Fehring, R. J., Hanson, L., & Stanford, J. B. (2001). Nurse-midwives' knowledge and promotion of lactational amenorrhea and other natural family-planning methods for child spacing. Journal of Midwifery & Women's Health, 46(2), 68-73. https://doi.org/10.1016/s1526-9523(01)00094-0
Fehring RJ, Hanson L, Stanford JB. Nurse-midwives' knowledge and promotion of lactational amenorrhea and other natural family-planning methods for child spacing. J Midwifery Womens Health. 2001;46(2):68-73. doi:10.1016/s1526-9523(01)00094-0
Fehring, Richard J., et al. "Nurse-midwives' knowledge and promotion of lactational amenorrhea and other natural family-planning methods for child spacing." Journal of Midwifery & Women's Health, vol. 46, no. 2, 2001, pp. 68-73.
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Most nurse-midwives mention natural family-planning to select clients
In a mailed survey of 1,200 randomly selected certified nurse-midwives, 450 practicing respondents answered questions on natural family-planning (NFP) and the lactational amenorrhea method (LAM). About 6 out of 10 would mention NFP to select clients, and only about 2 out of 10 would mention NFP to most or all clients. They ranked NFP ninth in use among 12 methods.
Key Findings
In an earlier Missouri physician survey, when a client asked for NFP information, 20% would give written NFP information and 9% would say NFP does not work. Nurse-midwives: 58% and 1%.
Nurse-midwives ranked NFP ninth in use and eighth in perceived effectiveness among 12 family-planning methods used by their clients. LAM was not ranked separately.
Among 450 nurse-midwives, 49 (10.9%) would not mention NFP, 286 (63.4%) would mention it to select clients only, and 101 (22.4%) would bring it up with most or all clients.
Respondents projected, on average, that 12.4% of women would become pregnant within 12 months of perfect use of modern NFP methods, and 28.3% within 12 months of typical use.
For LAM, 104 (23.1%) said it was not reliable and 38 (8.4%) were not familiar with it. Respondents projected, on average, unexpected pregnancy in 17.1% of women using LAM over 6 months.
Interpretation
This descriptive mail survey asked nurse-midwives about their knowledge and promotion of NFP and LAM. The authors say neither nurse-midwives nor physicians readily recommend NFP or LAM for avoiding pregnancy, pointing to perceived low effectiveness and perceived poor behavioral fit with clients as the major reasons. The physician comparison draws on an earlier Missouri survey. The findings support further survey work on NFP and LAM counseling across maternity-care disciplines.
RRM Context
Restorative reproductive medicine uses cycle charting. For women and couples having trouble getting pregnant, 81% of these nurse-midwives recommended observing the cervical mucus cycle. In the physician survey, 36% did. The authors call mucus a prospective marker of ovulation. Basal body temperature, they say, is a retrospective measure. The authors add that mucus is much more pertinent to achieving pregnancy.
Our editorial summary of this paper, not the article's abstract.
Abstract
The purpose of this study was to describe and assess certified nurse-midwives' (CNMs) knowledge and promotion of two modalities for child spacing, natural family-planning (NFP) and the lactational amenorrhea method (LAM). One thousand two hundred CNMs were randomly selected from a national membership list and mailed a 24-item questionnaire on NFP and LAM. Of the 514 respondents (42.8% return rate), 450 (87.5%) were currently practicing as CNMs. Respondents had an average age of 46 years, with an average of 10 years of practice. CNMs ranked NFP as the ninth most used and the eighth most effective family-planning method in their practice, with an average perceived method-effectiveness of 88% and use-effectiveness of 70%. Although most respondents felt somewhat prepared during their education program to provide NFP, only 22% would offer NFP as a family-planning option for child spacing.
