Figuring Out Fertility, especially postpartum
I am not an expert.
I am NOT an expert.
I am not a medical professional, nor highly skilled in the female reproductive cycle, nor a trained natural family planning educator.
I’m simply a woman who wanted to know how her body worked, and never really knew, honestly, until we did our marriage prep and had to take a natural family planning course. I have always had a very regular cycle. We’ve been blessed to easily conceive and I haven’t yet suffered any miscarriages or losses.
A number of you have asked me about how I have figured out postpartum fertility and what NFP’s all about in general. Remember, this is not medical advice, and at this point in my life I fall into the textbook fertility column, so for my many friends who have irregular or extra lengthy cycles, experience multiple miscarriages, or are blessed with quick fertility (meaning babies come more quickly than expected, or being aware and charting and following their bodies’ signs has not worked as they thought it would to avoid a pregnancy), my take on it isn’t going to apply.
We view babies as a gift! If I had been blessed with baby after baby, that would have been awesome. We’ve had our reasons to abstain and use a scientific method to have a little more space between them, but not for lack of appreciating the gift that is a new life growing within!
Here are a few answers to your questions:
1) What is your family planning method?
We use NFP (plus night nursing for me has meant it takes over a year to get my cycle back anyway). Natural Family Planning (“NFP”) or Fertility Awareness Method (“FAM”) are pretty similar ways of gauging what your hormonal cycle is as a woman, aka, when are you fertile, when are you not, when will you menstruate, etc. FAM users use barrier methods (non-hormonal birth control) and NFP uses abstinence while predicted fertility is taking place. Both focus on non-hormonal cycles and greater awareness and empowerment of women to know their bodies.
Before kids, we studied the sympto-thermal NFP method which involved taking your temp orally every day at the same time, checking your mucus, as well as your cervix. Pretty sure I had no idea what my cervix was until I actually birthed a baby out of it, but I digress.
2) How do you know when you’re fertile postpartum?
The sympto-thermal method worked fine enough for us, but after our first babe, my doctor told me off-handedly that the temperature wasn’t going to be a good indicator of fertility anymore as I was nursing–and that the postpartum period could generally wonk it up.
Oh. Well. So ?? I called the nurse hotline five months postpartum and said with great intrepidation, I’m bleeding vaginally!!! So am I dying? To which they said, “Uh, pretty sure that’s your period coming back.” Oh.
As it turned out, for me, so long as I’m night nursing (like deeply middle of the night) and co-sleeping, I don’t get my period back. My firstborn night weaned at 3 months (hence the period’s return) while the second and third night weaned after a year. For a number of my friends that’s not the case and they can co-sleep and night nurse and still get pregnant. Note, I’m not an expert.
Breastfeeding has an effect on your hormonal levels as well, so often my friends who are nursing and on hormonal birth control report a decrease in their milk supply.
We then switched to a pseudo Creighton method, which is solely mucus based. I say pseudo because we never actually took a course or had an instructor. We read a lot online and I was constantly gauging my mucus. It kinda drove me crazy.
After this third baby, we finally landed on the Marquette method which involves observing what’s going on with your mucus while also using a monitor to measure your hormone levels. So you pee on a stick every morning and slide it into a little handheld monitor that tells you what’s up. It “trends” upward as you approach your peek day so you can make a decision about having sex as you get closer and closer to the day your body produces the very most mucus (it’s pretty hard to miss this day for most of us!).
Remember, you ovulate before you bleed postpartum. And sperm can live up to five days. So there’s this window of fertility that can be hard to discern. The pee-on-a-stick method has helped us discern and be more aware of what my body’s doing.
3) How about abstinence?
Abstinence is hard. Not only because biologically we’re made to be intimate as our hormones trend toward fertility (propagation of the species et al.) but because sex is such a key way to communicate love toward each other. And when it’s not on the table if you’re choosing to pause on making babies for whatever reasons, that can mean a lack of connection, shorter tempers, more misunderstandings.
It also means when you’re not abstaining that sex is really appreciated! It’s like YAY! As with anything in life, lack of on-demand availability means you really appreciate it and can feel more purposeful when you do have that intimate time together.
Most frequently I get asked, Doesn’t NFP mean you don’t get to have sex for like weeks and weeks??
Day 1 is the first day of your bleeding, and usually around day 14 is your peak day. The marquette users I asked who are choosing to abstain will resume normal activities a day or two after peak. If you bleed for 5-6 days, that takes you to day 6, let’s say. Maybe you’re intimate when you have your period, maybe you’re not. If you’re not, you have about 14-15 days of abstinence. Or if you are, you have about 8-9 days off. Out of 28-30 days.
Do non-abstaining folks have sex 30-31 days a month? Probably not. A week or two off (though it is continual so that might differ) is probably well within the norm of most couple’s sexual activities.
4) Why is this empowering?
I was a grown woman who didn’t really know how her cycle worked! I mean, come on. Health classes should teach this stuff. Sex ed is about way more than STDs and STIs, right? Shouldn’t today’s young women know what mucus is, and when they’re fertile, and make their sexual decisions based from a place of knowledge?
I saw this article about how being on hormonal birth control from teenage years onward can really mess with your body. Not to mention all the side effects. It seems like the kind of thing that doesn’t liberate us. It seems like we are kept in the dark about how our bodies work and told to take pharmaceuticals that have the potential to really screw up our bodies and our long-term fertility.
It’s empowering because I learned so much about how my body works. And I can teach that to my kids, especially my daughters, but also my sons. Respect for your body starts with knowing how it functions on a very basic level. I have lots of single girlfriends (who aren’t sexually active) who have studied it simply for self-knowledge and I think that’s pretty empowering, and pretty beautiful.
I really enjoyed this post. Thank you for sharing. I only have boys, for now, and already they know a few insights on the female body. We involve them in most decisions, because we believe they will have to make them one day with their own families.
Thank you so much again!
Thanks so much! Yes, I really think sharing about this stuff when boys are old enough is so important, too!
Thank you for sharing. More of us need to share these things–they are hard to talk about. I need the post on “Figuring out fertility during the onset of menopause.”
Oh yes! And bookmark it for me in a decade or two!
Love this! I am still trying to figure it all out.
me TOO!
This is my favorite nfp post ever. You explained it well and did so in a non-judgmental way. So many times I read posts that whether intended or no are so holier-than-thou. Thank you for sharing your experience.
Awww I’m so glad I didn’t offend you. I really just wanted to share what our experience has been thus far!
Thanks for your post! I’m on my fourth pregnancy in 5 years! Postpartum tracking has been hard and obviously has not worked for me, but I will say I haven’t tried super hard either. I like the info about the Marquette nfp option. I actually have a clear blue monitor from when we were trying to get pregnant with our first. My only question is when do you start testing? After you get your first period? I would like to start testing before then but don’t want to throw off the monitor from not actually knowing my day 1. Typically I do get my first period around 5-7 months post partim but with brrastfeeding it’s irregular (last cycle was 6 weeks) so I thought the monitor might help next time around. Any advice would be great 🙂
I started testing about 6 months PP because that’s when my son starting sleeping a liiiiiittle longer at night and not necessarily nursing between 12-3am but didn’t actually have any signs of fertility until he was 13 months, and then when he was 14 months, I got my period back. So 7 months. If you wait till after your period, you’ve missed your first ovulation (which typically happens pre-period), of course, your body may be different! In your case, I’d start around 3 months pp to try to catch your fertility before your period starts up again. Ask your medical provider, of course, and consult the Marquette website which knows SO much more than me!
Great! Thank you! And the monitor doesn’t necessarily “need” to know its not “day 1” right? It will just test my hormone levels everyday?
The way I’ve used it, as I used it for months before I had an actual “day one” (period), the day didn’t really matter. It was all about the hormone levels 🙂
You can use Marquette method almost right away after birth. I think they usually say wait 6 weeks or so for hormones to level out. There is a postpartum “cycle zero” protocol (aka before menses returns) that you will want to read up on their website. You essentially test every morning and as long as the monitor reads low you are fine, but when it reads high or peak you need to abstain. The confusing part is learning when to retrigger/reset the monitor, because it will give you automatic readings that are not true readings after a certain point (I think it’s 19 testing days?). As with any method, the best way to learn is to get an instructor, but marquette is nice that they have free forums on their website where you can get your questions answered. There is also a marquette facebook group which is admin’ed by a very good instructor. It can be more abstinence heavy than other methods during postpartum, but for me it was worth it to have a clear yes or no on any given day instead of driving myself crazy.
Loved this, Nell. Thanks for sharing. I love reading about other’s experiences with NFP or FAM. After baby number 2 I started ovulating twice a month, and gosh, that threw me for a loop! So I’m always interested in how others navigate it all.
Everyone’s bodies are SO different!! So glad you’re here, sweet friend.
Thanks for this article Nell!! It’s so true what you say about it being unfortunate that young women aren’t taught this is sex-ed classes.. I decided to learn charting as a single college student, years before I met my fiance, and I am so glad I did. Not only did it make me more comfortable with my body at the time, but its making things way less stressful now since I have the basics
That is so cool!!
Can I ask what the cost associated with the Marquette method is? I remember hearing that it sounded expensive, which is one reason my husband and I chose Creighton Model…. but after two not exactly planned pregnancies, we’re looking at other options for the next time around.
So I have the old monitor which was about $250? And then a box of sticks (30) is about $30. The new monitor is about $142. And you use a box of sticks for maybe two months? People may always be willing to give or sell for low cost their old monitors, too! If you’re on a tight budget, I can ask around!
Where have you seen a cheaper new monitor? My only barrier to the Marquette is that huge upfront cost.
Amazon! Click through the link on it 😉
Violet, you can use health savings account funds to pay for the monitor, monitor test sticks, and ovulation predictor sticks. So if you or your husband have a HSA (or flex spending account) through work, you can buy all the supplies you need for Marquette with pre-tax money, which does make a difference!
AWESOME!!
It’s definitely the most empowering!
LOL at the cervix comment- I definitely didn’t understand it until I had our first baby either!
What kind of an idiot was I!!?!? hahahaha
This is great Nell! I’ve gotten very comfortable checking my cervix and feel like we couldn’t do NFP postpartum without that. In fact I’ve come to rely almost entirely on cervix checking. We have only moderately strong reasons right now to avoid pregnancy, so we usually feel okay having one or two ‘on’ nights after my period, as long as it has definitely been a dry day, and then abstaining until only one or two full days after my cervix has closed. I believe (okay okay I know personally!) you can get pregnant having relations before your cervix is open, but my impression is that it is extremely unlikely after it has definitely closed. I don’t ever have dry days after ovulation so I never felt super comfortable resuming relations before I finally got up the gumption to start cervix checking (also I doubt whether any of our first three amazing children would have been conceived if I had been checking my cervix so, man, that’s food for thought!)
Despite all the babywearing and night nursing in the world I always experience a fairly early return of fertility, and for six months or so my cycles are long and wonky and we know we’re in for abstinence of up to two or three weeks, but for more than a year of continued night nursing I’ve been having 26-32 day cycles and, relying heavily on cervix closure as I am, that means only 6 to 9 days of abstinence. Really not too bad.
I’m so impressed!!! Way to go on the cervix!!!!
Thank you for writing this post! I feel like postpartum nfp is such a taboo subject because it is so difficult sometimes, (ok, like all the time for most people) that in an effort to sell nfp people just skip over the truly hard parts. Marquette is a great option for people who just can’t wrap their heads around nfp postpartum and need something clear cut. I love that it gave me a “yes” or “no” on any given day. Although I do have one small issue with “The marquette users I asked who are choosing to abstain will resume normal activities a day or two after peak”- those users must not be trying very hard to avoid pregnancy because that is NOT how the method is supposed to be used if you are avoiding/spacing- it is peak plus 4 full days, resuming relations on the 5th day after peak. The method typically calls for avoidance starting on day 6, so if you peak on day 14, you will need to abstain days 6-18, which is 13 full abstinence days. Honest nfp instructors (for EVERY method) will tell you that with typical cycles, abstinence will usually be 1/3 to 1/2 the cycle. Your “8-9 days off” would be atypical, even for very regular women. Plus, postpartum women who are not back in cycles will often have more abstinence then their cycling counterparts. It is very common for women to need to abstain 30+ days with the marquette method when their body starts the process of returning to cycles or within their first few cycles.
Again, thank you so much for writing this blog post and I’m not trying to burst your balloon – Nfp and the Marquette method are great options. But too often we try to sell nfp with “look how easy and great it is” and then people try it and get frustrated and give up when things aren’t as sunshine and roses as we make them appear. I have known so many people who feel led astray by nfp promoters and have gone back to alternative birth control with the feelings of being lied to. It’s very important we give realistic information so that people who choose to make the switch know what to expect going in to it.
Thanks for your insights! I edited it to say the ones I had talked to 🙂 Nothing easy about my NFP path and I hope it didn’t come across that way! Just sharing my experience.
Nell,
I loved this post! I am single but plan to use NFP when I marry someday and love to hear different perspectives to be able to be prepared as possible. I am going into healthcare and hope to be an NFP instructor. Funny thing is, I went to Marquette and had never even heard of the model until after I graduated! We should definitely be taught this in school!
Totally! Way to go, you being so proactive!
Not an idiot at all! At least, I sure hope not because it took my doula and her hand knit turtleneck sweater-like uterus demonstration of birth before I finally got it. (I guess I’m a visual learner?)
I loved this. I don’t seem to get my cycles back for a looong time. Like 19 months. Having to be patient when I really want to be able to get pregnant has helped me to see pregnancy and babies as gifts and not a right to be demanded.
It’s so hard!! Our hearts and bodies aren’t always in the same place. Sending you love & prayers.
Love this. We did STM before kids and yeah… NO IDEA what that cervix business was about. I did STM after the first and remember thinking, “ohhhhh now it makes sense”. We did Marquette after our second and well… failed. It wasn’t totally the method’s fault or our fault, we just should have been more conservative. So! Surprise baby! And yes, you definitely ovulate before that first bleed… and that ovulation is the hardest to catch! (In the words of Bonnie on facebook… ask me how I know. 😉 )
hahahah that ovulation is so hard to catch! I had a false peak day, and then finally the real thing. Lots of abstinence before the first cycle! Cervix: totally a novice woman over here? I mean, come on, Nell!! 🙂
A huge YES to your last point! I was floored when I started finally learning about my amazing reproductive system at age, oh, 25? And I was already one of the lucky ones among my peers in college – my mom was super open about her period, so I was really prepared, and I was present at the home birth of my little sister at age 6. Even so – with birth and menstruation the opposite of a mystery – there was so much I didn’t know. I always encourage women I know to read TCOYF and to learn about their amazing bodies.
Our bodies are pretty amazing!!!
I would like to address the issue of abstinence, as an NFP instructor who personally uses the Marquette Method and teaches a method very similar to it, and specializes in the post-partum/breastfeeding transition to fertility and on to regular cycles.
I don’t know who you have been asking about their use of Marquette, but ceasing abstinence a day or two after peak is not what the method demands. It does lead me to wonder whether they are all keeping to the Marquette protocol for when abstinence begins, as well. There are two monitor peaks, and abstinence follows those for another full 3 days. This accounts for the ovulations that occur (based on ClearBlue research) on the day of monitor high following peak, and for the potential for double ovulation (a second egg released from the other ovary up to 24 hours after the first) and time for the egg(s) to dissolve.
Also, for women in *regular* cycles the average *method required* abstinence with Marquette is 16 days. This is according to the official Marquette studies that crunched the data from enough women to make that sort of statistic meaningful. This does not include any available days at the beginning of the cycle where the woman may be bleeding. Regular cycles is a kind of academic term that generally means something like cycles that are between 22-42 days in length and do not vary by more than 7 days. The first six full post-partum cycles in Marquette are not regarded as regular cycles.
Average *method-required* abstinence for Marquette users in regular cycles is something like 16 days, which is typically about 1/2 the cycle. Average method-required abstinence for NFP users across methods is something like 1/3 to 1/2 of each cycle. Billings says it’s about half. Marquette’s is about half. From what I can tell looking at Creighton and at various sympto-thermal methods, most other methods rest about there, as an average. Even the Two Days method, which holds the theoretical potential for the least method-required abstinence, has an average abstinence of 12 days a cycle, and is only 95% effective in perfect use, so the few days gained correspond with a few percentage points lost in efficacy.
Obviously there’s a wide spread, because it depends somewhat on how the woman’s cycle presentation meshes with the method’s approach. And all that goes for regular cycles, which are easier to navigate.
Marquette has a study specifically on the post-partum/breastfeeding transition to fertility, and the researchers have a wealth of data on the first 6 post-partum cycles, as well. Ovulation tends to be delayed in these cycles; although there’s a wide spread, the average window is something like between day 25-35 in the first full cycle beginning with a menses post-partum, and the default day to begin abstinence is day 10. So in the first cycle alone, a lot of women will be abstaining 20-30 days in a row (including the post-peak count.) Abstinence post-partum is a bit more of a crap shoot, because the first post-partum cycles can vary so much. But I’d guess it’s usually a bit more than the average for regular cycles. Marquette uses an algorithm once enough data on regular cycles is obtained, but for breastfeeding women who are not able yet to use the algorithm, they will probably have a heavier abstinence load.
I think it’s great that you’re raising awareness about NFP, but I wanted to address this point. I’m always careful to discuss a realistic expectation of abstinence with my clients, and especially so for phases in fertility where more abstinence tends to be typical. I’ve met a lot of people who’ve felt deceived and cheated by pop Catholic books and blog posts that lowball method required abstinence. Of course, on top of this abstinence, life often imposes more on top of the method, where work, travel, children and illness don’t cooperate with your NFP charting. But that’s another story!
Love hearing from an instructor! I’m just addressing what my experience has been with it postpartum. Thanks!
That’s great. Were you following the protocols correctly? If so, your experience of abstinence is not the average. Lucky you! It may be that you weren’t aware of the correct protocols, though. Whatever the case, I’m so glad you’ve had a good experience.
Thanks for your insights, Mikayla! As my cycles didn’t return til he was 14 months, we used the monitor for about 8 months and were able to follow what was going on with my body, which was helpful. Lots of abstinence! Now that I’m cycling, it’s much easier to identify the target windows of fertility 🙂
Did you teach yourself the Marquette method or did you go to some sort of class or something? We’ve used Creighton, but I don’t feel 100% confident in it while breastfeeding. I’m really intrigued by Marquette, but am wondering how easy it is to learn?
I sat down with a friend who practices it for about a half an hour! So no in-depth knowledge here! 🙂
Marquette is relatively easy to learn, especially if you’re in regular cycles. Post-partum/breastfeeding can be more confusing, however. I’ve done both Creighton and Marquette post-partum and found Marquette more simple (and in my case, it was less abstinence heavy as well, but that will vary from woman to woman.)
DO NOT try to teach yourself Marquette post-partum/breastfeeding from the public website. There’s a notice on the website that says it is no longer updated, and the protocols for that particular subset of user has been changed. You can join the official Marquette forums where where updated information is posted, and where the researcher-instructors will answer your questions, typically within a day or two. It costs $60 for a year’s access. Or you can contact Mary Schneider, one of the researcher-instructors, to see if there are any instructors in your area or who will work online with you.
There is also an unofficial facebook Marquette support group, called Marquette Method NFP. It has some 2000+ member so far, and is very supportive. It’s not the same as having personal instruction, because with so many members you can receive some conflicting advice at times, but I think it’s a helpful resource for those who wouldn’t otherwise seek instruction.
Thanks for sharing your experience!
Mikayla-
Would you be willing to email me, or give me your email so I can ask some specific questions.. it seems like you are insanely knowledgeable and I sure need that 🙂
I always find the postpartum time scary, and now I’m headed into it for the fourth time in 6 years. I get my period back very early (4-6 months) despite breastfeeding for over a year every time, but it seems like I don’t really get fertile cycles back till after I wean, either that or I’ve gotten lucky. Anyway, we tried Marquette last time but I got really confused/frustrated because I was getting very clear mucus signs that TOTALLY contradicted the monitor signs — like the monitor would say not fertile, and the mucous would be totally there, tben the monitor would say I was at peak but I’d be dry? I didn’t know what to trust so there was, you can imagine, much abstinence. Not so great, so I gave up. Maybe I’ll try again this time, I dunno. My husband has offered to move into a shed in the backyard as an alternate solution 😉
Above and beyond a general “thanks” for sharing your thoughts on postpartum NFP, I have a couple of thoughts to share.
#1 – We use the Sympto-Thermal Method (STM) as taught by the Couple to Couple League (CCL). We like the fact that you can compare two (or three, since the cervix sign is optional) signs of fertility and base your decisions on that. We’re engineers, so we kind of like not relying on one sign alone. You are totally correct in that the temperature sign doesn’t mean much for awhile postpartum. We did take the postpartum class (free if you’re a CCL member, though I suggest buying the book) and learned how to interpret postpartum mucus patches without a temperature shift. The important thing to note is that if you ovulate, there WILL be a temperature shift (even if you haven’t seem much mucus compared to normal, because postpartum mucus may not be the same as “normal” for you – it might be a lot less or you might even have mucus every day – if that’s the case, you can call the main office or your teacher and they’ll help you figure out when to consider this base/unchanging mucus “infertile” time). In the STM, they suggest that the first three cycles after baby are not “regular,” typically in that Phase II (the fertile phase with mucus) is longer. The mucus patches before first ovulation and during these first three cycles postpartum are typically the yucky times with more or unexpected stretches of abstinence (if you’re avoiding).
For information’s sake… Apparently my body wants to focus on nursing babies (two so far), because I typically don’t get my cycles back until about 15 months postpartum. I do ovulate before bleeding (our doctor, who is NFP only, says only about 5-6% of women ovulate before something that is enough bleeding to look like a period – but unless you have temperature or hormone levels recorded, you don’t know if it’s an actual period or just bleeding without ovulation. Either way, bleeding or mucus after baby is a good time to start charting. 🙂 My first postpartum cycle after baby #2 (I don’t remember after #! and I’m not going to get my chart now!) had something like 20 days of Phase II / fertility. We were really ready for the day the method said we were good to go! It wasn’t easy, but I like feeling as though my body “resets” after a pregnancy, so I have aimed to have 2-3 cycles between before starting to try again (we got married later in life, so no huge reasons to avoid here). For comparison’s sake, my “normal” cycles typically are 33-35 days long and the fertile/avoid time is maybe 10-12 days (not including when I have my period).
Sorry, that was long, but I thought I’d throw out some more info on the Sympto-Thermal Method and our experience postpartum. (Disclaimer!) We’re not actually teachers, but we’ve been discerning going through the training and have been promoting NFP (of any method) in our parish for the past few years. We also are friends with several teachers (both of STM and Creighton – and our doctor used to teach STM), so I’ve had good access when we’ve had questions.
#2 – If cost is a concern, I encourage interested parties to look into the Couple to Couple League’s classes. They just revamped their offerings and pricing. Based on what I’ve been told by Creighton instructors (at least around here – which may be different where you live. I’m in Omaha, where we have the Pope Paul VI Institute, so perhaps there’s more overhead built in for the intro session?), learning Creighton can be between $350-$400. CCL offers in person classes (the best way to learn NFP, in my opinion – there’s nothing like being in the room with your teacher), virtual classes online, and self paced online classes (a new thing). In person and virtual are $130 plus shipping for your book, charts, thermometer. The self paced online is about $100. So, you could generalize and say “under $150.”
Thanks for giving us the opportunity to hear about your experiences and chime in with our own. It’s only through honest sharing of our experiences that people will come to learn that NFP can be a beautiful addition to your marriage, even if it is hard (or extremely hard) sometimes (or all the time).
[…] of me wanted to wait even longer to stop using NFP to abstain from sex during my fertile times. Part of me wanted to hold out from going through my usual physically challenging pregnancies, and […]
[…] experienced in our communities. All three of us practice natural family planning (talked about it here) in some variation but the variations are wide ranging–as we suspect is the case for many […]
This is great! I had the same experience of taking an NFP class as an adult and I found it to be so empowering. Thanks for sharing your experience!