Women’s HealthFamily Planning and Contraception

Developed by D. Ann Currie , R.N., M.S.N.

Goal of Family Planning

To assist the clients with reproductive decision making, enabling the client to have control of the number of pregnancies, spacing the time between children, and to prevent pregnancy if desired

Decision to use a contraceptive

May be made by the individual man or woman or jointly as a couple

Legal Issues related to Family Planning and Contraception May vary from state to state concerning

minors,sterilization,and abortions. Informed consent-need to document

information provided and understanding of client -the nurse should use (BRAIDED)when counseling client on contraceptive methods

decision about contraception should be made voluntarily with informed consent

BRAIDED B- Benefits/Advantages R-Risks/Disadvantages A- Alternatives/Other methods available I-Inquiries/ Allow time for questions D-Decisions/opportunity to decide or

change mind E-Explanation/about method/how to use D-Documentation /everything taught

What to teach about each method What it is, How it is used , or How it works? advantages disadvantages effectiveness side effects risks contraindications long term effects

Assessment

Obtain a history to identify the client’s past and current health status and potential risks factors.

Sexual history Reproductive health Future plans for childbearing Psychosocial data- lifestyle, motivation,

religious beliefs,cultural influences,

Assessment Financial factors these factors may affect the

selection,access,and use of aparticular method

Don’t assume anything….ask. Knowledge of and concern about

contraceptive methods need to be determined to identify deficits and need

Assessment

For accurate and additional information

Identify actual or potential problems from the assessment.

Provide privacy for assessment and discussion about contraceptive methods

Methods of Family Planning or Contraception

Natural methods- abstinence Coitus interruptus -(withdrawal) Fertility awareness methods-

calendar method,basal body temperature (BBT), cervical mucus method, symptothermal method

Methods of Family Planning and Contraception

Mechanical methods- Barrier methods- Condoms- Male/Female Diaphragm Spermicides Intrauterine device(IUD)

Methods of Family Planning and Contraception

Chemical Methods- Oral Contraceptives(birth control pills) Subdermal implants(Norplant) Long-acting progestin injections Postcoital contraception Surgical Methods-Vasectomy Tubal ligation

Natural methods

Safe Situational methods requiring

increased self awareness Self control to be effective

Fertility Awareness Methods Based on an understanding of the

woman’s ovulation cycle and the timing of sexual intercourse

All methods attempt to identify the female fertility and to avoid unprotected intercourse during that time period

Free,safe,and acceptable to couple’s religious beliefs prohibit other methods

Female Reproductive Cycle

Cont. Increases awareness of the woman’s body encourages communication can be used to prevent or plan a

pregnancy Requires extensive counseling and

education interfere with sexual spontaneity difficult with irregular cycles no protection for STI’s

Calendar method Rhythm method 75-91 effective 6-8 months period shortest and longest cycles 18days from shortest cycle 11days from longest cycle avoid sex during fertile period

BBT Based on the thermal shift in the

menstrual cycle 75-97% effective drop prior to ovulation then raises .5-

1 degree F with ovulation Avoid intercourse when temperature

drops and for 3 days after. Factors which could effect BBT

Cervical mucus Ovulation or Billing’s Method Based on the cervical mucus changes

that occur during the menstrual cycle 75-97% effective Cervical mucus changes in response to

levels of estrogen and progesterone Assess for amount, color,consistency,

and viscosity

Cervical Mucus Assessment

Factors toassess

Infertile period Fertile period

Vaginalcharacteristic

dry Wet,moist

Cervicalmucus amount

scant profuse

color Cloudy,white-yellow

clear

Cervical Mucus Assessment-cont

viscosity none Strectchable,spinnbarkheitpresent,

Microscopicappearance

No ferning ferning

Dominanthormone

progesterone estrogen

Symptothermal Method

Incorporates the assessment of multiple indicators of ovulation-BBT, and cervical mucus,increased libido,abdominal bloating,mittelschmerz ,breast tenderness,pelvic tenderness,pelvic or vulvar fullness,softer cervix located higher in the vagina

75-97% effective

Mechanical Methods

Male condom-86-97 % effective water based lubricants proper technique to apply protection from pregnancy and Std’s Female condoms-79-95% effective Proper technique to apply no prescription is needed--OTC

Male Condom

Applying Male Condom

Female condom

Diaphragm 80-94% effective Dome- shaped appliance made of rubber

with flexible rim that fits over cervix used with spermicidal jelly or cream physician will assess for size reassessment after birth of baby or

weight loss or gain. Proper technique to apply

Diaphragm

Insertion of Diaphragm

Spermicides

Chemical barrier to prevent pregnancy by killing sperm or neutralizing vaginal secretions

74-94% effective creams,jelly,melting suppositories,

foaming tablets,foam,and films

Intrauterine device-IUD

A device placed in the uterus to prevent pregnancy

98.5-99.2 % effective Placed and removed by health

professional check for side effects

Oral Contraceptives-Birth control pills

Act by inhibiting the release of an ovum,blocking the cyclical release of gonadotropin-releasing hormones and changing cervical mucus

95099.5% effective combined oral contraceptives-

estrogen and progestin progestin-only pill-minipill

Subdermal implant(Norplant)

Consist of 6 silastic capsules containing levonorgestrel-progestin

98.5-99.5% effective placed and removed by health

care provider 5 years

Long-acting Progestin injection

Depo-Provera long-acting progestin that blocks lh

surge,suppresses ovulation and thickens cervical mucus

97.7% effective Repeat every 80-90 days

Postcoital contraception

Emergency method-not to be used on a frequent or regular basis

reduces pregnancy rates by 75-85% oral contraceptives-MAP (morning

after pill) insertion of IUD abortions

Vasectomy Male sterilization the vas deferens is resected through

small incision in the scrotum resulting in blockage of the passage of the sperm

Health care provider must do in clinic,office or hospital

sperm count to check for sterility 99.5%effective

Tubal ligation

Surgical procedure done in hospital cuts, tied ,or cauterized the fallopian tubes preventing sperm from fertilizing ovum

99.2-99.6% effective

OTHER