Counseling Iud Contraception : New Acceptor

Mrs. Rina & Assalamu’alaikum

Mr Agung
Midwife Lia Wa'alaikumussalam, come in ma’am and sir and please have a seat 
Iam midwife Lia who on duty this morning. May I know your name please?
Mrs. Rina My name is Mrs. Rina and this is my husband Mr. Agung
Midwife Lia Okay Mrs. Rina and Mr. Agung, is there anything I can help?
Mrs. Rina Yes miss. I want to have family planning
Midwife Lia Oh that’s good, so have you used family planning methods before Mrs?
Mrs. Rina Not yet a miss, this is the first time for us
Mr. Agung That’s right miss, this is the first time my wife want to use contraception
because she just delivered our baby about 7 weeks ago.
Midwife Lia Ahh…congratulations for your baby, so is this your first child ?
Mrs. Rina Yeah this is our first child
Midwife Lia Okay Mrs and Mr, that is a good choice to have family planning earlier. So
may I know, what do you know about family planning or contraceptions?
Mrs. Rina I just heard that family planning is a contraceptive to prevent pregnancy
like contraceptive injection or pill
Midwife Lia  Yeahh that’s right Mrs. Rina. So the purpose of family planning is to
prevent pregnancy / to delay the birth / to space the birth of children / to
ensure only a certain number of children.
 And there are various family planning methods not only injection and
pill contraceptive, but have you already discuss about family planning
methods you wanna apply?
Mr. Agung Honestly,we have not discussed it yet, because we don’t know exactly
which contraception thats good for us .
Mrs. Rina Yes miss, I don’t have a plan to use which contraception that suits me
and my husband.
Midwife Lia Okay then,let us discussed together about the types of family planning
metodhs
1st : Temporary Family Planning Methods such as LAM (lactational
amenorrhea method)…..
2nd : Modern Family Planning Methods which divided by 2 types,
hormonal and non hormonal. The hormonal contraception such as
 From all methods as I explained berfore, in here served all of them
except permanent contraception. So before we go on, is there anything
that you wana ask Mrs. Rina dan Mr. Agung? Or maybe form my
explanation you already have contraceptions methods that chacting your
eyes?
Mr. Agung Wahh… there are many option that we can choose ma, not only injection
and pills contraceptive. How, which methods interest you?
Mrs. Rina Yaa.. we just found out now and I think iam interest in 3 month injection
and IUD Contraceptive. What do you think?
Mr. Agung Hmm, I think its prefer to use IUD, because if you use injection, you
should come to the clinic every 3 month according to the specified date.
And I doubt I cant accompany you to get continued contraception every 3
month but if you use IUD, I think we can save money and time.
Mrs. Rina Okey iam understand your concern, and honestly Iam a bit afraid of
syringes  so miss how about IUD? is it okay for me?
Midwife Lia Its okay mam. But we will see if your health conditions and some other
aspect suit you or not. Is it okay if I ask you some question?
Mrs. Rina Yeah sure
Midwife Lia May I know Mrs and Mr. what your purpose of using contraception? May
be you want to space the birth of children or it is enough for you to have
one child?
Mrs. Rina We want to space children miss
Mr. Agung Yeah. Because we firstly had one baby and we want focus on it, then we
planned to have more children 5 or 6 years later.
Midwife Lia That good Mr. and actually if we want to have children again its so
recommended to space over 2 years and more after the previous birth.
So Mr. Agung and family support Mrs Rina to use contraception right?
Mr. Agung Of course miss, our family supporting our decision to use contraception.
And I remember our cousin recommend my wife to use contraception and
ask consultation in here  right ma?
Mrs. Rina That’s true
Midwife Lia Okay, then i will ask you, both Mrs. Rina and Mr.Agung about some
personal information to find out whether it is suitable for you or not to use
IUD. Is it okay with that?
Mrs. Rina Okay we don’t mind miss
Midwife Lia Because this is your initial visit, it will take a little longer. Do ypu have a
free time today?
Mr. Agung No problem miss, we already make time for today on purpose
Midwife Lia sebelumnya saya mohon kepada ibu dan bapak untuk memberikan data
dengan jujur dan benar bu, dan ibu, bapak tidak perlu merasa khawatir, saya
akan menjaga kerahasiaan informasi ibu, apakah ibu bersedia
Mrs. Rina Yes with my pleasure
Midwife Lia What’s your full name Mrs and Mr?
Mrs. Rina Rina Rustiawati
Mr. Agung Agung Prasetyo
Midwife Lia What is your address?
Mrs. Rina We live in Jl.Semangka No. 33 Ngadilangkung- Kepanjen
Midwife Lia How old are you?
Mrs. Rina 23
Mr. Agung 26
Midwife Lia Iam sorry, What is your religion?
Mr. Agung We are islam
Midwife Lia may I know your last education?
Mrs. Rina Our last education is Senior High Scool
Midwife Lia What line of work are you in?
Mr. Agung Iam security guard
Mrs. Rina Iam housewife
Midwife Lia Sorry Mr. Agung may I know how much do you get paid for a month?
Mr. Agung It’s about 2,5 jt / month
Midwife Lia Okay and then as you said before, Mrs. Rina want to use IUD, this is your
first baby, and the age is around 7 weeks. And want to space the birth of the
children about 5-6 six years later. Is it right?
Mrs. Rina Yeah that’s right miss.
Midwife Lia Let me explain one more time in detail related to IUD contraception, if
there is something unclear, just freely to ask.
Mrs. Rina & Correct miss
Mr Agung
Midwife Lia  An IUD is a small plasticand T- shaped device with a string attached to
the end that is inserted into the uterus.
 The IUD works by thickens the cervical mucus and preventing sperm
 from joining with the egg so it can prevent pregnancy.
 The Advantages are safe, effective, and long-acting (until 10 years),
easy to remove if the you wants to become pregnant, doesn't interfere
with sex, doesn't interfere with breastfeeding
 The Disadvantages are you may feel slight pain during the first few
days after IUD insertion, heavier and/or longer periods, which normally
decrease during the first and second years, doesn't protect against STDs
 Possible Side Effects of the IUD include: cramping and some pain
during and immediately after insertion, spotting or bleeding between
period, increased vaginal discharge. Heavier and longer bleeding is
normal and expected, especially in the first few months. Bleeding
usually decreases during the first and second years of IUD use.
 So how if you experienced the side effect as I said before, what do you
feel Mrs?
Mrs. Rina I think its okay with me, as long as iam not gain a weight, iam fine miss.
And I think some contraception methods that you explained to use
before this, also have the side effect that may occur.
Midwife Lia  That true, every methods have the side effect for you body, but don’t
worry its a normal things.
 Something that I need to explain that IUD may come with the risk of
accidental perforation ( a hole that develops through the wall of uterus)
and Expulsion (a small chance that IUD can slip out of your uterus), this
could occur due to improper insertion. But don’t Mrs and Mr, in our
clinic have been trained to insert the IUD. And our clients who have
used the IUD, allhamdullillah there are no complaints something like
that.
 So, How Mrs and Mr, do you still want to use IUD? or maybe you have
some concern or the things you may worried about? Just freely to ask
Mr. Agung How about the strings of IUD miss, it may disturb our sex, isn’t? like may
be I can feel the strings and may hurt one of us?
Midwife Lia That’s a good question Mr.Agung. but don’t worry. The strings of the IUD
are soft and flexible, cling to the walls of the vagina and are rarely felt
 during intercourse. The string is too short to wrap around the penis and
cannot cause injury to it. If the string is felt, it can be cut very short.
Mr. Agung Oke thanks miss iam relieved now 
Mrs. Rina Is the woman who has an IUD cannot do heavy work, miss? Because I
never heard experienced using IUD before
Midwife Lia Using an IUD should not stop a woman from carrying out her regular
activities in any way. There is no correlation between the performance of
chores or tasks and the use of an IUD.
Mr. Agung Iam sorry misss, I suddenly thought that IUD long-acting until 10 years
right? So may the IUD rots in the uterus after prolonged use?
Midwife Lia Your right that IUD can remain in place up to 10 years. Literally, the IUD is
made up of materials that cannot deteriorate or "rot", it simply loses its
effectiveness as a contraceptive after 10 years.
Mr. Agung Ahhh I see,
Midwife Lia Iam really happy you both seem so excited about this methods and asking
the things you may concerns. Is there anything you want to ask again?
Mrs. Rina & I think its enough miss
Mr Agung
Midwife Lia Then, I want to ask you some question related with your conditions and
after that we are gonna do some physical examination to know it is safe for
you or not to use IUD. can we jump to the next question?
Mrs. Rina Yups miss go ahead please
Midwife Lia In this month, do you already have your period ?
Mrs. Rina Actually Iam on my period miss, this is the 5th day
Midwife Lia How long usually you have your period ?
Mrs. Rina Usually it last for 6-7 days
Midwife Lia Can you tell me how much blood usually come out?
Mrs. Rina For the first 3 days, the blood come out a lot, then 4 th day it decreases and
become less and 2 last days there are only spots miss
Midwife Lia Do you ever experienced your blood period comes a lot than usual until you
have 1-2 pads changed per 4 hours? Or maybe you ever had a long period
like morethan 8 days?
Mrs. Rina Hmmm no, the range of my period and the blood its always like I said
before.
Midwife Lia Then did you ever experienced severe menstrual pain during your period?
Maybe you can’t tolerate the pain then took some medicine?
Mrs. Rina Alhamdullillah, a long of my period I haven’t experienced something like
that.
Midwife Lia Alhamdullillah, where did you gave birth and how the prosess?
Mrs. Rina In midwife Cahaya and its normal
Midwife Lia As you said before, you have one child right? but iam so sorry, have you
ever had a miscarriage or abortion? Or maybe you may experience
pregnancy outside of the womb?
Mrs. Rina Alhamdullillah, no miss. That was may first pregnancy and now become my
first child.
Midwife Lia That good, alhamdullillah. During your puerperium period have you ever
had fever, lower abdominal pain, abnormal bleeding and then had a puss or
abnorman vaginal discharge?
Mrs. Rina No, I think my puerperium period goes normally and I have no problem
with it.
Midwife Lia Then sorry for Mrs. Rina and Mr. Agung , have you ever had abnormal
discharge, pus or you ever seen red from your genital? And when you have
a pee you may feel pain or burning sensation or maybe during your sexual
intercourse you may feel pain or bleed?
Mr. Agung No miss, we have no experienced something like that
Midwife Lia And Excusme, may I know your marital history? This is the first or
maybe….
Mrs. Rina This is may first marriage
Mr. Agung Me too miss.
Midwife Lia Oke the las one for Mrs. Rina do you ever experienced like get exhausted
easily, felt dizzy, sweating more and irregular heart beat?
Mrs. Rina I do get exhausted when I do a lot of activity, but in normal activity I never
experienced anything like you said.
Midwife Lia That’s good, thank you for the answer from you both. So in short-term from
some question that I asked, Mrs.Rina can use the IUD contraception. But
we need to do physical examination to make sure whether the IUD suits
your whom or not.
So Mrs.Rina iam gonna check your genetals, the conditions of your serviks
then the length of your whom / uterus. And if there is no problem with your
genital or your uterus so we could insert the IUD right now or anytime if
you are ready. Do you mind with that?
Mrs. Rina I hope, there is no matter with my physical examination and I don’t mind if
we insert the IUD today miss. Do you mind pa?
Mr. Agung No, I think its prefer to do it right now, I hope the IUD suits with your
 conditions as well.
Midwife Lia Okay Please have a pee first Mrs.Rina, then dont forget to use the soap and
dry it, you can save your the underwear first and come to the physical
examination room without using your underwear, the bathroom is right
there and the examination room in front of it.
Mrs. Rina Okay thanks miss
Mr. Agung I will wait you in waiting room ma.
Midwife Lia do the physical examination for Mrs. Rina. There is no problem were found in the
examination of genetals, cervix and uterus. IUD has been inserted well to Mrs.Rina and now
Mrs. Rina and Mr. Agung have counselling post-insertion with Midwife Lia.
Midwife Lia What do you feel right now Mrs.Rina, is it okay with you?
Mrs. Rina A bit uncomfortable in my vaginal area, but I can handle it miss.
Midwife Lia  Yeah I know what you feel Mrs.Rina. Its normal to feel that way
because it’s the first time for you. Don’t worry, after few weeks or few
months you will get used to it.
 So the things that you have to know, like I said before after this
insertion, if you get your period become heavier and longer bleeding is
normal and expected, especially in the first few months. Please don’t
worry about it.
 But there are a conditions that you may aware such as you experience
abnormal bleeding, abnormal discharge, pain (whether abdominal or
pain with intercourse), fever, you felt like your strings is missing,
shorter, or longer or may be Mr.Agung felt unconfortable when you
have sexual intercourse. So you must come back in here to get the
examination or maybe you can call by telephone first.
 I’d like to remind you again that the IUD can stay in for up to 10 years.
But if you like to planning your next pregnancy as you said before its
about 5-6 years later or maybe before it, Or you want to changed
contraception method, you can come back here anytime to remove the
IUD.
 As long as you are able to feel the strings yourself in amonths time, you
don’t need to comeback for a review. If however you have some
problem you could come back to the clinic.
  Is there something that ypu worried about? Or maybe have a question?
Mrs. Rina How do I check the strings miss?
Midwife Lia  It’s a good question Mrs.Rina so you have to wash your hand first.
Then find a comfortable place to sit or squat and insert middle or index
finger into your vagina until you feel firm and rubbery, like the tip of
your nose and feel the strings coming out to your cervix.
 Its best to check your IUD strings a few times a week for the first few
months and then you may check once a month between periods.
Mrs. Rina Okay miss I got it
Mr. Agung Is it okay if a few days later we have sexual intercourse miss?
Midwife Lia That great question Mr. Agung. Generally IUD can be effective after 24
hours, but its better to have sexual intercourse when the pain of your wife
started to disappear.
Mr. Agung Okay miss thank you, I think I have no worries anymore.
Midwife Lia Hmm that sound good to you Mr.Agung  so can you repeat the
information as I said before Mrs.Rina and Mr. Agung?
Mrs. Rina My period may become heavier and longer bleeding but its normal.
Conditions that should be aware is if I got abnormal bleeding or
dischard,and……
Mr. Agung When you felt pain in abdominal area or while we are have intercourse,
fever, felt the strings is missing, shorter, or longer or felt unconfortable with
it.
The IUD can stay in for up to 10 years but if we want to planning the next
pregnancy we can come to the clinic and remove it anytime.
Midwife Lia Awesome Mrs. Rina and Mr.Agung. both of you seems understood what I
said. And how to check your IUD strings Mrs.Rina ?
Mrs. Rina Wash my hand, get sit or squat position, and insert middle into my vagina
and feel the strings coming out to my cervix.
I shpuld check it few times a week for the first few months and then once a
month between periods.
Mr. Agung And IUD can be effective after 24 hours miss.
Midwife Lia Its greats Mrs.Rina and Mr.Agung you are enthusiastic couple and
complement each others
Mrs. Rina Thanks miss, maybe I will call you if I have a problem or there is something
to ask. Is it okay?
Midwife Lia Its okay , with my pleasure
Mr. Agung Thank you so much miss Lia. We need to go now. Assalamualikum.