THE EFFECTS OF ARTIFICIAL BIRTH CONTROL PRACTICED BY MOTHERS AGES 25-35 AT PUROK ADELFA, BARANGAY 38, BACOLOD CITY,

NEGROS OCCIDENTAL DURING THE YEAR 20042005

A Thesis Proposal submitted in partial fulfilment for the Requirements in

Nursing Research 109

Submitted by: Rodolfo Efondo RS 00

Submitted to: Mrs. M. D. Diaz

I Chapter 1 Introduction Statement of the problem Objectives General Assumptions Hypothesis Scope of the Study Significance of the Study Limitation of the study Definition of terms

3 3 4 4 4 5 5 5 6 6

II Chapter 2 Review of Related Literature Related Studies

8 8 8

III Chapter 3 Methodology Research design Responds of the study Sample technique Data Gathering Instruments Validity of the Data Gathering Instrument Reliability of the Data Gathering Instrument Procedure for the Analysis & Interpretation of the Data References/Bibliography

18 18 18 18 18 19 19 19 20 21

Chapter I

Introduction All readers agree that none of them planned their own birth. Death will take us, usually, also in an unplanned sort of way unplanned event such as meeting the person we will love & live with, even our own fortune & fate, as opposed to mechanical, as long as they are free & spontaneous to a certain extent. Birth, in the old days was totally unplanned, & today, the timing of the event generally due to circumstances beyond our control. We are pushed to & fro on the sea of life, often not knowing if there is going to be a wave higher than the one we are on, or a valley deeper that the one is which we find ourselves. Unplanned events such as birth, caused tremendous effect worldwide. Problems on overpopulation causes food scarcity, sanitation problems, poverty, prostitution, child labor, health problems, & other consequences underlie this cause. Scientist, doctors, diplomats, & government agencies come up to a consensus to eradicate or eliminate population explosion. Various campaign programs, technique, & methods were implemented in addressing these global problems. Artificial Birth Control has come into existence, an easy way to stop life. Such method has various classifications: Mechanical, Chemical, Hormonal, Abortifacients, Immunological, & natural. This Birth Control Methods deter progression of life. Some are over the counter, some needs practitioner. This is prevalent among Students & teenagers with unwanted pregnancies But this Government induced birth control was not in all sense good & beneficial. This move was criticized by various pro life advocates & naturalist. The Church it self strongly condemned this. Anti-life act answers population explosion. They foresee the potential hazardous effects among its client. This is one reason why artificial birth control was not in progress especially here is the Philippines. Having the full knowledge of its hazardous & adverse effects and its preventive measures, it is therefore the duty & responsibility of every citizens to take careful steps for a much better & extra healthier life. Everyone must prepare for the unplanned steps and decisions which maybe detrimental.

Statement of the Problem This study aims to determine the extent effects of artificial birth control practiced by Mothers aged 25-35 at Purok Adelfa, Brgy.38, Bacolod City, Negros Occidental. Specifically, it attempts to answer the following questions: 1. To what extent Artificial Birth Control affects the size of the site? 2. What are the after effects experienced by most mothers practicing birth control? 3. Is there a significant difference in birth control practiced by mothers based on economic status? 4. What are the recent perspectives of mothers towards the practice of artificial birth control? 5. Is there a significant relationship in artificial birth control between practicing and nonpracticing mothers as to their health?

Objectives of the Study This study set objectives mainly to show the pros and cons of adopting the methods of artificial birth control. It also aims to update its impact to mothers who adapted it and to reveal the real experiences of those who practice such methods. This study will be conducted to know if the government is consistent in pursuing their program of controlling population growth despite of potential dangers.

General Assumptions 1. That the respondents answer the questionnaires honestly. 2. That the mothers are very cooperative. 3. That the interviewee responds frankly and convincingly 4. That the subjects of the study all belong to mothers with either high or low-level of educational attainment. 5. That the attitudes of the group of respondents are stable.

Hypotheses (1) There is no significant difference in birth control as to the size of the family. (2) There is no significant difference in birth control practiced by mothers based on economic status. (3) There is no significant relationship in artificial birth control between practicing and non- practicing mothers as to their health. (4) There is no significant difference in the after-effects experienced by mothers practicing birth control. (5) There is no significant relationship as to the perspective of mothers towards the practice of birth control.

Scope of the Study This study covers only to the mothers aged 25-35 who previously and presently are adapting the Artificial Birth Control Method. It covers only the resident of Prk. Adelfa, Brgy. 38, Bacolod City, Negros Occidental. It mainly focuses on their opinions about the different artificial birth control, their testimonies on the effects they have experienced, and the effects to their personal health.

Significance of the Study This study tries to establish a feeling of awareness among the resident of Prk.. Adelfa, Brgy. 38, Bacolod City, Negros Occidental. For them to be aware of the various potential side effects of using the artificial birth control and for them to have additional knowledge in the field of both Science and Medicine particularly on adapting Artificial Birth Control Method. For them to know that misuse or improper usage of these suggested methods would lead to problems. They must be properly advised, informed, and educate. To the Government Officials and Authorities. It is important to them to review the program with the elements of some moral principles upon its imposition. And to find alternatives because of its dangers and adverse effects based on actual experiences, testimonies, and some related evidences that prove its effectiveness and hazards.

To the Researchers, for them to find better ways of understanding their research and to whom the study is significant, and in order for them to have knowledge on how hard it is to make a research equipped of complete information to come up with better study; a one way of enhancing skills on investigation, fact-finding, survey and other related activities.

Limitation of the study Conducting this study limits only 20-30 respondents in Prk. Adelfa of Brgy. 38, Bacolod City due to insufficient funds and time constraints. This limits only to the side effects of Artificial Birth Control based on the testimonies of the mothers using the said methods.

Definition of Terms The following are the terms used in this research work, briefly defined for better comprehension: BIRTH CONTROL -- Control of number and frequency of children born, specifically through the control of conception. In this study, it means the various/different kinds of methods used by mothers whose family desires a few member of children. CONCEPTION -- the beginning of some process, chain of events, etc. in this study, it is used as becoming pregnant and the cause to life. The union of sperm cell and fertilized ovum. CONTRACEPTION -- an intentional prevention of fertilization of ovum, as by special device, drugs, methods, etc. CONTRACEPTIVE -- any devise or agent used for contraception or as a means of controlling birth or pregnancy. ABORTION -- Spontaneous or induced expulsion of an embryo or fetus before it is sufficiently developed to survive in this study, it is used as any deliberate procedure that removes fetus so as to end pregnancy. Commonly known as induced abortion. ARTIFICIAL BIRTH CONTROL -- an unnatural means of controlling family size or ending of unwanted pregnancy. In this study, it is used as any method used by mothers to control the age gap of their children. ABORTIFACIENT -- drugs or agents that causes abortion.

CONDOM -- a thin, protective sheath for the penis, generally of rubber, used to prevent venereal infections. In this study , it is used as a contraceptive. DIAPRAGHM -- a latex rubber inserted in the vagina as contraceptive. TUBAL LIGATION -- a surgical method of cutting and tying of both fallopian tubes to avoid pregnancy. VASECTOMY -- the surgical removal or tying of vas deferens to prevent the passing of sperm . in this study, it is used as a form of birth control. HYSTERECTOMY -- surgical removal of the uterus. SPERMICIDES --- substances, agents, drugs, that kills spermatozoa. INTRAUTERINE DEVICE (IUD) -- any of various devices, as a coil or a loop of plastic, inserted in the uterus as contraceptive. DIETHYLSBESTROL (DES) -- a synthetic estrogen used as a substitute for natural estrogen. In this study, it is used as a contraceptive for it prevent ovulation and the fetus in the uterus will be destroyed. PROSTAGLANDIN -- any of the groups of hormone like fatty acid found throughout the body, especially in the semen that affects blood pressure, metabolism, body temperature, and other important body processes. In this study, it refers to the contraceptive method cause violent contraction of the uterus and pushes out what is in it and subsequently dies. PILL -- a small ball- like, tablet, capsule, etc., of medicine to be taken whole; something like pill in shape. In this study, the term in used as any contraceptive drug for women taken in a form of a pill. IMPLANT -- to insert a substance, organ, or a piece of living tissue within the body. In this study, it refers to the hormonal contraceptive is a form of capsule sex- rubber rods and are surgically implanted under the skin. MENSTRUAL EXTRACTION --the simplest type of abortion. The menstrual flow is suctioned with the use of a syringe or vacuum. DILATATION & CURETTAGE (D & E) ---method of abortion by scraping the uterus clean with curette removing the zygote and trophoblast cell. DILATION & EXTRACTION (D & E) --- an abortive procedure through insertion of the suction plump tip, suctioning the uterus gently, evacuating the uterine content to the vacuum container.

CHAPTER 2

Review of Related Literature This portion of the research gives a review of different related literatures and studies, the researchers were able to gather and read from a variety of sources. These piece of literature are in the form of concepts or ideas expressed by the people considered authorities in the field conducted by other researchers along the same field. Nevertheless, they give the reader same insights into the phenomenon under consideration. Pope John Paul II once viewed mans life as Human life is precious because it is the gift of GOD whos love is infinite, and when GOD gives life, it is forever. Life is also precious because it is the expression and the fruit of love. This is why life should spring up within the setting of marriage, and why marriage and parents love for one another should be marked by generosity in self-giving. 1

Related Studies The term BIRTH CONTROL has come to be accepted by many. Only a few realize its origin. It seems to have been proposed by Margaret Sanger. She, with others, was trying to come up with a word that means the limitation of population without sounding too insulting. She explains, We tried population control, rate control and birth rate control. Then someone suggested we drop the rate. And Birth Control has become the answer.2 As we see from the very beginning the basic idea was not to enhance proposal freedom but to control the number of people in the world, to control the number of certain races of people in the world. At contraception, a new human being is created. New because no matter how many billions and trillions of people has come into this world, no two are exactly alike-except those identical twins, though still with further differences. It is also considered human because of the 46 chromosomes that he possesses. For if we have lesser chromosomes, for example, just eight, then, youd probably a fly.
1 2

Pope John Paul II, Sanctity of Life and Love, (Washington, USA, October 7, 1979) p.6 J.C. Espinosa, M.D., Why are they lying to woman? Birth Control (Manila Cachottermanos, INC, copyright 1999) p.5

Conception occurs when the male element (sperm) meets the ovum inside the fallopian tube of the mother. From 23 chromosomes contributed by each of these cells, we now have a unique 46-chromosomal individual who has never existed before and will not be created again in that uniqueness. At that moment, all physical Characteristics are determined. Whether male or female, will be tall or short, or will develop either diabetes or a heart disease. 3 Contraception is the prevention of that Union between a sperm and an ovum which may result from having sex. Birth control may also mean to some as with that, even a fetus was already developed, its birth can Still be prevented by the aid of some methods. They go so far as to include abortion as a method of contraception. Contraceptive Philosophy The philosophy of contraception views pregnancy as something to be avoided at all costsas a disease, almost. The referred pregnancy as the common venereal disease, since it is a result of a sexual contact. The contraceptive philosophy has its main goal-to stop humanity at the vaginal gate. The pubic arch, considered by French anatomists as the arch under which all humanity possess.4 It is now called as the arch of triumph if one passes alive. In the contraceptive philosophy, the worst thing that can happen is to become pregnant. No longer is pregnancy is viewed as the good, which it actually should be. Pessimists, who can only see evil, think that people are bad and that the best thing to do is to prevent people. Others see people as polluters. The contraceptive philosophy shows a total lack of faith in God and man. Man cannot take care of the problems that may give arise from people and God has created too many people.5 Thus, they resort to the use of contraceptives. And modern form of contraception often work by causing abortion. Contraception therefore, does not prevent abortion, rather, it is the other way around.

3 Ibid., p.30 4 N.M. Clatworthy, Study Faults Premarital Cohabitation, Study Family Planning, (New York; Parents Magazines Press, 2001) p.187

Methods of Birth Control The efficiency of any method will vary not only according to the method itself; but the motivation of the user is also important. Classification of Methods Birth control methods are classified according to their usage, such as mechanical, chemical, hormonal, abortifacients, immunological, and natural. Natural methods here are not discussed since we are only dealing with the artificial Birth control and its methods. 1. Mechanical Methods/Barriers Methods (a.) WITHDRAWAL It is commonly described as the ejaculation of sperm taking place outside the vagina. It fails to prevent pregnancy most of the time according to the some studies. One reason that it is unreliable is that there may be sperm contained in the liquid that lubricates the male urethra during sexual termination prior to ejaculation. This liquid can carry enough sperm to permit conception to take place even though ejaculation later occurs outside the vagina. (b.) The Condom Here, the sperm is deposited inside the sheath of latex rubber and there is prevented from entering the vagina. This is worn over the erect penis during sexual intercourse. (c.) The Diaphragm This is also a latex rubber membrane that is placed in the vagina to close the opening cervix to prevent the entrance of the sperm. It is usually used with spermicidal jelly or cream applied to the side of the dome facing the cervix.

5 Sex-Talk with Kids and Teens, Ed Marlon, C. Ramirez. (MANILA: ECFL-CBCP and HLT-ASIA, 2000) P.340

(d.) The Tubal Ligation This is the cutting and lying of both fallopian tubes. It works by interrupting the passage of the ovum toward the uterus. Thus, the sperm cannot reach the ovum for fertilization. (e.) Vasectomy This implies the cutting off of the segment of the tube inside which the sperm must travel from the testicle to the seminal vesicles and from there to the outside. (f.) Hysterectomy This entails the removal of uterus. It is sometimes used as a method for inducing sterility. 2. Chemical Methods Popularly known as spermicides. Substances that kills the sperm are utilized so that the sperm cannot travel to the tube and fertilize the ovum. Example of this are: jellies, creams, foaming tablets, douches, aerosol foams, and suppositories. These substances are sometimes used in conjunction with diaphragms or condoms. 3. Hormonal Methods Hormonal methods includes birth control pills, mini pills, sequentials, injections, and implants. There are several types of birth control pills. The combined pills which contain two female hormones, estrogen and progestin, and the mini pill which contain progestin only and is taken continuously. Those are most prevalent. There are also contraceptive injections. Depo- Provers (medoxyprogesterone acetate) otherwise know as couples choice is injected every three to six months. 6 Implants, the long- lasting hormonal contraceptives can be administered in several ways. These are tow kinds: Norplant and Norplant 2. it is a series of sex rubber rods or capsules and are surgically implanted under the skin in the inside portion of a woman upper arm. Norplant 2 differs in the number and size of the rods; its contraceptive effects last for seven years. These contraceptive injections and implants prevent ovulation.
6

J.F Greenwell, anti- progestational agents, steroids, (OHIO: The mankind first Company, 1998) p.514.

4. Abortifacients (a.) Intrauterine device (IUD) IUD is a plastic device of various shapes placed inside the uterus which may contain trace metals or hormones to increase efficacy. The mechanism by which the IUD works are not well understood. It does not prevent conception, but rather alters the living of the uterus in such the way that the developing fetus that came from the fallopian tube cannot implant and thus die. (b.) DES (Diethylstilbestrol) A powerful hormone that forces the lining of the uterus to shed. The fetus may die. This drug also prevent ovulation, and some recommend it for rape victims. (c.) Prostagladins These are also powerful hormones administrated by mouth, injection, or vaginal suppositories. They cause violent contraction of the uterus, pushing out what is in it.The fetus will be pushed out alive and will subsequently die of neglect or exposure this drug is used in second- trimester abortions. 5. Anti-Pregnancy Vaccine This vaccine when administered makes the woman produce anti-bodies which neutralize Human chorionic Gonadotropin (HCG). HCG is the mechanism which the fetus used uses to shut off the mothers menstrual period after conception HGC gives signal that the mother is pregnant. If the HCG level drop, miscarriage or spontaneous abortion may occur. Thus this anti- pregnancy vaccine, which is actually an antideveloping- child vaccine induces the early abortion of the new child.7

Adelle Pillitteri, Phd,RN, PNP, nursing process overview for reproduction Health.

Maternal and child health nursing , ( Philadelphia: Lippincott Williams and Wilkins, INC., 1999)p.97-117

Side Effects and Contrs-Indication DR. John Billings in his book entitled The Gift Of Love stated, It is a tragedy of modern times that so many men and women have been willing, even eager to destroy their fertility, that a husband or wife will not grant the other, even to them selves ad acceptance of their fertility. These modern in such as they have been called reflect a mortal sickness of the mind, an attitude which has produce in our oven time an anti-child society. 8 This section of the study will show the know and possible effects of using contraceptives, abortifacients, and the likes as a means of birth control ------ human individuals who dehumanises love, life, and sexuality. These data are gather together by the researcher mainly from the books as seen in footnotes and from the testimonies of mothers who indulged in artificial Birth control methods. Effects are either physical, emotional, and psychological. This is done in a table from for convenient reference, easy group, and understanding and higher retention for readers.

8. John Billings , M.D., The Gift Of Life and Love ( Atlanta, Georgia : The Liturgical Prels, 1999) p. 171.

Methods 1 Condoms

Side Effects And Contraindication: >No contraindication to the user of condoms excepts for sensitivity to latex. Not a 100 % effective in preventing diseases HIV,AIDS, Etc.

2 Diaphragms

> Urinary Tract Infection ( UTI) History of Toxic Shock Syndrome Local Skin irritation caused by allergy to rubber.

3 Tubal ligation Hysterectomy > Severe Vaginal bleeding/ haemorrhage Higher risk of pelvic infection Risk of ectopic pregnancy Post operative depression Sexual dysfunction Umbilical hernia Extensive obesity Risk for later desire for sterilization reversal Death due to anaesthesia, perforation of aorta, and bowel burns. 4 Vasectomy > Possible Prostate Cancer Increased risk for kidney stone Psychological difficulties may develop such as: anxiety, feeling of low- self worth and decreased sexual desire. Develop autoimmunity or form anti bodies against sperm which can lead to thyroid or joint disorders, heart and circulatory diseases, diabetes, and hematoma.

5 Chemical / Spermicides

> Vaginal Infection >Greater incidence of congenital disorders in Innocent children who are conceived during the use of spermicides Douens Syndrome, limb Reduction, malformations, malignant neoplasm (Cancerous tissue growth), and sever hypospadial.

6 Pills and Mini Pills

> nausea, vomiting, weight gain or loss Hypertension and impaired vision High risk for stoke and heart attack Breast cancer Breakthrough bleeding Gall bladder disease High risk for liver tumours Potential depression Shortness of breath severe headache Epilepsy Diabetes mellitus reproductive tract malignancy Sickle cell disease difficulty in conceiving birth after discontinue use

7 Subcutaneous Implants/ Norplant

>Irregular menstrual cycle >Hair loss Arm pain and infection Nervousness Liver tumour and gall bladder disease

 High blood pressure Migraine, headache, and blurred vision

8 Contraceptive Infection

> spotting, breakthrough bleeding return to fertility. Decreased breast milk production Leg p [ain or swelling Acute chest pain

9 Intrauterine Device (IUD)

>occasional perforation of uterus or cervix requiring surgery . Risk of miscarriage Risk of ectopic pregnancy Pelvic inflammation Anemia Pain or sexual intercourse Amenorrhea Fever and uterine infection

10 Elective termination of Pregnancy or Induce Abortion

>laceration or cervix by suction > haemorrhage > perforated uterus Laceration of urinary bladder Pulmonary embolism Laceration of bowel Shock Laparectomy Risk of developing breast cancer Edema Convulsion / fever Kidney failure Heart failure

 Septicaemia (measure Infection) Hypernatremia Peritonitis Death of mother Inadequate coping ability Elective Termination of Pregnancy and Induced Abortion (a) Dilation and Curettage (D & C). This procedure is done if the gestational period of the pregnancy is under 13 weeks. This is usually done in the ambulatory setting using Para cervical block to eliminate pain but limits experiences of cramping and pressure at the cervix. The anaesthetic block is administered and the cervix is dilated. The uterus then scraped clean with the curette removing the zygote & trophoblast cells.9 (b) Menstrual Extraction. Know also as suction evacuation. It is the simplest type of abortion procedure. It may be performed at out patient basis 5-7 weeks after the last menstrual period. A speculum is introduced vaginally .The cervix is stabilized by a tenaculum and a narrow the vagina into the cervix and uterus. The lining of the uterus that would be shed with a normal menstrual flow is then suctioned and removes by means of the vacuum pressure of a syringe. It is an ambulatory procedure completed quickly and with a minimum discomfort. 10 (c) Dilation and Vacuum Extraction. Most second trimester abortions (bet. 12- 16 wks) are done by D&C. Dilation of the cervix is done by the insertion of traditional dilators or by a laminaria into the cervix, under sterile condition. It absorbs the fluid and swell in size. It gradually & painlessly dilates the cervix enough for a vacuum extraction tip to be inserted. The negative pressure of suction pump or vacuum container gently evacuates the uterine content over a 15- minute period. (d.) Saline induction. This method is used if the pregnancy is between 16 & 24 weeks based on the principle that hypertonic (20%) saline causes fluid shifts and sloughing of the placenta & endometrium. Laminaria is inserted for delation of cervix. Abdominal wall is prepared with anti-septic solution and local anaesthesia a sterile spiral needle is inserted into the uterus through the abdominal wall and 100-200 ml. Of amniotic a sterile syringe with amniocentesis

technique removes fluid. A 20% hypertonic saline solution of up to 200 ml is that injected throughout the same needle through the abdominal wall then the needle is withdrawn.11
9

J.B.Jsimovich< MD. An ovulation Subsequent to Steroidal Antifertility Agents, uterine contraction, (John Wiley And Sex talk with kids and Teens, Ed. Marlon, C. Ramirez (Manila: ECFL CBCP and HLI Asia 2000) p. 82-90 M.P. Vessey, et. Al., Fertility after Stopping different methods of contraception , (British Medical Journal, February

Sons 2002) p. 408-409

10 11

1999), p. 265-267

CHAPTER 3

Methodology This chapter mainly tackles the kind of research design to be used, the number of respondents to be involved in the study, with what data-gathering instrument will be implemented and how and when the survey will be conducted which will assist researcher to complete the whole chapter.

Research Design Since the main purpose of this study is to determine the different effects of Artificial Birth control to mothers aged 25-35 of Purok Adelfa of Brgy. 38, Bacolod City, Negros Occidental, the researchers will use the non-experimental Or pre-experimental design, which is a post test only design.

Respondents of the Study The respondents to be involved in the development of this study will be exactly 30 mothers, aged 25-35 residing at Purok Adelfa, Brgy. 38, Bacolod City. They will be chosen by the researchers and will be given the privilege to be interviewed and answer the questionnaires.

Sampling Technique to be Used The study will use the Purposive Sampling Method Technique. In this type of Sampling, the researcher selects the sample units as the respondents become available. The researchers selected a total of 30 mothers with ages ranging from 25-35 from Purok Adelfa, Barangay 38,Bacolod City.

Data Gathering Instrument The researchers will use self- administered questionnaire with 10 items in a multiplechoice type as mothers basis in answering questions. They will be instructed to encircle their corresponding choice of answer.

Validity An item included in the questionnaire pertains to various side effects of using artificial birth control as practiced by mothers aged 25-35 residing in Purok Adelfa, Barangay 38 Bacolod City Negros Occidental. It will be submitted to Ms. M. D. Diaz my Professor in Nursing Research, as well as to the Punong Barangay of Purok Adelfa, arangay 38, Bacolod City.

Reliability An internal consistency (split-half) procedure will be employed to establish the reliability index of the questionnaire. It will be given to 30 mothers practicing the different Artificial Birth Control methods residing in Purok Adelfa, Barangay 38, Bacolod City. The 30 mothers will be divided, first 15 mothers in set A and the remaining 15 mothers in set B.

Procedure for the Analysis and Interpretation of Data The obtained mean scores of the affected and non-affected Effects of Artificial Birth Control by the practicing mothers aged 25-35 residing in Purok Adelfa, Barangay 38, Bacolod City, Negros Occidental, under consideration will serve as basis for the interpretation of the data. The guide below will be used for interpreting the data. Mean Score Range 4.34 5.00 3.68 4.33 3.01 3.67 2.34 3.00 1.67 2.33 1.0 1.66 Interpretation Highly very much affected Very much affected Much affected Affected Less affected Unaffected

References/Bibliography Pope John Paul II , October 07, 1979. Sanctity of Life and Love ; (Washington, USA) p.6 J.C Espinosa M.D., Why are they lying to Women? Birth Control, (Manila: Cachohermanos, INC. copyright 1999) p.5 Ibid. p.30 Clatworthy, N.M 2001. Study of Family Planning. (New York: Parents Magazine Press) p.187 Sex Talk with Kids and Teens ; Ed Marlon, C. Ramirez. (Manila: ECFL- CBCP and HLI Asia, 2000) p. 340 J,F Greenwell. Antiprogestational Agents, Steroids (Ohio: The Mankind first Company, 1998 ) p. 514 J.B. Josimovich, M.D. An Ovulation Subsequent to Steroidal Antifertility Agents ; Uterine Contraction . ( John Milley and Sons 2002 ) p. 408-409 Adelle Pillitteri, Phd , RN, PNP. Nursing Process Overview for Reproduction Health ; Maternal and Child Health Nursing (Philadelphia: Lippincott Williams & Wilkins INC. 1999 ) p. 97-117 M.P. Vessey et al., Fertility after Stopping Different Methods of Contraception. ( British Medical Journal, February 1983 ) p.265-267

John Billings, M.D. The Gift of Love and Life ( Atlanta Georgia The Littergical Press, 1997 ) p.171