1. Olds’ Maternal-Newborn Nursing & Women’s Health Across the Lifespan, 8/e Michele Davidson, Marcia London, and Patricia Ladewig Copyright ©2008 by Pearson Education, Inc. Chapter 5 Women’s Health: Family Planning

2. Copyright ©2008 by Pearson Education, Inc. Overview of Family Planning 62 million U.S. women are of childbearing age 62% of these women practice contraception 50% of all pregnancies are unplanned Four out of 10 are terminated 52% of these women are under 25

3. Copyright ©2008 by Pearson Education, Inc. Benefits of Family Planning Improved health of women Lower rates of induced abortions Fewer unwanted pregnancies and births Improved socioeconomic status

4. Copyright ©2008 by Pearson Education, Inc. Choosing a Contraceptive Method Awareness of: –Advantages –Disadvantages –Side effects –Contraindications –Long-term effects

5. Copyright ©2008 by Pearson Education, Inc. Choosing a Contraceptive Method (cont’d) Choice is influenced by: –Cultural practices and religious beliefs –Personality –Cost and effectiveness –Availability –Misinformation –Practicality of method –Self-esteem

6. Copyright ©2008 by Pearson Education, Inc. Fertility Awareness- Based Methods Fertility awareness, combined methods: –Use of a barrier method during fertile days –Takes into account lifepan of sperm 2 to 7 days and –Lifespan of ovum 1 to 3 days Natural family planning: –Abstinence during fertile days

7. Copyright ©2008 by Pearson Education, Inc. Fertility Awareness Methods Basal body temperature method Ovulation method Calendar rhythm method Symptothermal method Standard days method Lactational amenorrhea

8. Copyright ©2008 by Pearson Education, Inc. Spermicides Nonoxynl-9 (N-9) available as: –Jelly, cream –Foam –Vaginal film –Suppository Works by destroying sperm by disrupting the cell membrane.

9. Copyright ©2008 by Pearson Education, Inc. Barrier Methods Male condom Female condom Diaphragm Cervical cap Vaginal sponge

10. Copyright ©2008 by Pearson Education, Inc. Female condom

11. Copyright ©2008 by Pearson Education, Inc. Dysmenorrhea Painful menstruation Occurs at the onset of menstruation Disappears by the end of menses

12. Copyright ©2008 by Pearson Education, Inc. Combined Oral Contraceptives (COC) Contain estrogen and progestin Methods of administration: –Day one start –Sunday start –Quick start

13. Copyright ©2008 by Pearson Education, Inc. COC Contraindications Previous history of thromboembolic disease Acute or chronic liver disease Presence of estrogen-dependent carcinomas Undiagnosed uterine bleeding Heavy smoking Gallbladder disease

14. Copyright ©2008 by Pearson Education, Inc. COC Contraindications (cont’d) Hypertension, diabetes Migraine with visual disturbances Hypercoagulable disorders Hyperlipidemia

15. Copyright ©2008 by Pearson Education, Inc. Side Effects of COC Due to Estrogen Alterations in lipid metabolism Breast tenderness Fluid retention, weight gain Headache and hypertension Nausea Thromboembolic complications Decreased breast milk production

16. Copyright ©2008 by Pearson Education, Inc. Side Effects of COC Due to Progestin Acne Breast tenderness Decreased libido Decreased high-density lipoprotein (HDL) Depression and fatigue Hirsutism, weight gain, an amenorrhea

17. Copyright ©2008 by Pearson Education, Inc. Noncontraceptive Benefits of COC Relief of menstrual symptoms and premenstrual syndrome Decreased incidence of functional ovarian cysts Reduction in the incidence of: –Ectopic pregnancy and pelvic inflammatory disease (PID) –Ovarian, endometrial, and colorectal cancer –Iron deficiency anemia and benign breast disease

18. Copyright ©2008 by Pearson Education, Inc. Other Hormonal Contraceptives Combination estrogen-progestin: –Transdermal –Vaginal ring –NuvaRing Progestin only: –Minipill –Long-acting injectable progestin –Depo-Provera

19. Copyright ©2008 by Pearson Education, Inc. Nuvaring Left in place for 21 days, then removed for 7 days Inserted monthly

20. Copyright ©2008 by Pearson Education, Inc. OrthoEvra Patch Used weekly for 3 weeks on one of four sites: abd, buttocks, upper outer arm or trunk.

21. Copyright ©2008 by Pearson Education, Inc. Minipill Progestin-only pills (also called mini-pills) are taken daily at the same time. Micronor If you are late taking a pill or if you miss a pill, a back-up form of birth control is needed for a week or more. Good choice for BF moms

22. Copyright ©2008 by Pearson Education, Inc. Depo An injection of progestin is given in the arm or buttocks. It works for up to three months, so four shots are needed each year. In some cases, a lower dose shot of progestin is also available. DMPA 150 mg

23. Copyright ©2008 by Pearson Education, Inc. Side Effects of Depo Irregular menses Amenorrhea ? Weight gain Screen for depression Bone compromise

24. Copyright ©2008 by Pearson Education, Inc. Implanon The implant is a thin plastic rod that releases progestin. It works for up to three years.

25. Copyright ©2008 by Pearson Education, Inc. EC Worried about pregnancy Contraceptive failure Unplanned intercourse Sexual assault

26. Copyright ©2008 by Pearson Education, Inc. Emergency Contraception Combined oral contraceptive: –May cause nausea and vomiting –72 hours of unprotected intercourse Progestin-only contraceptive (Plan B): –More effective than combined postcoital emergency contraception (EC) –72 hours of unprotected intercourse Intrauterine device (IUD): –Must be placed within five days of unprotected intercourse

27. Copyright ©2008 by Pearson Education, Inc. Intrauterine Devices Copper IUD (ParaGARD T380A): –Provides protection for 10 years Mirena Levonorgestrel Intrauterine System (LNG-IUS): –Provides protection for 5 years

28. Copyright ©2008 by Pearson Education, Inc. Advantages of IUD High rate of effectiveness Continuous contraceptive protection Noncoitus-related activity Relative inexpensiveness over time

29. Copyright ©2008 by Pearson Education, Inc. Possible Adverse Reactions Increased and intermenstrual bleeding Increased risk of pelvic infection Perforation of the uterus during insertion Dysmenorrhea Expulsion of the device

30. Copyright ©2008 by Pearson Education, Inc. Post-Placental IUDs Mirena (20mcg Levo) Approved in 12/2000 after 10 years of use in Europe Paraguard Copper 380A Post placental: within 10 minutes of delivery of placenta Before repair. 90% of women first year postpartum want to delay Pregnancy at least 2 years

31. Copyright ©2008 by Pearson Education, Inc. Post Placental IUD Safe for HIV+ women No effect on BFg Expulsion first 3 mts is 12% Late PP (48 hrs to 4 weeks) expulsion rate too high Immediate PP 10 minutes to 48 hrs: 25-37% expulsion At c/s before closing incision.

32. Copyright ©2008 by Pearson Education, Inc. Sterilization Operative: –Vasectomy –Tubal ligation Nonoperative: –EssureEssure

33. Copyright ©2008 by Pearson Education, Inc. Post procedure counseling Vasectomy: full contraceptive benefit not realized until 4-6 weeks and 6-36 ejaculations, need to clear sperm from vas deferns BTL: PP ideal time, uterus enlarged and tubes easy to find Essure: no incision; within 3 months microinserts create at tissue response that occludes fallopian tubes.

34. Copyright ©2008 by Pearson Education, Inc. Surgical Pregnancy Termination First trimester: –Safer than second trimester –Vacuum curettage Second trimester: –Dilatation and evacuation Nursing management: –Support –Education

35. Copyright ©2008 by Pearson Education, Inc. Medical Pregnancy Termination Mifepristone (RU-486)/misoprostol: –First 7 weeks of pregnancy –Mife blocks progesterone, alters enometrium and inhibits implantation. Miso causes contractions that expell fetus Methotrexate: –First 7 weeks of pregnancy, stops cell division –Not currently approved for this use in US –Given with miso

36. Copyright ©2008 by Pearson Education, Inc. Resources International Planned Parenthood Federation This site offers information on family planning methods and sexually transmitted diseases. Health policies affecting family planning worldwide are discussed.International Planned Parenthood Federation Family Health International The Family Health International (FHI) site reports on research and projects in the U.S. and more than 60 developing countries related to family planning. There are links to publications and a glossary of terms related to family planning. Information is also provided in French, Spanish, Russian, and Arabic.Family Health International

37. Copyright ©2008 by Pearson Education, Inc. Resources Birth Control Guide The Epigee site provides facts about methods of contraception control, including risks and benefits. Included is a birth control quiz.Birth Control Guide Emergency Contraception This site is operated by the Office of Population Research at Princeton University and by the Association of Reproductive Health Professionals. It provides information about emergency contraception derived from the medical literature.Emergency Contraception

38. Copyright ©2008 by Pearson Education, Inc. Resources Contraception Online Baylor College of Medicine offers this online educational resource for healthcare providers and health educators seeking the latest information on reproductive health, family planning, and contraception. The resources can be used for self-study or to educate others about reproduction and a range of contraceptive methods. It includes downloadable issues of the Contraception Report.Contraception Online