist women in identifying their return of fertility postpartum to avoid pregnancy.Methods: In this prospective, 12-month, longitudinal cohort study, 198 postpartum women aged 20 to 45 years (mean age, 30.2 years) were taught a protocol for avoiding pregnancy with either online or in-person instruction. A hand-held fertility monitor was used to identify the fertile period by testing for urinary changes in estrogen and luteinizing hormone, and the results were tracked on a web site. During lactational amenorrhea, urine testing was done in 20-day intervals. When menses returned, the monitor was reset at the onset of each new menstrual cycle. Participants were instructed to avoid intercourse during the identified fertile period. Kaplan-Meier survival analysis was used to calculate unintentional pregnancy rates through the first 12 months postpartum.Results: There were 8 unintended pregnancies per 100 women at 12 months postpartum. With correct use, there were 2 unintended pregnancies per 100 women at 12 months.

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“…Only 1.7% became pregnant during the first 6 months of amenorrhea, only 7% after 12 months, and 13% after 24 months. [65][66][67][68][69][70] Comparisons of follicular development and hormonal profiles are important to understanding lactational amenorrhea.…”

Section: Lactational Amenorrhea Methodsmentioning

confidence: 99%

Reproductive Function During Lactation

Lawrence

2011

Breastfeeding

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Ovulation method use during breastfeeding: Is there increased risk of unplanned pregnancy?

Cited by 26 publications

References 3 publications

Pilot Evaluation of an Internet‐Based Natural Family Planning Education and Service Program

Pilot Evaluation of an Internet‐Based Natural Family Planning Education and Service Program

Efficacy of a New Postpartum Transition Protocol for Avoiding Pregnancy

Reproductive Function During Lactation

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