New Approaches to Fertility Awareness-Based Methods: Incorporating the Standard Days and TwoDay Methods into Practice


  • Elaine Germano CNM, DrPH,

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    • Elaine Germano, CNM, DrPH, FACNM, is the former Nurse-Midwifery Program Director at Georgetown University, and practices at Providence Hospital, Washington, DC.

  • Victoria Jennings PhD

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    • Victoria Jennings, PhD, is Director and Principal Investigator of the Institute for Reproductive Health, Georgetown University, and Professor in the Department of Obstetrics and Gynecology.

Georgetown University, Institute for Reproductive Health, 4301 Connecticut Avenue, NW, Suite 310, Washington, DC 20008. E-mail:;


Helping clients select and use appropriate family planning methods is a basic component of midwifery care. Many women prefer nonhormonal, nondevice methods, and may be interested in methods that involve understanding their natural fertility. Two new fertility awareness– based methods, the Standard Days Method and the TwoDay Method, meet the need for effective, easy-to-provide, easy-to-use approaches. The Standard Days Method is appropriate for women with most menstrual cycles between 26 and 32 days long. Women using this method are taught to avoid unprotected intercourse on potentially fertile days 8 through 19 of their cycles to prevent pregnancy. They use CycleBeads, a color-coded string of beads representing the menstrual cycle, to monitor their cycle days and cycle lengths. The Standard Days Method is more than 95% effective with correct use. The TwoDay Method is based on the presence or absence of cervical secretions to identify fertile days. To use this method, women are taught to note everyday whether they have secretions. If they had secretions on the current day or the previous day, they consider themselves fertile. The TwoDay Method is 96% effective with correct use. Both methods fit well into midwifery practice.