Women’s Health Family Planning and Contraception

1. Women’s HealthFamily Planning and Contraception Developed by D. Ann Currie , R.N., M.S.N.

2. 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

3. Decision to use a contraceptive • May be made by the individual man or woman or jointly as a couple

4. 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

5. 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

6. 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

7. 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,

8. 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

9. Assessment • For accurate and additional information • Identify actual or potential problems from the assessment. • Provide privacy for assessment and discussion about contraceptive methods

10. 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

11. Methods of Family Planning and Contraception • Mechanical methods- • Barrier methods- • Condoms- Male/Female • Diaphragm • Spermicides • Intrauterine device(IUD)

12. 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

13. Natural methods • Safe • Situational methods requiring increased self awareness • Self control • to be effective

14. 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

15. Female Reproductive Cycle

16. 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

17. 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

18. 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

19. 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

20. Cervical Mucus Assessment

21. Cervical Mucus Assessment-cont

22. 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

23. 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

24. Male Condom

25. Applying Male Condom

26. Female condom

27. 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

28. Diaphragm

29. Insertion of Diaphragm

30. 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

31. 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

32. 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

34. 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

35. 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

37. 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

38. 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

39. Tubal ligation • Surgical procedure done in hospital cuts, tied ,or cauterized the fallopian tubes preventing sperm from fertilizing ovum • 99.2-99.6% effective

40. OTHER