1. Family Planning Involves choosing the time to have children.
It includes contraception(prevention of pregnancy) as well as method to achieve pregnancy
The nurse’s role in family planning is counselor and educator
To fulfill this role nurses need current and correct information about contraceptives methods
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2. Consideration when Choosing a Contraceptive Method
Safety
Protection from STDS
Effectiveness
Acceptability
Convenience
Education needed
Benefits
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3. Religious and Personal beliefs Culture Other consideration
Side effects
Effect on Spontaneity
Availability
Expense
Preference
Religious and Personal beliefs
Culture
Other consideration
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4. Methods of Contraception
1.Sterilization:
A. Tubal Sterilization (Tubal Ligation or Female Sterilization)
Fallopian tubes may be cut or occluded so that fertilization cannot occur
Procedure can be done during C/S or the first 48 hours after vaginal birth (fundus is located near umbilicus)
There are various surgical method for tubal ligation, in each method the surgeon blocks the tube with clips or rings, removes a piece of the tubes and ties the ends or use electrocoagulation to destroy a portion of the tube
Note: see B0x 10-1 for advantages and disadvantages.
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7. B.Vasectomy :(Male Sterilization)
-Making small puncture or incision in the scrotum & cutting, tying, removing a section , or cauterizing the vas deference which carries the sperm from the testes to the penis.
After vasectomy, sperm no longer pass into the semen
Performed under local anesthesia
After procedure , complete sterilization doesn't occur until there are no longer sperm in the semen which may takes a period of three months or more
specimens must be taken for analysis and the procedure is effective , if two specimens show no sperm present
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8. 2.Hormonal Contraceptives
A.Hormone Implant :
A single rod implant(Implanon) is now available
Inserted subcutaneously into upper inner arm
It is 2mm *4cm and release progestin continuously to provide protection for 3 years
It acts by inhibiting ovulation and thickening cervical mucus
Side effects:
Irregular menstrual bleeding
Amenorrhea
Advantages : safe during lactation and fertility returns promptly when implants is removed
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9. B.Hormone Injections
Depo-Provera (Medroxyprogesterone acetate or DMPA) is an injectable progestin
Prevent ovulation for 12 weeks.
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10. Advantages of hormone injections
convenient, free of estrogen, Can be used at any age if woman in a good health.
Can be used by breast feeding mothers.
Injection started 6 weeks after delivery
Return of Fertility in approximately months.
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11. Injection is best given within 5 days of menstrual period
Women who should not use hormonal contraceptive should not also use Depo Provera.
Given I.M deeply & site of injection should not be massaged (accelerate absorption & decrease period of effectiveness).
Injection is best given within 5 days of menstrual period
Women who use Depo-Provera injections should get adequate amounts of calcium and vitamin D and should increase weight bearing exercise
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12. Disadvantages of injections
Menstrual irregularities
Spotting and break through bleeding
Amenorrhea in 50%
Weight gain 4 pounds/year
Headach,depression.hair loss. decreased bone density with long term use
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13. 3.Oral Contraceptives (OCs) :
Combination Pills :Estrogen and progesterone combination
Action:
-Inhibit maturation of follicle due to the increased level of Estrogen & Progesterone.
-Movement of sperm is inhibited by the thick vaginal secretions & endometrium become less hospital for implantation.
-Available in packets of 21 or 28 tablets.
Available as monophasic and multiphasic doses
Monophasic : contain estrogen and progesterone contents that remain constant through out the cycle
Multiphasic , estrogen and progestin levels varies at different times through out cycle which help to reduce side effects
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14. *Advantage : Mini Pills (Progestin only):
*Action:
They are less effective in inhibiting ovulation but causes thickening of cervical mucus which helps prevent penetration by sperm & makes the endometrium lining un favorable for implantation.
*Advantage :
-These pills reduce the side effects associated with estrogen
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15. Benefits of oral contraceptives
Decreased premenstrual syndrome
Reduce acne
Improve bone density
Cycle control that make periods regular and minimal bleeding
Improve endometriosis, Dysmenorrhea, polycystic ovary syndrome and hisutism
Decrease incidence of benign breast disease, ovarian cysts, pelvic inflammatory disease salpingitis and ectopic pregnancy
Reduce ovarian and endometrial cancer
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16. Risk Factors Benefits ,Risks of Oral Contraceptives : See Box 10-2
1. Smoking
2. Hypertension
3. High cholesterol level
4. Obesity
5. DM
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17. Side effect of oral contraceptives
Nausea
Headache
Breast tenderness
Breakthrough bleeding
Weight gain
Fluid retension
Amenorrhea
Cholasma
Mood swings
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18. Cautions In Using Oral Contraceptives :See box in page 193
Warning Signs of Oral Contraceptives & Possible Complications: See box 10-2
Notes:
-Missing one tablet usually does not require use of another contraceptive method. The woman should take the pill as soon as remembered. Take the next dose at the usual time.
-A woman who misses more than one tablet should use another form of contraception to avoid pregnancy. Intervention will differ according to the time she missed these dose and the preparation she used
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19. Complications of OCs:
*See Box 10-2, page 193
Acronym ACHES may help the woman to remember warning signs that may indicate complications.
A: Abdominal pain(Severe)
C: Chest pain, dyspnea , hemoptysis
H: Severe headache, weakness, or numbness of extremities,hypertension
E: Eye problems (visual changes, blurred, double vision or loss), speech disturbance
S: Severe leg pain or swelling (calf or thigh).
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20. 3.Intrauterine Devices :
-Intrauterine devices are inserted into the uterus to provide continuous pregnancy prevention.
-IUD are considered very safe at this time.
Types:
1.Copper T(ParaGard)
2. Levonorgestrel System(Mirena)
-Often inserted at the 6-week postpartum check up & safe during lactation.
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21. Note: For advantages & disadvantages see box 10-1
-IUD causes a sterile inflammatory response resulting in a spermicidal intrauterine environment , they don’t cause abortion. Very few sperm reach the fallopian tube.
- ParaGard produces changes in the uterine and tubal fluids to impair sperm function, it remains effective for 10 years
Mirena contain progestin which causes thickening in cervical mucus preventing sperm penetration, inhibits sperm motility and prevent implantation, its action lasts 5 years
Note: For advantages & disadvantages see box 10-1
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24. Side effects for IUD :
-Cramping & bleeding with insertion.
-Menorrhagia & Dysmenorrhea are common reasons for removal (mostly occurs with copper IUD ).
-Vaginal spotting may occur during the early months but may be followed by less bleeding with periods or amenorrhea ( mostly occurs with Levonorgesterl system also called LNG-IUS Mirena ).
*Note :
Ibuprofen relieve cramping,& iron supplement for prevention of anemia.
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25. Complications of IUD : Expulsion of IUD. Perforation of uterus.
Ectopic pregnancy or spontaneous abortions.
Pelvic infection
*Note :
Nulli parous women, recent or recurrent pelvic infections , history of ectopic , bleeding disorders or abnormalities of the uterus should choose another contraceptive method.
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26. Teaching about IUD
-Teach women to check string or tail of IUD once a week during the first 4 weeks , then monthly after menses & if she has signs of expulsion.
- Report signs of infection such as unusual vaginal discharge, pain or itching, low pelvic pain & fever.
-Report signs of pregnancy.
-Advice woman to do Pap smear yearly , & check for anemia if menses are heavy.
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27. Barrier Methods :
1.Chemicals
2.Mechanical (devices)
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28. Foams , foaming tablets, suppositories, vaginal films are used alone.
1.Chemical Barriers :
Chemicals that kill sperm are called spermicides and come in many forms such as creams,gels which are generally used with mechanical barriers such as diaphragm or cervical cap.
Foams , foaming tablets, suppositories, vaginal films are used alone.
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29. Should be reapplied with repeated intercourse
They are inserted deep into vagina just before intercourse, vaginal suppositories and films must melt before they become effective which takes about 15 minutes
They are effective for less than one hour and as long as 8 hours depending in the type used
Should be reapplied with repeated intercourse
Woman should not douche for at least 6 hours after intercourse
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30. -readily available, inexpensive and easy to use
Note:
-Should be used with condoms to increase lubrication and decreasing the risk of condom breakage.
-Helpful during lactation or in menopausal woman when vaginal secretions are decreased.
-readily available, inexpensive and easy to use
Do not protect against STDS
-Frequent use or sensitivity to the products may cause genital irritation which increases susceptibility to infection.
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31. Mechanical Barrier
-Are devices placed over the penis or cervix to prevent sperm from entering the uterus.
*Types:
1.Condom(male & female)
2.Diaphragm
3.Cervical Cap
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32. Male condom:
-It is one of the most popular contraceptive methods in USA. It prevent sperm from entering the vagina.
People allergic to latex should not used avoid use of latex condom
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33. *Advantage of Condom: -Inexpensive -Protect from STD
-Readily available
-Inexpensive
-Protect from STD
-Can be carried inconspicuously by the man or the woman
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35. Natural Family Planning
-Also called fertility awareness, or periodic abstinence methods.
-Woman uses the physiologic cues to predict ovulation & avoid coitus when conditions are favorable for fertilization.
-Also can be used by the woman who wishes to become pregnant.
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36. Types of Natural Method of Family Planning
1.Calendar Method :
2.Basal Body Temperature
3.Cervical Mucus(ovulation or Billing's method)
4.Sympto thermal Method
5.Abstinence
6.Breast Feeding
7.Coitus Interrupts
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37. 1.Calendar Method:
-Based on the timing of ovulation ,approximately 14 days before the onset of menses.
-Tract length of the cycle for 6 months then substract 18 days from the shortest cycle and 11 days from the longest cycle to predict the time when fertilization is possible.
*Disadvantage :
Un reliable because many factors such as illness or stress can affect time of ovulation.
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38. 2.Basal Body Temperature:
-Woman charts her oral temperature each morning before getting out of bed.
-Temp. may drop slightly before ovulation and then rise approximately c with ovulation .Then temp. remains higher throughout the second half of the cycle.
-The woman is no longer fertile on the night of the third day after the rise in temp.
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39. 3. cervical method(ovulation or Billing,s method)
Cervical mucus method
Based on the changes in the cervical mucus
In the first few 3-4 days after menses there is no mucus
Then thick sticky mucus begins to appear
T the time of ovulation , mucus changes to clear , slippery and stretchy like egg white
After ovulation mucus decreases in amount and becomes thick and sticky again
To prevent pregnancy, couples must avoid coitus from time mucus is first present until the 4 days after the end of the slippery mucus
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40. 4.Symptothermal Method:
-Combines the calendar ,BBT,and cervical mucus method.
-It based on a group of symptoms that occurs near ovulation such as :
1.Weight gain
2.Abdominal bloating
3.Mittelschmerz(lower abdominal pain on ovulation)
4.Increased libido are noted
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41. *Least Reliable Methods of Family Planning :
5.Abstinence :
-Avoidance of sexual intercourse and any activity that may allow sperm to enter the vagina
*Least Reliable Methods of Family Planning :
1.Breast Feeding ; for 10 times in 24 hours without supplements may be effective for 6 months only
2.Coitus Interrupts ( withdrawal) is the removal of the penis from vagina before ejaculation
this method requires great control by the man
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