CRISTIANI FESSICA NATALIA RUMIRIS ROSPITA VERONIKA

I-A

CHAPTER I

INTRODUCE
1.1 Background

Family planning programme is a progamme that the recommenaled to the society. Nowadays the family planning programme often broadcast in the TV, radio, even brocures. The goverment hope this family planning programme could be a way to press the childbirth in the society. Actually the family planning programme in order to welfare the society, because two child is better. They can tultill the child needed completely and balance. In addition, family with down to middle in come more welfareif they apply family planning programme. Recentlly, the family planning programme mootly using some advice. The government give some alternative ways to the society how to activate the family planning programme by using some ways. The writer analyzes two methods. That are LAM and IUd. Both of those methods are .Here will diseases how to apply each method.

1.2

Problem

In this paper, the writer would like to formulate the problem are: What are the LAM and IUD methods? How to apply those methods?

1.3

0bjective

The objective of this paper is to explain what are IUD and LAM methods and how to apply each of them to women.

CHAPTER III

CONCLUSION AND SUGGESTION

CONCLUSION
From the discussion before in chapter II, it can conclude that each of those methods IUD and LAM has characteristic. It selfs women can choose any of those method which more safe for them. Those methods usually in order to support the family planning programme.

SUGGESTION
Based on the disscusion before, the writer would like to give some suggestion as follow: 1. Women must precisely in choosing one of those methods which more safe for them. 2. Before they apply the method or other methods except those methods ( IUD and LAM ) is better for them to ask more clearly explanation about each of those methods.

INTRAUTERINE DEVICE ( IUD)

Copper IUD (Paragard T 380A)

Hormonal IUD (Mirena) 1.1 The intrauterine device (IUD) is a form of birth control; it is an object placed in the uterus to prevent pregnancy.Among modern IUDs, the two types available are copper-containing devices, and a hormone-containing device that releases a progestogen. Currently, there are over 10 different kinds of copper IUD available in different parts of the world, and there is one hormonal device, called Mirena.

1.2 Modern IUDS

In the United States, there are two types of intrauterine contraceptive available: the copper Paragard and the hormonal Mirena. Both of these contraceptives are referred to as IUDs in the United States. In the United Kingdom, where over ten types of copper-containing IUDs are available, the term IUD only refers to inert or copper-containing devices. Hormonal intrauterine contraceptives are considered to be a different type of birth control, and they are distinguished with the term intrauterine system or IUS. The WHO/ATC name is IUD for both copper and hormonal devices.

1.3 Copper IUDs

An IUD as seen on X ray Copper IUDs work by impairing the mobility of sperm and preventing them from joining with an egg. Additionally, the foreign body inside the uterus irritates the lining and wall making it hard for an embryo to implant. Most non-hormonal IUDs have a plastic T-shaped frame that is wound around with pure electrolytic copper wire and/or has copper collars (sleeves). The Paragard T 380a is 32 mm (1.26") in the horizontal direction (top of the T), and 36 mm (1.42") in the vertical direction (leg of the T). In some IUDs, such as the Nova T 380, the pure copper wire has a silver core which has been shown to prevent breaking of the wire. Following that line there's a new improvement in a Spanish device "Gold T IUD" replacing the silver core by a gold core to completely avoid the breaking of the wire caused by corrosion. The arms of the frame hold the IUD in place near the top of the uterus.Other shapes of IUD include the so-called U-shaped IUDs, such as the Load and Multiload. These are similar to the T-shaped IUDs, in that they have a plastic "leg" running vertically, but at the top, rather than two straight horizontal arms, they instead have two arms that curve downwards towards the "foot" of the device.

Another shape of IUD is the frameless IUD. It does not have a hard plastic shape of any kind. Rather, it has a plastic string (similar to fishing line) that holds several hollow cylindrical minuscule copper beads. It is held in place by a suture (knot) to the fundus of the uterus. It is mainly available in China, Europe, and Germany, although some clinics in Canada can provide it. It is removed like most other IUDs using forceps but is actually removed from the fundus.All coppercontaining IUDs have a number as part of their name. This is the surface area of copper (in square millimeters) the IUD provides.

1.4 Hormonal IUD - Mirena

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Hormonal uterine devices (sometimes called IntraUterine Systems) do not increase bleeding as copper-containing IUDs do. Rather, they reduce menstrual bleeding or prevent menstruation altogether, and can be used as a treatment for menorrhagia (heavy periods). Although use of IntraUterine Systems results in much lower systemic progestogen levels than other very-low-dose progestogen-only hormonal contraceptives, they might possibly have some of the same side effects. As of 2007, the LNG-20 IUS marketed as Mirena by Bayer - is the only IntraUterine System available. First introduced in 1990, it releases levonorgestrel (a progestogen) and may be used for five years. With the use of the Mirena the hormones are localized to the uterine area unlike oral contraceptives.

1.5 Historical IUDs

Copper-containing devices
One historical device is Grfenberg's ring, an early IUD designed by Ernst Grfenberg, a German gynecologist in whose honor the G-spot was named. Another historical IUD is the Dalkon Shield. Produced in the 1970s, the Dalkon Shield became infamous for its serious design flaw: a porous, multifilament string up which bacteria could swim into the uterus of users, leading to sepsis, injury, miscarriage, and death. Modern IUDs use monofilament strings which do not pose this grave risk to users. Hormone-containing devices Progestasert was the first hormonal uterine device, developed in 1976 and manufactured until 2001.It released progesterone, was replaced annually, and had a failure rate of 2% per year.

LACTATIONL AMENORRHEA METHOD ( LAM )

Lactational amenorrhea

An infant breastfeeding Background Birth control type First use Behavioral

Prehistory; Ecological method 1971 Failure rates (First six months) Perfect use 0.5% Typical use 2% Usage Up to 6 months (longer in some Duration effect cases, with greater failure rate) Reversibility Yes User reminders Adherence to protocols Clinic review None Advantages and disadvantages STD protection No Periods Absent Weight Loss No external drugs or clinic visits Benefits required Lactational amenorrhea is the natural postnatal infertility that occurs when a woman is amenorrheic and fully breastfeeding. If not combined with chemicals or devices, Lactational amenorrhea method (LAM) may be considered natural family planning.

1.1 Breastfeeding infertility

For women who meet the criteria (listed below), LAM is 98% - 99.5% effective during the first six months postpartum.

Breastfeeding must be the infants only (or almost only) source of nutrition. Feeding formula, pumping instead of nursing,and feeding solids all reduce the effectiveness of LAM. The infant must breastfeed at least every four hours during the day and at least every six hours at night. The infant must be less than six months old. The mother must not have had a period after 56 days post-partum (when determining fertility, bleeding prior to 56 days post-partum can be ignored).

Ecological breastfeeding
Ecological breastfeeding is a stricter form of LAM developed by Sheila Kippley, one of the founders of the Couple to Couple League. Studies have shown it has a 1% failure rate in the first six months postpartum, and a 6% failure rate before the womans first postpartum menstruation.The Seven Standards of ecological breastfeeding are slightly different from the LAM criteria:

Breastfeeding must be the infants only source of nutrition no formula, no pumping, and (if the infant is less than six months old) no solids or water at all. The infant must be pacified at the breast, not with pacifiers or bottles or by placing a finger in the mouth. The infant must be breastfed frequently. The standards for LAM are a bare minimum; greater frequency is better. Sucking should include non-nutritive sucking when the infant cues the mother, not just breastfeeding as a means of nutrition. Scheduling of feedings is incompatible with LAM. Mothers must practice safe co-sleeping as it is the proximity of the child to the mother that increases prolactin. Mothers must not be separated from their infants. This includes substitutes for mother such as babysitters and even strollers or anything else that comes between mother and physical contact with her child. Babywearing (using cloth carriers) means tactile stimulation between mother and child and increases access to the breast. Any separation from the mother will decrease the efficacy of ecological breast feeding. Mothers must take daily naps with their infants. A mother must not have had a period after 56 days post-partum (bleeding prior to 56 days post-partum can be ignored).

1.2 Return of fertility

Return of menstruation following childbirth varies widely among individuals. A strong relationship has been observed between the amount of suckling and the contraceptive effect, such that the combination of feeding on demand rather than on a schedule and feeding only breast milk rather than supplementing the diet with other

foods will greatly extend the period of effective contraception. The closer a woman's behavior is to the Seven Standards of ecological breastfeeding, the later (on average) her cycles will return. Average return of menses for women following all seven criteria is 14 months after childbirth, with some reports being as soon as 2 months while others are as late as 42 months.Couples who desire spacing of 18 to 30 months between children can often achieve this through breastfeeding alone. Although the first post-partum cycle is sometimes anovulatory (reducing the likelihood of becoming pregnant again before having a post-partum period), subsequent cycles are almost always ovulatory and therefore must be considered fertile. However, some women find that breastfeeding interferes with fertility even after ovulation has resumed. Luteal phases being too short to sustain pregnancy is a common example.

1.3 What is the Lactational Amenorrhea Method (LAM)?

The Lactational Amenorrhea Method (LAM) is a modern, temporary family planning method that has been developed as a tool to help support both breastfeeding and family planning use. It is based on the natural infertility resulting from certain patterns of breastfeeding. Lactational means related to breastfeeding; Amenorrhea means not having menstrual bleeding; and Method means a technique for contraception. LAM is defined by three criteria:

1. the womans menstrual periods have not resumed, AND 2. the baby is fully or nearly fully breastfed, AND 3. the baby is less than six months old.

When any one of these three criteria is no longer met, another family planning method must be introduced in a timely manner to ensure healthy birth spacing.

Optimal breastfeeding practices include exclusive breastfeeding for the first six months and breastfeeding with appropriate complementary feeding for two years or more. LAM is a family planning method which supports improved breastfeeding, healthy child spacing, child survival, and womens health.

1.4 How effective is LAM?

LAM provides family planning protection comparable to other family planning methods.

1.5 What are the three LAM criteria?

1. The womans menstrual periods have not resumed Following childbirth, the resumption of menses is an important indicator of a womans return to fertility. During breastfeeding a woman is less likely to ovulate. However, once a woman starts to menstruate, ovulation has returned or may be imminent. Bleeding during the first two months postpartum is lochial discharge and is not considered menstrual bleeding. Menstruation is defined for LAM use as two consecutive days of bleeding, or when a woman perceives that she has had a bleed similar to her menstrual bleed, either of which occurs at least two months postpartum. 2. The baby is fully or nearly fully breastfed1 Full Breastfeeding is the term applied to both exclusive breastfeeding (no other liquid or solid is given to infant) and almost exclusive breastfeeding (vitamins, water, juice, or ritualistic feeds given infrequently in addition to breastfeeds). Nearly Full Breastfeeding means that the vast majority of feeds given to infants are breastfeeds. While exclusive breastfeeding is not necessary for LAM to be effective, the closer the pattern is to exclusive, the better for mother and baby. The optimal pattern for the baby is to be nursed frequently and for as long as the infant wants to remain on the breast, both day and night. At night, no interval between feedings should be greater than six hours. 3. The baby is less than six months old At six months of age, the baby should begin receiving complementary foods while continuing to breastfeed. Introduction of water, liquids, and foods can

reduce the amount of sucking at the breast, triggering the hormonal mechanism that causes ovulationand mensesto resume. A mother may not want to switch to other family planning methods when she no longer meets the LAM criteria and may choose to continue to rely on lactational amenorrhea for pregnancy delay. In this case the woman should be counseled to keep breastfeeding frequently and to breastfeed before giving the infant other foods. She should be informed that her risk of pregnancy increases.

1.6 What are the advantages and disadvantages of LAM?

Advantages

Disadvantages

Very effective Provides up to 0.5 CYPs (Couple Years Protection) Has no side effects Does not require insertion of any device at the time of sexual intercourse May attract new family planning users Contributes to family planning prevalence directly and through increased acceptance rates Can be initiated immediately postpartum Is economical and requires no commodities or supplies Contributes to optimal breastfeeding practices and therefore enhances maternal and infant health and nutrition Acceptable to all religious groups

Can only be used for a short period (up to six months postpartum) Requires breastfeeding frequently both day and night

1.7 When can LAM be initiated?

LAM can be initiated at any time during the first six months postpartum. The best time to begin counseling a woman about LAM and other family planning methods is during the antenatal period to allow her to make an informed choice about which method she wishes to use following the birth of her baby. LAM can be started immediately postpartum. The health care provider can help prepare the woman to

begin breastfeeding immediately after birth and, if the woman has decided to use LAM, verify that she understands the three criteria for LAM use. If a woman wants to initiate LAM use within the first two months postpartum, she must verify that she has been fully or nearly fully breastfeeding her baby since delivery. A woman may still be having postpartum bleeding (lochial discharge) that may be similar to a monthly bleed. As long as she is fully or nearly fully breastfeeding, the bleeding in the first two months does not disqualify her from initiating LAM during this period. If a woman wants to start using LAM when she is more than two months postpartum, the health care provider must carefully verify that she has met the three criteria for LAM use since delivery.

1.8 What is the difference between LAM, breastfeeding, and amenorrhea?

LAM is a contraceptive method, based on the physiology of breastfeeding. LAM is a method of contraception that a woman consciously chooses to use to reduce her chance of becoming pregnant by adhering carefully to the three criteria. Breastfeeding is a feeding practice. Amenorrhea, or the absence of menstrual bleeding, reflects a reduced risk of ovulation, but neither breastfeeding nor amenorrhea is a family planning method.

1.9 What are the optimal breastfeeding practices1 that contribute to breastfeeding and LAM success?

1. Breastfeed as soon as possible after birth, and remain with the newborn for at least several hours following delivery. 2. Breastfeed frequently both day and night. 3. Breastfeed exclusively for the first six months: no water, other liquids, or solid foods. 4. After the first six months when complementary foods are introduced, breastfeed before giving complementary foods.

5. Continue to breastfeed for up to two years and beyond. 6. Continue breastfeeding even if mother or baby is ill. 7. Avoid using bottles, pacifiers (dummies), or other artificial nipples. 8. Mothers who are breastfeeding should eat and drink sufficient quantities to satisfy their hunger and thirst.

Guidelines: Breastfeeding, Family Planning, and the Lactational Amenorrhea Method (LAM). Institute for Reproductive Health, Georgetown University, 1994 (available in Arabic, English, French, Russian and Spanish).

1.10 How many return visits are needed by LAM users?

When counseling a new LAM acceptor, the health care provider should discuss her follow-up needs and determine with the client how frequently she needs to be seen and what setting is most accessible for her. At the very least, a client needs to return for a visit if she perceives any breastfeeding difficulties or as soon as any one of the LAM criteria changes. An additional followup visit at five to six months postpartum is essential to determine the clients plans for switching to another contraceptive method and for introducing complementary foods when her baby is six months old. Whenever possible, the health care provider should schedule the visit when the client brings her baby for assessment or immunization, in this way saving the mother time by reducing the total number of visits to the clinic. If the client is unable to schedule a visit or if she lives far away and will have difficulty returning, the provider should give her a supply of condoms, spermicides, and/or progestin-only pills. In this way she can maintain contraceptive protection if LAM is discontinued before she is able to return to the clinic.

1.11 What contraceptive methods can be used after LAM?

When any one of the three criteria for LAM use is no longer met or when a woman decides to stop using LAM, she needs to begin using another contraceptive method for as long as she wants to prevent another pregnancy. Women who are breastfeeding and who switch to another method should be advised on contraceptive options. Combined oral contraceptive pills (COC) and combined injectables are not recommended before six months postpartum because they contain estrogen, which may decrease the quantity of breastmilk. After six months postpartum, a woman who is breastfeeding can use any method of her choice as long as she is properly screened

and meets the eligibility criteria.

1.12 Can a woman who is separated from her baby use LAM?
The amount of time that a woman is separated from her baby is a key factor in establishing the LAM criterion of full or nearly full breastfeeding, day and night, with no long intervals between feedings. A woman who is separated from her baby regularly for more than four to six hours cannot expect a high level of contraceptive protection from LAM, even if she expresses milk during the separation. Expressing breastmilk may not be as effective as suckling at the breast in suppressing ovulation, and for this reason a woman who expresses her milk may not be able to rely on LAM. In a study on LAM in working women, the pregnancy rate increased to five percent. Some women can make arrangements to have their babies brought to them to nurse and/or are able to go to their baby at regular intervals. Women who are able to keep their babies with them at the work site, market, or in the fields and are able to breastfeed their children frequently can rely on LAM.

1.13 How flexible is the method?

LAM is a flexible method. In some countries, programs may modify the criteria slightly to reflect cultural norms or national policies without decreasing the methods efficacy. Many women have occasionally had longer intervals between feedings, their baby has slept through a night, or they have fed the baby regularly with small amounts of complementary foods, and still have had the same high level of effectiveness. In some settings, programs modify or simplify the method to meet local conditions. For example, they may require exclusive breastfeeding as an eligibility criterion and not accept nearly full breastfeeding. It is important for the health care or family planning provider to understand the criteria and the parameters of flexibility of LAM when modifying any aspect of the method.

What guidance can health workers give mothers about the use of LAM in areas of high human immunodeficiency virus (HIV) prevalence?
Women who are HIV+ and who choose to breastfeed can use LAM if they meet the three eligibility criteria. HIV+ women need to be carefully counseled regarding their reproductive intentions and the contraceptive methods available to them. These women and women at risk for HIV infection should be advised to use condoms in addition to whatever contraceptive method is used. It is important that HIV+ women be counseled about the benefits and risks of breastfeeding and other infant feeding options. In fact, some studies indicate that exclusive breastfeeding may help reduce the risk of passage of HIV to the infant when the mother is infected. The infant feeding decision is the mothers to make.

Some general counseling guidelines are:

Where confidential testing for HIV is not available or used and a mothers HIV status is not known, promote exclusive breastfeeding for the first six months as safer than breastmilk substitutes as these may not be regularly available, affordable, or safely used. If status is unknown, exclusive breastfeeding is especially important. Promote use of condoms and teach women how to avoid exposure to HIV and other sexually transmitted infections. Under these conditions, if the mother chooses to breastfeed, LAM can be used. If a mother knows she is HIV+ and breastmilk substitutes are not available, not affordable, or cannot be safely used, promote exclusive breastfeeding (never mixed breastfeeding) for the first six months as safer than breastmilk substitutes. Promote use of condoms and teach her how to prevent transmission of HIV to her partner and how to protect herself from repeated exposure to HIV and other sexually transmitted infections. Under these conditions, LAM can be used. If a mother is HIV negative, promote exclusive breastfeeding for the first six months as the safest option for infant feeding. Promote use of condoms and teach her how to avoid exposure to HIV.2 Under these conditions, LAM can be used.

REFERENCE

 http://en.wikipedia.org/wiki/intrauterin_device http://en.wikipedia.org/wiki/lactational_amenorrhea http://rehydrate.org/breasfeed/fag-lam.htm

TABLE OF CONTENTS

CHAFTER I INTRODUCE
1.1 Background 1.2 Problem 1.3 Objective

CHAFTER II LITERATUREREVIEW INTRAUTERINE DEVICE (IUD)

1.1IUD 1.2Modern IUDs 1.3 Copper IUDs 1.4 Hormonal IUD- Mirena 1.5 Historical IUDs

LACTATIONAL AMENORRHEA METHOD (LAM)

1.1 Breastfeeding infertility Ecological breastfeeding 1.2 Return of fertility 1.3 What is the LAM? 1.4 How effective is LAM? 1.5 What are the three LAM criteria? 1.6 What are the advantages and disadvantages of LAM? 1.7 When can LAM be initiated? 1.8 What is the difference between LAM, breastfeeding, and amenorrhea? 1.9 What are the optimal breastfeeding practices that contribute to breastfeeding and LAM success? 1.10 how many return visits are needed by LAM uses? 1.11 What contraceptive methods can be used after LAM? 1.12 can a women who is separated from her baby use LAM? 1.13 How flexible is the method?

CHAFTER III CONCLUSION SUGESSTION