REPRODUCTIVE LIFE PLANNING  Explore own beliefs and values

 Provide informed consent

 Decisions of individuals or couples
 When to have children NATURAL FAMILY PLANNING (Periodic abstinence
 How many children methods)
 How they are spaced
- No introduction of chemical or
CONTRACEPTIVE foreign material into the body
- Spiritual beliefs
 Intentional prevention of pregnancy by - Involves no expense
artificial or natural means - Does not introduce any foreign
ASSESSMENT substance to the body
- No risk to fetus should client get
 Changing social values and lifestyles pregnant
 Others may be uncomfortable - 2%-25% failure rate, depending on
 Ask patient if they want more information the couple’s ability of refrain from
or need help having sexual relations on fertile
 Culture /tradition (Catholic – natural Family days
planning) - Fertile Days- days which the
woman is most likely to become
CONTRAINDICATIONS OF FAMILY PLANNING
pregnant (9 days day after
menstruation and 9 days before
start of menstruation)
 Abstinence
 Lactation Amenorrhea Method
 Coitus Interruptus
 Postcoital Douching
 Fertility Awareness Method
 If the client has poor memory, it is most
o Calendar (rhythm) Method
likely that they wouldn’t be able to follow
o Basal Body Temperature
the family planning method chosen (poor
o Cervical Mucus Method (Billing’s
compliance)
Method)
NURSING DIAGNOSIS o Two-day Method
o Symptothermal Method
 Readiness for Enhanced knowledge
o Standard Days Method (Cycle
regarding contraception options related to
the desire to prevent pregnancies Beads)
o Ovulation Detection
 Deficient knowledge related to the use of
diaphragm o Marquette Mode
 Spiritual distress related to partner’s
preferences for contraception (especially if 1. ABSTINENCE
they have different cultural and religious  Refraining from sexual relations
beliefs)  Has 0% theoretical failure rate
 Decisional conflict regarding choice of birth  Most effective way to prevent STIs
control because of health concerns (such as  High failure rate because compliance is
due to contraindications vs chosen very difficult
contraceptive) Nursing Actions:
 Decisional conflict related to unintended
pregnancy  Suggestion of ways to comply the
 Powerlessness related to failure of chosen methods
contraceptive  Safer sex practice
 Altered sensuality pattern related to fear of Advantages
pregnancy
 Risk for ineffective health maintenance  Prevent pregnancy
related to lack of knowledge about natural  Prevent STDs
family planning methods  Wait until person is ready for sexual
relationship
PLANNING AND IMPLEMENTATION
 Acceptable to all religious groups
 Realistic plans for couple e sensitive to  Focus on school, career, or
couple’s spiritual, cultural, and moral beliefs extracurricular activities
 Disadvantages
 People may find it difficult to
abstain for longer periods of time
 End abstinence without protecting
themselves against pregnancy or
infection
 Requires motivation and periods of
abstinence for both partners
2. PERIODIC ABSTINENCE
 Avoiding sex on the days a woman
may conceive
 Use those in Fertility Awareness
Method
3. LACTATION AMENORRHEA METHOD
 When a woman is Breastfeeding,
there is a natural suppression of
both ovulation and menses
 It is a safe birth control method
 Begins after giving birth
 After 6 months, or if the infant
begins to receive supplemental
feedings or isn’t sucking we’ll, LAM
is less effective
 Advice woman to use a different
method of contraception or in
conjunction with other
contraceptive methods
 When an infant is (failure rate of 1-
5%):
o Under 6 months of age
o Totally breastfeed every
four(4) hours during the day
and six (6) hours at night
o Receives no supplementary
feedings
 Failure of LAM will
be prevented
 Menses of the
mother has not
returned
o After 6 months, if the
infants begins
supplementary feeding or
isn’t sucking well, the use of
LAM is questionable if the
woman is advised to use
another method
 Advantages of LAM
o Controlled and provided by the woman
o Effective while infant is totally breastfed
o Approve by all religious and cultures
o Begins immediately after childbirth
o Health benefits both mother and infant
o No commodities/supplies required
o Can be used by women everywhere
o Builds on established cultural and religious
practices
o Improves Breast-feeding and weaning
pattern of infants
o No interference with sexual intercourse
o Provides time to learn other natural Family
planning method during the postpartum
period
 Benefits to Mother and Baby
o Enhance mother-baby bonding (through
Breastfeeding)
o Support growth and development
o Stimulates uterine contraction to reduce
postpartum blood loss
o Prevent Neonatal and infant illness
(diarrhea, respiratory infections, etc.)
o Prevents Neonatal and infant mortality
 Disadvantages
o Full or nearly full Breastfeeding maybe
difficult
o No protection against sexually transmitted
diseases, including HIV
o Temporary (only up to when the baby is
6mo or before menses return)
4. COITUS INTERRUPTUS (Withdrawal)
 One of the oldest
 Couple proceed with coitus until the
moment of copulation/ejaculation.
Then, Penis is removed from the
vagina before ejaculation and
Spermatozoa are emitted outside the
vagina
 Pre-ejaculation can cause pregnancy
 82% effective
 Can lead to STIs
 Because there are a few spermatozoa
present in the pre-ejaculation fluid,
fertilization may occur even if
withdrawal seems controlled
 Advantages:
o Costs nothing
o Require no device
o Involves no chemicals
o Cause no medical side effects
o Always available
 Disadvantages
o Risk of not withdrawing on time
o Pleasure is compromised
o Effectiveness rate is low
o Effectiveness rate is low
o No protection against STDs,
including HIV
5. POST COITAL DOUCHING
 Douching following intercourse
  Water, vinegar, or other products
theoretically flush semen out of the
vaginal (spermicidal properties)
 No matter what solution is used, it
is ineffective as a contraceptive
measure, as sperm may be present
in the cervical mucus as quickly as
90 seconds after ejaculation
 Sperm are known to appear in the
mucus as quickly as 90 seconds
after ejaculation
 Sperm can reach the fallopian tube
within a short time
 In the fallopian tube, pregnancy can
result and Douching cannot prevent
this
 Ineffective as a contraceptive,
hence not reliable
 Advantage
o Makes woman feel cleaner
 Disadvantages :
o Vaginal infections (bacterial
vaginosis)
o Pelvic inflammatory
disease= infection of the
uterus, fallopian, tubes,
and/or ovaries, cervical
cancer
6. FERTILITY AWARENESS METHOD
 Rely on detecting when a woman
will be capable of impregnation
(fertile) so she can use periods of
abstinence during that time
 Common Fertility Awareness
Methods:
o Cycle beads
o Calendar
o Measure the woman’s body
temperature
o Consistency of the cervical mucus
o Combination of these methods
 These methods consider the length
of sperm survival and length of time
an ova is ripe for fertilization
o Typical length of sperm survival: 3-5
days
o Length an ova is ripe for fertilization:
about one day
o Fertile period: 5 days before ovulation
to 1 day after
 Based on this, a fertile period exists
from about 5 days before ovulation
or 1 day after
a. Calendar (Rhythm) Method
o Abstain coitus on the days of
menstrual cycle when womb is most
likely to conceive
o Keep a diary about six (6)
months/menstrual cycles
o To calculate “safe” days: subtract 18
from the shortest cycle (1st fertile
day) ; subtract 11 from the longest
cycle (last fertile day)
o Example :
 September =25
 October =26
 November =27
 December =28
 January=29
 February= 26
 Shortest period= 25-18= 7
 Longest period = 29-11= 18
Question 1:
a. Shortest menstrual cycle is 22
Shortest period : 22-18= 4
(first fertility day)
b. Longest menstrual cycle is 33
Longest period: 33-11= 22
(last fertility day)
c. Entire fertile period
4th day (shortest cycle) to
the 22nd day (longest cycle)
Question 2:
a. Shortest menstrual cycle is 22
Shortest period : 24-18= 6
(first fertility day)
b. Longest menstrual cycle is 33
Longest period : 29-11= 18
(last fertility day)
c. Entire fertile period
6th day (shortest cycle) to
the 18th day (longest cycle)
Question 3:
a. Shortest menstrual cycle is 22
Shortest period : 28-18= 10
(first fertility day)
b. Longest menstrual cycle is 33
Longest period : 35-11= 24
(last fertility day)
c. Entire fertile period
10th day (shortest cycle) to
the 24nd day (longest cycle)
  Advantage of the Calendar
Cycle
o No cost
 Disadvantages of the Calendar
Method
o Requires motivation
c. Cervical Mucus Method (Billing’s
o Needs cooperation
Method)
b. BASAL BODY TEMPERATURE
 BBT- temperature of a woman
early in the morning when she
wakes up in the same
environment or condition
o Body temperature in
resting state on waking
o Slight drop immediately
before ovulation
 Taken through a basal body
thermometer (tympanic
thermometer)
 Designed to determine when a
woman’s body is ovulating
 BBT drops before the day of
ovulation at about 0.5°F
 Rises a full Fahrenheit degree
(0.2°C) on ovulation
 Sexual activity should be
stopped for 3 to 4 days after
temperature elevates
 Woman that works at night
should take their temperature
at their wakening (when they
wake up)
 Intercourse before ovulation
can carry a great risk of
pregnancy than post ovulation
 Sperm can remain viable up to
72 hours (or 3-5 days and rarely
7 days)
 Advice couple to combine this
with calendar method
 Ideal failure rate : 3%
 Failure rate : 35%
 Advantages
o Inexpensive
o Convenient
o No side effects
o Instructions : take temp
prior to getting out of
bed each morning
 Disadvantages
o Reliability can be
influenced by many
variables:
o Stress
o Fatigue
o Illness
o Alcohol
o Warmth or
coolness of
sleeping
environment
o Risk: pregnancy
 Observe the cervical mucus
 Thick and does not stretch
before ovulation
 Mucus secretion increases
before ovulation
 Before Ovulation
o Cervical mucus is thick
o Does not stretch when
pulled between thumb and
finger
 On the Day of Ovulation
o Cervical mucus is copious,
thin, watery and
transparent (like an egg
white) stretch to 1inch
until it break (known as
Spinnbarkeit)
 Breast tenderness
 Anterior tilt to the cervix
 Fertile : all the days when
mucus is copious and 3-4 days
thereafter
 High failure rate because of
difficulty interpreting mucus
status
 Should be combined with the
calendar method
 Advantage :
o Cost of thermometer
 Disadvantages :
o Motivation and
cooperation of male
partner
d. Two-day Method
 Woman assesses vaginal
secretions daily
 If she feels secretions for two
days in a row, avoid coitus on
that day and the following day
 Secretions suggests fertility
  Must be done at least 12 days
per month in which she must
avoid coitus, the same as
Calendar Method
 Advantage
o No cost
 Disadvantages :
o Motivation and
cooperation of male
partner
e. Symptothermal Method
 A combination of the cervical
mucus and the BBT methods
 Procedure
o Woman takes
temperatures everyday
watching for rise in
temperature which marks
ovulation
o Analyze cervical mucus
everyday and observe
signs of ovulation such as
mittelschmerz (mid cycle
abdominal pain), or if her
cervix feels softer than
usual
 Abstain: 3 days after the rise of
temperature or the 4th day after
the peak of the mucus change
 Advantage
o No cost
 Disadvantages :
o Motivation and
cooperation of male
partner
f. Standard Days Method: Cycle Beads
 Designed for women who have
menstrual cycles between 26-
32 days.
 A woman purchases a circle of
beads that helps predict fertile
days
 First bead (red)= first day of
menstrual cycle
 Six brown beads= “safe days”
 12 glow-in-the-dark white
beads= fertile days
 13 brown beads= “safe” days to
follow
 Wom
 Advantages :
o Helps the couple avoid
unplanned pregnancy
o Helps couple plan
pregnancy
o Visual aid can improve
compliance
o Available at iPhone app
 Disadvantages:
o Initial cost
o May need to mark a
calendar
 Ovulation Detection
 Over-the-counter detection kit
 Detects mid cycle surge of
luteinizing hormone (LH)
 Detected in urine 12-14 hours
before ovulation
 98-100% accurate
 Method of choice
 Marquette Method
 Combines the use of ovulation
detection with other signs of
ovulation
 Cervical mucus
 BBT
 Cervix position and softness
 SIDE EFFECTS AND
CONTRAINDICATIONS FOR NATURAL
FAMILY PLANNING
 Don not have side effects
 Couples who must prevent
conception
 Failure rate is 25%
 No effect if a woman should get
pregnant while using them
 More spontaneity in sexual
relation is possi2
 Not contraceptive method of
choice for adolescents
 EFFECTS OF NATURAL FAMILY
PLANNING
 Good for perimenopausal
women
 Good for postpartal women
BARRIER METHODS OF CONTRACEPTION
 Place chemical or latex barrier between
the cervix and advancing sperm so
 sperm cannot reach and fertilize An
ovum
1. Spermicide
o Caused the death of spermatozoa
o Often used with other physical
Barrier method
o Vaginal pH changed to strong level
o Forms of Spermicide :
 Gel and creams
 Film of glycerin
 Cocoa butter and glycerin-
based vaginal suppositories
 Foam-impregnated
synthetic sponges
o Advantages:
 Purchased without
prescription
 Increase the effectiveness
of other contraceptive
 Various preparations
available
 Over-the-counter
 Easy to use
o Disadvantages:
 Do not protect against STD
 Annoyi3vaginal discharge
o Side Effects and Contraindications
 Contraindicated in women
with acute cervicitis
 Vaginal suppositories are
bothersome
2. Male Condom
o Male condom= latex rubber or synthetic
sheath
o Apply condom when penis is erect and
provide space at the tip
o One time use only
o Ideal failure rate of 2%
o True failure rate of 15%
3. Female Condoms
o Made of latex or polyurethane,
prelubricated with spermicide
o Inner ring covers the cervix
o Outer ring rests against the vagina
o Advantage
o Protects against STIs
o Male responsibility
o No prescription
o Disadvantages
o Interruption of sexual activity
o Side Effects and Contraindications
o Sensitivity or allergy to latex
o Natural membrane types
maybe used
4. Diaphragm
o Circular rubber disc placed over the
cervix
o
Spermicide is usually used
o
Failure rate is 6%(ideal) to 18%
(typical use)
o Advantage
o Easy to insert
o Disadvantages
o Prescription needed
o Necessary to make
measures to avoid
dislodging of the diaphragm
o Side Effects and Contraindications
o Not effective if uterus is
prolapsed, anteflexed,
retroflexed
o Difficult to insert if there is
intrusion in the vaginal like
rectocele and cystocele
o Higher incidence of UTIs
o Contraindicated for women
with cervicitis, herpes virus
in, or papillomavirus
o Contraindicated for toxic
shock syndrome (TSI)
allergy to rubber or
spermicide and recurrent
UTIs
5. Cervical Caps
o Made of soft rubber shaped like a
thimble
o Failure rate is as high as 23% (ideal)
to 35% (typical)
o Can be kept longer than diaphragm
(up to 47 hours)
1:00:30
REPRODUCTIVE LIFE PLANNING
 Although there are many contraceptive
options for reliable pregnancy prevention,
only condoms (both male and female)
provide protection against sexually
transmitted diseases (STD) or HIV
 Because no method of contraception,
except abstinence, offers 100% protection
against pregnancy, it is important to
carefully answer the patient’s questions
regarding methods of contraception
Characteristic of an Ideal Contraception
  Before a patient begins a new method of
contraception, information that should be
obtain must include:
o Vital Signs
o Pap Smear
o Pregnancy Test
o Gonococcal & Chlamydia Screening
o Hemoglobin (for detection of
anemia)
o Obstetric History
o History of STIs
o Past Pregnancies
o Previous Elective Abortions
o Failure of previously used methods
o Compliance history of past method
o Subjective Assessment of
Patient’s :
 Desires
 Needs
 Feelings
 Understanding of
contraception (a teenager
may believe she is too
young to get pregnant)
o Sexual Practices
 Frequency
 Number of Partners
 Feelings about sex
 Body image

Nursing Care Planning to Respect Cultural Diversity

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