Tuesday, September 18, 2012

A Christian Physician’s Perspective: Why I prescribe Natural Family Planning (NFP) instead of Artificial Hormonal Contraception.

My first guest post!

This is from a good friend, Billy, of mine who is truly inspiring. He's a single, young adult man who also happens to be a physician with the Navy. He believes in informed consent and treating the problem, not masking it with a pill. I've been strengthened in my drive to educate people about NFP many times because of his passion for it as a healthy and moral alternative for his patients. Take a few minutes and read this!

I was once asked by another physician, “What’s the real difference, since both are 98% effective, and one requires occasional abstinence while the other does not?” Below is a summary of my opinion as a grounded Christian and as a physician passionate about science.
  1. I believe in the dignity of human life. I believe God is the author of life, that He created us in His image – unique yet complementary as male and female. Taking the pill is a conscious decision we can make as humans, to actively create an environment hostile to the beginning of life. This hostile environment is created before and after fertilization, the latter mechanism is more simply abortion.  Remember that the very word “contraception” in this case means to “go against the beginning of life.”  Contraception is the very opposite of openness to the beginning of life, by obstructing the natural development of a process that is pro-creative in God’s beautiful design.  On the other hand, natural family planning does not create an environment hostile to the beginning of life.  Instead, intercourse remains open to life as God intended. Though natural family planning and hormonal contraception have the same “efficacy” in preventing/postponing a child, the two could not be more different. (A future post will follow regarding the abortive potential of hormonal contraception).
  2. I believe women should be respected, in their entirety. Their entirety includes their fertility and fascinating reproductive system. I will not use a drug to suppress this beautiful design God has created. Since the widespread use of the pill, sexual moral standards have generally declined.  Not much life experience is needed to realize that men often need incentives to adhere to a moral code.  It is evil to ease the transgression of moral code. Some physicians have done so already, allowing some men to grow accustomed to the use of contraception. In doing so, men may forget the sincere reverence due to a woman, reducing her to an instrument of pleasure, and disregarding her physical and emotional equilibrium.  He may see no immediate consequences to their actions, yet several have been observed in society since the pill: general lowering of standards for women, a rise in infidelity and prostitution. If you are not aware of these results, take a step away from the Church for a day.  
  3. I am pro-life, and most hormonal contraceptives act against the dignity of life as abortive agents.  Just reference the common Physician’s Desk Reference or UpToDate. Or, consider the history: In 1965, The American College of Obstetrics and Gynecologists (ACOG) issued a bulletin to redefine "conception" to mean "implantation."As a prestigious society, ACOG redefined life for money. The pill would soon bring in millions, as their new definition removed abortion from most informed-consent discussions with patients. However, the mechanism of contraceptives has not changed with their new definition of life. For nearly all progestin-only contraceptives, ovulation is not consistently suppressed, and “endometrial thinning” is one of the key mechanisms. This then promotes early abortion because the endometrial lining is not suitable to early life. All hormonal contraceptives have the potential to promote an abortion, some more than others. Note that the new emergency contraceptive Ella hits the same progesterone receptors as most current contraceptives, and the package insert states “not indicated in pregnancy due to hazard to fetus.” One may state in reply, “But God has caused many spontaneous abortions as part of a natural process.” I will ask, “What role do you have as the cause of abortion?” Or, consider Hippocrates, the father of modern medicine: “I will not give to a woman an abortive remedy. In purity and holiness I will guard my life…”
  4. I only prescribe medication for disease or injury. To prescribe medication to alter our natural fertility is to prescribe a poison. A drug can only be considered a medication when treating an actual disease. Fertility is not a disease, but rather quite beautiful. Rather than suppressing fertility, we should work with God’s beautiful design. NFP does just this, not altering or suppressing our body. Instead, NFP asks a woman to work with her body and to know her body better. NFP strives to find any underlying medical problems, and does not consider fertility as one of them.
  5. I believe low-risk life style changes should always be introduced before prescribing any medication, and that the side effects of every medication should be considered. Hormonal contraception increases risk of heart attack and stroke by 50-80% (NEJM). I have witnessed or interviewed three patients with blood clots related to contraception in the last six months.  The physicians that performed a hypercoagulability (blood clot) workup suggested the patient stop taking contraception, as they felt it was likely related in each case.
  6. I believe in informed consent. Many patients are on the pill, not knowing the risks or alternatives. Copied below is a conversation I had with one patient.
“Were you counseled on any alternatives to artificial hormonal contraception, besides any of these pills you’ve been taking?” I asked my patient, after she had tried 3 different options with a variety of side effects. 
“Yes, Implanon – the implant that goes in your arm with a small surgery.”  (Implanon is a progestin – hormonal)
“What about any alternatives to medication, abstinence or natural family planning?”
“No. I was just given the pill.”

Whatever happened to informed consent?!  How can these conversations exist with my patients? 

NFP in its greatest practice is not just about a proven scientific method. It’s part of a greater respect for life and God’s role in creation. I’ve had contracepting couples switch to NFP solely based on the medical risks and benefits of contraception, in comparison to NFP. Did this change their philosophy regarding life’s dignity and God’s role in creation? Unfortunately, I somewhat doubt it. However, medically it certainly is safer than hormonal contraception. 

The beauty in NFP should include this appreciation of life and its dignity. One can keep true to this philosophy in practicing NFP, but not by contraception.  Unfortunately, it is possible to practice NFP and not hold dear the dignity of life.  If you do practice NFP to delay a pregnancy, prayerfully consider God’s role in planning His next child with you.  If you practice NFP in a contraceptive mentality, you have forgotten God’s role.  For everyone, I encourage learning a little basic science on this subject.  Ask questions.  Don’t accept a pill as the only option when the physician fails to fully inform. Ask about risks and alternatives.  More importantly, keep God and His plans close to your heart.  Respect all life. Do not thwart the transmission of life as God so beautifully designed.

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