HANDOUT No. 7: Family Planning and Its Methods
NATURAL FAMILY PLANNING there is
Purpose
1. To prevent pregnancy
2. To plan pregnancy
3. To achieve planned number of children
Reproductive Life Planning
Mother and father have 50:50 right to the child so
health teaching is necessary for the both of them
- Includes all the decision an individual or
couple make about having children.
- Include when to have children, how many
children to have and how they are spaced.
- “a child is born by choice not by chance.”
Signs of ovulation (release of the fertile egg)
- Increase body temperature
- Cervical mucus
- Unilateral pelvic pain (mittelschmerz)
- Breast tenderness
- Blooming
- Increase sexual urge
Contraception (voluntary prevention of
pregnancy)
- Natural fertility awareness
- Coitus interruptus
- Spermicides
- Barrier methods
- IUD intrauterine device
- Pharmacologic methods
- Sterilization
Family Planning and Its Method
Health Teaching
- Some couples they want counselling first,
how to avoid conception, advantage, and
disadvantage
Reproductive life planning
- 50/50 decision
- A child is born by choice and not by chance
I. ABSTINENCE
Complete avoidance of having sex
- Most effective away to protect against
conception
- 0% failure rate
- Disadvantage: Difficult to adhere
- Refraining from sexual relationship
- Most effective way to prevent STI or STD
- Difficult to adhere because we are human
being
II.
no medication
- Those that involve no introduction of
chemical or foreign material into the body
- No expense
- Effectiveness vary greatly depending Mainly
on the couple’s ability to refrain from
having sex on fertile days
- No use of foreign material or chemical
- Accepted by certain religions
Not hazardous to health
Approved by some religions
Fertility Awareness Method
 Detects when the women is capable of
impregnation
 Measurement that will detect the mother
if there is the capacity to get pregnant
Types:
1. Calendar Method (rhythm method)
 Abstain from coitus during fertile days/3-5
days before ovulation
 Average menstrual cycle: 28 days
 Day of Ovulation: 14th day (applies to the
women with 28-day menstrual cycle)
 For female with regular menstruation
(UNSAFE DAYS- +5 days before and after the
ovulation)
 Irregular menstruation (6-12 months
needed data to determine the fertile
period)
 Subtract 18 from the shortest cycle (1st
fertile day)
 Subtract 11 from the longest cycle (last
fertile day)
 Avoid pregnancy through vaginal foam
 6 to 12 months data
 Formula: Longest minus 11, Shortest minus
18
 It requires a couple to abstain from coitus in
the days of a menstrual cycle when the
woman is most likely to conceive (3-4 days
before until 3-4 days after the ovulation)
2. Basal Body Temperature (BBT) Method
 Day before ovulation, a drop in
temperature (0.5F) is observed
 During ovulation- increase in temp about 1
degree because of progesterone (have
thermogenic effect)
 Woman’s take temperature early in the
morning immediately after waking up and
before she undertakes any activities
 No sexual contact for 3 days (due to life
span of the sperm to the to the
reproductive system)
  Combine with calendar method before
ovulation
 Disadvantage: increase in temp during
illness
 Seminal fluid can be confused with
ovulatory mucus
 Due to high level of progesterone which has
a thermogenic effect
 No sexual contact for three days
 Check early in the morning before doing
anything
Contraindicated: insomnia (need adequate sleep),
stress, infection, extreme exercise, eating spicy
food, area temperature
3. Cervical Mucus Method
 a.k.a BILLINGS method
 Before Ovulation- cervical mucus is thick
and does not stretch (unfertile)
 During Ovulation- cervical mucus in
copious, thin, watery, transparent, slippery
and stretches up to 1 inch (SPINNBARKEIT)
(fertile)
 Fertile days- until 3 days after the peak days
 Disadvantage: check the vaginal secretions
daily
 Spinnberkeit; clear, translucent, strechy,
thin, and watery (fertile)
 Can be stretched up to 1 inch
 Thick, cloudy, sticky (infertile)
 Just before the ovulation the mucos
excretion increases
4. Symptothermal Method (highly effective)
 Combination of cervical and BBT method
 Takes temperature daily and analyzes
cervical mucus daily
 More effective than just BBT or just cervical
mucus methods
 Abstain from sex 3 days after the rise in
temperature or 4th day after the mucus
changed
 Observe other signs of ovulation such as
mittelschmerz (pain in pelvic left or right
depends on where the ovulation takes
place)
- Highly effective
- Mittleschmerz; painful sensation in right and
left lower quadrant of the abdomen
- Abstain from coitus 3 days after the rise in
temperature
5. Ovulation Awareness
 Ovulation detection kit
 Detect the midcycle surge of Luteinizing
Hormone 12 to 24 hours before the
ovulation
 Specimen Needed: Urine
 98% to 100% accuracy
 Disadvantage: expensive
 For lactating women menstruation
comeback after 6 months after the delivery
 For non-lactating 2-3 months
6. Lactation Amenorrhea Method
 Considered natural suppression of ovulation
 Continuous breastfeeding of the infant
 Can be used until 6 months, after 6 months
the use of another method is advised
 Frequent and intense sucking disrupts
secretion
- Absence of menstruation during
breastfeeding
- Will return 6 months after the pregnancy
- But if the mother is not breastfeeding the
menstruation will return after 2-3 months
after the pregnancy
- Natural suppression of ovulation
- Because woman may ovulate however but
not menstruate, still the woman may be
fertile even she has not had a menstruation
since childbirth
7. Coitus interruptus Pull out method
 Couple proceeds with coitus until the
moment of ejaculation
 Disadvantage: unenjoyable, offers little
protection against contraception
 Precum might be present
- 75% effective
- During climax the guy withdraw his penis in
the vagina
- Premature ejaculation
III. ARTIFICIAL FAMILY PLANNING
METHODS
- Barriers, chemicals, foreign materials
1. Oral contraception 97% effective
A. Combined Oral Contraceptives
 “Pills”
 Contains estrogen and
progesterone
 Estrogen-suppress ovulation by
suppressing LH surge responsible
for ovulation
 Progesterone-decrease in sperm
permeability and decrease in the
possibility of implantation
Types: Severe leg pain (thrombophlebitis)
1. Monophasic Shortness of breath
2. Biphasic
Loss of interest in coitus for the first 18 months
3. Triphasic
 99.7% effective Discontinue pills if positive pregnancy
 Decrease incidents of dysmenorrhea, PDS,
Discontinuity of pills – no pregnancy (1-2/6-8
iron deficiency anemia, decrease in
months)
incidence of ovarian endometrial CA,
Fibrocystic breast diseases, osteoporosis Contraindications:
 21 or 28 pills - Heart disease
 Should be taken on the first day of the cycle - Smoker
 If you missed to take a drug for the day you - DVT or Deep Vein Thrombosis
can take 2 drug the next day, but you - Liver cirrhosis
cannot take 3 in a day. Make it 2 only, but - High Blood Pressure
better if you can follow the needed dosage - Nape Pain
which is 1 daily. If it keeps happening throw
Stop taking the pills if;
the used pack and start with a new one
 After delivery- start on a Sunday closest to 2 Abdominal pain
weeks after the procedure Chest pain
 After Abortion- on the Sunday after the
procedure are not effective until the 7th day Headache
 28 pills- 21 active pills 7 placebo pills Eye problems
 Should be taken consistently
Severe leg pain
SIDE EFFECTS
When is the best time to take the pill?
 Nausea
- Should be take on the 1st day of the cycle
 Weight gain
- Taken everyday
 Headache
- COC or combined oral contraceptive
 Breast tenderness
 Mild hypertension
 Depression B. Mini pills
 Breakthrough bleeding
 Monilial Vaginal infection  Progesterone only pill
 Ovulation may occur
 Endometrium does not develop fully hence
CONTRAINDICATIONS
implantation cannot occur
1. Thromboembolic diseases (common in  Advantageous for women who cannot take
smokers, DVT, CVD, DM, HDM, estrogen estrogen-based pills
dependent cancer patients)  Taken everyday
2. Cardiovascular/Cerebrovascular Accidents  No negative effect on milk production
(CVA) hence can be taken during breast feeding
3. Liver cirrhosis  Estrogen inhibits milk production
There is a waiting time; 3 months
Missed pills: C. Emergency postcoital contraception
1st day take 2 then go back to taking 1  Also called “morning after pills”
2nd day take 2  Taken within 72 hours after unprotected
3rd day take intercourse
 Contain high levels of estrogen that
DANGER SIGNS: interferes with the production of
progesterone thereby prohibiting good
(ACHES)
implantation
Abdominal pain  Causes nausea
 Effectiveness 98%
Chest pain
 Congenital abnormalities if positive
Headache (severe) pregnancy
Eye problems
  Progestin only method contains high levels
of progesterone instead of estrogen
1. Subcutaneous implants (NORPLANTS) 96-
99% effective
 6 nonbiodegradable implants
(levonorgestrel) match stick like
 Embedded under the skin just
inside of the arm there could be
scar formation
 Effective for 5 years
 Inserted not later than the 7th
day of menstrual cycle
 Can be inserted immediately
after an abortion or 6 weeks
after birth of a baby
 Suppress ovulation, stimulate
production of thick cervical
mucus, alter endometrium
 Disadvantages: expensive,
weight gain, irregular menstrual
cycle, hair loss, scarring, needs
removal
 Advantages- long term and
reversible, rapid return to
fertility (3 months after
removal), no effect on
breastfeeding
 Contraindications: pregnancy,
desired to be pregnant within 1-
2 years
Ovulation will return 3 months
after removal
or lactation
Norplant (Implant)
- Injected/implanted subdermal
- C match stick like capsule containing
progesterone
- Effective for 5 years protection from
pregnancy
- Side effect is scar formation in the area
2. Intramuscular Injections
 Depo-Provera/DMPA
(Depomedroxyprogesterone
acetate)
 Lunelle injection
 Effectiveness- 100%
 Inhibit ovulation, alter
endometrium and change
cervical mucus
 Side effects are same as that of
implant
 Advantage: Long term reliability
 Disadvantage: injected every 3
months
 Return to fertility is delayed
Can be used by breastfeeding
woman, seizure patients
Never massage the injection site
it may affect the effectivity of
the drug
Ovulation will return after 6-12
months of discontinuation
- IM injection given every three months
- Ovulation will resume 6-12 months after
discontinuation
- Do not massage the injected site because it
will decrease the effectivity of the drug
- New drug; lunelle given every month
3. Intrauterine device IUD
 Small plastic object that is
inserted into the uterus through
the vagina
 Presence of foreign substances
in the uterus decrease the
chances of implantation by
causing local sterile
inflammation that prevents
implantation
 Pelvic examination done prior to
insertion
 Inserted immediately after
menstruation/child birth (cervix
is already dilated, and you are
sure you are not pregnant)
 Placed in the uterus with string
protruding through the cervix
and vagina
 Regularly checked each
menstrual flow to make sure IUD
string is in place
 YEARLY PELVIC EXAM NEEDED
Contraindicated: nulliparous
(uterus did not expand,
perforation), multiple sexual
partners (do not protect from
STI’s)
Complication: PID- narrowing of
fallopian tube may lead to
ectopic pregnancy
CONTRANDICATIONS:
- PID or pelvic inflammatory disease
- Ectopic Pregnancy; remove the IUD as soon
as possible to avoid the fertilization in the
fallopian tube
- The best time to insert IUD is during
menstruation and after birth
- After insertion there will be no more pain
but during insertion it is really painful
- Because of the copper; has spermicidal
effect
- Gives 5-10 years protection from pregnancy
 - The woman should undergo Pelvic Cause of death of sperm before they enter the
examination (Yearly pelvic exam) cervix
Change the pH of the vagina making it
Types: nonconductive to sperm
2. Copper T380- copper interferes with sperm Preparations: gels, creams, sponge, foam
motility suppositories
3. Progestasert- changed yearly
Gels and creams: inserted into vagina before coitus
4. Mirena- effective for 5 years
with an applicator no more than an hour before
coitus and should not douche after 6 hours after
Advantages:
coitus
1. Convenient
2. Decrease incidents in endometrial cancer Advantage: lower cost, various preparations are
3. Does not require daily attention available
4. Does not interfere with sexual enjoyment
Side effects/Contraindications, Acute cervicitis
Side effects: Failure rate is 20%
1. Spotting and uterine cramping (2-3 weeks)
- (killing/death), gel like, foam, sponge
2. PID pelvic inflammatory disease
- Only 1 hour
3. Ectopic pregnancy
- Side effects; acute cevicitis
4. Increase in menstrual flow
- Nonooxynol the agent that kills the sperm
5. Dysmenorrhea
6. TSS
Danger signs (PAINS)
Effective for 1 hour only
Period late
Abdominal pain 2. Diaphragms reusable (can last up to 2-3 years,
Infection make sure to check if there’s holes before putting
Noticeable spotting in)
String missing
- Circular rubber disk that is placed over the
cervix before intercourse
Contraindications:
- Forms a barricade against the entrance of
Nulligravid
spermatozoa
Distorted uterus
- Prescribed and fitted initially by a physician
Severe dysmenorrhea
or nurse or midwife
Menorrhagia
- Fit of the diaphragm should be checked if:
- Circular rubber disc that is placed over the
IF THE MOTHER IS PREGNANT IMMEDIATELY cervix before coitus
REMOVE THE IUD TO PREVENT ECTOPIC - Lea’s Shield; made of silicon rubber and is
PREGNANCY bowl in shape
- Fit the diaphragm if the patient experienced
1. Barrier Method weight loss
 Forms of birth control that work by the - Should be refitted in size (15-20 pounds)
replacement of a chemical or other barrier - After sex, keep the diaphragm for 6hrs
between the cervix and the advancing - Reusable (1 year)
sperm so the sperm cannot enter - Wash after intercourse
 Advantage: lack the abnormal side effects - Check the holes before usage
of oral contraceptives 1. Patient gains or loses more than 15 lbs (to
 Disadvantages: Failure rate is high and change size)
interferes with sexual enjoyment
2. After pregnancy. Miscarriage, D&C as the
shape of the cervix is changed
- Kept in place for at least 6 hours after coitus
(spermatozoa may still be alive) and may be
TYPES left in place for as long as 24 hours but not
longer than that as it causes cervical
1. Spermicides (Nonoxynol-9 chemical agent that inflammation
kills sperm) 5-50% effective - Side Effects: higher incidence of UTI
 - Contraindications: Cervicitis, Prolapsed
uterus, TSS (toxic shock syndrome), Allergy
to rubber or spermicides
3. Cervical Caps stronger and durable compared to
diaphragm
- Made of soft rubber shaped like a thimble
and fit snugly over the uterine cervix
- Disadvantage: can dislodge more readily
than diaphragms during coitus.
- Advantage: Can remain in place longer than
diaphragms (but more than 48 hours) if left
for more than 48 hours it may cause
pressure to the vaginal wall and urethra
- Contraindication: abnormal/long/short
cervix, previous abnormal pop smear,
history of TSS, allergy to latex, history of
cervical cancer, undiagnosed vaginal
bleeding, previous PID
Do examine under the light
Out 6 hours post coitus
No to
Toxic shock syndrome
Sizes are available if experiencing weight loss get
checked by your doctor to change the size of the
cap
Cervical cup
- Made up of soft rubber and shaped like a
thimble with thin rim and fit snugly over the
uterine cervix
- More durable
- Keep in place for 24 hrs but not longer than
48 hrs
Contraindication:
- Short or long cervix
- Previous abnormal pap smear
- History of TSS
- Allergy to certain latex
- PID
- Cervicitis
- Papilloma virus
- Cervical cancer
- Undiagnosed vaginal bleeding
4. Male condoms 86% effective
- Latex rubber or synthetic sheath that placed
over the erect penis coitus begins
- Advantage: no prescription/no health care
visits needed prior to use, prevent spread of
STD’s
- Side effects/Contraindication: sensitivity to
latex
- Penis must be erected before putting on
- Leave extra space for the release of fluid
- Protects from STI’s
- Reduce sexual satisfaction
- Always check for damages or holes
- Must be disposed immediately after use
5. Female condoms difficult to use 80% effective
Not reusable
- Made of polyurethane and pre-lubricated
with spermicide
- The inner ring (closed end) covers the cervix
and the cervix and the outer ring (open
end) rests against the vaginal opening
- Disadvantage: more expensive than make
condom, difficult to use
Prevents pregnancy
Prevents STI’s
Only one (the male or the female) should use
the condom during intercourse. Do not use
together.
Don’t put pressure and heat (might cause
damage)
Use water-based lubricants
IV. SURGICAL METHODS
1. Vasectomy (simple surgery under out
patient department)
Small incision is made on each side
of the scrotum (site of incision)
cauterized, tied and cut, clipped the
vas deferens
 Vas deferens pathway of semen
 Local anesthesia (lidocaine)
 99.9% effective
 Sperms in vas deferens remain
viable in 6 months
 Resume sexual intercourse in 1
week
 Use additional birth control until
2 negative sperm reports are
obtained (10-20 ejaculations)
 No effect on sperm production
and erection and ejaculation
 Reversible 40-90% reversal
success-some have chronic pain
6 months to 1 year
There will still be fluid discharge
but no sperm in it

2. Tubal Ligation
 Bilateral
 Cut the isthmus (site of BTL)
 Below umbilicus (site of incision)
 Banded, cauterized, tied and cut, clipped
the fallopian tubes
 Minor surgical procedure whereby fallopian
tubes are occluded thereby preventing
passage of both sperm and ova
 Done after a menstrual flow and before
ovulation, 4-6 after birth of birth of baby or
after an abortion via mini laparotomy
 Make sure that woman has no unprotected
coitus before the procedure as this may
cause ectopic pregnancy
 Fallopian tube
 99.9% effective
 Done via
laparoscopy/culdoscopy/colpotomy
 Can have coitus 3-4 days after
 Positive menstrual cycle
 There is a cutting, tied, fold of isthmus in
the fallopian tube
 Site of incision is below umbilicus
 Avoid heavy lifting objects
 Rest for 3 days
 Coitus can have 3-4 days after the BTL
 Minor operation
 Done after the menstrual flow and before
ovulation, 4-6 hrs after birth of the baby or
after an abortion
Post-tubal ligation syndrome
 Pain and vaginal bleeding
 Intermittent
Contraindication
1. Umbilical hernia
2. Obesity
Post tubal ligation syndrome
 Characterized as vaginal spotting,
intermittent vaginal bleeding and severe
lower abdominal cramping after tubal
ligation
 Reversible 50-70% reversal success
 Rest for 3 days no heavy lifting
During sexual intercourse
300 million of sperm will enter the vagina
- It will pass the cervix
- While ovulation the cervix is open
Fertilization
- Union of the sperm and egg cell
Zola pellucida
- Outer part glycoprotein coat
- Inside the plasma membrane it will divide
into two multiple cells
- Splitting of 2 multiple cells (cleavage)
- When the cells multiply it’s called morula
After the morula…
- Compaction will happen
- The zona pellucida will be replaced with
trophoblast
- Blastocyst is the multiplication of the
morula forming solid clump cell
- Ball like structure
Capacitation
- Process which happens on the sperm move
toward the ovum, consist of change in the
plasma membrane of the sperm head, reveal
the sperm binding receptor
Fetal Growth
Ovum – from ovulation and fertilization
Zygote – from fertilization to implantation
Embryo – from implantation to 5-8 months (1st
trimester)
Fetus – from 5 weeks up to term
Conceptus
- Developing embryo or fetus and placental
structure
The travelling of zygote is 3-4 days
Endometrium – decidua
1. Decidua basalis – attached to the embryo
2. Desidua capsularis – stretcges and encapculate
trophoblast
3. Desidua vera – remaining portion of the uterine
lining
Chorionic Villi
- Finger like projections which are
responsible for the secretion of hormone
- Human chorionic Gonadotropin (Morning
sickness); positive pregnancy test; mild
vasoconstriction
- Human Placental Lactogen; responsible for
increase of sugar of the mother; decreases
the effective of insulin (Gestational Diabetes
Meletus)
3 membranes
1. Chorionic Membrane – protects and support the
embryo during its growth and development
2. Amniotic Membrane – protective membrane the - fetal side portion
contains the amniotic fluid (bag of water); normal
- shiny
color is clear and has little white specks of vernix
coseosa cheese like subs. In the skin of the baby 2. Duncan
- abnormal color is green (first bowel movement or - dirty and uneven
meconium); risk of infection, watch out for fever
and fetal distress (the baby cannot breathe) - maternal side portion

- yellow color means RH incompatibility meaning Functions:

the blood of the baby and the mother is not 1. Serves as fetal lungs, kidneys (waste product),
compatible GT (nutrition)
Rhogam (RH incompatibility) 2. Endocrine Functions; HCG, Estrogen,
- given within 3 days postpartum Progesterone, HPL (responsible for lactation),

- to prevent death of baby on the second pregnancy
- red colored amniotic fluid; danger sign
- brown colored; infection
Normal pH is 7.25-7.35 (slightly alkakline)
Test:
1. Nitrozine paper test
- the lithmus paper will turn into blue
- if it’s urine it will turn into red and yellow color
Normal volume:
- 800 to 1,200 cc
- 500 to 1000 ml or cc
Less than amniotic is Oligohydramnios
- Unable to urinate, sign of renal (kidney)
anomaly
Higher than 1,000 is polyhydramnios
- because the fetus is unable to swallow fluid, sign
of TEF (Tracheoesophageal fistula); chocking,
cyanosis, cough
Functions:
1. Protection from injury or possible trauma
2. Regulates or maintains temperature
3. It aids the fetus to move
3. Offers some protection against microorganism
(Rubella Virus or German measles; can enter in the
placenta in the first trimester; period of
organogenesis)
- Cognitive impairment
- Congenital cataract
- Congenital heart defects
For 2nd Trimester
- Syphilis (Treponema Pallidum)
- Spirochete bacteria, can enter in the
placental barrier on the 2nd Trimester
- Destruction of the bicuspid valve of the
heart
Umbilical Cord
- Formation from the amnion to the chorion
- Provides circulatory pathway
- Gelatinous substance that prevents from
cord coiling (wharton’s jelly)
- It consist of AVA (2 arteries and 1 vein)
Functions:
- Transport o2
- Nutrients to the fetus from the placenta
- Return waste products from the fetus to the
placenta
- On the 2nd month of the pregnancy the
placenta develops and the placenta will work
on the 3rd month

4. Prevents cord coiling 3 GERM LAYER

Fern like appearance is the presence of estrogen or 1. Endoderm

amniotic fluid - lining of GT
3. Placenta - respiratory tract
- pancake of the pregnancy 2. Mesoderm
- has mature separate segments (16-30) cotyledons -
- if there is retention of placental fragments the 3. Ectoderm
mother will bleed
-
- only one placenta during pregnancy
L/S ratio 2:1
2 types of Placenta
- Indicates lung maturity
1. Schutz - 1:1 risk for respiratory depression
Nervous System
- EEG (Electrocephalogram)
- ECG (Electrocardiogram)
- Vit k is given IM vastus lateralis
Before cutting the umbilical cord wait for 1-3
minutes
- Bandage scissor or bamboo stick
- Surfactant is the one that helps the baby
breath
25-year old woman who has menstrual
cramping
14. All of the following are true regarding
norplant except: it must be removed in two
years
15. The iud effectiveness appears to be due to its
ability to: irritate the uterine lining
16. All of the following are guidelines regarding
male condom usage except: after
ejaculation, wait until the penis is
completely flaccid before removing from
vagina
17. A vasectomy is performed by: severing the
two vas deferens
18. What is most correct about lubrication: use
water based lubricants instead of oil based

Quiz Answers:
1. How many ejaculations does it generally
take for a man’s vas tubes (the tubes that
carry sperm from the testes to the penis) to
be free of sperm after a vasectomy: up to
16, but only a semen test can tell for sure
2. Can you conceive while breastfeeding: Yes,
its possible to get pregnant while
breastfeeding
3. What is family planning: The way that
such couples control if and when a
woman becomes pregnant through
natural and artificial contraceptives
4. What are the two types of contraceptives:
Natural and artificial contraceptives
5. Which of the following is an example of
Artificial contraceptives: none of the above
6. Which of the following is not an example of
artificial contraceptives: not having sex
7. Which of the following is a Christian belief
on family planning and contraceptives: all of
the above
8. What is a contraceptive: any device or drug
that is used to prevent pregnancy
9. Which type of contraception is not
appropriate for a woman with a history of
stroke? : pill
10. Effectiveness rates of contraception devices
vary depending on how accurate they are
used?: true
11. Which type of contraception should not be
used in women with a history of toxic shock
syndrome? – Diaphragm
12. The only form of contraception that protects
one completely from STDs are – abstinence
13. Which of the following women would
benefit from taking oral contraceptives – a