Fertility ignorant - Please help me!

[anjsmama]

Brief background - DH (boyfriend then) and I got pregnant with DS the first time we were together. The. first. time. I was 18. 19 when DS was born. After he was born, the ONLY thing I knew/cared about was that I COULD NOT get pregnant again anytime soon. We were lucky to have jobs and a place to live and we were able to put together a decent life for a baby, but knew I couldn't do it with 2. So I got Mirena, with very little education. After we bought a house, got married, moved on in our careers, etc, we started trying for #2 .. DS was 18 months, I was 20. At this point, I still knew ZERO about my cycle.... I didn't have one from 18-19 and then it was barely existent with Mirena and I wasn't smart enough? to keep track.

SO when we started TTC Feb 2010, I had to get some basic knowledge. I know how many days my cycle is, and what mucus is like near ovulation, but that's about it. Lucky for us, it only took a few months and I found out DD was on her way May 2010 and she was born Jan 2011. Now, I'm exclusively breastfeeding and haven't had any return of menstruation.

NOW... DD is rapidly approaching that 6-month mark and I'm starting to panic a bit. I honestly haven't done a thing to prevent pregnancy thus far. But DD has sort of been nursing around the clock, so I haven't worried much. I don't even know HOW to know if my fertility is returning? I realize I should probably get some kind of birth control (or at least, a birth control plan) because we don't want another baby right now... 

In the last few years I have learned SO much - about my body, food, medicines, etc. At this point, I have NO desire to add anything hormonal to my life. Does anyone have positive experiences with non-hormonal birth control? And the idea of fertility awareness really intrigues me, but can  you count on it? And how do you learn how? And can you still do it when you don't have a period?

Btw... if these sound like questions for a HCP, I will just say I have had some of the world's most ignorant doctors, and I'm relatively certain I am more knowledgeable than several of them about several things... NOT being ridiculous; I am from the world's lowest rated medical area, seriously. We just moved to a new city and I barely know where the grocery store is, so I am w/o a doctor at the moment. 

Anything anyone can offer, or advice to point me in the right direction would be greatly appreciated! TIA!

[JMJ]

I would definitely recommend reading a book called "Taking Charge of Your Fertility" by Toni Weschler.  No matter what you decide, it is very empowering to have the knowledge of your fertility.  I would also recommend reading "Breastfeeding and Natural Child Spacing" and/or "The Seven Standards of Ecological Breastfeeding" by Sheila Kippley to understand more about breastfeeding and the return of fertility.

There are several options when it comes to charting the return of your fertility.  The effectiveness of charting has not been as well researched as a method of avoiding pregnancy as I would like, but about 6% of women will get pregnant before their first PPAF if they do nothing, so any charting that you do is likely to decrease that number further.

CM - You can chart CM.  I wouldn't worry too much about your fertility returning until you are having fertile CM.  You may be having it already.  I had almost none until 18 months postpartum.  Consider yourself potentially fertile until the 4th day of dry-up.  Note: most women have CM for a while before ovulating.  I went almost 3 months without a dry day.  There are ways of dealing with this if you can establish a Basic Infertile Pattern (2 weeks of the same exact mucus), but there is likely to be a lot of time to consider yourself potentially fertile.  Look into Creighton or Billings for more information.

Temping - I'm not sure whether or not to recommend this one to you or not.  It likely won't help you much and might really confuse you if you don't have experience with it.  It won't tell you that you are getting ready to ovulate.  If done correctly, it will tell you when you actually ovulate, but you may think that you ovulated several times just because when you are in breastfeeding amenorrhea, your temp jumps around a lot.

Calendar - Postpartum guidelines by Georgetown University recommend DTD no more often than every 10 days for about 97% effectiveness if you DTD every 10 days, effectiveness would increase if you wait an extra day or 2 every once in a while.

Marquette Method - If you're uncertain, I would really recommend this.  It uses the Clear Blue Fertility Monitor, and they have a specific breastfeeding protocol that you can look into.  They're still doing their research on the effectiveness, but preliminary studies are very, very promising.  This takes out a lot of the guesswork that goes along with trying to figure out fertility signs because it is so objective.  The only downsides are the cost of the monitor and test strips and the fact that the test strips are not reusable.  The protocol requires that you use a separate urine test strip at least every other day.

[jodi5]

JMJ gave you some great advice.  When I was postpartum this time, I used Marquette so I will give you my experience with that in case you want to consider it as an option.  I started fairly early postpartum and then took a break when I realized I had no cm to worry about yet and was not close to when my cycle had returned my previous 2 births.  When I was about 9 months postpartum, I started up again as my cycles had returned my first 2 times at 11 months postpartum so thought I should start to be more cautious.  It was also approaching when I would have to return to work.  Soon after that I started temping as well as I figured it would likely not be long before I started cycling and hoped to catch the shift.  This time round, my cycle arrived at 14 months postpartum.  The monitor that cycle did not give me a peak reading but did give me a high reading so kept me safe.  I had a temp shift 2 days later so was able to confirm that I had ovulated.  Since then I have had a peak reading each cycle with the monitor.    You do tend to go through a lot of test strips post partum where now that I am cycling, it is much less.  I got my monitor and test strips on ebay as they were much cheaper than in the stores.  Some people get their test strips from Amazon who has a program where you can subscribe.  Since I am not in the US, I don't qualify for that but sounds like a nice option. 

Good luck deciding what you want to do.  I highly recommend Taking Charge of Your Fertility recommended by JMJ.  There is a lot of good information in that book. 

[Jaimee]

Yep, another recommendation for Taking Charge of Your Fertility by Toni Weschler.  It taught me so much about my body that I never knew- it's very empowering.  I also second the recommendation for charting your cervical fluid.  As soon as you see return of creamy or eggwhite cervical fluid I would take precautions!  Abstain or use barrier methods.  I personally would also start to temp at that point to see if you could catch ovulation and know better what was happening with your fertility and see it changing as your cycles slowly regulate.  But if your CF dries up and you don't get any spotting or bleeding, I would stop temping until more fertile CF showed up.  This could go on for months.

I want to throw out a warning, though, that using charting to avoid pregnancy when you're not terribly familiar with it AND you're postpartum AND you're breastfeeding is not the safest.  I have had TWO oops pregnancies CTA postpartum.  I seem to be getting more fertile with each pregnancy!  There are conservative rules you can follow that should work, but if you really cannot have an oops pregnancy I would use even higher levels of caution than you might ordinarily (more abstaining, more use of barrier methods).  Lastly, this isn't my personal recommendation, but you could also look into and consider the Paraguard IUD, which is copper and non-hormonal.

Good luck and if you decide to start charting, please joining the Charting to Avoid Thread in this forum for more support!

[physics girl]

Taking Charge of Your Fertility is fabulous, and I'd recommend reading it whether you end up deciding to use charting to avoid or not. Many public libraries carry copies so you might be able to read it before deciding whether to buy a copy to use for reference. I'm pretty new to charting (currently working on getting the hang of it before I decide whether I'm comfortable using it for family planning), and I've found the ladies from the Charting to Avoid Thread incredibly helpful.

I've had positive experiences with non-hormonal birth control. My partner and I have been relying on condoms and spermicide since I went off of the pill over a year and a half ago, and I have no complaints, at least not since we switched to latex-free condoms, and no pregnancy scares. I recently got a Femcap to use as further back-up, but since those have higher failure rates in women who have children, a diaphragm might be a better choice for you.