Counseling on FABMs - National Clinical Training Center€¦ · Counseling on FABMs . Pregnancy...
23
replyobgyn.com Counseling on FABMs Pregnancy prevention using a decision-making tool Lori Hartley, MPH, RN Reply Ob/Gyn & Fertility Cary, NC
Transcript of Counseling on FABMs - National Clinical Training Center€¦ · Counseling on FABMs . Pregnancy...
replyobgyn.com
Counseling on FABMs
Pregnancy prevention using a decision-making tool
Lori Hartley, MPH, RNReply Ob/Gyn & Fertility
Cary, NC
replyobgyn.com
Outline
1. Clarifying commonly used terms
2. Our experience at Reply Ob/Gyn
3. Intro to the tool
4. Discovery questions
5. Brief breakdown of each FABM
6. Tips for counseling on FABMsIncorporating them into your practice
7. Wrap it up
replyobgyn.com
Fertility Awareness-Based Methods (FABMs) o Umbrella termo May or may not involve use within a religious contexto Permits either abstinence or use of a barrier method
during the fertile window
Natural Family Planning (NFP)o Often associated with religious contexto Typically teaches abstinence during the fertile window
What’s the difference between FABMsand “NFP”?
Why create a tool?
Our challenges:
Differences among FABMs are not well understood
Lack of reliable information about effectiveness rates
No central location for reliable and non-biased information
replyobgyn.com
Our goal:Equip women with reliable information so they may take the driver’s seat of their reproductive health!
replyobgyn.com
Introducing our FABMdecision-makingtool!
replyobgyn.com
As with all methods ofpregnancy prevention, not every FABM is right for every person!
replyobgyn.com
Can you abstain from intercourse or use a barrier method during the fertile time?.
And are you comfortable negotiating those choices with your partner?
replyobgyn.com
Discovery questions:
• Short/long term fertility intentions?
• Effectiveness needs?
• Learning style preference?
• Postpartum or breastfeeding?
• Long/irregular cycles?
• Physical or learning limitations?
• Financial or time barriers?
• Religious considerations?
replyobgyn.com
replyobgyn.com
Help me decide…
replyobgyn.com
Considerationso For use only by women with 26-32 day cycleso Uses a 12-day fixed fertile window on CD 8-19 for all cycleso Uses calendar, cycle beads, or free app to track cycleso Method is self taught and easy to learn/teach (30 mins)o Cost: approx. $14 for beads; free Appo For more information visit Cyclebeads.com
Advantages o Requires tracking of only last menstrual periodo No ongoing cost
Disadvantageso Only works with regular cycles (26-32 days)o Less useful for trying to conceive or health monitoring and
management
Calendar MethodsStandard Days
replyobgyn.com
Calendar MethodsDynamic Optimal Timing (DOT)
replyobgyn.com
Considerationso Available in Spanish onlineo Helpful for long/irregular cycles o Preovulation intercourse is recommended only at the
end of the day; every other day on non-fertile dayso Learning time: 3 hours over 3-5 sessionso Cost: Varies; may be billable through insuranceo For more information visit Boma-usa.org
Advantages o Requires tracking of only cervical mucus sensationso Can also be used for health monitoring/managemento Can be used by reading/visually impaired
Disadvantageso Abstinence is recommended during first month of
use
Cervical Mucus MethodsBillings Method
replyobgyn.com
Considerationso Easy to learn and teacho Smartphone app availableo Can be used with irregular cycleso Cost: no cost to learn nor ongoing cost; free appo For more information visit twodaymethod.com
Advantages o No charting necessaryo Requires tracking of only cervical mucus sensationso Can be started at any point in the cycle
Disadvantageso May be difficult for women with constant cervical mucuso Less useful for trying to conceive or health monitoring and
management
Cervical Mucus MethodsTwoDayMethod
replyobgyn.com
Considerationso Cervical mucus is cross-checked with basal body
temperature to identify fertile windowo In-person training by certified instructoro Learning time: 4-6 hours over 4 sessionso Cost: Varies; may be billable through insuranceo For more information visit replyobgyn.com/sensiplan
Advantages o Can also be used for health monitoring and managemento No ongoing cost
Disadvantageso Need literacy and basic math skillso Potentially long fertile time for those with long cycles
Symptothermal MethodsSensiplan
replyobgyn.com
Considerationso Designed for women ages 20-40o Computer algorithm predicts daily chance of pregnancy based
on woman’s cycle historyo Approved in Europe as contraceptive deviceo Learning time: <60 minuteso Cost: $10/month or $80/yearo For more information visit naturalcycles.com
Advantages o Method is self taught online
Disadvantageso Ongoing cost of app useo Potentially long fertile time while computer algorithm learns user
patterns
Basal Body Temperature MethodsNatural Cycles
replyobgyn.com
Considerationso Cervical mucus is cross-checked with basal body temperature to
identify fertile windowo In-person or online trainingo App availableo Learning time: Three 30 min sessions over 3-6 moso Cost: Varies; may be billable through insuranceo For more information visit nfp.Marquette.edu
Advantages o Can also be used for health monitoring/managemento Multiple user options availableo Perhaps a more objective view of fertile window?
Disadvantageso Ongoing cost of test stripso May not detect urinary hormones of all women
Symptohormonal MethodsMarquette
replyobgyn.com
Considerationso A breastfeeding woman MUST meet the following three criteria:
Exclusively breastfeeding day and night No return to menses since delivery Baby is less than six months old
o Learning time: <60 minuteso Cost: no cost for online informationo For more info visit waba.org.my/resources/lam
Advantages o Can be used immediately after deliveryo No need to observe and track signs of fertility
Disadvantageso Temporaryo Cannot be used for health monitoring/management
Lactational Amenorrhea MethodLAM
Tips for supporting your FABM counseling
• Counsel about high chance of pregnancy with imperfect use
• Encourage personalized instruction by a certified educator where appropriate
• Promote support system network (partners, clinical providers, educators, community resources)
• Create a list of local and long distance fertility educators
• Consider billing options- ICD 10: Z30.02 Family planning education- Procedure code: 99404 Preventative medicine
counseling and/or risk factor reduction
• Contact Reply OB/GYN & Fertility for copies of our decision-making tool
replyobgyn.com
Start here…
• View webinar: Understanding and Counseling Potential Users on
Fertility Awareness-Based Methods (FABM) for Pregnancy
Prevention –https://vimeopro.com/nctcfp/videohub
• Consider participating in online trainings - Standard Days Method Training (2 hours to complete)
http://archive.irh.org/SDM_Training/index.php
- Order TwoDay Method Tool Kit https://www.k4health.org/toolkits/twoday
• Consider becoming a user of a method that interests you
replyobgyn.com
replyobgyn.com
Let us come to you!
Reply Ob/Gyn & Fertility
replyobgyn.com
o Lori Hartley [email protected] 919-230-6702
o Visit our website at replyobgyn.com
o Engage with us on Social Media
o Subscribe to our “To Your Health!” newsletter
Let’s Stay Connected!
Reply Ob/Gyn & Fertility
Thank You!
© Guttmacher Institute 2018 23
Thank you, and we are happy to take questions!
