Family Planning

Family Planning
 What is family planning?
 The prevention of having children until
choosing if and when to have children
 Recognizing many women learn of
contraceptives from friends, the media,
magazines, internet, etc.
 Realizing that if both partners are fertile, 90%
will conceive with in one year
 Family Planning
 Unintended pregnancies may result in
economic hardship, interfere with
educational or career plans, etc.
 Most women choose a variety of birth
control before they reach menopause
 The average woman must consider the
use of contraceptives for up to 35 years of
her life!!
 Role of the FP Nurse
 Health care provider, counselor, educator,
advocate
 Initial teaching involves selection of a
contraceptive method, considering the
clients individual lifestyle, not to persuade
 Reinforcing teaching
 Provide opportunity to ask questions
 Role of the FP Nurse
 Nurses must feel confident and
comfortable discussing methods, and
coitus-SEX
 Be sensitive to woman's concerns and
feelings
 Avoid being bias, judgmental and personal
choices/beliefs
 Focus needs to be the needs and feelings
of the patient and her partner
 Role of the FP Nurse
 The nurse must provide individualized FP
information to woman in every situation in
which it is appropriate:
 Teenage years
 Child bearing years 20-30+
 Career/ peri-menopausal years
 Considerations
 Safety
 STD protection
 Effectiveness
 Acceptability
 Convenience
 Education needed
 Benefits
 Considerations
 Side effects
 Interference with spontaneity
 Availability
 Expense
 Preference
 Religious and Personal Beliefs
 Culture
 Contraceptive Methods
 The perfect method does not exist
 Abstinence-practiced perfectly
 Contraceptives methods change based on
the clients circumstances
 30% of married and 61 % of unmarried
females change methods within 2 years
 Careful consideration of all factors can
help a woman choose the best method
 Sterilization
 Bilateral Tubal Ligation (BTL)
 2nd leading method of birth control
 Performed in between pregnancies or after
childbirth, same day surgery
 The fallopian tubes are occluded by clips,
band, rings, or destroying portion of the tubes
with electro-coagulation
 Rest 24 hrs and no heavy lifting nor
intercourse x 1 week
 Sterilization
 Vasectomy
 Local anesthesia used, office visit
 Vas deferens ligation and removal of section
of the vas or cautery
 Semen no longer contains sperm
 Lower morbidity rates than BTL
 Lower cost than BTL
 May take up to 3 months for completion with 2
negative samples
Advantages vs. Disadvantages
 Ends contraception issues, less 1%
pregnancy risk
 Initially high cost, low long term cost
 Reversal is difficult, expensive, most likely
unsuccessful
 Surgery complications
 No STD protection
 Oral Contraceptives
 Leading method in the U.S.
 Combined: estrogen & progesterone
 Progesterone only pill (POP)
 Mode of action:
 Increases thickening of cervical mucous to
block sperm
 Inhibits maturation of follicles and ovulation
 8% failure rate
 Oral Contraceptives
 Advantages
 Unrelated to coitus
 Highly effective
 Reduces ovarian and endometrial cancer,
cramping, blood loss and anemia
 Regulates cycle
 Return to fertility 3-6 months
 Oral Contraceptives
 Disadvantages
 Taken everyday near  Requires Rx
same time, especially  No STD protection
POP  Caution:
 BTB  antibiotics
 Headaches  herbals
 Breast tenderness  anticonvulsants
 Weight gain?  antituberculosis
 antifungal
 Melasma
 BUM necessary
 Mood swings
 Oral Contraceptives
 21 day, 28 day
 Triphasic, Monophasic
 Extended Regimen
 84 active, 7 placebo
 4 cycles a year
 Continuous regimen
 Oral Contraceptives
 Decreases:  Improves:
 ovarian cysts  Acne
 PID  Endometriosis
 Ectopic Pregnancy  PMS sx
 Benign breast dz  Dysmenorrhea
 Fibroid bleeding
 PCO
 Hirsutism
 Oral Contraceptives
 Risks
 Women who smoke over 35 years of age
 DVT
 PE
 MI
 Stroke
 HTN
 Migraines
 Vaginal Ring
 NuvaRing
 Combined: estrogen & progesterone
 OCP mode of action
 Self placement
 Flexible ring placed intravaginally for 3 weeks
and 1 free week.
 95% effective, when used correctly
 Vaginal Ring
 Advantages  Disadvantages
 Unrelated to coitus  Must be comfortable
 Easy placement with insertion
 Private  SE like OCPs
 No fitting necessary  Rx only
 No weight restriction  Expulsion risks
 No STD protection
 Transdermal Patch
 Ortho Evra Patch
 Combined: estrogen & progesterone
 OCP mode of action
 Absorbed via the skin
 Apply to clean, dry skin not tattooed, broken
skin.
 Place on abdomen, buttock, arm, upper
back/shoulder-NEVER near breasts
 99% effective, when used correctly.
 Transdermal Patch
 Advantages  Disadvantages
 Unrelated to coitus  Rx only
  Weight restriction
Easy to place
 198 lbs
 Convenient  May come off
 SE like OCPs
 Difficult to conceal
 Skin irritation for some
 No STD protection
 Intrauterine Device (IUD)
 T shaped device
 5 years Mirena-levonorgestrel (LNG-IUS)
 Failure rate <0.1%
 More effective than sterilization
 10 years-Para Guard IUD- copper T 380A
 Failure rate <0.8%
 Intrauterine Device (IUD)
 Action
 Para guard
 copper changes the uterine/ tubal fluids to impair
sperm function.
 Mirena
 thickens cervical mucous
 Inhibits sperm function
 Causes the endometrium to react to the foreign
body
 Only small amt of systemic hormone absorbed
 Intrauterine Device (IUD)
 Advantages
 Very safe
 Insert any time; medically placed
 Can be inserted 6 wks pp
 Low long-term cost
 Unrelated to coitus
 Fertility returns promptly
 Intrauterine Device (IUD)
 Disadvantages
 Some complain of feeling the string (rare)
 No STD protection
 Rx…Mexico?
 Initially high up front cost
 Must be surgically placed
 Can be expelled without the woman’s knowledge
 Menorrhagia
 infection, ectopic pregnancy,
 Abortion, perforation
 educate the on the signs
 Intrauterine Device (IUD)
 Check strings monthly after cycle
 Know infection signs
 hCg when necessary
 Check for anemia with heavy cycles
 Limit sexual partners to reduce PID risks
 Depo Provera
 Progesterone hormone
 IM injection
 1st 5 days of cycle or restart protocol
 Prevents ovulation
 Do not massage the site
 97% effective
 Depo Provera
 Advantages
 Unrelated to coitus
 Eventual amenorrhea
 Very effective
 Cost effective over time
 Depo Provera
 Disadvantages (possible)
 Prescription only
 Irregular menstrual
 Spotting / BTB
 30-50% amenorrheic at 1 year
 Depo Provera
 Weight gain, 4-5 lbs annually, etc
 Headaches
 Decreased libido
 Depression
 Nervousness
 Depo Provera
 BMD risks
 2 year limit
 Dexa scan
 Ca+ use daily 1000-1200mg/Vit D 400iu
 Increase weight bearing exercises
 Implanon
 Awaiting FDA approval ?
 4 cm long, must be surgically implanted
 Releases progestin over 3 years
 NO pregnancies were reported in clinical
trials
 SE c/w progestin only methods
 Fertility returns completely after removal
 Mechanical Barrier & Chemical
Methods
 Chemical Spermicides
 Condoms
 Diaphragm
 Cervical cap
 Spermicides:
Foam, films, suppositories
 Chemicals that kill sperm
 Cream, foam, gel based, tablets
 To be used WITH barrier methods
 29% effective used alone
 not recommended
 Spermicides:
Foam films, suppositories
 Advantages  Disadvantages
 Quick and easy to use  Related to coitus
 No Rx  Interrupts spontaneity
 Inexpensive  Can be messy
 Increases lubrication  New application
 Increase effectiveness  1 hr effectiveness
of condom use  No STD protection
 97%  Can be irritating
 micro-ulcerations
 STD risk?
 Condoms
 Mechanical Barrier
 Latex/ plastic /lambskin
 Available in various colors, textures, flavors
 Placed over penis to prevent passage of sperm
to the uterus
 The ONLY male contraceptive
 15% failure rate
 When used alone
 Never use 2 condoms at the same time
 Condoms
 Check expiration
dates
 Use only water
soluble lubricants
 Avoid:
 Vaseline
 Baby oil
 Lotions
 Apply correctly to
prevent breakage
 Demonstration
 Condoms
 Advantages  Disadvantages
 Good STD protection  New condom with
 Quick and easy to use repeat coitus
 No Rx  Possible sensitivity
 Inexpensive  Can slip or break
 Increase effectiveness  Some complain of
with spermicidal use decrease coital
 97% sensation
 Check for
holes/expiration
 Female Condom
 Plastic pouch that fits over the cervix like a
diaphragm and another ring that extends
outside the vagina which partially covers
the perineum
 21 %failure rate
 Do NOT use in combination with male
condom
 Diaphragm
 A latex dome surrounded by a spring coil
 Spermicidal gel is placed in the dome
facing the cervix
 Prevents sperm from entering the cervix
and kills additional sperm
 Must be fitted by HCP
 Diaphragm
 Weight gain or loss, must re-fit
 Replace q 2 yrs
 No oil based lubricants
 16% failure rate
 No STD protection
 Cervical Cap
 FemCap
 Silicone cap placed over the cervix w/
spermacide on both side
 No pressure on the bladder
 Can remain in place for 48 hrs
 Cap has loop device to help with removal
 Cervical Cap
 Cap size dependent on gravida
 Replace after 2 years
 No oil based lubricants
 16% failure rate
 No STD protection
 Natural Family Planning
 Calendar
 Standard Days Method
 Basal Body Temperature
 Cervical mucous
 Symtothermal method
 Natural Family Planning
 Based on knowledge of how the female
body and menstrual cycle works
 Uses the physiological cues to predict
ovulation
 Ovum may be fertilized for 24 time frame
 Sperm can live up to 3-5 days, 7days in
some studies
 Calendar
 Based on timing ovulation 14 days before
menses.
 Keep track of cycles at least 6 months to
determine pattern
 Must abstain or use barrier method during
fertile times
 Can be unreliable
 Standard Days Method
 String of beads that is color coded to keep
track of days/fertile days.
 Designed for women that have cycles that
vary from 26-32 days
 Coitus is allowed on days 1-7 and 20 to
the end of the cycle
 Days 8-19 are considered fertile days
 Basal Body Temperature
 The woman charts her oral temperature
each am, before getting out of bed
 During ovulation, temperature rises
0.4-0.8 F
 Coitus the day before the temperature
rise may well result in pregnancy
 Keep track of cycles at least 6 months to
monitor temperature changes
 Cervical Mucous
 Billings/ Ovulation Method
 This method is based on changes in the cervical
secretions caused by a rise in the estrogen levels
during the follicular phase of the cycle
 Wiping from the vaginal orifice with tissue each day
 Couples must avoid intercourse from time clear
stretchy mucus is first present to 4 days after the end
of slippery mucus
 Spinnbarket
 Symtothermal method
 Combines the
calendar, BBT, and
cervical mucus
methods AND
 Paying close attention
to symptoms like
weight gain, bloating,
mittelschmertz --
Ovulation is near!
 Natural Family Planning
 Advantages  Disadvantages
 Acceptable to most  COUPLES must be
religious groups highly motivated
 Avoids drugs,  Abstinence is a vital
chemicals and devices piece to the success
 Can use barrier  Perfect use 95-98%
method during fertile effective…typical 75%
times  Method is very
unforgiving
 NO STD protection
 Abstinence
 Avoidance of sexual intercourse and any
activity that may allow sperm to enter the
vagina.
 Requires perfect use to be effective
 Most women are not abstinent for all of
their productive lives.
 Abstinence
 Advantages  Disadvantages
 100% no  Must be highly
pregnancy/STDs motivated
 No cost  Stress-for some
 No hormones
 No SE’s
 No medical risks
 Lactation Amenorrheic Method
LAM
 Breastfeeding inhibits ovulation
 Sucking and prolactin interfere w/ secretion of
gonadotropin-releasing hormone and LH
 No bottle, solid foods can be given
 LAM
 Menses resumes in 6 months regardless,
then another method must be used
 Must be highly motivated
 Low risk pregnancy only if used right
 No STD protection
 Least reliable
 Coitus Interruptus
 Withdrawal
 Removal of the penis from the vagina prior to
ejaculation
 Failure rate 27%
 Men must have great control
 May be unsatisfying for some couples
 Misjudging timing may cause pregnancy
 Pre-ejaculant ??
 Educate and do not judge
 Least reliable
 In Summary
 Contraceptive failures often occurs
because lack of knowledge/understanding
or method is not suited to their needs
 Consider the bio-psycho-social-spiritual
consequences of unintended pregnancy
 Lack of understanding can increase risk
for STD’s as well.
 In Summary
 Nurses role in family planning
 Educate
 Provide accurate information & counseling
 Advocate
 Support
 Be patient
 Be non-judgmental