Natural Family Planning International

The last NFP conference I attended (2010) lasted several days.  My one disappointment, even surprise, was that none of the speakers mentioned the cervix sign, even when discussing the use of NFP during difficult times. Nor was the internal mucus exam mentioned.  See last week’s blog on the internal mucus sign.

As I mentioned last week, Dr. Edward Keefe at first taught the mucus sign at the vulva “but it was insufficient, inconstant, and lagged behind the true state of the ovaries according to my patients.  Most of them had been ‘rhythm-failures’ many times over and they demanded perfect results.”  So he began having his patients obtain the mucus with their fingers at the source, the cervix.  Soon his patients were describing changes in the cervix which they observed while doing the internal mucus exam.  That is, the women noticed that the cervix was higher and more open and softer when the mucus was most abundant and stretchy.

Dr. Keefe studied their observations for more than 10 years.  The women could not understand why the cervix sign was not given more publicity.  I feel the same way.  Why is the cervix sign ignored by many experts in the field of natural family planning?  The internal mucus exam, discussed in the previous blog, is likewise ignored by many in the NFP field.

John visited Dr. Edward Keefe twice at his home after the doctor retired, the last time just a few months before he died.  We are grateful for his work and interest in helping couples determine their fertile and infertile times.  In addition to his practical research on the cervix and the internal mucus exam, he developed the Ovulindex thermometer which was used by many couples practicing NFP.  It is no longer available, but I’m sure there are a few of us who still have one stored somewhere even though we no longer need it.  (Quotation from Coverline: “Recollections on Mucus Alone as a Fertility Sign” by Edward F. Keefe, M.D., Spring, 1975)

Both the internal mucus sign and the cervix sign are taught in the NFP International manual highlighted below.

Sheila Kippley
Natural Family Planning: The Complete Approach

Dr. Edward F. Keefe, who practiced oblstetrics and gynecology in New York City, was interested in improving “systematic abstinence as a means of family limitation.”  He was excited when he read a paper by A. F. Clift in 1945 “on the rheology of human cervical mucus.”  Rheology is the study of fluids and something women judge everyday when working with syrups, jellies and batters, etc.  This paper made him wonder if women could judge the fertile time by the mucus as was demonstrated in farm animals.

He gave a medical report to a hospital staff in 1950.  The staff listened politely but many doubted there was a fertile time in women at all!  He soon became convinced of the changes in the mucus sign as an important sign of fertility.  Thus he incorporated this sign in his thermometer instructions.  At first he taught observation of the mucus at the vulva, but his patients found this observation “insufficient” and “inconstant.”  He felt the “best mucus sample was needed and the place to find it was in the cervical canal, unaffected by passage through the vagina.”  He began to teach his patients the internal mucus exam—–getting the mucus at its source, the cervix.  He tried aspiration of the mucus through a tube but found the best exam was achieved with the use of the fingers.

Dr. Keefe was disappointed when Dr. Billings promoted only the mucus sign at the vulva and dropped the teaching of the temperature sign.  In Dr. Keefe’s words regarding Dr. Billings’ new book, “I would rather that mucus signs supplement the charting of temperatures, not replace them, as the book demands.  Moreover, just because mucus on the vulva is not a dependable sign, its shortcomings must not cause us to undervalue the changes in the cervical mucus and the cervix itself.”  Cervical mucus was meant to mean that mucus obtained at the cervix. (Quotations from Coverline: “Recollections on Mucus Alone as a Fertility Sign” by Edward F. Keefe, M.D., Spring, 1975. His work was first published in 1962, Bulletin of Sloane Hospital for Women, 8, 129.)

Next blog:  How Dr. Keefe learned the cervix sign from his patients!

Sheila Kippley
Natural Family Planning: The Complete Approach