Q&A: charting for birth control while nursing

Susan writes:

"I've got one for you.  Is there a way to chart or do any other kind ofnatural birth control while breastfeeding?  I really don't want to go back on hormones (swore them off after I went off of them last time), and we both hate condoms.  That leaves the diaphragm, but I tend to get UTIs so I'd really like to only have to use it during my fertile period.  This worked great before we got pregnant with our now-9 month old (which was planned).  I'd like to do it again.  We didn't do any sort of birth control before my period returned, 7 months after giving birth.  I'm now only breastfeeding about 5 times a day and none at night, so I know I can't rely on breastfeeding to prevent ovulation (as evidenced by the return of my period).  I tried charting, but it's now been 2 months and still no second period.  Is there any way I can predict when I may be fertile again?  Does temping work?  She's still awake a lot at night (not feeding) so I violate all kinds of temping rules even aside from the breastfeeding.  Are we doomed to a roll of the dice if I don't want to use the diaphragm every time?  We really like the spontaneity of not using anything, so suggestions of alternative forms of birth control are only of limited usefulness.  (We plan on having another baby eventually, so the old snip-snip isn't in the cards yet.)

Thanks for any advice you've got."

This is a tough one. I never came up with a good solution for it in the netherworld between having my period come back and having my cycle be regular again. And I was never able to find anything online or in any books about using NFP/FAM addressing this, either.

My feeling is that you're stuck with the usual suspects (condoms, diaphragm/foam/sponge/etc., or abstinence) if you're only going for the short-term until your cycle becomes regular again and you can temp. If you want to hold off on pregnancy for another year or more, you could look into getting an IUD put in. There are two on the market right now. Mirena has a hormonal compenent, and the copper IUD does not (so if you're off hormonal birth control, you'd want to go with the copper). You have to have it inserted and taken out by your provider, and it's kind of expensive, so it's better for longer-term birth control. If it sounds like something you'd be interested in, call your provider and ask about it.

Is there anyone out there who knows more about NFP/FAM than I do who can address the issue of knowing if you're fertile when your cycles aren't regular again?

(Those of you out there scratching your heads because you have no idea what we're talking about with "temping" and NFP/FAM and knowing when you're fertile, welcome to the wide world of learning your body's signals that tell you when you're ovulating and when you're not. If you know when you can get pregnant, you can act accordingly to prevent or initiate pregnancy. NFP stands for Natural Family Planning, which is the family planning method of choice for Roman Catholics*, and involves abstaining from sex during the woman's fertile times. FAM is Fertility Awareness Method and is the same thing, only it allows for using other forms of birth control [such as condoms] during the woman's fertile times. NFP/FAM works best for couples in committed relationships, obviously provides no protection against STDs, and takes a couple of months to ramp up into, during which you'll have to either abstain or use backup birth control methods to avoid pregancy.

To get started, check out the book Taking Charge of Your Fertility by Toni Weschler, M.P.H. or check out this site on FAM or this site on NFP.

* NFP is NOT "the rhythm method." The rhythm method involves assuming a woman is fertile on day 14 of her cycle and just abstaining right around then. NFP has you watch your own body's signals to figure out on any given day whether you're fertile or not, and acting accordingly. The rhythm method has a low rate of effectiveness, while NFP has a rate of between 80-99% effectiveness depending on  how strictly the couple sticks to the guidelines.)