Family Planning

Contraceptives

• Nursing plays a primary role in providing education about contraceptive choices and teaching about the use of different methods

Contraceptives

• Educate about “safe sex” practices

• Be sure to F/U in 1 – 3 weeks on the effectiveness of the method chosen

The Ideal Method Should Be

• Safe

• 100% effective

• Free of SE

• Easily obtainable

• Affordable

• Acceptable to the user & sexual partner

• Free of effects on future pregnancies

Abstinence

• Compliance

• 0 % failure rate

• Most effective way to prevent STD

Oral Contraceptives “The Pill”

• Prevents ovulation; mimics the hormonal state of pregnancy– Increased estrogen--- Diminishes hypothalamic

effect on GrHR--- Inhibits the release of FSH / LH------NO OVULATION OCCURS

– Progestin• Affects cervical mucus & endometrial lining

Oral Contraceptives “The Pill”

• Monophasic– Provides fixed doses of both estrogen and

progestin throughout the 21 day cycle

• Triphasic– Vary both estrogen / progestin throughout the

cycle– Mimics woman’s natural hormonal pattern

Oral Contraceptives “The Pill”

• Side effects & contraindications– P. 107 Pillitteria– Absolute– Possible

• “ACHES” – Should call health care provider immediately

Oral Contraceptives Client Education

• A= Abdominal pain

• C= Chest pain

• H= Headache (severe)

• E= Eye problems (loss or blurring)

• S= Severe leg pain (calf or thigh)

Oral Contraceptives Client Education

• Missed pills

• Drugs (barbiturates, griseofulvin, isoniazide, penicillin, tetracycline decreases the effectiveness of the pill

• Avoid if BF’ing until milk supply is well established

• Discontinue if pregnancy occurs

Oral Contraceptives Client Education

• Adolescent girls should have well established menstrual periods (2 years) prior to starting the pill

• When to start pills– 1st Sunday after beginning period; after

childbirth Sunday 2 weeks post delivery; post Ab – 1st Sunday after procedure

Emergency Contraception

• “morning after pill”

• 75% effectiveness rate

• Combination estrogen/progestin

• Progestin only – < NV– 89% effective

Emergency Contraception

• Can be taken immediately and up to 72 hrs• Taken 2 doses; 2nd dose taken 12 hrs first• Major SE – Nausea

– Call health care provider if severe – may prescribe antiemetics

• Next period should begin within 2 – 3 weeks• START IMMEDIATELY WITH AN

ACCEPTABLE METHOD OF BIRTHCONTROL

Norplant Implants

• Long acting hormonal method

• 6 silastic membrane capsules filled with

35 mg progestin

Inserted upper arm

Last for 5 years

Norplant Implants

• Effective within 24 hours after insertion

• Mode of action: suppress ovulation, thicken cervical mucus, creates a thin atrophic endometrium, causes more rapid tubal transport of ovum

Norplant Implants

• Does not suppress lactation

• Side Effects– Menstrual irregularities– Amenorrhea after a few months– Abdominal pain– H/A– Hair growth / hair loss

Norplant Implants

• Contraindications– Liver Dz– Pregnancy– Unexplained vaginal bleeding– Breast CA– Hx thrombophlebitis

Depo- Provera (DMPA)

• Medroxyprogesterone Acetate

• Injectable progestin

• Mode of action: prevents ovulation, thickens cervical mucus

Depo- Provera (DMPA)

• Dose 150 mg single dose vial

• IM – Do Not massage (hastens absorption and shortens the period of effectiveness

• Given with 5 days of onset of period

• Within 5 days from delivery

Depo- Provera (DMPA)

• Contraception begins immediately and last for 3 months

• Instruct client to F/U for injection 2 weeks before 3 months is up

• Usually will not have period after 1 year of use

Depo- Provera (DMPA)

• Side effects and contraindications same as Norplant

• 99.7 percent effective

• ***May be used during lactation

• Women who plan to get pregnant within 6 – 9 months suggest another method

Intrauterine Device

• Progestasert & Paragard 380A• Device inserted into uterus• Mode of action

– Inhibits migration of sperm– Speeds ovum transport– Local inflammatory response in uterine cavity-

endotoxins are releases that destroys sperm– Cervical mucus

Intrauterine Device

• Side Effects– Increased Bleeding (anemia)– Dysmenorrhea– Pelvic Infections– Ectopic Pregnancy– Uterine perforation

Intrauterine Device

• Contraindications– Multiple sexual partners (risk for STD’s)– Active, recent, or chronic pelvic infection– Postpartum endometritis or septic abortion– Pregnancy– Endometrial or cervical malignancy– Valvular heart disease– Immunosuppression

Intrauterine Device – Client Education

• Palpating string – check before intercourse and after each period

• Inspect pads and tampons for an expelled IUD

• Advise alternate contraception 1st month after insertion

Intrauterine Device – Client Education

• Teach PAINS• P – period late, abnormal spotting or

bleeding• A – abdominal pain, pain with intercourse• I – infection exposure, abnormal vaginal

discharge• N – not feeling well, fever, chills• S – string missing, shorter or longer

Intrauterine Device – Client Education

• Advise to wait 3 months after removal before becoming pregnant – this reduces the risk of ectopic pregnancy

• Annual F/U

Diaphragm

• Mechanical Barrier to entry of sperm into the cervix

• Used with a spermicide cream or jelly provides additional protection

Diaphragm

• Safe

• Flexibility according to frequency of intercourse

• Used with spermicide protects against STD

Diaphragm

• Complications– Toxic Shock Syndrome– Pg 1442 – 1443 Pillitteri

Diaphragm

• Contraindications– Hx of TSS– Allergy to latex or spermicide– Recurrent UTI– Inability to learn insertion technique (mentally

or physically challenged)– Abnormalities of vaginal anatomy that prevents

a good fit or stable placement – uterine prolapse, extreme retroversion

Diaphragm – Client Education

• S/S TSS

• Annual visits

• Needs to be refitted after significant weight gain > 10 lbs, pelvic surgery, full term delivery (after pregnancy should wait about 12 weeks PP before using the diaphragm)

Diaphragm – Client Education

• May be left in place up to 12 – 24 hrs

• Must be left in place 6 hrs after intercourse

• May be inserted up to 2 hrs before intercourse

• Must be fitted by MD or NP

Cervical Cap

• Barrier method; soft rubber dome with a flexible rim

• Shaped like a thimble

• Filled with spermicide

• Inserted prior to intercourse & should be left in place at least 8 hours

• Should not be worn longer than 24 hours

Cervical Cap

• Complications– Cervical trauma

• Client should have F/U 3 months then annually

• Contraindications – p. 114

Cervical Cap – Client Education

• Practice insertion & removal• Cap should not be worn during periods• Cleaning – mild soap & water• Check for tears• Do not use petroleum products• Schedule RTC 3 months • Should be refitted after delivery, gyn surgery,

significant weight gain / loss

Male Condom

• Covers penis acts as a mechanical barrier to prevent sperm from entering the vagina

• Protects against STD’s

• Inexpensive & available without a prescription

Male Condom

• Contraindications– Allergy to latex or collagenous tissue– Inability to maintain erections– Inability to use properly

Male Condom – Client Education

• Application and removal – put on before vaginal penetration; leave space in tip

• Should not be lubricated with petroleum

• Store in cool dry place (not wallet)

• To maximize protection against STD’s use with spermicide

Female Condom

• Vaginal Pouch

• Flexible ring that fits over cervix

• Provides some protection against STD’s

• May be inserted up to 8 hours before intercourse

• Expensive

• One time use

Vaginal Spermicides

• Creates a physical barrier and also kills sperm secondary to a chemical action

• Safe & Simple

• Preps include: jellies, creams, foam, suppositories, tablets, thin square film

Vaginal Spermicides

• Inserted into the vagina about 5 – 10 minutes before intercourse; usually are effective for 2 hours

• Tablets and suppositories take longer to dissolve – insert 10 – 30 minutes prior to intercourse

Vaginal Spermicides

• Available without a prescription

• Protects against STD’s

Vaginal Spermicides

• Contraindications– Allergy to spermicidal– Inability to use consistently at the time of

intercourse– Physical / mental delays– Cervicitis

Vaginal Spermicides – Client Education

• Consistent use

• Times of insertion

• Good contraceptive to use during the immediate PP period

• Need to add more if intercourse is repeated

Breast Feeding

• Prolongs anovulation for a certain period of time, but is not always effective and ovulation may return before menstruation reoccurs and PREGNANCY may result

• Not an absolutely reliable method

Fertility Awareness Methods

• Rely on ovulation prediction by the couple

• Important points– Ovulation occurs 14 days before the beginning

of the next menses– Ovum can be fertilized for 24 hours; sperm are

viable for 72 hrs– Regular cycles can vary by +/- 2 days

Fertility Awareness Methods

• Important points– Period of abstinence must be at least 8 days due

to variability of menstrual cycles– *Risk of fertility is often 15 or more days, or

about half the cycle

Fertility Awareness Methods

• Calendar Method

• Basal Body Temperature Method

• Cervical Mucus

• Symptothermal Method

• Ovulation Predictor Test

Withdrawal – Coitus Interruptus

• Male ejaculates outside vagina

• Sperm are contained in pre-ejaculatory fluids

• Interfere with sexual satisfaction of both partners

• **LEAST reliable method of contraception