Insel10ebrup Ppt Ch06

Contraception and Abortion

Chapter 6

chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 2

Principles of Contraception

Based on the physiology of reproduction

Types: Barrier, Hormonal, Natural Methods, and Surgical

Factors affecting choice Advantages and disadvantages

Effectiveness


Oral contraceptives (OCs): “The Pill”

Estrogen and progesterone taken orally Mimics the hormonal activity of the

corpus luteum Most common is the combination pill Extended-cycle pill “Minipill” Advantages Disadvantages Effectiveness


Contraceptive Skin Patch

Thin 13/4 inch square patch Releases estrogen and progestin slowly

into the bloodstream. Prevention the same way as OCs Worn for one week, replaced on the same

day for 3 consecutive weeks. Fourth week no patch

Advantages Disadvantages Effectiveness


Vaginal Contraceptive Ring

The NuvaRing Resembles the rim of a diaphragm and is

molded with progestin and estrogen 2 inch ring slowly releases the hormones During fourth week, remove the ring and

use a new ring after the fourth week. Advantages Disadvantages Effectiveness


Contraceptive Implants

Norplant; Jadelle (Norplant II); Implanon (2006)Hormonal method6 flexible matchstick capsulesProtection for 5 yearsProgestin inhibits ovulationAdvantagesDisadvantagesEffectiveness


Injectable Contraceptive

Depo-Provera, Lunelle (2002 voluntary recall) Hormonal treatment Injectable progestin every 12 weeks Advantages Disadvantage Side effects

period will subside - ovaries will not release egg

It may take 12 months before cycle will return

Effectiveness


Emergency Contraceptive

Postcoital Pill, Morning After Pill, Plan B (OTC) Use a EPT kit Most common is the two dose regimen Prevents uterine implantation Needs to be taken within 72 hours. Best

used within 24 hours Intrauterine Device


Intrauterine Device (IUD)

T-380A (ParaGard) 10 years of protection Copper

Levonorgestral (Mirena) 5 years of protection Release small amounts of progestin

Not exactly sure how it prevents pregnancy

Advantages Disadvantages Effectiveness


Male Condoms

Thin latex sheaths Protection against STD’s Advantages Disadvantages Effectiveness

Use with spermicide


Female Condom

Reality Brand Polyurethane sheath with two

flexible rings Advantages Disadvantage Effectiveness


The Diaphragm with Spermicide

Dome shaped cup of thin rubber stretched over a collapsible metal ring.

Custom fit Following intercourse Advantages Disadvantages

Toxic shock syndrome (TSS) Effectiveness Lea’s Shield


Cervical Cap

Small rubber or plastic cap Must use foam kit Advantages Disadvantage


Vaginal Spermicide

How it works Advantages Disadvantages Effectiveness


Abstinence, Fertility Awareness, and Withdrawal

Abstinence Without intercourse or sexual activities Benefits: more self respect and respect

for others. Security that you are being pursued for sexual reasons. Less worry about STDs and Pregnancy.


The Fertility Awareness Method (FAM)

FAM Calendar method Temperature method Mucus method

Withdrawal Combining methods


The Fertility Awareness Method (FAM)


Male Sterilization: Vasectomy

Severing of the vasa deferentia May return to work in 2 days Semen tested in 12 weeks or 20

ejaculations Reversal varies between 80% to

50%, depending on the report. Complication rate Effectiveness


Female Sterilization

Tubal sterilization (laparoscopy) is most common

Essure system (2002) Sprng-like metallic implants causing

scarring blocking the Fallopian tubes Hysterectomy Surgical cases Complication rate Reversibility


Which Contraceptive Method is Right for You?

Appropriate method of birth control Individual health risks Implications of unplanned pregnancy Risks of STDs Convenience and comfort level Type of relationship Ease and Cost Religious or other philosophical beliefs


The Abortion Issue

The history of abortion in the U.S. Mid-1800’s: Prior to 20 weeks was legal 1900’s: Physicians joined with other

groups - stating untrained people were performing them. All states made abortion illegal


Current Legal Status

1973: Roe versus Wade Supreme Court ruled :

Pregnancy divided into 3 trimesters 1st trimester - up to women & doctor 2nd trimester - state may regulate 3rd trimester - state may regulate and bar all abortions

that are not life threatening to mother

U.S. Congress and federal Medicaid funds 17 states provide nonfederal public money Current issues

2000 Nebraska ban on partial birth 2006 Supreme Court reconsideration of Partial Birth

Abortion Ban Act


Moral Considerations

Pro-lifePro-life: The fertilized egg is a human being from the moment of conception and therefore an abortion is murder. Any women having sex knows pregnancy is

possible - she has a moral obligation Women unable or unwilling to raise the children

should consider placing him/her up for adoption Abortion has destructive effects on our traditional

morals and values


Moral Considerations Pro-Choice :Pro-Choice :There are distinct stages of fetal

development and that preserving the fetus early in pregnancy is not the ultimate moral concern. Women should have the right to make their own

decisions If not legal then unsafe and unregulated practices

would occur Women would be divided into those who could afford

and those who could not. Some physicians would be forced to break the law


Public Opinion

U.S. public opinion seems to change depending on the situation

Many approve legal abortion when health or welfare consequences could result

The issue in later pregnancy is when does the right of the fetus take precedence over the woman’s rights


Personal Considerations

Legal arguments Moral arguments Short and long term ramifications


Methods of Abortion Two categories

Surgical - 98% of all abortions Medical

Ends a pregnancy before birth takes place Miscarriage/Spontaneous abortion - embryo or fetus

dies in the uterus and is expelled by the body Ending a pregnancy voluntarily - induced abortion Approx. 88 % of all abortions are performed during the

first trimester Typically performed at a clinic, health center, or in a

doctors office. Women are usually able to return home an hour or so

later


Suction Curettage Vacuum aspiration Early abortion; about 6th to 12th week Used about 90% of all abortions Vagina is washes with antiseptic, Anesthetic is

injected into or near the cervix. Cervix is gently and gradually stretched over a 24

hour period. After dilation a tube connected to a suction machine

gently empties the uterus After suction a Curette (narrow metal loop) gently

scrapes the walls of the uterus After a few hours in recovery the woman can return

home


Manual Vacuum Aspiration

MVA Done within 4 or 5 weeks of last menstrual

cycle More effective and safer if performed at least 6

or 7 weeks Gentle suction of a syringe Cervix is dilated with meds. Uterus is emptied with a handheld syringe If a definitive gestational sac is not identified

then women is tested for possible ectopic pregnancy


Complications of Abortion Possible physical effects

Fever above 100º F. Abdominal pain or tenderness Swelling Backache Prolonged or Heavy bleeding Foul smelling vaginal discharge Vomiting Fainting Delay of 6 or more weeks in resuming menstruation


Possible Psychological Effects

Possible feels after having an abortion Guilt New strength in having made and carried out an

important decision Depression Sense of loss Negative feelings about sex Relationship may end Anger Bitterness

Contraception and Abortion

Chapter 6

Insel10ebrup Ppt Ch06

Business

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