Do Female Doctors Support Fertility Awareness Methods? (Episode 580)

Full Transcript: Episode 580

Lisa Hendrickson-Jack:

This is the Fertility Friday podcast, episode number 580.

In today’s episode, I’m addressing an interesting question. Are female practitioners more likely to support you when you are considering using fertility awareness? When you’re an active user? I think that it’s natural for many of us to expect that female care providers are going to be more open to this, more supportive, and potentially even more knowledgeable. But is that really the case? So, in today’s episode, we’re going to dive into a research paper that looks at this exact question.

This was an interesting study because it assessed primarily female healthcare workers. So women in the healthcare field, they had 329 participants. About half of them were nurses and 97% of them were female. So whether they had intended to specifically assess women or not, it was women that predominantly responded to their call to participate in this study. And they specifically are looking at the attitudes around fertility awareness-based methods and how frequently they’re recommending them, how likely they are to recommend them, and then the attitudes part includes what they actually think about them, if they think they’re effective. And I feel like the results are very eye-opening. So certainly going to be an interesting discussion.

So the reason that the researchers are specifically looking at this question is because although fertility awareness users represent a small percentage of all the people who use any type of contraceptive, that small percentage is growing. So they cite an interesting stat in the paper showing that from 2007 to 2017, so over this 10-year period, the users at least in their area that they were surveying doubled. So what they’re pointing out is that there is a growing use and awareness and based on the results of the study as we will get into, it’s often to the chagrin of healthcare providers.

So fertility awareness-based methods are not most medical providers’ favorite method. And certainly we’ll get into what the response was to the study, which is really, really interesting and eye-opening. So, of course, I like to talk about this type of research when we’re actually getting in and seeing what the medical providers actually think about it, what those survey responses are, because at the end of the day, when you’re working with clients who are using fertility awareness-based methods, we shouldn’t be setting them up for a false hope. A lot of women who discover this method — who this method really fits with their goals and objectives, their lifestyle, their values in terms of potentially reducing their exposure to synthetic hormones or having a better understanding of their body — a lot of women who use this method and love this method are really jazzed about it. And so it’s often a huge just burst to your bubble to go to your healthcare provider only to discover that they’re not open to it. And so again, instead of me just talking about this in a general sense, we can at least get a sense of what like a little pulse test of how health providers really feel about this, especially female providers, because I do know that many women are specifically searching out female providers because we think that they’re going to be a lot more supportive. Unfortunately, this is not always the case.

So, one of the things they point out in the study is they kind of paint a little picture of the women who may be looking at using fertility awareness-based methods based on those numbers that they reported, the increase in users from 2007 to 2017. So, women use these types of methods for a variety of reasons. Some that I’ve mentioned, a lot of us want to avoid the synthetic hormones. A lot of us maybe want to find a way to incorporate our partner into this process. With fertility awareness-based methods, it does make the process of contraception more — just maybe I don’t know if equal is the word because it’s probably not equal, but it’s certainly you can’t do it without the participation of your partner. So I feel like it does open up those conversations and a lot of women who use fertility awareness-based methods find that they actually are talking with their partner a lot more about these issues. But of course there’s other reasons as well. A lot of women have concerns about various hormonal imbalances or various reproductive health issues or menstrual cycle problems, and cycle tracking is certainly one of the ways to monitor and establish kind of a baseline of what’s really going on and have that opportunity to address those concerns, and as you address them, you have the opportunity to see how your cycle is changing.

One thing that the researchers do say, so I’ll just read this little excerpt here. So besides contraceptive uses, FABMs may also be used by women or couples to achieve a pregnancy or monitor health conditions such as PCOS and infertility. In turn, they say they must accept that these methods may be less effective than some other methods and are especially susceptible to imperfect use. People who use fertility awareness-based methods deserve transparent information about their effectiveness, benefits, and challenges.

There’s nothing wrong about that statement. I mean, certainly the effectiveness of fertility awareness-based methods is the topic of the day. I’ve shared previous studies where this is a continuous conversation. It’s in question and what I always say about fertility awareness-based methods is, A, they are not for everybody. Just like condoms aren’t for everybody or just like tacos are for everybody. So that’s something to always keep in mind. I think that I would say that users of fertility awareness-based methods, they are self-selecting. So no one’s really forcing people to use fertility awareness-based methods. It’s not the most popular way to go. So women who are choosing this are effectively choosing to use it. They feel called to use it for one reason or another. And with that, some education needs to take place.

There’s a variety of different ways to do this essentially to approach this. And under the umbrella of fertility awareness-based methods, there are several options. There are mucus-only methods. There are symptothermal methods, which tend to be the most commonly known, the methods that use temperature and cervical mucus and other body signs. There are hormonal methods, methods that use ways to measure the urinary metabolites so that you can actually get a direct measure of your estrogen metabolites or your luteinizing hormone around ovulation, your progesterone. So there’s different methods that use those approaches. There are also methods that are calendar. So there are modern evidence-based calendar methods if you will. And so under that umbrella, you know, those are the kind of official types. But then we also have the advent of tech, all the different apps and apps that actually purport to be birth control. So we could even add another category of kind of, you know, the wild wild west where women with potentially not a lot of direct instruction from a certified educator in a specific method are turning to an app to directly use that as their birth control.

And so what happens is because there’s so many different ways to do this, when we look at effectiveness, sometimes the effectiveness that is reported in various studies are not making a distinction between different types of methods and certainly not actually looking at which methods are most effective or why they’re most effective or how the effectiveness of this method that has a really low unplanned pregnancy rate compares to someone who’s just using an app who’s never really learned a specific style of charting. So I always like to kind of talk a little bit about the effectiveness conversation where it fits in.

The other thing that I just like to draw attention to is obviously fertility awareness-based methods are not an IUD. So with an IUD, it just gets placed and then you don’t have to do anything after that. It’s just going to be as effective as it is. And so with the IUD, for example, the effectiveness rate is not 100% but it’s very high, right? And it’s not a user-dependent method. And that’s the big distinction. Fertility awareness-based methods are basically 100% user-directed. And what that means is that your success is entirely based on your understanding of the method, your education, what you’ve learned about it, your ability to identify which days are fertile, which days are not, your success and effectiveness at whether it’s abstaining from unprotected sexual contact or abstaining from all sexual contact, or even the effectiveness if you’re using a barrier method or something like that on your fertile days, the effectiveness of that barrier. So basically, it’s all on you. And what that means is that it’s susceptible to user error.

So if you have someone who’s using a method that already has a lower efficacy rate, like I said, there’s multiple methods under the umbrella of fertility awareness-based methods, if you have somebody who’s using the method but didn’t really ever learn from a certified instructor who knows what they’re talking about and all of that kind of stuff, then you end up with a wide range of effectiveness. And this is why when you’re looking at studies, effectiveness rates do range from the perfect use effectiveness of 99.4% with the symptothermal method that also employs a pre-ovulatory infertile day calculation, as well as all the way down to 70-something percent effectiveness when you’re just taking app users who are not necessarily using a specific method. And so because there’s such a range in effectiveness, there certainly is this predominant idea, particularly by a lot of healthcare providers, that fertility awareness just doesn’t work. It doesn’t work for anybody. Effectiveness rates are really low. It’s really risky because we’re just kind of lumping everything into the same category.

So let’s continue our discussion, but I definitely wanted to take a little side road there and just go into some of the effectiveness. You could tell where this is going when we get into the data of what the attitudes and responsiveness was to fertility awareness-based methods. So let’s get into what the study actually found.

So as I mentioned, this study, 97% of the respondents were female, about half were nurses, and interestingly, about a quarter, so 25% of the women who responded in this study, predominantly women, said that fertility awareness-based methods are a non-viable, non-effective birth control option for most women. So 25% were like hard pass, absolutely not. And then 43%, so just about half, just shy of half of the total, rated fertility awareness-based methods as neutral. So what that means is that basically only a quarter had favorable things to say about it. So out of all of these healthcare professionals that were women, only about a quarter, maybe a little bit over a quarter, said that it was yes, they’re viable. It’s a good option. It’s a valid option, even like the word valid. So the majority were either neutral or like hard pass.

And what was interesting as well is that they also surveyed their knowledge. So they did ask them questions to determine how knowledgeable they were about fertility awareness-based methods so that they could get a sense of, was there a correlation? Do they have a high degree of knowledge? Do they not know about it? So the results are a little bit mixed. So interestingly, there was a good knowledge base in general. So based on the study results, over 90% of the women who completed the study could correctly identify the luteal phase length. They could correctly categorize ovulatory cervical fluid. Now they provided this data. They didn’t necessarily explain exactly what they meant by all of those things. I don’t know that they provided the exact study questions they used. I’m sure I would have something to say about how they asked it because I’ve been in the field so long. I’m pretty specific about how I talk about things. But either way, they’re showing that the respondents did have a really good grasp of kind of the general aspects of the menstrual cycle to a greater degree than maybe you would even expect. So about 80% were correct when they were identifying the typical length of a menstrual cycle and about 75% were correct regarding their knowledge around the shift of basal body temperature after ovulation. Overall this was a pretty knowledgeable bunch about the different aspects of the menstrual cycle. It said that about half of the participants, so 52%, answered all of the fertility questions correctly. So this gives you some interesting background because it’s not to say that these are women who’ve never heard of these methods maybe. And it’s not like they have no knowledge of the menstrual cycle and mucus and BBT, right? Luteal phase, cervical mucus — like they do have some knowledge of it, the majority of them. So that also is something to consider because they still were not too keen on this method.

Something else that I found really interesting is that they did survey a variety of different fertility awareness-based methods. So as I mentioned there is an umbrella. Not a lot of our — even when we are working with new FAM practitioners, our very first module in the program is to go through fertility awareness-based methods so that at least you know, like when you’re jumping into this field and working with fertility awareness clients, you really do need to know what the different methods are because as soon as you are working in this area, you’re likely to have clients who potentially have had some fertility awareness training or experience before. So, it is really good to know about the different methods, what they are, how they work, so that when you’re engaging in these conversations, you at least know. And also so that you know what options are out there because I think part of the reason there’s so many different fertility awareness-based methods, it’s one method isn’t going to work for every person. So, there’s pros and cons for all the different methods.

So with that said, they kind of rated their knowledge and whether they had training in certain types of methods versus other methods. And interestingly, a lot of the practitioners within this survey did have training on certain methods. So almost half of the practitioners who responded reported training on the Standard Days Method. Now the Standard Days Method is an evidence-based method. It is a modern-day calendar method. So it really is the rhythm method but for the modern day, and there is research behind it. And so just to give you a little sample, it’s like if your cycle is between this long and this long, then you use this method and it gives you a kind of defined period of time of like, don’t have sex on these days. So quite literally the modern-day rhythm method. About 25% of the respondents reported that they had some training in the Billings Method, which is a mucus-only method that has been around for a very long time. And there’s a lot of research and information about it out there. And the lactation amenorrhea method, which is related to breastfeeding and the effect of breastfeeding on ovulation. And again, lots of research on these methods.

So what was interesting to me was that the symptothermal method — only about 20% of providers actually had some knowledge about the symptothermal method. I mean, in some ways it makes sense because the methods that they’re talking about that they did have experience with, they are evidence-based methods. So there is research about it. And maybe it just so happens that in their organizations and their part where they are in the world, those are the predominant types of fertility awareness-based methods that are available, that they received training on, that they might have learned about. I just find it to be interesting because the double-check symptothermal methods, I should say, are the methods with the highest efficacy, right? The lowest failure rate, even the lowest typical use failure rate. So like the correct use failure rate for the double-check symptothermal methods is, like I said, 99.4%. And then even the typical use in research is like 98%. And so there’s a really big difference between these double-check symptothermal methods in terms of their perfect and typical use effectiveness versus other methods that are not employing the same kinds of strategies.

So, I mean, at this point, I’m just speculating — maybe the lack of knowledge of the most effective methods and the differences between methods played a role in just how the attitude and responsiveness landed. Maybe not. But it is very eye-opening to read a study like this where I was actually a bit surprised that such a high percentage of these female medical providers actually were aware of one form of fertility awareness-based method or another but still had a predominantly negative feeling about them in terms of their effectiveness. And perhaps one of the reasons why they have that negative perception is because the majority of the respondents did have some education in fertility awareness-based methods. They did not have education in the methods that are associated with the highest efficacy rates. So if that’s the case and they’re predominantly seeing users of methods that have a far lower typical use effectiveness rate, then maybe that’s one of the reasons why they have just a less favorable attitude towards it.

So I want to talk about some of the specific issues that were raised. I think potentially none of these will be surprises to anybody, but it is useful to really dig into, well, why did they feel this way? What were their objections? What were their specific concerns around fertility awareness-based methods? So many of the providers felt that fertility awareness-based methods were just not suitable. They just weren’t a good choice. And what they say from the study is particularly those with low health literacy, irregular cycles, or where partners do not support mutual decision-making. So there certainly is definitely this idea still that fertility awareness-based methods require you to have regular cycles.

Again, interestingly, half of the participants said that they were familiar with the Standard Days Method, which is a modern-day rhythm method. And that method does require you to have regular cycles in order for it to be effective. And so maybe that’s part of the reason, because again, we’re still linking fertility awareness, that term, with the rhythm method, which is a calendar method where we’re calculating your fertile window based on the past or based on a standard set of days. And so maybe that’s part of the reason why they’re saying, nope, this isn’t going to work because her cycles aren’t regular and therefore it can’t be effective. However, modern-day fertility awareness-based methods, particularly the double-check symptothermal method or other methods that are not relying on estimating days based on a calculation like that — when we’re not using those types of methods and we’re looking at your fertility signs in real time, then if your cycle is irregular, we can certainly manage that. It can be just as effective for women who have irregular cycles if they’re using a specific method that would be appropriate for that situation.

But one of the points that they make — if you have a client whose partner is absolutely not supportive and they’re not going to modify, he’s not going to modify his behavior in any way, then it’s not going to work. So with fertility awareness-based methods, you do need the cooperation and participation of your partner because you have to modify your behavior on your fertile days during that fertile window. So if your partner is not willing to do anything differently and you’re just going to be having unprotected sex whenever in the cycle and you don’t have any control over that, then fertility awareness-based methods are not going to be a suitable choice. So there are some times when it’s not suitable, obviously. That was one of the reasons why the providers were not necessarily comfortable recommending it. And this is one of the common reasons. I feel like sometimes that objection is reasonable, obviously, in some of the cases. But I do think that there are times when healthcare providers are just overly negative about it and kind of thinking basically it’s too hard for anybody to do. No one would want to do this. So I think what can happen is that particular individual, the healthcare provider themselves, they would not be open to doing this. So then they’re kind of projecting that like no one would be open to doing this. And that’s obviously not — everyone’s going to be different.

Effectiveness concerns, again, that’s huge. In previous episodes, I’ve talked about the kind of attitudes around fertility awareness-based methods. And so one of the most common objections from healthcare practitioners is that they’re not effective, they don’t work. And I would say that this is a result of how they’re trained, especially medical providers going through medical schools and our traditional medical system. After interviewing many doctors over the years, that’s pretty much what they’re taught. They’re taught that they don’t work, they’re ineffective. And like I said, they’re often lumped in together. So instead of actually going through and discussing the different evidence-based methods and looking through which methods show the highest efficacy versus the lowest so that they have a better understanding of how they could set their patients up for success if they did show interest in a fertility awareness-based method, instead they just lump them all together and they just say they don’t work. Effectiveness rates are low. Basically it’s useless. It’s like not using anything. And so they have this kind of like tarred image of all fertility awareness-based methods because we’re not really looking at it and assessing it in a fair way.

Even with hormonal contraceptives, you don’t just lump them all together and pretend like the highest efficacy options are the same as the lowest efficacy options. So for example, the progesterone-only pill tends to have a lower typical use and perfect use efficacy rate, but no one’s kind of lumping them all together and saying they’re all the same. And even if you think about the implant or the IUD, they’re not lumped in with the pill in terms of efficacy when healthcare providers are talking about these different methods. They’re actually making the distinction between the efficacy of the shot versus the efficacy of the implant versus the efficacy of the ring and the patch and all the things. So why don’t we take that same approach with fertility awareness-based methods? Because they’re definitely not all the same. And absolutely, some of the approaches that people take to this are less effective than others. But again, if we want to set our patients up for success, we need to be knowledgeable enough to be able to tell them the differences and why some methods do have a really low effectiveness rate versus others.

Perceptions that they’re not appropriate for their patients, perceptions that they’re not effective. Another theme was the training and education gaps. So, some providers did honestly just say that they didn’t have the training. So even that I think is interesting because your doctor isn’t necessarily the person who should be teaching you to use fertility awareness. So I feel like the education is twofold. It’s like, one, I don’t have enough education to teach about it, but two, you should be educated so that you understand that you don’t have to teach it. Like you can refer your patients to trained professionals who can teach this. Another objection was that they didn’t have the staff to support it. So again, feeling like if I can’t teach this in-house essentially, then I can’t do it. Time constraints. So that’s certainly an objection because it’s like, well, I only have five minutes for an appointment so how am I supposed to teach this whole method or whatever. And then administrative and financial barriers. So just not having — I think those three are kind of similar because it’s like they don’t have they’re not necessarily trained and they don’t necessarily have the time or the resources to teach themselves. So those were some of the kind of common objections.

Now, interestingly, the researchers asked if they have had any kind of success stories related to fertility awareness-based methods. And the responses were predominantly like, no, we haven’t really seen any success. We’ve just seen a lot of people get pregnant when they weren’t intending to. So the overall feeling was that these providers had a lot of knowledge around fertility awareness-based methods generally speaking, right? I think more than you would expect, to be honest. But most of them were very skeptical or just neutral. Like they certainly weren’t positive about it. And when they were asked a variety of different questions, it was kind of the general impression as you go through the study was like, well, if someone was asking about birth control, you know, the majority of the providers would probably not even mention it at all or mention it only if prompted or mention it like last and potentially position it in a very negative light.

I also wanted to just take a minute or two and read some of their qualitative findings. So this means that they have a chart in the study where they actually write down word for word what some of the responses were to the open-ended questions so that you could get a sense of where they’re coming from. Okay, so let me read a few here.

Quote, “Many patients do not seem to have the self-control or motivation to be strict within the guidelines of abstinence or condom times.” Another provider said, “We also have many women with irregular menses and partners that do not agree that women get to determine when sexual contact occurs. In other words, the male partner determines when the couple has sex, not the female. Therefore, planned sexual contact is not possible.”

So this is another direct quote from the study. Quote, “I have no challenge about the method if someone chooses to use it. I have both a niece and nephew who were very much unplanned using this method.” Another example. Quote, “There are other methods with more demonstrative effectiveness to prevent pregnancy.” And I’ll read another one. Quote, “I consider it valuable at the bottom of the preferred option list, better than simple withdrawal, and am biased as to the value of more effective methods for most women.”

I’ll just read a couple more. Quote, “No time for education because I have patients every 15 minutes and we get overbooks and walk-ins and I can’t say no to late patients.” So that’s more of like there’s no time. Another response along those lines, quote, “Counseling takes more time than other methods.” So again, a time objection.

Another quote, “We have so many other more effective methods that patients aren’t usually interested in FABMs.” Here’s one related to education. Quote, “Lack of education. I don’t feel I have enough training to give accurate information on all the different NFP methods.” NFP — natural family planning.

Okay, so the question around successes, if they’ve seen any successes. Quote, “We have had very little success. In fact, we have had unintended pregnancies as a result. Stressing this as a truly effective and viable option for women is, in my personal opinion, taking a huge step backward and I am disturbed to see the renewed focus on suggesting this as a good option for women, particularly for adolescents who already struggle with impulse control. Fertility awareness is the reason I and three of my four brothers and sisters are here.” Particularly negative and a little spicy.

I’ll read another response to the success question. Quote, “I personally do not feel that I have had any success with this method and frankly feel that this method is best used by monogamous individuals and families seeking pregnancy rather than pregnancy prevention.”

Okay. So there’s a couple kind of a little bit more neutral and a little bit more positive. Quote, “I make the referral but do not know the outcome.” Another provider said, quote, “I have only had two ask about it as they did not want any hormones. I have not seen them since their original evaluation. I am sure if the information we gave them helped.” A more positive response. Quote, “I have had a few patients looking specifically for a fertility awareness method. The discussion increases awareness of their bodies and how they work, which is always fabulous.” And a second positive, quote, “Nearly everyone who chooses it uses it for a long time, much longer than hormonal methods and other IUDs and implant.” And then last positive, so we can end on a positive note here. Quote, “The few that follow this method are satisfied.”

So the reason that I took a few minutes to read these quotes like that was because I wanted you to actually hear what they were saying. The reason that I chose to do this episode today, the reason that I wanted to go through this study is because we really need to hear the truth about how healthcare providers see this method. We really need to know what we’re up against. We really need to understand why they have objections to it. Understand that not all the objections are not valid. So I think the challenge is that a lot of the objections don’t apply to you specifically or to your client specifically. So there’s certainly a lot of bias and there’s certainly a tendency to make a lot of assumptions. And we’re not in their shoes unless you are a healthcare provider listening who is in their shoes.

If you’re working with the general public, you have a variety of people coming through and seeking your services on a daily basis. And it is safe to say that the vast majority of patients that you see are probably not interested in fertility awareness-based methods. And that could be for a variety of reasons. I mean, if you think of the broader culture, most women still don’t even know about fertility awareness-based methods at all, let alone that they’re a legitimate alternative with as high efficacy as some of the most common hormonal methods. So most women don’t have that information. So we still have a lot of outdated beliefs that fertility awareness methods are the rhythm method. They don’t work. We’re not making that distinction between modern, highly effective fertility awareness-based methods versus the rhythm method or Standard Days Method phenomenon. And so the patient population that’s coming in, they’re going to fit a lot of those biases themselves because most people are not knowledgeable about this.

So you have that kind of situation where your healthcare provider is already assuming that most people don’t know about this. Most people aren’t interested. Most people aren’t capable of doing it. That’s what they’re assuming. They’re assuming it’s too hard. They’re assuming that I personally, as the medical professional, have to teach it, and or I have to find a way to teach it in-house. Right? So all of those things mean like it’s basically impossible. There’s no way I’m not counseling people on this. They’re coming in here wanting birth control and I’m going to give them a prescription because that’s what I was taught. That’s the most effective method. You know, that’s what most people want.

So that’s kind of to give you the responses in their own words, hopefully lets you know what you’re getting into. So what do we do with this information, right? No, we don’t just cry into our pillow or whatever. I think that it’s really important to understand where our healthcare professionals are coming from. It’s really important to know how at times limited their knowledge base is around fertility awareness-based methods, because that allows you to understand and it can allow you to even have a more productive conversation.

When you go in expecting, especially going back to the very beginning of this conversation, most of these providers that responded were female. So again, you would think that they would be the ones that would be so much more receptive to this, but no, that’s not necessarily the case. So, I feel like it really gives us a more realistic idea of where we stand, what’s going on, what to expect, and to know some of their most common objections.

And so, like I said, I think from the perspective of a woman who has done her research, she has maybe tried hormonal methods in the past and she decided that it wasn’t for her. She’s like, you know, I tried all these hormonal methods, it wasn’t for me. I have done my research now and I’m more than happy to take the time, the effort to educate myself on how to track my cycle. I’m very responsible. I’m capable of handling the responsibility of this. I have a supportive partner who’s willing to modify his behavior. So, a lot of their objections simply don’t apply to you. And it doesn’t mean that the objections themselves aren’t valid because obviously there are patients within their community that all of those objections potentially are valid for the other patients that they’re seeing.

So I think maybe this could help even your mindset around it. Like their objections, they’re valid for a lot of different patients, but they’re not valid for me because they don’t actually apply to me. I actually fall into the category of someone who this method would be suitable for. And I think that’s one way even just to kind of pump yourself up around when your doctor is saying all this stuff to you. They’re telling you like it doesn’t work. You can understand who that is geared to and know that it actually just doesn’t apply. Like they just didn’t know that I’m actually a really good candidate for this method.

I think the other thing, hopefully, that it can do is if you have a good understanding of where they’re coming from and what their objections are and what their training is around it — and even though this group of providers was generally educated, they are not educated in fertility awareness-based methods to the point that they could even explain the difference between the different types and which ones are most effective and not. So you’re going to somebody who very potentially doesn’t know a lot but really thinks they know everything. And so even though the survey results show that they had very limited knowledge of the variety of different methods and their effectiveness, those providers are very confident in their assessment. So when they say they don’t work, they’re so confident that that’s true.

What that means also is, don’t pick the fight. You have to make that decision. If you’re thinking, well, no, I’m going to argue with this person and I’m going to convince them that this method is effective — I teach this for a living and I’m not picking that fight when I go to a doctor’s office, right?

So, I think that hopefully this information not only gives you more of a sense of what to expect, but also could help you to plan those visits and help you to support your clients who are learning fertility awareness, really excited about this opportunity, charting and so excited to show their charts to their doctor. And I can’t tell you how many times I’ve seen that happen where you have a client who started charting and like, “Let me show you my charts.” The doctor gets like — they get a whole earful from their doctor that is just not supportive. And because doctors have such a prominent place in our society and we give so much weight to everything that comes out of their mouths, when your doctor isn’t supportive, when they’re putting you down, when they’re saying that it doesn’t work, when they’re saying even laughing at you — because this is a thing — laughing at you and basically, you know, oh well, it’s just a matter of time till you get pregnant. And like, come back when you’re ready to go back on the — like that kind of stuff. That can be very disconcerting. It can be very demoralizing. And for a lot of women, it causes them to question the validity of their choices and makes them really nervous because they feel like, oh, maybe I made the wrong decision. Maybe this isn’t going to work.

So anyway, I hope that this has been helpful to give some specific insights into what we’re up against and to prep you for your next appointment to some degree and to set some realistic expectations and hopefully to also help you to pick those battles, to know that sometimes there’s just no point in fighting. And at the end of the day, your doctor doesn’t have to be a cheerleader for fertility awareness-based methods. I think that what we’re looking for is just having respect and respecting your choices and not being rude, not being unprofessional. So, I feel like even if your doctor isn’t thrilled about it, like if they’re in kind of like that neutral camp, they’re just like, whatever, you know, I have very few patients that are interested in this, but if you’re interested in that, that’s completely fine. That’s actually — I’ll take that. You know what I mean? Like, they’re not actually a barrier to you doing it. They’re just not really interested in it. I can deal with that.

If I were to suggest a line, it would be when the doctor’s laughing at you, when they’re putting you down, when they’re actively telling you like absolutely not, no — like that kind of stuff is where you might have to think about finding another provider if that is the case. If they’re really not getting it, really not supportive. And even if you try to explain, well, actually, I did a lot of research and here’s why I think I’m a suitable candidate for this method. Like, let’s say you happen to fit what they’re saying. Like, I’m in a monogamous relationship. My partner’s really supportive. He’s willing to modify his behavior. And I’m really committed to tracking and I’m working with an instructor. And so I feel like this actually feels really good to me. And I’ve looked into the efficacy stats for the particular method that I’m using and the typical use efficacy of the method that I’ve chosen is actually in line with the hormonal method. So if there was a best case scenario for using this type of a method, it would actually be me. And so I recognize that a lot of your patients may not fit into that example. So like I said, I’m not saying you should justify yourself, but if you did fall into that conversation, at least thinking about it in a way that they could understand and showing them that their objections may apply to some people but they don’t really apply to me — that could be helpful. It could not. But anyways, I hope that this has been useful just to think it through.

And what I’ll end with is just by saying that we also have a lot of — they are coming into these conversations with a lot of biases, but we also go into our medical doctor’s offices with a lot of biases. And especially when we’re working with female healthcare practitioners. And so I’ve used the word practitioner — that can apply to a medical doctor, that can apply to a midwife. It can apply to a nurse. It can apply to a nurse practitioner. It can apply to virtually any type of healthcare provider. It could apply to a naturopath. It could apply to your chiropractor. And so we often think that more alternative care providers are definitely going to be more supportive. And while that is the case sometimes, it is not always the case. So even if you go to your midwife — I’ve worked with many clients over the years — like you’re usually pretty safe, right? They’re usually more supportive overall. But sometimes that’s not what happens. Sometimes you find it can be in any profession. Everybody has their biases.

And interestingly, when I was reading through the examples that were stated, some of the biases by the healthcare providers that were basically convinced that it wasn’t going to work weren’t even based on their professional experience. It was based on their personal experience. I had a niece and nephew. Oh, my mom had all these kids because it didn’t work for her. Like, this is not evidence-based stuff. So your providers are people too. And many of us have a negative view of things because we had a personal experience. It’s not even a professional experience. It’s not even evidence-based. We’re not even looking at it rationally.

So I think again it’s important to remember we have our own biases of what we think these female doctors are going to be like. They have their biases of what they think patients are going to be like. And we just have to kind of navigate through it respectfully. And the more we know about how they feel, then the better equipped we are to have a productive conversation. So, I will leave you with that. I hope that you enjoyed today’s episode. If you can think of somebody who would benefit from hearing it, the share link is fertilityfriday.com/580. And with that said, I hope you have a wonderful week, weekend, whenever you tune into the show. And of course, as always, until next time, be well and happy charting.