WEEK 2 MCN 1 SKILLS LABORATORY

RESPONSIBLE PARENTHOOD
MY LIFE, MY BODY, MY CHOICE.
Prepared by:
Asst. Prof. 1 Jennifer T. Mansing
Asst. Prof. 2 Liezel B. Pandi

I. INTRODUCTION:
Reproductive and Sexual Health problems is most seen in an acutely developing countries,
where reproductive health problems are the leading cause of ill health and death for women
and girls of childbearing age. Most documented cases are impoverished women who
underwent unintended pregnancies, unsafe abortion, maternal death and disability, sexually
transmitted infections (STIs), gender-based violence, and other related problems.
With proper knowledge, skills, and attitude in disseminating clear concepts of information on
sexual and reproductive health, nurses play a key role in contributing to the achievement of
the Sustainable Development Goal 3, which is geared towards good health and well-being,
and it will also catapult the Sustainable Development 5 that calls for gender equality, as well
as the other goals.
Reproductive health ensures that people can have a satisfying and safe sex life, they are
capable of reproducing and have freedom to take decision regarding when and how often to
perform it.
II. OBJECTIVES:
At the end of this lesson the student/s is expected to:
• Identify National Health Goals related to reproductive health and sexuality
• Describe common methods of reproductive life planning and the advantages,
disadvantages, and risk factors associated with each.
• Create infographic that pertains to responsible parenthood as an output for
information dissemination.

III. LESSON PROPER

A. Definition of Concept:
• DOH- responsible parenting is the will and the ability of parents to respond to the
needs and aspiration of the family and children.
o It is shared responsibility of the parents to determine and achieve the
desired number, spacing and timing of their children according to their
own family life aspirations, taking into account psychological
preparedness, health status, socio-cultural and economic concerns.
• POPCOM- defines Family Planning as a program that enables parents to
deliberately and responsibly decide the number and spacing of their children, by
avoiding for the time being, or even for an indefinite period.
o It is not a prognosis imposed on the parents, but an expression of
responsible parenting based on informed choices and decisions of
couples to achieve their desired family size based on their social and
economic capacity.
• WHO -family planning allows people to attain their desired number of children
and to determine the spacing of their pregnancies. It is achieved through use of
contraceptive methods and the treatment of infertility.

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 o Goal
✓ Contraceptive information and services are fundamental to the health
and human rights of all individuals.

✓ The prevention of unintended pregnancies helps to lower maternal

ill-health and the number of pregnancy-related deaths. Delaying
pregnancies in young girls who are at increased risk of health
problems from early childbearing and preventing pregnancies among
older women who also face increased risks, are important health
benefits of family planning.

✓ By reducing rates of unintended pregnancies, contraception also

reduces the need for unsafe abortion and reduces HIV transmissions
from mothers to newborns. This can also benefit the education of
girls and create opportunities for women to participate more fully in
society, including paid employment.

• According to 2017 estimates, 214 million women of reproductive age in developing

regions have an unmet need for contraception. Reasons for this include:
o limited access to contraception
o a limited choice of methods
o a fear or experience of side-effects
o cultural or religious opposition
o poor quality of available services
o gender-based barriers.
• The legal basis of the Philippine Population Program is Republic Act 6365,
otherwise known as the “Population Act of 1971.” It created the Commission on
Population (POPCOM). It was amended in 1972 by Presidential Decree No. 79. The
tandem of Responsible Parenthood and Family Planning is the basic program of the
Philippine Population Management Program (PPMP).
• The current population of the Philippines is 111,181,365 as of Sunday, August 8,
2021, based on World meter elaboration of the latest United Nations data.
• The Philippines 2020 population is estimated at 109,581,078 people at midyear
according to UN data.
• The Philippines population is equivalent to 1.41% of the total world population.
• The Philippines ranks number 13 in the list of countries (and dependencies) by
population.
B. BENEFITS OF USING FAMILY PLANNING
Family planning provides many benefits to mother, children, father, and the family.
1. Mother
✓ Enables her to regain her health after delivery.
✓ Gives enough time and opportunity to love and provide attention to her husband
and children.
✓ Gives more time for her family and own personal advancement.
✓ When suffering from an illness, gives enough time for treatment and recovery.
2. Children
✓ Healthy mothers produce healthy children.
✓ Will get all the attention, security, love, and care they deserve.
3. Father
✓ Lightens the burden and responsibility in supporting his family.

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 ✓ Enables him to give his children their basic needs (food, shelter, education,
and better future).
✓ Gives him time for his family and own personal advancement.
✓ When suffering from an illness, gives enough time for treatment and
recovery.
C. METHODS OF FAMILY PLANNING
1. Natural methods
no intro-duction of chemical or foreign material into the body or sustaining from
sexual intercourse during a fertile period:
a. Fertility awareness – (EFFECTIVITY RATE: 25% - 85%) is a method to
plan or avoid a pregnancy by recognizing the signs of fertility in your
menstrual cycle. It can be used to:
• understand your own menstrual cycle
• plan a pregnancy
• avoid a pregnancy.
✓ Calendar (Rhythm) method
• The calendar method requires a couple to abstain from coitus
(sexual relations) on the days of a menstrual cycle when the
woman is most likely to conceive (3 or 4 days before until 3 or 4
days after ovulation.
• To calculate “safe” days
✓ You must chart at least 6 cycles
✓ CYCLES - first day of your period (this is day 1) to the first
day of your next period. Count the total number of days
between each cycle.

FIG. 1
✓ If all of your cycles are shorter than 27 days, the
calendar method won’t be accurate for you.
✓ subtracts 18 from the shortest cycle documented. This
number represents her first fertile day.
✓ subtracts 11 from her longest cycle. This represents her last
fertile day.
o SC 26-18 = 8
o LC 37-11 =26

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 o FERTILE PERIOD (from 8th-26th day)
o
b. Calendar (Rhythm) method
• SC (8th day) - Count that number from day 1 (the first day of
your period) of your current cycle and mark that day with an X.
(Include day 1 when you count.) FIRST FERTILE DAY
• LC (26th day) Count that number from day 1 (the first day of
your period) of your current cycle and mark that day with an X.
(Include day 1 when you count.) LAST FERTILE DAY
•

FIG.2
(RED lines is unsafe days, BLUE lines is safe days)

c. BASAL BODY TEMPERATURE (BBT)

• before the day of ovulation there’s a drop the body temperature.
During ovulation BBT increases due the presences of
progesterone.
• increased in BBT remains high during her menstrual cycle
• Pattern is the guide for the use of BBT contraception
• Take the temperature upon waking up. No other activity should
be done yet.
• take note of sudden drop in the temperature followed by an
increased in BBT (ovulated)
• avoid for having contacts for 3 days better to use this method
with calendar method.

FIG. 3
https://bit.ly/37tFYXP

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 d. CERVICAL MUCUS METHOD
• is a type of natural family planning. Also called the Billings
Ovulation Method, the cervical mucus method is based on
careful observation of mucus patterns during your menstrual
cycle
• Before ovulation each month, the cervical mucus is thick and
does not stretch when pulled between the thumb and finger.
▪ Just before ovulation, mucus secretion increases.
▪ With ovulation (the peak day), cervical mucus becomes copious,
thin, watery, and transparent. It feels slippery and stretches at least 1
inch before the strand breaks, a property known as spinnbarkeit

FIG.4
https://bit.ly/3jCTIoR
e. CERVICAL MUCUS METHOD
• To use the cervical mucus method:
✓ Check your cervical mucus every day. Observe the color and
feel the consistency by rolling and pulling it between your
thumb and index finger. To check mucus, you can:
✓ Collect discharge from your underwear.
▪ Put a clean finger into the vagina.
▪ Wipe the vagina with toilet paper.
▪ Record the description. Track your finding on a chart,
list or fertility tracking app so you can compare each
day’s findings.
✓ The typical phases of cervical mucus quality during the cycle
includes:
▪ “Dry” days of very little mucus.
▪ Cloudy, sticky mucus leading up to ovulation.
▪ Clear, slippery, stretchy mucus just before and
during ovulation
▪ Plan sex with the fertile period in mind.
f. Sympto-thermal Method
✓ combination of cervical mucus and BBT methods.
✓ The woman takes her temperature daily, watching for the
rise in temperature that marks ovulation.
✓ She also analyzes her cervical mucus every day and observes
for other signs of ovulation such as mittelschmertz
(midcycle abdominal pain). The couple must abstain from

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 inter-course until 3 days after the rise in temperature or the
fourth day after the peak of mucus change, because these are
the woman’s fertile days.

FIG. 5
https://bit.ly/3iyXa4F

g. Ovulation Detection
✓ to predict ovulation is by the use of an over-the-counter
ovulation detection kit
✓ 98%-100% accurate
✓ These kits detect the mid-cycle surge of luteinizing hormone
(LH) that can be detected in urine 12 to 24 hours before
ovulation.

FIG.6
https://bit.ly/3AnwolC

h. LACTATIONAL AMENO RRHEA METHOD (LAM)

• A woman can use LAM if:
✓ her menstrual period has not returned since delivery
✓ she is breastfeeding her baby on demand, both day and night
and not feeding other foods or liquids regularly
✓ her baby is less than six months old.

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 FIG. 7
https://bit.ly/2Xfe7c7
i.Coitus Interruptus
• is the practice of with-drawing the penis from the vagina and
away from a woman's external genitals before ejaculation to
prevent pregnancy.
• 75% effective
j. Postcoital Douching
• Douching following inter-course, no matter what solution is used, is
ineffective as a contraceptive measure as sperm may be present in
cervical mucus as quickly as 90 seconds after ejaculation.
2. HORMONAL CONTRACEPTION
a. COMBINATION ORAL CONTRACEPTIVE (COC’s)

• 99.7% effective
• composed of synthetic estrogen combined with a small amount of
synthetic progesterone (progestin).
• Estrogen suppress follicle-stimulating hormone (FSH) and LH,
thereby suppressing ovulation.
• Progesterone action complements that of estrogen by causing a
decrease in the permeability of cervical mucus, thereby limiting
sperm motility and access to ova.
• Progesterone interferes with tubal transport and endometrial
proliferation thus decrease the possibility of implantation.

FIG. 8
https://bit.ly/2Xfe7c7

✓ 21 or 28 pills in a package (21 active pills and 7 placebo)

✓ generally recommended taken on first Sunday after the
beginning of a menstrual flow

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 ✓ After delivery start taking on the Sunday closest to 2
weeks after childbirth.
✓ After abortion start taking first Sunday after the
procedure
✓ Not taken any pills for 1 week, should restart a new
month’s supply on the Sunday 1 week after the woman
stopped.
✓ Side Effects
✓ Nausea
✓ Weight gain
✓ Headache
✓ Breast tenderness
✓ Breakthrough bleeding (spotting outside the menstrual
period)
✓ Monilial vaginal infections
✓ Mild hypertension
✓ Depression
• How to take 21-day pills - standard regime
✓ Take your 1st pill from the packet marked with the correct
day of the week, or the 1st pill of the 1st colour (phasic
pills).
✓ Continue to take a pill at the same time each day until the
pack is finished.
✓ Stop taking pills for 7 days (during these 7 days you will get
a bleed).
✓ Start your next pack of pills on the 8th day, whether you are
still bleeding or not. This should be the same day of the
week as when you took your 1st pill.
• How to take everyday pills
✓ Take the 1st pill from the section of the packet marked
"start". This will be an active pill.
✓ Continue to take a pill every day, in the correct order and
preferably at the same time each day, until the pack is
finished (28 days).
✓ During the 7 days of taking the inactive pills, you will get a
bleed.
✓ Start your next pack of pills after you have finished the 1st
pack, whether you are still bleeding or not.
• What if I have missed 1 pill?
✓ If you have missed 1 pill anywhere in the pack or started a
new pack 1 day late, you're still protected against pregnancy.
o You should:
❖ take the last pill you missed now, even if this means
taking 2 pills in 1 day
❖ carry on taking the rest of the pack as normal
❖ take your 7-day pill-free break as normal, or if
you're on an everyday (ED) pill, take your dummy
(inactive) pills
❖ You do not need to use extra contraception.
• What if I have missed 2 or more pills?

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 ✓ If you have missed 2 or more pills anywhere in the pack or
started a new pack 2 or more days late (48 hours or more),
your protection against pregnancy may be affected.
o You should:
❖ take the last pill you missed now, even if this means
taking 2 pills in 1 day
❖ leave any earlier missed pills
❖ carry on taking the rest of the pack as normal
❖ use extra contraception, such as condoms, for the
next 7 days
❖ When you come to the end of your pill pack, after
missing 2 or more pills:
❖ if there are 7 or more pills left in the pack after the
last missed pill – finish the pack, take your 7-day
pill-free break as normal, or take your inactive pills
before you start your next pack
❖ if there are less than 7 pills left in the pack after the
missed pill – finish the pack and start a new pack the
next day; this means missing out the pill-free break
or not taking your inactive pills
❖ You may also need emergency contraception if you
have missed 2 or more pills in the first week of a
pack and had unprotected sex in the previous 7 days.
• Contraindications
✓ Women with a history of thromboembolic disease
✓ a family history of cerebral or cardiovascular accident
✓ who are over 40 years of age
✓ who smoke because of the increased tendency toward
clotting as an effect of increased estrogen.
• Mothers should notify their healthcare providers of the following
myocardial and thromboembolic problems such as chest pain,
shortness of breath, severe headache and leg pain, and eye problem
(blurring of vision).
• if pregnancy is suspected discontinue pills*
• when stops taking, 1-2 months she will not get pregnant possibly 6-8
months.
b. Mini Pills
✓ Progesterone only
✓ Ovulation may occur but no implantation will take place because of
progestin the endometrium is not fully developed.
✓ Advantage with mother with thromboembolic problems because of
no estrogen content
✓ Taken every day even with menstruation
✓ Can be taken while breastfeeding because does not interfere in the
milk production.
✓ It thickens the mucus inside the cervix
✓ It also thins the lining of the uterus*
✓ it also helps prevent ovulation

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 FIG. 9
https://bit.ly/37yFTC9

✓ The minipill comes in a pack of 28 Unlike combination birth control

pills, there’s no row of inactive, or placebo pills
✓ How to take it?
o When you first start the minipill, take it within 5 days of
when your period starts
o Use a condom every time you have sex in the first week
after you start the minipill. It takes time for the minipill
It’s important to take the minipill every day and at the
same time each day
o If you miss the 3-hour window, use a condom or don't
have sex for the next 2 days.
o If you forget to take a pill, take one as soon as you
remember. That may mean you take two pills in one day.
Take them a few hours apart. Then take the next pill at
your regular time to work.
c. Transdermal Route/TRANSDERMAL CONTRACEPTION
✓ refers to patches that slowly but continuously release a combination
of estrogen and progesterone
✓ Patches are applied each week for 3 weeks. No patch is applied the
fourth week –patch free – Menstrual will occur.
✓ After the patch-free week, a new cycle of 3 weeks on/1 week off
begins again.

FIG. 10
https://bit.ly/3s7GjJu

✓ The efficiency is equal to that of COCs,

✓ less effective in women who weigh more than 90 kg (198 lb)

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 ✓ Because they contain estrogen, they have the same risk for
thromboembolic symptoms as COCs (Cole et al.,2007).
✓ Patches may be applied to one of following four areas:
✓ upper outer arm, upper torso (front or back, excluding the breasts),
abdomen, or buttocks.
✓ They should not be placed
o on any area where makeup, lotions, or creams will be
applied
o at the waist where bending might loosen the patch
o where the skin is red or irritated or has an open lesion.
d. VAGINAL INSERTION/VAGINAL RING (NUVARING)

✓ is a silicone ring that surrounds the cervix and continually releases a

combination of estrogen and progesterone.
✓ It is inserted vaginally by the woman and left in place for 3 weeks, then
removed for 1 week (Roumen, 2007)
✓ Menstrual bleeding occurs during the ring-free week
✓ advantage for women with liver disease*
✓ effectiveness is equal to that of COCs
✓ Fertility returns immediately after discontinuing using the ring.

FIG.11
https://bit.ly/3lPDATR

e. IMPLANTATION/SUBDERMAL IMPLANTS

✓ rods the size of pencil lead are embedded just under the skin on the
inside of the upper arm
✓ contain etonogestrel, the metabolite of desogestrel, the same progestin
that is used in the NuvaRing
✓ long-term reversible contraceptive 3 to 5 years
✓ slowly release the hormone, suppressing ovulation, stimulating thick
cervical mucus, and changing the endometrium so that implantation is
difficult.
✓ implants are inserted with the use of a local anesthetic, during the menses
or no later than day 7 of the menstrual cycle.

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 FIG. 12
https://bit.ly/3AoXYPw
✓ can be inserted immediately after an elective termination of pregnancy or
6 weeks after the birth of a baby.
✓ Implants can be used during breastfeeding without an effect on milk
production.
✓ safe in adolescents.
✓ rapid return to fertility (about 3 months after removal)
✓ DISADVANTAGES/SIDE EFFECTS:
• Weight gain
• Irregular menstrual cycle such as spotting, breakthrough
bleeding, amenorrhea, or prolonged periods
• Depression
• Scarring at the insertion site
• Need for removal
✓ CONTRAINDICATIONS
• pregnancy
• desire to be pregnant within 1 to 2 years,
• Undiagnosed uterine bleeding.
f. INJECTABLE (Depo-Provera [DMPA]

✓ a progesterone, given every12 weeks

✓ inhibits ovulation
✓ alters the endometrium
✓ changes the cervical mucus (Box 6.8).
✓ The effectiveness rate is almost 100%
✓ Do not massage the injection site after administration as you want
the drug to absorb slowly from the muscle.
✓ it can be used during breast-feeding.
✓ ADVANTAGES
• reduction in ectopic pregnancy, endometrial cancer,
endometriosis,
• for unknown reasons, reduction in the frequency of sickle cell
crises (Burkman, 2007),
✓ DISADVANTAGES
• woman must return to a health care provider for a new injection
every 4 to 12 weeks
• return to fertility is delayed by 6 to 12 months.

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 ✓ SIDE EFFECTS
• irregular menstrual cycle,
• Headache
• weight gain
• Depression
• May impair glucose tolerance in women at risk for diabetes.
• an increased risk for osteoporosis from loss of bone mineral
density.
g. INTRAUTERINE DEVICE (IUD)

✓ is a small plastic object that is inserted into the uterus through the
vagina
✓ inserted before a woman has had coitus after a menstrual flow
✓ Two common types of IUDs
• Copper T380 (ParaGard) (US) a T-shaped plastic device
❖ It is effective for 10 years,
• LNG-IUS (Mirena), which holds a drug reservoir of
progesterone in the stem
❖ progesterone in the drug reservoir gradually diffuses into
the uterus through the plastic
❖ it both prevents endometrium proliferation
❖ thickens cervical mucus.
❖ is effective for 5 years (possibly as long as 7 years).
❖ It has a failure rate as low as 0.1% to 1.5%.
✓ ADVANTAGES
• Only one insertion is necessary, so there is no continuing
expense.
• The device does not require daily attention or interfere with
sexual enjoyment.
• It is appropriate for women who are at risk for complications
associated with COCs
• avoid some of the systemic hormonal side effects.
• They may create lighter or fewer periods.
• Check regularly after each menstrual flow to make sure the IUD
string is in place
• obtain a yearly pelvic examination.
✓ SIDE EFFECTS
• spotting or uterine cramping the first 2 or 3 weeks after IUD
insertion
• has a higher-than-usual risk for pelvic inflammatory disease
(PID)
• Some women have a heavier than usual menstrual flow for 2 or 3
months
• experience more dysmenorrhea.
✓ CONTRAIDICATIONS
• STD or had a recent pelvic infection.
• pregnant
• cancer of the cervix or uterus.
• unexplained vaginal bleeding

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 •liver disease, breast cancer, or are at a high risk for breast cancer.
(HORMONAL IUD)
• woman whose uterus is distorted in shape
3. BARRIER METHOD (GELS, CREAMS, SPONGES, FILMS, FOAMS,
SUPPOSITORIES)
• forms of birth control that work by the placement of a chemical or other
barrier between the cervix and advancing sperm so that sperm cannot enter
the uterus or fallopian tubes and fertilize the ovum.
• is an agent that causes the death of spermatozoa before they can enter the
cervix.
a. DIAPHRAGM
1. Wash their hands thoroughly with soap and water before insertion or
removal.
2. Do not use a diaphragm during a menstrual period.
3. Do not leave a diaphragm in place longer than 24 hours.
4. Be aware of the symptoms such as elevated temperature, diarrhea,
vomiting, muscle aches, and a sunburn-like rash.
5. If symptoms of infection should occur, immediately remove the
diaphragm and call a health care provider.

b. CERVICAL CAPS
✓ Caps are made of soft rubber, are shaped like a thimble with a thin
rim, and fit snugly over the uterine cervix
✓ can remain in place longer than diaphragms, because they do not put
pressure on the vaginal walls or urethra.
✓ should not exceed 48 hours, to prevent cervical irritation.
✓ CONTRAINDICATIONS
• An abnormally short or long cervix
• A previous abnormal Pap smear
• An allergy to latex or spermicide
• A history of pelvic inflammatory disease, cervicitis, or
papillomavirus infection
• A history of cervical cancer
• An undiagnosed vaginal bleeding
c. MALE CONDOM
✓ is a latex rubber or synthetic sheath that is placed over the erect penis
before coitus to trap sperm
✓ There are no contraindications to the use of condoms except for a
sensitivity to latex.
✓ must be applied before any penile-vulvar contact*
✓ must be withdrawn before it begins to become flaccid after
ejaculation.
d. FEMALE CONDOM
✓ Latex sheaths made of polyurethane and pre-lubricated with a
spermicide
✓ The inner ring (closed end) covers the cervix, and the outer ring
(open end) rests against the vaginal opening may be inserted any
time before sexual activity begins and then removed after ejaculation
occurs.
✓

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 4. PERMANENT/SURGICAL METHOD
a. VASECTOMY
• a small incision or puncture wound is made on each side of the scrotum.
• The vas deferens at that point is then located, cut and tied, cauterized, or
plugged, blocking the passage of spermatozoa
• can be done under local anesthesia in an ambulatory setting
• Spermatozoa that were present in the vas deferens at the time of surgery
can remain viable for as long as 6 months.
b. TUBAL LIGATION
• it usually refers to a minor surgical procedure, such as tubal ligation,
where the fallopian tubes are occluded by cautery, crushing,
clamping, or blocking, thereby preventing passage of both sperm and
ova.
• could include removal of the uterus or ovaries (hysterectomy)
• 99.5% effective
• Laparoscopy - an incision as small as 1 cm is made just under the
woman’s umbilicus with the woman under general or local
anesthesia. A lighted laparo-scope is inserted through the incision
• culdoscopy (a tube inserted through the posterior fornix of the
vagina) or colpotomy (incision through the vagina).

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