1. Contraception and Abortion Chapter 6

2. 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

3. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 3 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

4. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 4 Contraceptive Skin Patch  Thin 1 3/4 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

5. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 5 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

6. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 6 Contraceptive Implants  Norplant; Jadelle (Norplant II); Implanon (2006) Hormonal method 6 flexible matchstick capsules Protection for 5 years Progestin inhibits ovulation Advantages Disadvantages Effectiveness

7. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 7 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

8. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 8 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

9. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 9 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

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11. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 11 Male Condoms  Thin latex sheaths  Protection against STD’s  Advantages  Disadvantages  Effectiveness Use with spermicide

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13. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 13 Female Condom  Reality Brand  Polyurethane sheath with two flexible rings  Advantages  Disadvantage  Effectiveness

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15. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 15 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

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17. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 17 Cervical Cap  Small rubber or plastic cap  Must use foam kit  Advantages  Disadvantage

18. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 18 Vaginal Spermicide  How it works  Advantages  Disadvantages  Effectiveness

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20. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 20 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.

21. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 21 The Fertility Awareness Method (FAM)  FAM Calendar method Temperature method Mucus method  Withdrawal  Combining methods

22. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 22 The Fertility Awareness Method (FAM)

23. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 23 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

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25. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 25 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

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27. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 27 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

28. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 28 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

29. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 29 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

30. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 30 Moral Considerations  Pro-life  Pro-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

31. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 31 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

32. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 32 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

33. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 33 Personal Considerations  Legal arguments  Moral arguments  Short and long term ramifications

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35. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 35 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

36. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 36 Suction Curettage  Vacuum aspiration  Early abortion; about 6 th to 12 th 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

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38. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 38 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

39. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 39 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

40. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 40 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

41. Contraception and Abortion Chapter 6