6. dr. Bram Pradipta, SpOG Keluarga Berencana Alamiah

  

Natural Family Planning

as Contraception Alternative dr Bram Pradipta, SpOG KOJA GENERAL HOSPITAL

Overpopulation Problem

• Environment problem
• Hunger • Poverty • Economic stagnation
• Health issues

  Family Planning

Methods that allow individuals

and couples to anticipate and

attain their desired number of

children and the spacing and timing of their births

  Artificial Family Planning

Any unnatural product, procedure/practice/

technique that used to prevent pregnancy

  Pandangan Gereja Katolik tentang KB

  1. Perkembangan sikap dan posisi positif terhadap

gagasan pokok KB, dalam hal penentuan jumlah

anak dan jarak antar kelahiran.

  

2. Ungkapan tanggungjawab sebagai makhluk Tuhan

dalam bersikap dan berperilaku dalam masalah

prokreasi.

  4. Orangtua mempertimbangkan berbagai faktor untuk menentukan jumlah anak yang dapat dipertanggung-jawabkan.

  Pandangan Gereja Katolik tentang KB

  Gereja mempersoalkan cara-cara dalam mewujudkan Keluarga Bertanggungjawab itu.

  Prinsip dasarnya adalah: tegas menolak setiap cara KB yang bersifat abortif (menggugurkan) dan umumnya tidak mendukung cara-cara kontrasepsi buatan.

  What does the Church really say?

• Sexual Intercourse is a sacred expression of a sacramental reality
• – Love-giving/Unitive
• – Life-giving/Procreative
• Fertility is a gift of God

  Pandangan Gereja Katolik tentang KB KB-A dianjurkan Gereja Katolik dan KB-Buatan (kontrasepsi) tidak didukung.

  What is the difference?

Birth Control

NFP

• Suppresses fertility
• Places barriers to deliberately prevent the transmission of life
• Pregnancy occurs in spite of the couple’s actions
>Accepts fertility
• Always open to the possibility of life
• Pregnancy occurs because of the couple’s actions The end may be the same, but the means are not equal.

  

Natural Family Planning

monitoring and interpreting

• Methods of

  natural biological markers of fertility fertile and

• To help determine the

  infertile times of a woman’s menstrual cycle to

• Information can be be used

  achieve or avoid pregnancy

Abstinence

• Only 100% method of birth control
• Abstinence is when partners do not engage in sexual intercourse

• • Communication between partners is important

  for those practicing abstinence to be successful

WITHDRAWAL

• Removal of penis from the vagina before ejaculation occurs
• Effectiveness rate is 80%
• Very difficult for a male to ‘control’

Cara Menyusui Penuh/ MAL

• • Mengandalkan pemberian ASI pada

  bayinya

• • Mempunyai efek tidak terjadi ovulasi

  apabila menyusukan secara penuh

  (eksklusif)
• Efektif hingga 6 bulan

• • Bila tetap belum ingin hamil, metode

  ini dapat diganti atau kombinasikan dengan metode KBA lain setelah bayi berusia 6 bulan

• A man and woman together are fertile for only 6 days.

• • The day of ovulation when a egg is

  released.
• And 5 days before ovulation!

Phases of the Menstrual Cycle

  Pre-Ovulatory Infertile Phase Fertile Phase

  Post-Ovulatory Infertile Phase Ovulation

Natural Biological Signs of Fertility

Resting Body Temp

  Changes in

  Changes in

  

Cervical Mucus

  Changes in

  Female Hormones

METHODS OF NFP

• CALENDAR/RHYTHM
• BASAL BODY TEMPERATURE
• OVULATION METHOD
• SYMPTO-THERMAL

Metode Ovulasi Billings (MOB)

• Adanya lendir kesuburan
• Harus membedakan lendir kesuburan dengan sperma atau keputihan

LENDIR SERVIKS

• Dasar:

  Perubahan siklus dari lendir serviks yang terjadi karena perubahan kadar estrogen.

  2 macam lendir serviks, yaitu:

• – Lendir Type-E (Estrogenik)

  Fase akhir pra-ovulasi dan fase ovulasi Sifat : banyak, tipis, seperti air (jernih) dan bila dikeringkan terjadi bentuk seperti daun pakis

• – Lendir Type G (Gestagenik)

  Awal pra ovulasi dan setelah ovulasi  karena kadar progesteron

  ↑. Sifat: kental, keruh

• Ciri-ciri lendir serviks pada berbagai fase dari

  siklus haid:

• Fase 1 (hari 1-5)

  Saat haid, lendir dapat ada / tidak dan tertutup oleh darah haid. Merasa basah / licin

• Fase 2 (hari 6-10)

  Pasca haid, tidak ada lendir / sedikit sekali.

  merasa kering

• Fase 3 (hari 11-13)

  Awal pra ovulasi, lendir keruh, kuning atau

• - Fase 4 (hari 14-17) segera sebelum, pada saat dan sesudah ovulasi.

  lendir bersifat jernih, licin, basah dan dapat di regangkan. hari terakhir dari fase ini dikenal sebagai “gejala puncak”. Merasa basah

• - Fase 5 (hari 18-21)

  pasca ovulasi, lendir sedikit keruh dan liat. Merasa liat dan atau lembab

  Progesterone Type Mucus Estrogen Type Mucus

  Cervical Mucus

  Fertile Time Infertile Time

Mucus Cycle

  Beginning Peak End Fertility

• Lendir awal, sedikit, tebal, putih, lengket .

Merasa lembab atau lengket

• Lendir masa transisi, jumlahnya meningkat, lebih tipis, berawan, sedikit elastis. Merasa basah
• Lendir dengan kesuburan tinggi, banyak, tipis, transparan, elastis. Licin.

  

PRINSIP POLA PERUBAHAN

KESUBURAN : seperti pola

Pagi-Siang-Sore-Malam

  Haid PDTS Masa Subur sampai

  Masa Luteal Post-Ovulatory Phase Constant

  Last day of Menstrual Cycle 2 weeks 2 weeks 2 weeks

  Ovulation Ovulation Ovulation

  23 Days

  28 Days

  32 Days Before Ovulation After

  Ovulation When does ovulation occur?

  

Rules

  2. Pada saat periode tidak subur: Dapat berhubungan tiap 2 hari sekali

  3. Hindari hubungan intim setiap hari ketika lendir, cairan atau pendarahan menyelingi Pola dasar tidak subur

  4. Bila Puncak (ovulasi) sudah diketahui dengan pasti, maka pantang harus dilanjutkan 3 hari lagi

Metode Simpto Termal

  Merupakan Gabungan antara

metode suhu basal

dengan pengamatan lendir kesuburan

  Standard Day method ▪ Identifies days 8 to19 of the cycle as fertile.

  ▪ Is appropriate for women with menstrual cycles between 26 and 32 days long

  (women who have their periods about once a month fit within this range)

  

▪ Helps a couple avoid pregnancy by knowing

which days they should not have sex ▪ Helps a couple plan a pregnancy by knowing which days they should have sex ▪ Does not protect against STIs/HIV

  

Determining the Fertile Window

Ovulation

  12 to 24 hours 5 days (sperm life) (ovum life) Day 8 Day 19 NFP Efficacy Studies

  

Terms

perfect or correct use unintended pregnancy rate refers

   The to those pregnancies that occur when the method is used consistently and according to instructions.

  

typical use (or total) pregnancy rate includes the

   The combination of unintended pregnancies when the methods are followed correctly and the unintended pregnancies that occur when users of the method do not always follow the instructions of the method correctly.

  Billings Ovulation Method ▪ Cervical Mucus ▪ Perfect Use = 99 - 100% ▪ Typical Use = 89 - 99%

  Representative Studies of the BOM S. Thapa, M. V. Wonga, P. G. Lampe, H. Pitojo, A. Soejoenoes. “Efficacy of three variations of periodic abstinence for family planning in Indonesia.” Studies in Family Planning, 21: 327-34, 1990. J. X. Xu, J. H. Yan, D. Z. Fan, D. W. Zhang. “Billings natural family planning in Shanghai, China.”

  Sympto-Thermal Methods (STM)

• Combines indicators of fertility
• Common indicators are BBT, cervical mucus, and calendar formulas
• Provided by Couple to Couple League and Northwest Family Systems • Perfect Use =

  99%

  90

• – 94%
• Typical Use =
Effectiveness of NFP*

Single Index Multiple Indexed Methods Methods

• • Perfect Use - 97% • Perfect Use - 98%

• • Typical Use - 84% • Typical Use - 90%

• •Kambic, R - The Effectiveness of Natural Family Planning, Current

  Medical Research; Vol 11; Winter/Spring, 2000. Based on meta- analysis of 23 ovulation methods studies and 15 STM studies.
• Effectiveness rates are calculated on 100 women over 12 months of
Pregnancy rate over one year by family planning method

Correct Use Typical Use

  85

  85

• CHANCE

  18

  29

• SPERMICIDES

  27

• WITHDRAWAL 4

  

2

  15

• CONDOMS

  

5

  12

• SDM

  3

  16

• OVULATION METHOD

  0,5

  2

• MAL

  0,6 1,8

• SYMPTOTHERMAL

  0.3

  8

• PILL

  0.1

  0.6

• IUD

  0,1 0,1

• Vasectomy

  

Benefits of using NFP

➢Are adaptable —to

  ➢No harmful side achieve or avoid effects pregnancy

  ➢Supports ➢Requires couple communication reproductive health

  ➢A “shared” ➢Environmentally responsibility friendly

  ➢Respects God’s design for married love! ➢Virtually cost free

  “Cons”

• Require dilligence from both partners
• Require periode of abstinence
• Consistent and accurate record keeping
• Challenging for irregular cycle women

Whom NFP best for

• Couples who don’t desire hormonal methods or devices
• Regular menses
• Religious belief

Take Home Message

• Family planning is one of the solution for overpopulation problem
• Natural family planning offer advantageous benefit for couples
• With correct use, the effectiveness come close to artificial family planning
• It needs patience and consistency from the couples

Reasons for Choosing the NFP

  1

  2 Six Countries U.S.

  70% 80% Doesn’t affect health

  No side effects 20% 30% Economical 30% 5% Easy to learn/use 10% 45%

  How CycleBeads Work _{If you have not started your On the day you start your bread, contact your NFP put the ring on the last brown period by the day after you}

  1 _{period, move the ring to the RED bead. teacher.}

  Also, mark this date _{on your calendar Every morning Keep moving the ring one} move the ring to _{period before If you start your you put the ring bead every day. When you start your next period, move the ring directly to the red}

  2 _{Move the ring the next bead. NFP teacher. contact your brown bead,} on the darker _{bead and begin again. when you ’ re} ^{even on days} _{monthly bleeding having your intercourse. days you can have On BROWN bead Do not have intercourse can get pregnant.} On WHITE bead days you to prevent a pregnancy.