Choosing the Right NFP Method During Postpartum

By Elizabeth Timpe, Fertility Coach and CCL teacher.

Congratulations you are a new mom! Sore, tired, and overjoyed you wonder if you are really allowed to leave the hospital with this new little human being.

At delivery, you undergo the biggest drop of progesterone and estrogen your body has ever experienced. This drop stimulates the production of prolactin which will maintain the milk supply. As the pituitary gland increases prolactin it suppresses the production of LH. As long as LH is low, ovulation is delayed, causing lactational amenorrhea, which is the absence of periods due to breastfeeding. The length of time of this natural infertility varies greatly from woman to woman and is directly connected to the type of baby feeding and the mother’s physiology.

Most women will experience what is called lochia for approximately three to six weeks postpartum. It will start out as bleeding and gradually decrease in quantity eventually changing into a thicker, whitish discharge. This discharge may seem to appear like mucus but is not related to fertility.

During this time most women are prescribed pelvic rest as a time of healing before they are cleared for exercise and marital relations at their 6-week postpartum appointment. When lochia has cleared and knowing there will be some length of time before the first ovulation leads many women to wonder how to even begin thinking of charting again. 

Here are some important things to remember about choosing a postpartum method.

Type of baby feeding will affect your return to fertility.

Feeding formula will not delay ovulation and many women will experience a return to normal fertility within 6-8 weeks. Women in this situation may not need to learn a specific postpartum protocol. A consult with a FSI coach or certified instructor may be helpful to start charting again. Breastfeeding can be ‘exclusive’ or ‘mixed’ and it is important to understand the differences in these types of feeding when it comes to the return to fertility.

FABM methods have specific postpartum protocols

If you were using a FABM method previously the postpartum protocol will be different than the ‘normal’ method.  Taking a class or meeting one on one with an instructor is a must for this time of transition in order to learn the nuances and different guidelines. 

  • STM (symptom-thermal method taught by CCL + FSI): It is important to note that STM postpartum relies solely on mucus observations to determine fertility, as temperatures will be sporadic due to sleep and hormone fluctuations until after the first ovulation.
  • Creighton/Billings/FEMM – mucus only methods that have different guidelines for postpartum. Schedule a follow up with your instructor.
  • Marquette – Many women find charting with Marquette postpartum to be helpful especially postpartum women that find it difficult to establish fertile and infertile mucus patterns. This method uses the Clear Blue fertility monitor. The initial cost of the clear blue fertility monitor is $120 (new) to $70 (used). In regular cycles women usually use 8-12 test strips per cycle at about $1/test strip. Postpartum women using the postpartum breastfeeding protocol will test more often. 

Intimacy postpartum can be difficult

It can be hard to know when as a woman you are ready to return to physical intimacy with your spouse.  The postpartum time can be a beautiful time to build intimacy in other emotional, intellectual, and spiritual ways with your spouse. If wanting to space your children this postpartum time could be a time of increased abstinence compared to normal times. It is important to remember you should choose the method you want based on lifestyle and comfortability and not expect that any FABM method will involve more or less abstinence because every woman’s body is different in her own return to fertility.