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Running head: FERTILITY AWARENESS PROJECT 1

Fertility Awareness Project

Elizabeth Ping – T-012

Spring Arbor University

NUR 494: Senior Nursing Project

May 1, 2010
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Table of Contents

I. Abstract....................................................................................................................3

II. Introduction..............................................................................................................4

III. Section I - Assessment

A. Background Description.....................................................................................4

B. Institutional Structure..........................................................................................5

IV. Section II – Plan

A. Purpose Statement...............................................................................................7

B. Subjects...............................................................................................................8

V. Section III – Outcomes

A. Data Analysis Techniques.....................................................................................

B. Presentation and Discussion of Data.....................................................................

VI. Section IV. – Analysis

A. Findings and Identification of Problems..............................................................

V. Section V. – Evaluation

A. Findings and Identification of Problems..............................................................

VII. Section VII. – Conclusion

A. Findings and Identification of Problems..............................................................


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VIII. References..................................................................................................................

IX. Appendices ................................................................................................................

Abstract

A communication audit provides insight into a Christian liberal arts university community. The

audit consisted of quantitative and qualitative data collection methods based on the 12 culture

factors found in Hunt (2005) and an additional web-based communication audit. Six individuals

were purposively selected representing three different institutional levels, as well as the

traditional and non-traditional educational approaches within the university. Four factors

emerged with mixed responses. These four factors are discussed and recommendations are

identified. Analysis of the data indicates primarily positive support for the university

communication processes.

Keywords: communication, culture, university


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Fertility Awareness Project

Fertility awareness methods provide women with the ability to monitor their own

personal signs of fertility and infertility, which is useful in terms of either achieving or

preventing pregnancy. The methods include detecting changes in cervical mucus and positioning

patterns and by charting basal body temperatures. Although almost a quarter of the world’s

married women report using fertility awareness methods, research indicates that many women

have incorrect or incomplete knowledge in reference to the monitoring of fertility (Sinai,

Lundgren, Arevalo & Jennings, 2006). The purpose of this project is to increase knowledge of
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fertility awareness methods for the prevention or achievement of pregnancy among people who

have Internet access. This will be accomplished by creating a Web site about fertility awareness

methods and by encouraging people to participate in a pretest before touring the Web site and a

post-test after touring the Web site in order to assess whether their knowledge of fertility

awareness has increased from viewing the site.

Section I – Assessment

Not taught. In economically advanced countries, counseling about fertility awareness

methods is generally not a part of yearly gynecological visits. According to Jennings and Landy

(2006), one reason why fertility awareness methods are not taught during routine exams may be

due to gynecologists seldom receiving proper training about fertility awareness methods in

medical school or during residency training (p. 49). The fact that few women are taught the most

basic signs and symptoms that should alert them to their fertile and infertile periods may explain

why according to Becker, Koenig, Kim, Cardona, and Sonenstein (2007), approximately 48% of

pregnancies that occur in the United States are unplanned. The prevention of unwanted

pregnancy is a problem not limited to the United States. The World Health Organization (2008),

reports that there is an unmet need for fertility awareness methods in developing nations in order

to facilitate the prevention of pregnancy to achieve the goal of child spacing, for limiting the

number of overall births, and for decreasing the rate of abortions (pp. 1-3).
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Non-hormonal Birth Control. Discussions with acquaintances of the writer have

encouraged the writer to promote further education of fertility awareness methods for the

prevention of pregnancy through the use of the proposed fertility project. Specifically,

acquaintances of the writer have voiced the desire to learn more about ways that are independent

of hormones (which they have noticed cause unwanted side effects such as weight gain) in order

to control their fertility. Not all women are good candidates for chemical forms of birth control

due to health concerns. Health concerns related to hormonal contraception usually fall into one

of two categories -those who dislike the side effects of chemical birth control and those whose

health is put into danger by taking chemical birth control. Singer (2006) mentions the health

problems associated with hormonal birth control pills and shots such as increasing the risk for a

woman to develop hypothyroidism, bone loss, breast cancer, blood clots, and insulin resistance

(p. 48). Furthermore, she notes that some woman develop a decreased interest in sex while

taking birth control pills. Ultimately, there is a great need for a safe, effective, and ethically

sound means of birth control for all women of reproductive age despite the paucity of

educational resources for fertility awareness methods.

Religious Concerns. For couples with religious concerns related to contraception,

fertility awareness may be an acceptable means of limiting family size and child spacing. fertility

awareness methods related to religious considerations may include couples choosing abstinence
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during their fertile times. According to Stanford (as cited by Liu, 2003), 60 percent of women

who follow Natural Family Planning are Catholic while the remaining 40 percent are non-

Catholic. Within the Catholic population it is estimated by Toohill (2009) that only two percent

of Catholic couples actively practice Natural Family Planning Methods.

Achievement of Pregnancy. Alternatively, some women desire to know their most

fertile days in order to facilitate conception. Many women are surprised to learn that they can

easily note their personal signs of fertility by using the same awareness methods that are used to

prevent pregnancy. The writer has been asked by acquaintances about methods that can be used

to achieve pregnancy by simply observing their own bodies which can consequently assist

women to detect individual characteristics in their menstrual patterns. According to Fehring,

Schneider, and Raviel (2006), realizing the individual variability in the fertility window is very

important for couples who are struggling to achieve pregnancy (p. 376).

Furthermore, according to Barron (2004), daily charting of basal body temperatures and

cervical mucous patterns can be used to recognize problems in a woman’s cycle that could

decrease her chances of conceiving (pp. 81-82). Once a cycle abnormality is detected, the

woman, along with her health care provider, can make informed decisions in order to correct

infertility conditions that may be present. Therefore, fertility awareness is a critical component
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in terms of successfully identifying fertile periods in a woman’s menstrual cycle and in

enhancing the probability of her conceiving.

Increased Intimacy. Although Fertility Awareness Methods focus on the woman's

cycle of change, it has been documented that it is best if the male partner is involved in the

monitoring process. According to Murphy (1994), studies have shown that Fertility Awareness

Methods are just as effective as oral contraceptives when women and men work together to

determine the woman's peak fertile time. Furthermore, Murphy (1994) describes that men are

often inspired to take greater responsibility for intercourse because by monitoring fertile and

non-fertile patterns, men have tangible evidence of changes in their partner's cycle.

Health Promotion. Women who have intimate knowledge of their menstrual cycles

have greater self-awareness about their bodies. Fertility Awareness methods, as described by

Murphy (1994), give women responsibility and respect about their menstrual cycles. Women

can more easily detect variations and changes in their cycles that may indicate that a disease

process is taking place. Women who are unaware of their hormonal cycles may not be tuned in

to these slight changes.

Cost Effective. Since Fertility Awareness Methods involve the direct observation of

bodily functions such as cervical mucous and positioning patterns in combination with

monitoring basal body temperature, Fertility Awareness Methods are typically inexpensive
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compared with the monthly cost of hormonal birth control, surgery, or hardware. Price ranges

are dependent on how many predictors of a woman's fertile period that a woman wants to rely

on.

Health Promotion Model. Nola Pender's, health promotion model, was selected as the

theoretical model for the fertility awareness project. Pender's health promotion model was a

choice selection for the fertility project because of the strong emphasis on education as a means

to promote health and well-being using natural, instead of pharmacological means of birth

control or pregnancy achievement (Pender, Murdaugh, and Parsons, 2006). Additionally,

Pender's health promotion model is congruent with the methods of fertility awareness which

encourage women to listen to their own bodies in order to determine their times of infertility and

infertility. Accordingly, women who are taught to actively reflect and act upon their own self-

awareness will have the ability to modify their environments to promote health and well-being.

Section II – Plan

Setting. A multipage Web site was developed for the fertility awareness project using

Web-building software. The setting for the project is the World Wide Web. The home page for

the Web site is located at http://speculativespeculum.ipage.com. The Internet was chosen as the

medium of teaching because a wide range of people can be reached. Not only would the

minimum of 15 women benefit from touring the Web site, but also all of those throughout the
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world who have access to the Internet. Furthermore, participants were able to access fertility

awareness information at their own convenience and within the privacy of their own homes or at

coffee shops, libraries, or other public places. Privacy was an important factor in determining

the medium for education since fertility awareness is often excluded from polite conversation

and since many women may be too embarrassed to converse with their peers or physicians about

monitoring their fertility naturally. The Internet allows for the necessary privacy.

Demographics. The focus population of the project included those who are interested in

learning about preventing pregnancy without the use of hormonal contraception or who wish to

become pregnant, those who want to understand more about personal fertility patterns, and those

who want to learn more about fertility awareness methods for increased health benefits for

themselves or others. The minimum age of 18 was also chosen because avoided legal

complications that might ensue from minors taking the pretest and post-test. No upper age limit

was chosen for the project because the writer feels that the more people should be aware that

fertility awareness methods exist. Furthermore there was no discrimination between those who

are not fertile anymore or by gender or sexual orientation. By having increased understanding of

what fertility awareness methods are and why they are important may be beneficial to all of

human society.
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A minimum of 50 people who have voiced to the author the desire to learn more about

either how to achieve or how to prevent pregnancy using natural methods were selected. The

participants were acquaintances of the writer through church, school, or personal contacts made

over the Internet. Except for one Canadian female, all participants selected were Americans.

Since no formal institution was used to increase knowledge about fertility awareness methods for

either a teaching base or to locate a focus population for the project, no institutional

acknowledgement form needed to be completed.

Teaching Materials. The Web site provides evidence-based information concerning

fertility awareness for both the prevention and the achievement of pregnancy. Participation in

the fertility awareness project was a self-study endeavor, and it was the participant’s

responsibility to adequately peruse the Web site to attain information on fertility awareness

methods. Furthermore, through the use of a contact page found within the Web site, the

participants had the ability to ask the writer questions when they found it necessary. Moreover,

an E-mail address of the writer was included for further contact information.

The information on the site covered an overview of fertility awareness methods as well as

basal body temperature monitoring, cervical monitoring, ecological breastfeeding, ovulation

prediction kits, and trying to conceive while breastfeeding. These topics are essential to having a

basic understanding of how fertility awareness methods can be used in the achievement of
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pregnancy, the prevention of pregnancy, and for gynecological health. The fact that the majority

of information provided through the Web site is evidence-based is what sets aside the proposed

Web site from others now found on the Internet. Citations for the information used on the Web

site are located on the bottom of each page for easy reference. Attempts were made to provide

reference materials that were as current as possible. Specific topics and questions answered

about fertility awareness methods are included in Table 1.

Table 1. Fertility Awareness Methods Covered in Web site.

Web Page Name Topics Covered


What is Fertility Awareness? • Is Fertility Awareness (FA) the same as natural family
planning (NFP)?
• Is Fertility Awareness (FA) the same as the Rhythm Method
or Calendar Method?
• What clues to Fertility Awareness Methods use?
• What are some other terms that refer to Fertility Awareness
Methods?
• What are the disadvantages of using Fertility Awareness
Methods?
• Are Fertility Awareness Methods effective at preventing
pregnancy?
• Are Fertility Awareness Methods just for women?
Basal Body Temperature • How does Basal Body Temperature Monitoring Work?
• Preventing Pregnancy
• What materials will I need?
• How much does charting Basal Body Temperatures cost?
• How to start charting
• What are the Rules to Charting?
• When does charting indicate ovulation?
• What can affect Basal Body Temperatures?
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• When is charting not a good option?
• Commonly used acronyms
Cervical Monitoring • What does the cervix look like?
• What does cervical mucous look like?
• How does the cervix change over a woman’s cycle?
• How does a woman check her cervix?
• How does a couple avoid or achieve pregnancy using cervical
monitoring?
• What can influence cervical mucous?
• Where can a person find more pictures of cervices?
• When should a woman not check her cervix?
Ecological Breastfeeding • How can breastfeeding keep me infertile?
• What are the seven standards of using breastfeeding as birth
control?
• What are my chances of becoming pregnant while
breastfeeding?
• Ovulation Prediction • How expensive are OPKs?
Kits • On what cycle day (CD) should I start testing?
• What time of day should I test?
• What does a negative OPK look like? What does a positive
OPK look like?
• I always see two lines. Is this normal?
• How long will an OPK be positive for?
• Does having a positive OPK always mean that I will ovulate?
• What if I never see a positive OPK?
• When should we have intercourse?
Trying to Conceive While • What are the easiest ways to promote ovulation while
Breastfeeding nursing?
• Can every mother conceive while breastfeeding?
• Is it safe to breastfeed during pregnancy?
Links • Fertility Awareness Methods
• Cervix Pictures
• Menstruation
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• Breastfeeding
• Childbirth
• Ovulation Prediction Kits
Handouts • Fertility Awareness Quiz Pre-test/post-test printouts
Products • Amazon books
Educators • Links to Fertility Awareness educators in the United States
About • About the Web Site
• About the writer
Contact • Contact the writer
Legal Disclaimer • Liability
• Link disclaimer
• Web site terms of use

Printable fertility awareness handouts for distribution were offered, and links to other

fertility awareness Web sites were provided. Additionally, photographs taken and images made

by the writer using graphic editing software and images from the public domain were included to

enhance the Web site’s appearance and to provide visual representation of fertility awareness

methods. For legal purposes, a medical, Web site terms of use, liability, and link disclaimer for

all content within the site were integrated.

Timeliness and Resources. Timeliness for the implementation of the Web site was

dependent on multiple factors. Initially, time was needed to learn about Web site design, using

graphic editing software, using web-building software, and using cascading style sheets for the

format of the Web site. Preparation for the Web site began in October 2009 with the viewing of

online movies about how to create a Web site and multiple trips to the library to view books on
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the basics of Web site design. Over 24 hours were spent researching information. Moreover, the

ability of the writer to maintain a time schedule relied on the writer's capacity to research

evidence-based information on fertility awareness, create or find images, develop the Web pages,

upload the individual Web pages, formulate the online pretest and posttest, and test links within

the site.

Actual construction of the Web site began in December 2009 where the site took on

multiple appearances in an attempt to become visually appealing, inviting, and easy to maneuver.

It was challenging to design a fertility awareness site that clearly delineated whether a person

wanted to focus on fertility methods that prevented pregnancy or achieved pregnancy. Different

Web site templates were trialed with the most orderly design remaining. A site name of

“Speculative Speculum” was chosen to represent the material found in the fertility awareness

project. When choosing a name for the site, the writer wanted to confer the feeling of the desire

to know more about gynecological health through inquiry and reflection.

Two basic template designs were created with the Web-building software. The first page

created was a home page or index page. On the index page, the Web site invited participants to

“know thyself by learning more about your fertility.” The name “Speculative Speculum” was

clearly displayed in the upper right hand corner of the site with links to “home,” “news,” “links,”

“handouts,” “books,” “fun,” “educators,” “about,” and “contact” were located in the upper left
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hand corner of the page. The design of the index page is two-columned, meaning that the page is

separated into two parts. On the left column, a quote on fertility from the writer was displayed to

inspire the participants to think more about reproductive well-being. Underneath the quote, the

index page is divided into two separate areas of links that are demarcated by whether the

participant desires to learn more about either the prevention of pregnancy or the achievement of

pregnancy. On the right column of the index page, a link to the pretest and post-test is provided.

Below the link for the participants to take their pretests and post-tests is an area for fertility

awareness polls and for the monthly news of the Web site. Located on the bottom of the fertility

awareness Web site is copyright information, a link to the legal disclaimers, and a link to the

Web site’s E-mail address. The second template created was very similar to the first, however,

does not include polls or the news section.

After the two templates were created using web-building software images for the Web

site were sought after using public domain and stock photo resources. Images that the writer

could not find easily on the Internet were produced by the writer using graphic-editing software.

After images were collected and placed in the Web site, the individual pages of the entire site

was uploaded or "put" on a server so that the Web site could be viewed by the general public.

Lastly, the writer tested links throughout the Web site and imbedded the third party survey,

pretest, and post-test into the site.


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Project Mentor. The project mentor was Shannon Mcquaide, who was the writer’s

obstetrical nurse during the writer’s second pregnancy and is the current nursing supervisor at the

writer’s place of employment (see Appendix A). Shannon served as a resource for insuring that

information on the Web site was cogent, attractive, and free of grammatical and syntax errors.

Shannon Mcquaide has viewed the writer’s Web sites in the past and has offered invaluable

advice. One of the suggestions that Shannon made concerning the Web site included changing

the font of the headings to all the subjects. The writer agreed with Shannon that the headings

would look better if the font were changed, however the writer had to learn how to change the

cascading style sheets for the entire Web site in order to improve the Web site.

Project Invitation. An invitation was created using computer software to attract people

who would be interested in learning more about fertility awareness methods. The invitation or

flyer was modeled after several leaflets seen at the University of Michigan for their research

studies. The flyer included the name of the project in bold, information regarding who was

eligible to participate, and the steps to be part of the project (see appendix B). Each flyer

provided a password of "cervix" (in order to limit access to the online tests only to participants)

and a random four-digit number for the pretest and post-test log-in.

Pre/Post Tests. The site was accessible to the public and the participants of the project in

April 2010. At that time, invitations were sent to approximately 50 acquaintances of the writer
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either by a letter or by electronic mail. The instructions given to potential participants advise the

participant to, first take demographic questionnaire and pretest without touring the Web site, then

tour the Web site at their own leisure, and then take the post-test without using the Web site to

look for answers to the questions. The participants were allowed one week from April 10 to

April 18, 2010 to respond to the invitation to tour the Web site by taking a multiple-choice

electronic pretest and post-test on the Internet.

An online quiz maker was used to generate pretest and post-test questions. A link to both

the pretest and post-test questions was electronically embedded within the Web site. Anonymity

while maintaining congruency between pretest and post-test questions was preserved by having

the participants log-in to take the test by using a four-digit number located on the back of the

fertility awareness invitation flyer. The four-digit number was the same one used to log-in to the

pretest and post-test. It was unknown to the writer about who received what four-digit number.

Only those selected to participate in the project were permitted to take the pretest and post-test

because the questions were closed to the general public. The password of “cervix” was used by

all participants in the fertility awareness project.

The multiple-choice pretest consisted of the same ten questions that were on the post-test.

The ten questions were directly related to commonly known methods of fertility awareness that

most people who utilize fertility awareness methods would easily recognize and for which they
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would know the answers. Questions for the pretest and post-test were loosely based on Katie

Singer’s (2006) “How well do you know Natural Family Planning?” (pp. 66-72). Participants

were required to choose from four possible answers with only one answer being correct. Results

of the pretest and post-test were available immediately after completing the post-test questions so

that participants would become aware of what questions were answered correctly or incorrectly.

Survey. An online survey maker was used to create a means to gather demographic

information regarding gender, age, race, education level, occupation, income level, marital

status, whether or not that they have ever heard of fertility awareness methods before, and

whether or not that they enjoy learning about health information over the Internet. The

demographic survey was limited to ten questions because the service was free of charge (see

Appendix M). Additional questions would have been too expensive for the writer. A link to the

survey was provided in the Web site for the participants to take the survey. In order to track

which demographic survey went with which pre-test and post-test, the participant was required to

entire the same four-digit number that they used for taking the pretest and post-test. In order to

limit the survey to only the participants, the password of "cervix" was again required to enter the

survey.

Pilot Study. A pilot was conducted at the end of March 2010 for the pretest and post-test

questions as a way to predict complications. A total of four acquaintances of the writer were
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selected to take the pretest, tour the Web site, and take the post-test. Multiple problems were

discovered in the process. These barriers included broken links inside the Web site, failure of the

imbedded pretest and posttest to initiate testing, inability to log-in to take the tests, slowness in

new questions to appear, and marketing ads that made the testing environment appear cluttered.

As a result of the pilot study, multiple online quiz makers were trialed. The four acquaintances

voiced to the writer with the most favored or user friendly online quiz maker, and the one most

preferred remained embedded in the Web site and was used for the project. A pilot study was

not completed using the online survey maker for acquisition of demographic information because

the survey was added to the Web site immediately prior to the participants.

Cost. The cost of the fertility awareness project was more than initially expected. The

library system local to the writer does not have information regarding fertility awareness

methods. The writer preferred to purchase her own fertility awareness books and Web design

books for future reference which amounted to be approximated $100. The approximate amount

for the rights to use some of the images found on the Web site was $20. To replace the writer's

hard drive so the project continue cost $100, and to replace the computer software lost when the

previous hard drive failed was $200.

Section III – Outcomes


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Demographic Survey. The participant's demographic information was obtained through

an online questionnaire consisting of nine questions concerning gender, age, race, education

level, occupation, income level, marital status, whether or not that they have ever heard of

fertility awareness methods before, and whether or not that they enjoy learning about health

information over the Internet. Additionally, the internet protocol (IP) addresses obtained from

the online pretests and post-tests allowed the writer to determine where in the world participants

were responding from. All participants came from southeastern Michigan except for one who

came from Canada, all participants were female except for one male, and all participants were

Caucasian except for one Asian.

In general, the 18 participants who responded out of the 50 project invitations were

between the ages of 18-30, married, had a Bachelor's degree, were a type of health care worker,

and had an income level of $50,000-100,000 (see Figures 1-5). Furthermore 68.8 % of the

participants responded that they had never heard of fertility awareness methods before, and 81.3

% of the participants responded that they enjoyed reading about health information over the

Internet.

Figure 1. Age.
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Figure 2. Marital Status.

Figure 3. Educational Level.

Figure 4. Income Level.

Figure 5. Occupation

Pretest/Post-test Outcomes. Three people who responded initially to the demographic

survey did not complete the pretest and post-test, and these scores were removed from the

project. Overall, post-test scores were higher after touring the Web site (see Figures 6-7). The

time to take the pretest was 141 seconds, and the time to take the post-test was 78 seconds.

Moreover, a relationship was seen between the pretest and post-test score, and the correlation

coefficient of pre-test and post-test scores was r=.51. Thus, there was a moderately strong

positive correlation between participants who took the pretest, viewed the Web site, and took the

post-test. The post-test outcomes indicate that additional teaching is needed concerning

ovulation prediction kits, basal body temperatures, and defining different fertility awareness

methods because these were the most frequent questions answered incorrectly (see Figure 8).
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Figure 6. Average Pretest and Post-test Scores.

Figure 7. Participant’s Individual Pretest and Post-test Scores.

Figure 8. Individual Post-test Questions Answered Correctly and Incorrectly.

Section IV – Analysis

Revisions. There were two major revisions that occurred to make the fertility awareness

project occur. The foremost revision was the actual project proposal statement which changed

from “increasing knowledge of fertility awareness methods among women of childbearing age

with Internet access” to simply "increasing knowledge of fertility awareness methods for the

prevention or achievement of pregnancy among people who have Internet access." This way,

more people could participate in the project, and the project would not be limited to just females

or just those who are most likely fertile. The writer wanted to include any males who might be

interested in natural methods to obtain or prevent pregnancy for their wives or significant others.

Likewise, the writer wanted to include any females who are older who may have the desire to

learn more about fertility awareness methods for their children or friend's benefit. The second

major revision of the project consisted of adding a demographic survey to the Web site so that
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information could be gathered regarding who was responding. The writer felt that it would be

interesting to analyze how people with differing backgrounds did on the pretests and post-tests.

Limitations. There were unforeseen factors that limited the success and timeliness of the

fertility awareness project. The limitation that impacted the writer the most during the

implementation of the project was related to the writer’s personal health problems. The writer

became pregnant after the fertility awareness project was proposed. Hyperemesis, a condition of

severe nausea and vomiting in pregnancy, prevented the writer from continuing with the project,

and the writer was ultimately hospitalized during the months October and November of 2009.

Continued rehabilitation extending into December of 2009 and January of 2010 inhibited rapid

completion of the Web site. Specifically, the writer experienced difficulties with vision,

memory, mood, weakness, and ambulation secondary to starvation, alternative nutrition, and

medications that made researching information of fertility awareness methods and learning how

to create a Web site very challenging.

Computer hardware failure in the beginning of February of 2010 prevented further

completion of the Web site. During that time, the folder containing the site was not located

permanently on the Web hosting server. Instead, the folder containing the Web site was located

on a refurbished computer, and the computer’s hard drive became corrupted. All information

regarding the fertility awareness project become irretrievable, and a new hard drive was required
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to continue with the project. Time was needed to purchase a new hard drive, install the new hard

drive, install all computer software, recreate the Web site’s overall design, create new images

using graphic-editing software, and rewrite the information found on the individual Web pages.

Essentially, the entire project needed to be restarted.

A navigational limitation of the participants was the major limitation during

implementation of the demographic surveys, pretests, and posts. Some people who were not as

adept at browsing the Internet and found it difficult to go back to the home page of the Web site

after taking the survey and tests. As a consequence, one participant only did the demographic

survey and did not attempt the pretest and post-test. About 50 % of the participants who

responded contacted the writer in order to obtain assistance in what the next step of the project

was for them. This problem was not adequately detected during the pilot study and may have

been due to the fact the four trial participants use the Internet heavily and are very

knowledgeable about Internet navigation.

Facilitator. There were no barriers or limitations after the implementation of the project.

Alternatively, the major facilitator of the project was using an online survey maker and quiz

maker for collecting the demographic information and pretest and post-test results. The online

programs automatically tallied the number of participants who took the survey and tests and gave

statistics as to which questions were answered incorrectly and correctly. Furthermore, the time
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taken to complete the pretests and post-tests was recorded. Graphs could be viewed on the Web

site, however only members who pay additional fees have access to copy and print the

information from their site. Despite not being able to copy and paste some of the information

that the quiz-making Web sites displayed, the collection and analysis of data took little effort.

Feasibility. The creation of a Web site for such a broad topic as fertility awareness was

an enormous task similar in comparison to writing and editing a small book, and the writer found

the time line to plan and implement the Web site tight. The writer feels like she could have used

more time to research and write about fertility awareness methods. Overall, however, the plan

was realistic and the demographic survey, pretest, and post-test reflected the type and amount of

information expected. Furthermore, the writer would have benefited from greater expertise in

Web site design, and having a person more adept at designing Web sites to communicate with

would have made the formulation of the Web site easier. In retrospect, it would have been

simpler give an oral presentation on fertility awareness methods instead.

Section V – Evaluation

Outcomes Met. The purpose of the fertility awareness project was to increase knowledge

of fertility awareness methods for the prevention or achievement of pregnancy. Increased

knowledge was gained from the touring the Web site as evidenced by participants scoring higher

taking the post-test than when they took the pretest. However, not all knowledge could be
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accounted for from only from viewing the Web site before taking the post-test. This is due to the

fact that approximately 50 % of the participants need assistance in navigating back to the home

page after taking the survey or the pre-test, and the writer needed to visit the participants in order

to show them how to move on to the next step. The participants, in general, showed great

interest in learning about fertility awareness methods and had many questions for the writer.

Consequently, approximately 15-20 minutes were spent discussing fertility awareness methods

to the participants who had difficulty with Web site navigation. This was an unintended,

however, pleasant side effect of limited Internet knowledge.

Recommendations. One practical recommendation for creation of a Web site for

increasing knowledge for any subject matter would include saving the entire Web site in multiple

locations in the event of hardware or server failure occurs. In this way, loss of data in one

location would not result in an overall total loss of information. Another recommendation for the

creation a Web site would include learning a programming language that could be used to

manually generate a survey and test into the Web site without having to rely on third party online

quiz makers. Thus a tailor-made survey and test could be combined, and navigation problems

would then be reduced.

Expansion of the Web site to include additional topics related to fertility awareness

methods and gynecological issues would enhance the Web site’s content. Additions to the Web
FERTILITY AWARENESS PROJECT 28

2
site may include an overview of the menstrual cycle, how to perform a breast exam, nutrition for

increased fertility, barrier methods of birth control, sexually transmitted diseases, transcultural

practices regarding the menstrual cycle and sexual intercourse, menopause, infertility, and

increasing the odds of having a baby of a certain sex. Furthermore, adds for the Web site could

be made so that more people would be drawn to the site and learn more about fertility awareness

methods. Moreover a forum and a blog can be added to the Web site in order create open

discussion of fertility awareness methods and gynecological health.

A future-related project may include evaluating what is the best method for teaching

about fertility awareness methods. Since there are many modalities of teaching, it would be

interesting to such as whether one-to-one instruction, instruction given only by a physician or

nurse midwife, instruction from a brochure, instruction from an online source, or instruction in a

group setting would provide the greatest gain in knowledge concerning fertility awareness

methods. Furthermore, it would be interesting to study who is more likely to practice fertility

awareness methods regularly such as whether they are more or less religious, more or less

educated, have a greater or lesser income level, and so forth.

Section VI – Conclusion

Knowledge Gained. The knowledge gained from completing the fertility awareness

project is multi-fold. Firstly, the writer’s knowledge on the basics of creating multi-page Web
FERTILITY AWARENESS PROJECT 29

2
sites and the intricacies of using Web-building and photo-editing software was expanded.

Secondly, the writer's knowledge of fertility awareness methods has broadened. Thirdly, the

writer has learned that it is best to save digital information in several locations and to never

assume that just because a person is younger, they will understand how to navigate around a

Web site.

Applicability. The writer benefits from the data generated by the fertility project as she

prepares herself to become a certified nurse midwife and women’s health nurse practitioner. She

will be able to use the Web site and the information gathered from the fertility project to enhance

the teaching methods about fertility awareness when she is a practicing midwife in the clinical

setting. Additionally, the writer can refer patients to the Web site for additional information

when desired by the patient.

Perhaps the most significant benefit of creating a Web site for the fertility awareness

project is the continued effect that it will have on women around the world who are interested in

natural methods of fertility awareness who have Internet access. By virtue of the fact that the

writer plans to maintain the Web site and modify it according to the data gathered from the

project, English-speaking women around the world will be able to find answers to questions that

they might not feel comfortable asking in regular conversations.


FERTILITY AWARENESS PROJECT 30

2
FERTILITY AWARENESS PROJECT 31

2
References

Barron, M. (2004, April). Proactive management of menstrual cycle abnormalities in

young women. Journal of Perinatal & Neonatal Nursing, 18(2), 81-92. Retrieved

August 29, 2009, from CINAHL Plus with Full Text database.

Becker, D., Koenig, M., Kim, Y., Cardona, K., & Sonenstein, F. (December 2007).

The quality of family planning services in the United States: Findings from a literature

review. Perspectives on Sexual & Reproductive Health, 39(4), 206-215. Retrieved from

CINAHL Plus with Full Text database.

Fehring, R., Schneider, M., & Raviele, K. (2006, May). Variability in the phases of the

menstrual cycle. JOGNN: Journal of Obstetric, Gynecologic, & Neonatal Nursing,

35(3), 376-384. Retrieved from CINAHL Plus with Full Text database.

Jennings, V., & Landy, H. (July 2006). Explaining ovulation awareness-based family

planning methods. Contemporary OB/GYN.

Liu, L. (2003, 2003 Jan-feb). Mind/body. Sex ed: contraception au naturel. Health 17(1), 48.,

CINAHL Plus with Full Text database.

Pender, N.J., Murdaugh, C. L., & Parsons, M.A. (2006). Health promotion in nursing practice

(4th Edition). Upper Saddle River, NJ: PrenticeHall. Retrieved from

http://www.nursing.umich.edu/faculty/pender/HPM.pdf
FERTILITY AWARENESS PROJECT 32

Sinai, I., Lundgren, R., Arevalo, M., & Jennings, V. (June 2006). Fertility awareness-

based methods of family planning: Predictors of correct use. International Family

Planning Perspectives, 32(2), 94. Retrieved from General OneFile via Gale:

http://find.galegroup.com.ezproxy.arbor.edu/gps/start.do?prodId=IPS

Singer, K. (2006). Honoring our cycles: A natural family planning workbook. Winona Lake, IN:

New Trends Publishing.

Toohill, B., (2009). Natural family planning: The Catholic priest's perspective. Psy. D.

dissertation, Wheaton College, United States --Illinois. from Dissertations & Theses:

A&I. (Puplication No. AAT 3360062).

World Health Organization. (2008). Repositioning family planning: Guidelines for

advocacy action. Retrieved August 28, 2009, from http://www.who.int/

reproductivehealth/publications/family_planning/fp_advocacy_tool/en/index.html
FERTILITY AWARENESS PROJECT 33

Appendix A

Mentor Agreement
FERTILITY AWARENESS PROJECT 34

2
FERTILITY AWARENESS PROJECT 35

Appendix B

Fertility Awareness Project Flyer


FERTILITY AWARENESS PROJECT 36

2
FERTILITY AWARENESS PROJECT 37

Appendix C

Basal Body Temperature Monitoring

BASAL BODY TERATURE


FERTILITY AWARENESS PROJECT 38

Charting Basal Body Temperature (BBT) is one way of determining whether a woman is
ovulating or not. Basal Body Temperature is simply the body's resting temperature which
varies at different stages of a woman's menstrual cycle. Gynecological charting is
retrospective in nature, meaning that only after the fact will a woman know if ovulation
has occurred or not. Basal Body Temperature charting is best used in combination with
other Fertility Awareness Methods.

HOW DOES BASAL BODY


TEMPERATURE MONITORING
WORK?
Each month there are unique temperature changes that occur in relation to a woman's
cycle of change and the different hormones present in a woman's system. In the beginning
of the menstrual cycle, which starts at the first day of bleeding, a woman's temperature is
lower that it is after ovulation. As a woman's gets ready for ovulation, there will be a slight
drop in temperature followed b a sharp rise in temperature (0.5 to 1 degree) 24 hours
after ovulation for the remainder of the cycle until menses begin again which will be noted
by another sharp in temperature. Estrogen is the predominant hormone during the
follicular or beginning half of the menstrual cycle, while progesterone is the predominant
hormone during the luteal phase or last half of the menstrual cycle.
FERTILITY AWARENESS PROJECT 39

PREVENTING PREGNANCY
For women who are avoiding pregnancy, charting Basal Body Temperature allows women
to know when ovulation has ended and that sexual abstinence may end or that it is allowed
to have intercourse without contraception. It is difficult to determine before noticing the
drop and rise in temperatures indicating ovulation that the fertile period has ended, thus
Basal Body Temperature charting is poor at predicting ovulation.

In other words, assessing basal body temperature before the chart indicates ovulation
will not provide the information needed to absolutely know whether the fertile period
has been reached. By abstaining from intercourse or using contraception before ovulation
FERTILITY AWARENESS PROJECT 40

is indicated on the chart (by the fall and rise of temperatures), pregnancy can can avoided.
Charting for the women who desires to avoid pregnancy is important because by charting
Basal Body Temperatures patterns can be seen and women may notice that they ovulate
during the same time most months. This knowledge aides in allowing women to know when
their most fertile times are.

WHAT MATERIALS WILL I


NEED?
Materials needed to get started in charting Basal Body Temperatures are a Basal
Thermometer, pen, alarm clock (optional), and a calendar chart or charting software. Basal
Body Thermometers are more ideal than regular fever thermometers because they
measure to a tenth of a degree. Variations of temperature are slight so the greater degree
to which measurement can be taken is the most desirable. Basal Body Thermometers can
be found online and at drug stores.

HOW MUCH DOES CHARTING


BASAL BODY TEMPERATURE
FERTILITY AWARENESS PROJECT 41

COST?
Basal Body Thermometers- Basal Body Thermometers are fairly inexpensive, costing around
10 USDs for a basic thermometer. More advanced Basal Body Thermometers exist that
store temperatures, light up, and beep when the temperature is finished reading.

Charting Software- Charting software varies in price from a one-time download (40 USDs)
to monthly online fees. Many women use:

• Ovusoft (FDA approved)

• Fertility Friend

• Hormonal Forecaster

Paper Charts- There are many places online where free charts can be printed.

• Fertility Plus Charts

• Baby Hopes

• I Parenting

• Baby Center

HOW TO START CHARTING


FERTILITY AWARENESS PROJECT 42

The best time to start charting Basal Body Temperatures is on the first day of bleeding
which is also considered the first day of the menstrual period or Cycle Day 1 (CD1). Make
sure that everything you need to chart a temperature is by the bedside ready for the
morning which may include a pen or pencil, the actual chart or scrap of paper, and the
Basal Body Thermometer. Each morning at the same time before doing anything (kissing,
yawning, drinking, brushing teeth, getting out of bed) take your Basal Body Temperature
either orally, rectally, or vaginally. Record each temperature and look for a dip followed
by a quick rise in temperature (indicating ovulation). During the day, mark down any other
makers of fertility, periods of stress or sickness, and times of intercourse.

WHAT ARE THE RULES OF


CHARTING?
• Take temperature using Basal Body Thermometer before getting out of bed every
morning

• Obtain at least a minimum of 5 hours of sleep

• Try to take temperature using Basal Body Thermometer at the same time every day

• Try to use the same method of taking Basal Body Temperature each day such as
orally, vaginally, or rectally

• Do not drink or eat anything before taking Basal Body Temperature


FERTILITY AWARENESS PROJECT 43

• Test for pregnancy if Basal Body Temperature remains elevated for 18 days or more
past ovulation

• Report cycle abnormalities to your nurse-midwife or physician

WHEN DOES THE CHART


INDICATE OVULATION?
A chart will indicate ovulation when there is a slight drop then rise in temperature.
Sometimes by drawing a line called the "coverline" (see below) can help show when
ovulation was most likely. In order to achieve pregnancy it best to have intercourse around
the time that a drop and rise in temperature is seen.
FERTILITY AWARENESS PROJECT 44

CAN YOU NOTICE PROBLEMS


WITH YOUR MENSTRUAL
CYCLE WHILE CHARTING?
By charting basal body temperatures (BBTs), problems such as anovulation, miscarriages,
and luteal phase defects can be noticed which may prevent a couple from achieving their
full fertility potential.

WHAT CAN HAVE AN EFFECT


BASAL BODY TEMPERATURES?
There are a variety of things that may alter waking body temperatures.

• illness

• alcohol

• traveling

• sleeping with electric blankets

• not getting enough sleep


FERTILITY AWARENESS PROJECT 45

COMMONLY USED ACRONYMS


CD Cycle Day
CM Cervical Mucous
CF Cervical Fluid
CNM Certified Nurse Midwife
CP Cervical Position
DPO Days Post Ovulation
EPO Evening Primrose Oil
EPT Early Pregnancy Test
EW Egg white
EWCF Egg white Cervical Fluid
EWCM Egg white Cervical Mucous
IF Infertility
GP General Practitioner
IUD Intrauterine Device
LH Luteinizing Hormone
LMP Last Menstrual Period
LP Luteal Phase
LPD Luteal Phase Defect
MC or
Miscarriage
m/c
NP Nurse Practitioner
O or OV Ovulation
OB Obstetrician
OB/GYN Obstetrician/Gynecologist
OC Oral Contraceptives
OPK Ovulation Prediction Kits
OTC Over the Counter
P4 Progesterone
PA Physician's Assistant
PCO Polycystic Ovaries
PCOS Polycystic Ovarian Syndrome
PCP Primary Care Physician
FERTILITY AWARENESS PROJECT 46

PG Pregnant
PI Primary Infertility
PID Pelvic Inflammatory Disease
PMS Premenstrual Syndrome
Rx Prescription
SI Secondary Infertility
TL Tubal Ligation
Tx Treatment
US or u/s Ultrasound
UTI Urinary Tract Infection
V Vasectomy

RESOURCES
Barron, Mary. (2004). Proactive Management of Menstrual Cycle Abnormalities in Young
Women. Journal of Perinatal & Neonatal Nursing, 18(2), 81-92. Retrieved December 2009,
from ProQuest Nursing & Allied Health Source. (Document ID: 651576921).

Dagmar, Ehling, & Katie Singer. (1999). Gauging a women's health by fertility signals:
Integrating western with traditional Chinese medical observations. Alternative Therapies in
Health and Medicine, 5(6), 70-83. Retrieved December 2009, from ProQuest Nursing &
Allied Health Source. (Document ID: 46539625).

Fertility; Software Program Receives FDA Approval As Device to Aid Conception. (2001,
December). Medical Devices & Surgical Technology Week, 18. Retrieved December 2009,
FERTILITY AWARENESS PROJECT 47

from ProQuest Nursing & Allied Health Source. (Document ID: 197493681).

Fertility; Timing Fertility: out with the old, in with the new. (2002, December). Women's
Health Weekly, 13. Retrieved December 2009, from GenderWatch (GW). (Document ID:
270666851).

London Draper. (2006). Working Women and Contraception: History, Health, and Choices.
AAOHN Journal, 54(7), 317-24; quiz 325-6. Retrieved December 2009, from Proquest
Nursing & Allied Health Source. (Document ID: 1073061281).

Appendix D

Cervical Monitoring
FERTILITY AWARENESS PROJECT 48

Cervical monitoring involves the act of observing the cervix for changes such as how high or
low the cervix is in the vagina, how open or closed the opening of the cervix is (cervical os),
and the softness or firmness of the cervix itself in relation to periods of fertility in a woman's
menstrual cycle.

Additionally, the cervix secretes fluid in relation to changes in hormones over the menstrual
cycle. The cervical fluid that is secreted can be observed for signs of fertility and infertility.

In this section the following topics will be covered:

• What does the cervix look like?

• What does cervical mucous look like?

• How does the cervix change over a woman's cycle?

• How does a woman check her cervix?

• How does a couple avoid or achieve pregnancy using cervical monitoring?

• What can influence cervical mucous?

• Where can a person find more pictures of cervices?

• When should a woman not check her cervix?

WHAT DOES THE CERVIX LOOK


FERTILITY AWARENESS PROJECT 49

LIKE?
The cervix is literally the area that separates the uterus and the vagina, and through its
opening or cervical os, sperm, babies, menstrual blood, infectious organisms, and
contraceptive devices can travel. It may come as a surprise to some women that the cervix
looks like a penis at the end of the vagina. Many women have not seen their own cervices, and
some may be curious to see what their individual cervix looks like or how their cervix changes
in relation to their cycle. Cervices can be very unique in their characteristics and will appear
different if a woman has had a baby vaginally (i.e., slit like) or has never given birth vaginally
(i.e., circular).
FERTILITY AWARENESS PROJECT 50

Normal Cervix with no


Vaginal Births
FERTILITY AWARENESS PROJECT 51

WHAT DOES CERVICAL MUCOUS


LOOK LIKE?
Women can often be mislead that all secretions found on underwear or on their toilet paper
are bad or unclean. While it is true that certain vaginal secretions especially those that are
green, yellowish, and/or foul smelling may indicate infection, most cervical mucous is natural
and is part of the body's fertility pattern. Cervical mucous changes over a woman's cycle. It can
appear in a variety of consistencies from creamy like lotion to snotty like egg whites.
FERTILITY AWARENESS PROJECT 52

HOW DOES THE CERVIX CHANGE


OVER A WOMAN'S CYCLE?
In response to the hormones estrogen and progesterone, the cervix changes in texture,
openness, and positioning. The mnemonic "SHOW" or "softness," "height," "opening," and
"wetness," can be used to remember the observations that can be made by using the cervix as
a marker of fertility. Additionally, "SHOW" can be used to remember what the cervix is like
FERTILITY AWARENESS PROJECT 53

during impending and peck ovulation as "soft," "high," "open," and "wet."

Impending &
Before
Cervix During After Ovulation
Ovulation
Ovulation
firm as tip of
soft as lips or firm as tip of nose or
[S]oftness nose or
tongue, mushy "medium"
"medium"
[H]eight low in vagina High in vagina low in vagina
closed, partly
[O]pening Open closed, partly open
open
egg white,
[W]etness dry stretchy, like sticky, creamy
snot

HOW DOES A WOMAN CHECK HER


CERVIX?
• Check the cervix every day at the same time after menstruation has ended.

• Wash hands before checking cervix.

• Make sure that nails are cleaned and trimmed.

• Squat and insert middle finger into the vagina.

• Feel for openness, firmness, position, and wetness.


FERTILITY AWARENESS PROJECT 54

1- MENSTRUATION 2 - HARD CERVIX 2 - SOFT CERVIX 2 - CERVIX


IS LOW & DRY 3 - CERVIX IS MOIST, IT'S MOVING UP 4 - CERVIX
IS HIGH & WET 5 - UTERUS 6 - CERVIX . O O - LEVEL OF CERVIX
OPENING
FERTILITY AWARENESS PROJECT 55

HOW DOES A COUPLE AVOID OR


ACHIEVE PREGNANCY USING
CERVICAL MONITORING?
Cervical monitoring, by assessing the changes in the cervix and the cervix's secretions, is best
used with Basal Body Temperature (BBT) monitoring. In combination, these signs of fertility
are called the Sympto-thermal Method. To prevent pregnancy, a couple would either choose
abstinence when the woman's cervix is observed as approaching/being soft, high, open, and
wet or choose to use a barrier method of birth control. Alternatively, for a couple who desire
to achieved pregnancy, sexual intercourse should be pursued when the cervix is observed as
approaching/being soft, high, open, and wet.

WHAT CAN INFLUENCE CERVICAL


MUCOUS?
There are many things that may influence cervical mucus such as:

• antihistamines

• cough syrup
FERTILITY AWARENESS PROJECT 56

• vaginal infections

• breastfeeding

• swimming in a chlorinated pool

• fertility medications like Clomid

• birth control medications

WHERE CAN A PERSON FIND MORE


PICTURES OF CERVICES?
Beautiful Cervix Project: Cycles of Cervical Change -shows images of entire menstrual cycles
including images of pregnant cervices.

Billings LIFE: The Behaviour of the Cervix over the Phases of the Ovulatory Cycle-shows
animation of the cervix as it changes throughout a cycle

The Garden of Fertility: The Cervix Pictures-shows images of different cervices

Women's Health Specialists of California: Vaginal and Cervical Self-Examination-shows images


of different cervices
FERTILITY AWARENESS PROJECT 57

WHEN SHOULD A WOMAN NOT


CHECK HER CERVIX?
A woman should not asses her cervix if she does not feel comfortable monitoring its changes, if
she has an active sexually transmitted disease (STD), or if she is unwilling to use other Fertility
Awareness Methods (FAM) in conjunction with cervical monitoring for pregnancy prevention.

RESOURCES
Hennell, E. (1992). The Billings Ovulation Method and breastfeeding. Breastfeeding Review,
2(6), 260-262. Retrieved from CINAHL Plus with Full Text database.

Pallone, S., & Bergus, G. (2009). Fertility awareness-based methods: another option for family
planning. Journal of the American Board of Family Medicine, 22(2), 147-157. Retrieved from
CINAHL Plus with Full Text database.
FERTILITY AWARENESS PROJECT 58

Appendix E

Ecological Breastfeeding

Breastfeeding has been known for hundreds of years to prevent pregnancy, and it is how mothers in
other underdeveloped countries space their children.

After reading you should be able to answer:

• How can breastfeeding keep me infertile?

• What are the seven standards of using breastfeeding as birth control?

• What are my chances of becoming pregnant while breastfeeding?

HOW CAN BREASTFEEDING KEEP ME


INFERTILE?
Breastfeeding prevents pregnancy by suppressing ovulation. The more frequently a mother nurses her
child, the less likely she will become pregnant. However, breastfeeding will not prevent all
FERTILITY AWARENESS PROJECT 59

2
pregnancies especially when a mother nurses less often and introduces food or formula into the baby's
diet.

WHAT ARE THE SEVEN STANDARDS


OF USING BREASTFEEDING AS BIRTH
CONTROL?
1. Breastfeed only for the first six months (i.e., no formula or rice)

2. Use your breasts to comfort your child

3. Do no use bottles or pacifiers

4. Keep your baby close to you when sleeping during the night

5. Keep your baby close to you when sleeping during the day

6. Nurse frequently

7. Do not separate yourself from your baby for long periods of time

WHAT ARE MY CHANCES OF


BECOMING PREGNANT WHILE
BREASTFEEDING?
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2
Women have a two percent chance of becoming pregnant in the first six months after giving birth if
they have not had a return of the menstrual periods and if they breastfeed almost or nearly full time
(Blincoe, 2005).

RESOURCES
Blincoe, A. (2005). The health benefits of breastfeeding for mothers. British Journal of Midwifery.
13(6), 398-401. Retrieved from CINAHL Plus with Full Text Database.

Hale R. (2007). Choices in contraception. British Journal of Midwifery, 15(5), 305. Retrieved from
CINAHL Plus with Full Text Database.

Too, S. (2003). Breastfeeding and contraception. British Journal of Midwifery, 11(2), 88-93. Retrieved
from CINAHL Plus with Full Text Database.
FERTILITY AWARENESS PROJECT 61

Appendix F

Ovulation Prediction Kits

Ovulation prediction kits or OPKs are tests that assess for the luteinizing hormone (LH) which is found
right before ovulation. Many tests come in the form of strips (like as the ones seen below) that are
similar to pregnancy tests. A woman urinates either directly on the end of the test strip or urinates in a
cup and then dips the test strip into the urine to find out whether ovulation is approaching. Ovulation
will most likely occur within 36 hours of a luteinizing hormone (LH) surge.

After reading you should be able to answer:

• How expensive are OPKs?


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2
• On what cycle day (CD) should I start testing?

• What time of day should I test?

• What does a negative OPK look like?

• What does a positive OPK look like?

• I always see two lines. Is this normal?

• How long will an OPK be positive for?

• Does having a positive OPK always mean that I will ovulate?

• What if I never see a positive OPK?

• When should we have intercourse?

HOW EXPENSIVE ARE OPKS?


OPKs can be fairly expensive. This is why other fertility awareness methods such as charting basal body
temperature (BBT) and monitoring cervical mucous and positioning should be tried before or in
conjunction with using OPKs preferably. OPK test strips can average between 11 USDs for 50 test strips
to buying a monitor such as the popular Clearblue Fertility Monitor for 150 USDs (not including test
strips).

ON WHAT CYCLE DAY (CD) SHOULD I


START TESTING?
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2
Use the chart below to determine on what day to begin testing. If you have variable cycles or very long
cycles, use your shortest cycle length over the past 6-12 months to determine which day you should
begin testing using OPKs.

Cycle Length Start Day


21 5
22 6
23 7
24 8
25 9
26 10
27 11
28 12
29 13
30 14
31 15
32 16
33 17
34 18
35 19
36 20
37 21
38 22
39 23
40 24
41 25
42 26
FERTILITY AWARENESS PROJECT 64

WHAT TIME OF DAY SHOULD I TEST?


Luteinizing hormone (LH) does not usually appear in the urine until about 2 PM. Testing at 2 PM or later
is recommended for this reason. This is contrary to pregnancy tests that encourage the use of first-
morning urine. The exception to this rule is using the Clearblue Fertility Monitor which suggests using
first morning urine since LH is not the only hormone assessed with the monitor.

WHAT DOES A NEGATIVE OPK LOOK


LIKE?
A negative OPK results in a test line (seen below on the left) that is fainter than the test line (seen
below on the right).

WHAT DOES A POSITIVE OPK LOOK


LIKE?
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2
A positive OPK results in the test line that is as dark or darker than the control line. You may notice
that your OPK results seem to "fade in" meaning that they get darker in the days leading up to the
surge. This does not always happen, and your OPK can be negative even two hours before a positive
OPK. Sometimes only half of the test line shows positive, and the results are usually considered
negative unless otherwise specified by the OPK manufacturer.

I ALWAYS SEE TWO LINES. IS THIS


NORMAL?
It is normal to always see two lines on an OPK. This is different from a pregnancy test where two lines
would indicate pregnancy. Two lines may be seen on an OPK during the entire menstrual cycle because
luteinizing hormone is almost always present, however if the test line is always as dark or darker than
the control line all of the time polycystic ovarian disease (PCOS) may be indicated.

HOW LONG WILL AN OPK BE POSITIVE


FOR?
FERTILITY AWARENESS PROJECT 66

2
An OPK can be positive for up to three days. If you notice your OPK to be positive all of the time, you
may have polycystic ovarian syndrome (PCOS) which will result in positive OPKs because of the
continual elevation in luteinizing hormone (LH).

DOES HAVING A POSITIVE OPK


ALWAYS MEAN THAT I WILL
OVULATE?
Having a positive OPK does not always mean that a woman will ovulate. Stress, illnesses, and traveling
can prevent the act of ovulation from occurring even though the luteinizing hormone is present. This is
another reason why other fertility awareness methods such as charting basal body temperatures (BBT)
and monitoring cervical mucous and positioning are important.

WHAT IF I NEVER SEE A POSITIVE


OPK?
This may indicate that no ovulation is occurring in the menstrual cycle. This may also indicate that
testing more than once during the day should be tried since some women have shortened luteinizing
hormone surges.
FERTILITY AWARENESS PROJECT 67

WHEN SHOULD WE HAVE


INTERCOURSE TO ACHIEVE
PREGNANCY?
Ovulation usually occurs within 36 hours of a luteinizing hormone surge. Try to have intercourse the
day of your positive OPK or LH surge and two to three days afterward. Having intercourse before your
positive OPK is also good, but you will not know that you are going to have your surge until after you
see your positive OPK.

RESOURCES
Hoyt, K., & Schmidt, M. (2004). Polycystic ovary (Stein-Leventhal) syndrome: etiology, complications,
and treament. Clinical Laboratory Science, 17(3), 155-163. Retrieved from CINAHL Plus Full Text
database.

Scolaro, K., Lloyd, K., & Helms, K. (2008). Devices for home evaluation of women's health concerns.
American Journal of health-System Pharmacy, 65(4), 299-314. Retrieved from CINAHL Plus with Full
Text database
FERTILITY AWARENESS PROJECT 68

2
Appendix G

Trying to Conceive While Breastfeeding

Trying to become pregnant while breastfeeding can be very difficult for some couples.

After reading you should be able to answer:

• What are the easiest ways to promote ovulation while nursing?

• Can every mother conceive while breastfeeding?

• Is it safe to breastfeed during pregnancy?

WHAT ARE THE EASIEST WAYS TO


PROMOTE OVULATION WHILE
NURSING?
1. Nursing less often

2. Sleep with the light on

CAN EVERY MOTHER CONCEIVE


WHILE BREASTFEEDING?
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2
Although rare, some women find it nearly impossible to conceive while breastfeeding and must make a
decision either to wait to try to conceive until their child weans or wean the child early.

IS IT SAFE TO BREASTFEED DURING


PREGNANCY?
There are many mothers who continue to breastfeed through pregnancy. After they have their infant
and continue to breastfeed their new baby and toddler, it is called tandem breastfeeding.

RESOURCES
Singer, Katie. (2006). Honoring our cycles: A natural family planning workbook. New Trends Publishing:
Winona
FERTILITY AWARENESS PROJECT 70

Appendix H

Links

There are many wonderful resources on the Internet about Fertility Awareness Methods and other
women's health topics. Please speculate more!
FERTILITY AWARENESS PROJECT 71

FERTILITY AWARENESS METHODS


Billings LIFE

Cycle Beads

Couple to Couple League

Fertility Friend-Trying to conceive online tools

The Garden of Fertility

CERVIX PICTURES
Beautiful Cervix Project: Cycles of Cervical Change -shows images of entire menstrual cycles including
images of pregnant cervices.

Billings LIFE: The Behaviour of the Cervix over the Phases of the Ovulatory Cycle

The Garden of Fertility: The Cervix Pictures

Women's Health Specialists of California: Vaginal and Cervical Self-Examination


FERTILITY AWARENESS PROJECT 72

MENSTRUATION
Divacup

Instead Soft Cup

Ladycup

Moon Cup

Museum of Menstruation and Women's Health-contains interesting information on the history of


menstruation

OVULATION KITS AND PREGNANCY


TESTS
Early-Pregnancy-Tests.com

PeeOnAStick-provides hilarious details on pregnancy tests and ovulation prediction kits

BREASTFEEDING
FERTILITY AWARENESS PROJECT 73

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Kellymom: Breastfeeding and Parenting-provides evidenced-based information on breastfeeding,
exclusively pumping, and relactation

La Leche League

CHILDBIRTH
Orgasmic Birth

The Business of Being Born

Appendix I

Educators

Fertility Awareness educators may be difficult to locate in certain areas, however many teachers may
be found among lactation consultants, herbalists, doulas, and midwives.

Billings Ovulation Method Association

Couple to Couple League

Becoming a Fertility Awareness Teacher


FERTILITY AWARENESS PROJECT 74

Appendix J
FERTILITY AWARENESS PROJECT 75

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About

ABOUT THE WEB SITE


The Web site, Speculative Speculum, was created for a senior nursing project on Fertility Awareness
Methods in the winter of 2010. Dreamweaver CS4 was used to create the Web site. Images come from
the public domain, personal photos taken and created using Photoshop CS4 by the author, Lunagirl, and
Fotolia.

ABOUT THE WRITER


Elizabeth Ping graduated in 2003 from paramedic school and in 2004 with her associate's degree in
nursing. She plans to attend nurse-midwifery school in the future. She has two children and is pregnant
with her third (visit personal blog). Other gyencological areas of interest include promoting research
for hyperemesis (severe nausea and vomiting in pregnancy) after having suffering with the illness with
each pregnancy. Please visit the HER Foundation for more information on hyperemesis and current
research projects.

A heartfelt thanks goes to everyone who has helped me over the past two years including my wonderful
husband, coworkers, schoolmates, friends, and family.
FERTILITY AWARENESS PROJECT 76

Appendix K

Contact

Do you have any questions, comments, or concerns about Speculative Speculum or would like to

contact the author of the Web site? Please E-mail the writer at: speculativespeculum@gmail.com
FERTILITY AWARENESS PROJECT 77

Appendix L

Legal Disclaimer

Speculative Speculum is written by a registered nurse for educational purposes only. Although, the
author attempts to provide evidence-based information about fertility awareness, the content of the
web site including text and graphics are not exhaustive in nature and do not replace the advice given
by your nurse-midwife or physician. Please contact the writer at speculuativespeculum@gmail.com if
you have any questions or concerns.
FERTILITY AWARENESS PROJECT 78

LIABILITY
Speculative Speculum is not responsible or liable for any loss, damage, or claim from using information
from this web site.

If you think that you have a medical emergency, please call your doctor or 911 immediately. Do not
rely on electronic communication on this web site for urgent medical needs.

Speculative Speculum is a Fertility Awareness web site that contains medically-related materials such
as images and descriptions that some may consider sexually explicit. Do not use this web site if you
find the materials presented offensive.

LINK DISCLAIMER
Speculative Speculum provides links to other web sites not associated with Speculative Speculum.
These links are provided for convenience only and does not mean that Speculative Speculum endorses
or controls information found on third-party Internet sites.

WEB SITE TERMS OF USE


Feel free to download and distributes handouts found on this site. Not all pictures are within the public
domain and may be subject to copyright.
FERTILITY AWARENESS PROJECT 79

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Appendix M

Demographic Survey Questions and Results

Total Started Survey: 18


Response Summary Total Completed Survey: 18 (100%)
Page: Default Section
1. Enter your four-digit number found on the back of the Fertility Awareness flyer.

answered question 16

skipped question 2

Response
Count

Hide replies 16
FERTILITY AWARENESS PROJECT 80

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1. Enter your four-digit number found on the back of the Fertility Awareness flyer.

25 responses per page

1. 1115

2. 8058

3. 9217

4. 8888

5. 7231

6. 4579

7. 1983

8. 2011

9. 1987

10. 7700

11. 8215

12. 6213

13. 1159

14. 5226

15. 2222

16. 9857
FERTILITY AWARENESS PROJECT 81

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2. What is your gender?

answered question 18

skipped question 0

Respons
Response
e
Count
Percent

Male 5.6% 1

Female 94.4% 17

3. What is your ethnicity?

answered question 18

skipped question 0

Respons
Response
e
Count
Percent

Caucasia
94.4% 17
n
FERTILITY AWARENESS PROJECT 82

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3. What is your ethnicity?

Black
0.0% 0
American

Hispanic 0.0% 0

Asian 5.6% 1

Other 0.0% 0

Choose
not to 0.0% 0
answer

4. What is your age?

answered question 18

skipped question 0

Respons
Response
e
Count
Percent
FERTILITY AWARENESS PROJECT 83

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4. What is your age?

18-
66.7% 12
30

31-
16.7% 3
40

41-
11.1% 2
50

50+ 5.6% 1

5. What is your occupation?

answered question 18

skipped question 0

Respons
Response
e
Count
Percent

Health
care 77.8% 14
worker
FERTILITY AWARENESS PROJECT 84

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5. What is your occupation?

Stay at
home 11.1% 2
parent

Student 0.0% 0

Other 11.1% 2

6. What is your educational level?

answered question 18

skipped question 0

Respons
Response
e
Count
Percent

High
5.6% 1
school

Some
5.6% 1
college

Associate's 38.9% 7
FERTILITY AWARENESS PROJECT 85

2
6. What is your educational level?

degree

Bachelor'
50.0% 9
s degree

Doctorate
0.0% 0
degree

7. What is your income level?

answered question 17

skipped question 1

Respons
Response
e
Count
Percent

0-20,000 0.0% 0

20,000-
29.4% 5
50,000
FERTILITY AWARENESS PROJECT 86

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7. What is your income level?

50,000-
52.9% 9
100,000

100,000+ 17.6% 3

8. What is your relationship status?

answered question 18

skipped question 0

Respons
Response
e
Count
Percent

Single 5.6% 1

Dating 5.6% 1

Engaged 16.7% 3

Living
0.0% 0
together
FERTILITY AWARENESS PROJECT 87

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8. What is your relationship status?

Married 72.2% 13

9. Have you ever heard of fertility awareness methods (FAM) before?

answered question 18

skipped question 0

Respons
Response
e
Count
Percent

Yes 38.9% 7

No 61.1% 11

Maybe 0.0% 0

10. Do you enjoy reading about health information over the Internet?

answered question 18
FERTILITY AWARENESS PROJECT 88

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10. Do you enjoy reading about health information over the Internet?

skipped question 0

Respons
Response
e
Count
Percent

Yes 83.3% 15

Sometime
11.1% 2
s

No 5.6% 1
FERTILITY AWARENESS PROJECT 89

Appendix N

Fertility Awareness Pretest

Before touring Speculative Speculum please take the Fertility Awareness Pre-test to
assess your knowledge of fertility awareness methods. After you are finished, please
take a look around Speculative Speculum and come back to take the Fertility
Awareness Post-test to see how much you have learned. Good luck!
Total Questions » 10
Top of Form
purplefungi 105231 fertility-aw arenes

Q.1) Which of the following can affect cervical mucous (CM)?


A. Cough Syrup
B. Breastfeeding
C. Birth Control Pills (BCPs)
D. All of the above

Q.2) Which of the following is incorrect about ovulation prediction kits (OPKs)?
A. A woman may receive a positive OPK for up to 36 hours
FERTILITY AWARENESS PROJECT 90

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B. The best time to test using an OPK is between 2-4 pm.
C. A positive OPK will always mean that ovulation has occurred.
D. A positive OPK will result in a test line that is at least as dark or dark than
the control line.

Q.3) Which of the following is incorrect about Fertility Awareness Methods (FAM)?
A. Protects against sexually transmitted diseases (STDs)
B. Requires careful observation of signs of fertility by the woman
C. Requires either abstinence or a barrier method of birth control (BC) if
pregnancy is not desirable when the woman is fertile or reaching fertility.
D. Is unforgiving to mistakes

Q.4) Benefits of Fertility Awareness Methods (FAM) include everything except:


A. Provides greater awareness of gynecological health
B. Provides a non-hormonal form of birth control (BC)
C. Is very expensive
D. May be an acceptable form of child spacing for those with religious
considerations

Q.5) Which of the following is not a fertility awareness method (FAM)?


A. Cervical Mucous Method (Billing's Method)
B. Rhythm Method
C. Basal body temperature method (BBT)
D. Sympto-thermal Method

Q.6) The cervix changes as a woman approaches ovulation to be:


FERTILITY AWARENESS PROJECT 91

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A. Low, firm, and closed
B. High, soft, and open
C. Mid-level, firm, and open
D. High, firm, and slit-like

Q.7) Fertile cervical mucous (CM) is:


A. Usually absent during times of ovulation
B. Green and smelly
C. Scant, creamy, and sticky
D. Stretchy, extending often an inch or more when stretched, and resembles
raw egg whites

Q.8) Fertility Awareness Methods (FAM) may be used:


A. As a health resource and as a means to understand one's body better
B. As a means to prevent pregnancy
C. As a means to achieve pregnancy
D. All of the above

Q.9) Before ovulation a woman's basal body temperature (BBT) is:


A. Cooler
B. Warmer
C. Fluctuates between warm and cool
D. Always remains constant

Q.10) This ovulation prediction strip indicates:


FERTILITY AWARENESS PROJECT 92

A. A faulty test strip


B. User Error
C. A positive OPK
D. A negative OPK
Appendix O

Fertility Awareness Post-test

Bottom of Form
Fertility Awareness Post-test

After touring the Speculative Speculum, please take the following quiz! Good luck!
Total Questions » 10
Top of Form
purplefungi 105231 fertility-aw arenes

Q.1) Which of the following can affect cervical mucous (CM)?


A. Cough Syrup
B. Breastfeeding
C. Birth Control Pills (BCPs)
D. All of the above

Q.2) Which of the following is incorrect about ovulation prediction kits (OPKs)?
A. A woman may receive a positive OPK for up to 36 hours
B. The best time to test using an OPK is between 2-4 pm.
C. A positive OPK will always mean that ovulation has occurred.
D.
A positive OPK will result in a test line that is at least as dark or dark than
FERTILITY AWARENESS PROJECT 93

2
the control line.

Q.3) Which of the following is incorrect about Fertility Awareness Methods (FAM)?
A. Protects against sexually transmitted diseases (STDs)
B. Requires careful observation of signs of fertility by the woman
C. Requires either abstinence or a barrier method of birth control (BC) if
pregnancy is not desirable when the woman is fertile or reaching fertility.
D. Is unforgiving to mistakes

Q.4) Benefits of Fertility Awareness Methods (FAM) include everything except:


A. Provides greater awareness of gynecological health
B. Provides a non-hormonal form of birth control (BC)
C. Is very expensive
D. May be an acceptable form of child spacing for those with religious
considerations

Q.5) Which of the following is not a fertility awareness method (FAM)?


A. Cervical Mucous Method (Billing's Method)
B. Rhythm Method
C. Basal body temperature method (BBT)
D. Sympto-thermal Method

Q.6) The cervix changes as a woman approaches ovulation to be:


A. Low, firm, and closed
B. High, soft, and open
C. Mid-level, firm, and open
FERTILITY AWARENESS PROJECT 94

2
D. High, firm, and slit-like

Q.7) Fertile cervical mucous (CM) is:


A. Usually absent during times of ovulation
B. Green and smelly
C. Scant, creamy, and sticky
D. Stretchy, extending often an inch or more when stretched, and resembles
raw egg whites

Q.8) Fertility Awareness Methods (FAM) may be used:


A. As a health resource and as a means to understand one's body better
B. As a means to prevent pregnancy
C. As a means to achieve pregnancy
D. All of the above

Q.9) Before ovulation a woman's basal body temperature (BBT) is:


A. Cooler
B. Warmer
C. Fluctuates between warm and cool
D. Always remains constant

Q.10) This ovulation prediction strip indicates:

A. A faulty test strip


B. User Error
FERTILITY AWARENESS PROJECT 95

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C. A positive OPK
D. A negative OPK
Bottom of Form
FERTILITY AWARENESS PROJECT 96

Appendix P

Pretest and Post-test Results

Participant Time Pretest Time Post-test


log-in Location Pretest Post-test Seconds Seconds
1115 unknown 40 90 107 46
8056 unknown 100 100 210 47
9271 Michigan 80 90 56 34
8888 Michigan 100 100 46 72
7231 Canada 100 100 52 66
4579 Michigan 70 100 50 37
1983 Michigan 50 100 77 38
2011 Michigan 70 90 63 53
1987 Michigan 70 100 69 43
0077 Michigan 90 80 195 139
8215 Michigan 70 100 121 143
6213 Michigan 40 100 209 107
1159 Michigan 40 100 229 189
FERTILITY AWARENESS PROJECT 97

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5226 Michigan 40 100 532 72
2222 Michigan 100 100 110 91
Averages 70.66666667 96.66666667 141.7333333 78.46666667

Appendix Q

Post-test Individual Question Results


FERTILITY AWARENESS PROJECT 98

Post-test Questions Right Wrong


Which of the following can affect cervical mucous (CM)? 100 0
Which of the following is incorrect about ovulation prediction kits? 88.24 11.76
Which of the following is incorrect about Fertility Awareness
Methods? 100 0
Benefits of Fertility Awareness Methods includes everything except: 94.12 5.88
Which of the following is not a Fertility Awareness Method (FAM)? 88.24 11.76
The cervix changes as a woman approaches ovulation to be: 100 0
Fertile cervical mucous (CM) is: 100 0
Fertility Awareness Methods (FAM) may be used: 100 0
Before ovulation a woman's body temperature (BBT) is: 88.24 11.76
This ovulation prediction strip indicates: 82.35 17.65

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