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Description
Reproductive life planning includes all the decisions an individual or couple make about
whether and when to have children, how many children to have and how they are spaced. This
module will provide the student an understanding of the different methods of reproductive life
planning and the advantages and disadvantages, and the risk factors associated with each. It
will also tackle how the couple can utilize the chosen method considering their religious,
personal and cultural beliefs.
Learning Outcomes
LO1 Integrate concepts of different methods of reproductive life planning and the
advantages and disadvantages, and the risk factors associated with each in the formulation and
application of appropriate nursing care during childbearing and childrearing years.
LO3 Assess clients for reproductive life planning needs
LO4 Formulate nursing diagnosis/es related to reproductive planning
LO5 Implement safe and quality nursing interventions related to reproductive planning.
LO6 Conduct individual/group health education activities such as educating adolescents
about the use of condoms as a safer practice as well as to prevent unintended pregnancy.
LO7 Evaluate with the client the health outcomes of nurse-client relationship.
Module Outline
I. Reproductive life planning
II. Commonly used birth control methods
III. Assessment for reproductive life planning needs
IV. Nursing Diagnoses Related to Reproductive Life Planning
V. Interventions Related to Reproductive Life Planning
VI. Evaluating Outcomes Related to Reproductive Life Planning
Counseling may include the topics of avoiding conception, increasing fertility, and/or
what to do if contraception has failed.
An ideal contraceptive should be
a. Safe
o Effective
o Compatible with religious and cultural beliefs and personal preferences of user
and partner
Abstinence has a theoretical 0% failure rate and is also the most effective way to prevent STIs.
Because it is difficult for many couples to adhere to abstinence, the method has a high failure
rate.
2. Lactation Amenorrhea Method (LAM)
3. Coitus interruptus
Coitus interruptus or withdrawal method is one of the oldest methods of contraception. The
couple proceeds with coitus until the moment of ejaculation. Then, the man withdraws and
spermatozoa are emitted outside the vagina. Unfortunately, ejaculation may occur before
withdrawal is completed and, despite the caution used, some spermatozoa may be deposited in
the vagina. Furthermore, spermatozoa may be present in pre-ejaculation fluid, fertilization may
occur even if withdrawal seems controlled. For these reasons, coitus interruptus is only about
82% effective and can also lead to STIs.
4. Fertility Awareness Method
A fertile period exists from about 5 days before ovulation to 3 days after.
• Calendar (Rhythm) Method
The calendar method requires the couple to abstain from coitus on the days of a menstrual
cycle when the woman is fertile. To plan for this, the woman keeps a diary of about six
menstrual cycles. To calculate for “safe” days, she subtracts 11 from her longest cycle and 18
from shortest cycle. To avoid pregnancy, the couple should avoid coitus during these days
Example: menstrual cycle ranging from 25 to 29 days
Shortest cycle = 25 days – 18 days = 7
Longest cycle = 29 days – 11 days = 18
FERTILE PERIOD = 7th to 18th day of the menstrual cycle.
• Basal Body Temperature
Just before the day of ovulation, a woman’s basal body temperature (BBT) falls about 0.5oF. At
the time of ovulation, her BBT rises 1oF (0.2oC) because of the rise in progesterone
(thermogenic hormone) with ovulation. To use this method, the woman takes her temperature
each morning immediately after waking before she rises form bed or undertakes any activity;
this is her BBT. As soon as a woman notices a slight dip in temperature followed by an increase
she knows she has ovulated. She refrains from having coitus for the next three days.
A problem with assessing BBT for fertility awareness is that many factors can affect BBT. For
example, a temperature rise caused by illness, activity or warm environment could be mistaken
as the signal for ovulation.
• Cervical Mucus Method (Billing’s Method)
The symptothermal method combines the cervical mucus and BBT method. The woman takes
her temperature daily, watching for the rise in temperature that marks ovulation such as
mittleschemerz or cervix feels softer than usual. The couple then abstain coitus until 3 days
after the rise in temperature or the fourth day after the peak of mucus change. The
symptothermal method, because it assesses more clues to ovulation, is more effective that
either the BBT or cervical mucus alone.
Natural family planning methods do not have side effects. If there is contraindication to their
use, it would be for couples who must prevent conception because their failure rate of all forms
is about 25%.
B. Barrier Methods of Contraception
Barrier methods are forms of birth control that place a chemical or latex barrieron the cervix
and advancing sperm so sperm cannot reach and fertilize an ovum.
1. Spermicides
A spermicide is an agent that causes the death of spermatozoa before they can enter the cervix.
It is a chemical barrier method and is often used in combination with other physical barrier
methods. Spermicides not only actively kill sperm but also change the vagina pH to a strong
acid level, a condition not conducive to sperm survival. They do not protect against STIs.
Spermicidal foam, cream, jelly, and suppository capsules are over-the-counter (OTC)
Male condoms are sheaths of thin latex, polyurethane, or natural membrane worn on the penis
during intercourse. Condoms collect semen before, during, and after ejaculation. They come in
various styles, such as ribbed, lubricated, and colored, and with or without spermicide. They
are single-use, low cost items that are available OTC. Latex condoms provide some protection
from STIs. Natural membrane condoms do not prevent the passage of viruses. To prevent
condom breakage, water-soluble lubricants should be used of the condom or vagina is dry.
Female condoms are essentially used for the same purpose as malt condoms. Two flexible rings,
one that fits into the vagina and one that remains outside, connected by a polyurethane
sheath. They are prelubricated, single-use items that are available OTC.
Side effects of and contraindications to condom use are rare. Either or the partners maybe
allergic to latex, in which case a polyurethane or natural membrane condom can be used
successfully. The failure rate is 18%.
3. Diaphragm and cervical cap
Diaphragms and cervical caps are rubber domes that fit over the cervix and are used with
spermicides to kill sperm that pass the mechanical barrier. A health care provider fits the
diaphragm and cervical cap. The woman must learn how to insert and remove the diaphragm
or cervical cap and to verify proper placement.
Before insertion, the woman should check either device for weak spots or pinholes by holding it
up to the light. Diaphragm or cervical cap is inserted before coitus and should be removed six
hours after sexual intercourse but not longer than 24 hours (Diaphragm) or 48 hours (Cervical
cap). The diaphragm must be refitted after each birth or after a weight change of 10 pounds or
more. The cap must be refitted yearly and after birth, abortion, or surgery.
C. Hormonal Contraceptives
Hormonal contraceptives include one or more of these contraceptive effects:
• Prevent ovulation.
• Make the cervical mucus thick and resistant to sperm penetration.
• Make the uterine endometrium less hospitable if a fertilized ovum does
arrive.
1. Oral contraceptives
Oral contraceptives, commonly known as pill, OCs (for oral contraceptive), or COCs (for
combination oral contraceptives), are composed of varying amounts of natural estrogen or
synthetic estrogen combined with small amounts of synthetic progesterone (progestin). The
estrogen acts to suppress follicle-stimulating hormone (FSH) and Leutinizing hormone (LH) to
An intrauterine device (IUD) is a small plastic device that is inserted into the uterus through the
vagina by a healthcare provider. IUDs can be either hormonal or non-hormonal. It prevents
fertilization and it creates a local sterile inflammatory reaction that prevents implantation. The
method has a failure rate of 0.1% and reversible, and no specific actions are required related to
intercourse. The hormonal IUD is usually replaced every 3 to 6 years.
Surgical methods of reproductive planning, often called sterilization, include tubal ligation for
women and vasectomy for men. Both have 99.5% effectiveness.
1. Vasectomy
In a vasectomy, a small puncture wound (referred to as “no-scalpel technique”) is made on the
scrotum. The vas deferens on each side are then pulled forward, cut and tied, cauterized, or
plugged, blocking the passage of spermatozoa. A vasectomy can be done under local anesthesia
in an ambulatory setting, such as in primary healthcare provider’s office or a reproductive life
planning clinic. Although the procedure is about 99.5% effective, spermatozoa, which were
present in the vas deferens at the time of surgery, can be viable for as long as 6 months.
Therefore, although the man can resume sexual intercourse 1 week, an additional birth control
method should be used until two negative sperm reports at about 6 and 10 weeks have been
obtained (proof all sperm in the vas deferens have been eliminated, usually requiring 10 to 20
ejaculations).
2. Tubal ligation
Sterilization of women could include removal of uterus or ovaries (hysterectomy), but it
usually refers to a minor surgical procedure, such as tubal ligation, where the fallopian
tubes are occluded by cautery, crushed, clamped, or blocked, and thereby preventing
passage of both sperm and ova. A fimbriectomy, or removal of the fibria at the distal
References
Flagg, J. (2018). Maternal and child health nursing: Care of the childbearing and childbearing
family (8thed.). Philadelphia, PA: WoltersKluwer.
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