PREGNANCY, BIRTHING,

& EARLY CHILDHOOD

CULTURE
Tonisia Brown-Cotton, Katelyn McDonnell, & Miranda Nelson
PREGNANCY
CULTURE
Turkish Pregnancy Culture
• According to Turkish custom, pregnant
women should look at nothing but pretty
things while expecting, for fear that the baby
could take on unpleasant characteristics
• Many beliefs about food consumption
affecting the gender and looks of the
baby.
• Many Turksbelieve that cutting the mother’s
hair will cut the baby’s life short.
• Traditionally, new mothers didn’t leave the
house for
the first 40 days of the baby’s life, but this is
rarely the case today in Turkish cities
• Women received instruction about acceptable weight gain from
their Japanese doctor or midwife, with 7-8 kg being the most
cited range.
• In Japan, the majority of women are requested to stay in the
hospital between five and eight days after giving birth.
• A small, but growing trend is to request the support of a
doula-someone who offers emotional and physical support to Japanese
a woman before, during, and after childbirth. Pregnancy
• Have various beliefs about things that assist in the Culture
conceiving process.
Chinese Pregnancy Culture
• Assume a ‘sick role’ in which they depend heavily
on others for assistance
• If a pregnant woman criticizes someone, the baby
will look and act like the person criticized
• Touching anything with glue or adhesive can cause
the baby to have birthmarks.
• Since pregnancy is considered a “hot” condition, a
pregnant woman should eat “cold” food to keep
yin and yang balanced.
 Chinese
Gender
Chart
Predict the
baby's gender
with over 90
percent
accuracy.
• They often do not seek prenatal care until
later in the pregnancy.
• Observing a lunar eclipse will cause the
developing baby to have a cleft lip/palate
• Babies who don't listen to music during
pregnancy end up being deaf Latino
• Teen pregnancy is most prevalent in Latino Pregnancy
teens compared to other culture groups Culture
• https://www.youtube.com/watch?v=9BBlTdGi30
s
Korean Pregnancy Culture
• Baby eats, feels, thinks and sees
what mom eats, feels, thinks
and sees.
• "Saam(three)-chil(seven)-
il(days)"
• If a woman’s abdomen sticks out
roundly, the older members of the
family would announce that it was a
girl, while a flat stomach indicated she
was carrying a boy.
• Traditionally in Haiti, babies are born at home
with the aid of midwives. These midwives are
not necessarily medically trained, but most likely
were born into the profession.
• Pregnancy does not relieve a woman from work
nor does it require medical visits, thus prenatal Hatian
care is not traditionally sought. Pregnancy
• Diet when pregnant is somewhat restrictive Culture
Irish Pregnancy Culture
• A pregnant woman should wear a medal of
their patron saint to protect them from evil.
• A pregnant woman had to avoid meeting a
rabbit, or her child would be born with a
hare- lip.
• Washing windows or raising both
hands/arms above your head was avoided
during pregnancy.
• Being a “godmother” was usually a
very important role for the Irish
• You shouldn’t swear around pregnant women.
• You shouldn’t announce your pregnancy until your
belly is clearly visible.
• An expecting woman should not sleep on her back.
Russian
• You shouldn’t buy baby clothes for the baby before
Pregnancy
it is born, or gift any baby things.
Culture
Modern Pregnancy Trends
• Gender reveal / gender reveal parties
• Placenta Encapsulation
• Belly Casts
• Pregnancy photo shoots
• Pregnancy Apps
Connection to Counseling

• Challenges Associated with Pregnancy

and Birth
• Pregnancy and Mental Health Concerns
BIRTHING CULTURE
Balinese babies cannot touch
the ground...
• Until they are three months old.
• Any contact with the floor before that time
will result in the baby being defiled.
• After the three months, a formal ceremony is
held in which the baby walks the unclean
ground for the first time.
 Spitting on the Baby

• The Wolof people of Mauritania and

surrounding countries believe that human
saliva retain words.
• This act of spitting on newborns is to add
blessings that ‘stick’.
• The women spit on the newborn’s face and
the men spit in its ear.
• For added measure, the saliva is rubbed all
over the newborn’s head.
Wedding cake on the babies forehead

• Irish couples save a bit of their

wedding cake for the first child’s
christening.
• After the parents serve the top tier
of the cake to guests, a few
crumbs are sprinkled on the child’s
forehead as an act of good luck.
 Baby Fellatio
• The Manchu, an ethnic minority in
China, extend affection to their
newborns with joyous genital tickling to
the girl babies and full-on fellatio to the
boy babies by their mothers.

• The acts are not intended as sexual,

but interestingly enough, the Manchu
do consider kisses to always be
sexual. Manchu parents will never kiss
their child’s face.
Shoving Mayan babies in Chilled H20

• To prevent heat strokes and

rashes, Mayan mothers
douse their babies in icy
water.
 Isolated Pakistani Mothers
• In Pakistan, Kalash mothers in
labor are considered unclean;
therefore, they deliver their
children in a special isolated
building called the Bashleni.
• This isolation is to prevent the
fearful pollution of others.
• The only assistants to the
laboring mothers are
menstruating women,
because they are unclean too.
 Unique Birthing Traditions

Bali Japan
Latin America • Because the placenta,
• New Japanese
• Some women choose an organ, is
to practice the mothers traditionally
considered “alive” in
custom of quarantine recover in their
some Hindus, the
(La Cuarentena). parents’ home on
ancient postpartum
• For six weeks, new bedrest for three
tradition of burying the
mothers abstain from weeks after
cleaned placenta
sex, certain foods and childbirth.
outside during an
strenuous activity and
solely dedicate their intricate and detailed
time to breastfeeding ceremony is practiced
and other cares of the in Bali.
newborn.
 Unique Birthing Traditions
The Netherlands
• Because the Dutch view • While in the hospital
birth as a natural part of
life and not a medical
illness, the women opt
to have home births.
• In the Western world, at
only 20 percent, the
Netherlands hold the
highest ranking of home
birth.
Turkey
Brazil • A beverage, Lohusa
Serbeti, consisting of
after childbirth, cinnamon, sugar
Brazilian mothers give and red food
gifts to their hospital coloring is served to
visitors. the new mothers.
• It is again enjoyed at
home by guests
who visit the new
infant.
 Unique Birthing
Traditions
Pakistan Nigeria
• Postpartum care or
• On 7th, 14th OR 21st Omugwo is a Nigerian
tradition.
day after a baby’s birth,
a baby-naming • The new baby’s
tradition is observed. grandmother, if available, or
aunt or close friend, if not
• During this Aqiqah, available gives the infant
his/her first bath.
the infant’s head is
shaved and an animal • This seemingly small
is sacrificed on his/her gesture is a reminder to the
new mother that she is not
behalf. alone in the childrearing.
Isreal
• Eight days after a
Jewish baby boy is born,
a Jewish ritual, Brit
Milah, takes place to
circumcise and name
him.
• This ancient practice
takes place during
morning prayers and is
graciously followed by a
festive meal.
 Connection to Counseling
• Mental Health is a concern for new mothers. Due to past family issues,
insecurities, difficulties in relationships and financial matters can all play
into a new mother’s psych. Mood swings, fear, anxiety, forgetfulness,
body image nightmares can all lead to depression; therefore, mental
health conditions must be taken into consideration for postpartum
women.
• If the new mother experienced mental health issues before
pregnancy, it is highly likely she will experience mental health issue
during/after pregnancy.
• Immediate health care, support and referrals to mental health
professionals is required of the doctor. Especially if the new mother is
anxious that she has passed on the illness to her infant.
• When a child cannot be carried to term, is stillborn or is discovered to
have a fatal or life-threatening birth defect, if left untreated, significant
grief may lead to serious mental health concerns.
Connection to Counseling
• Before irritation, anger, doubt of their abilities to be good
mothers sets in, counseling may be advantageous to the new
mothers.
• Clinically significant anxiety or depression after childbirth is
experienced by 15 and 20% of women.
• Severe diagnosed cases of postpartum depression began in
mood changes during pregnancy in two thirds of mothers.
While a whopping sixty percent of mothers with moderate
postpartum had pregnancy complications such as gestational
diabetes.
 Connection to Counseling
• Posttraumatic stress (PTSD), stress that occurs during pregnancy
is one condition that a trained counselor can assist the new
mother through.
• A counselor will be equipped to recognize and attend to a period of low
mood and tearfulness for a week or two following childbirth. This
experience is known as “baby blues”. To help rule out a more serious
mental condition, it is imperative to be mindful if the new mother has
feelings of hopelessness, negative thoughts about self or baby, and/or
loss of appetite.
• A more serious but rare condition known as Postpartum Psychosis is
characterized by delusions, rapid mood swings, paranoia, and
hallucinations. This condition carries a five percent rate of suicide and
a four percent rate of infanticide. Within two weeks after giving birth,
symptoms suddenly appear.
Mood Lightener
• https://youtu.be/nis64r4-HVU
EARLY CHILDHOOD
CULTURE
 Adoption Across Cultures
• Arab Culture- In Arab cultures, if a child is adopted, he or she traditionally does
not become a “son” or “daughter”, but rather a “ward” of the adopting
caretakers. The child’s surname is not changed to that of the adopting parents,
who are publicly recognized as guardians, making it close to other nations'
systems for foster care.

• Korean culture- In traditional Korean culture, adoption almost always occurred

when another family member (sibling or cousin) gives a male child to the first-
born male heir of the family. Adoptions outside the family were rare.

• Indian Culture- The Hindu Adoption and Maintenance Act of 1956 allows
only Hindus, Sikhs, Jains, and Buddhists to adopt. Muslims, Christians,
Jews and Parsees can become only guardians under the Guardians and
Wards Act of 1890. Guardianship expires once the child attains the age of 18
 Customs After
Childbirth

The Netherlands
• "Kraamhulp" or maternity home care
• For seven days a nurse comes to the
home. Not only does she provide
medical care, but she also cleans the
home, cooks, and instructs the new
parents on basic parenting skills.
Customs After
Childbirth
Germany
• If a German woman tells her
employer she's pregnant,
she cannot be fired.
• Her job is held for three
years.
• Government list of
"accepted names" to
prevent future ridicule.
 Customs After
Childbirth

Japan
• After leaving the hospital, mother
and baby often stay at the
mother's parents' home for a
month or sometimes longer .
• It is a cultural tradition that women
stay in bed with their baby for 21
days.
 Customs After
Childbirth
Turkey
• The mother and child receive a
handkerchief filled with a single egg
(for a healthy baby) and candy (for a
good- natured baby).
• They also rub flour on the baby's
eyebrows and hairline, which is
supposed to grant him or her a long
life.
 Breastfeeding
• Breast milk provides the ideal nutrition for infants. It has a nearly perfect
mix of vitamins, protein, and fat.

• Breast milk contains antibodies that help your baby fight off viruses and
bacteria.

• Breastfeeding has been linked to higher IQ scores in later childhood in

some studies.

• Some believe it lowers the risk of diabetes and obesity later in childhood.
 Why Women Choose Not to Breastfeed

• Some women don't want to breastfeed in

public.
• Some prefer the flexibility of knowing that a
father or any caregiver can bottle-feed the
baby any time.
• The time commitment, and being "on-call" for
feedings every few hours of a newborn's life,
isn't feasible for every woman.
• Some women fear that breastfeeding will ruin
the appearance of their breasts.
 • In America, we typically sleep
Sleep our babies in a crib, usually in a
separate nursery.
• In many Asian countries, babies
sleep with their parents until
they’re toddlers, and at that
point, they move to their own
small bed near their parents’
bed.
• It’s also common in some
countries to sleep your baby
in the same bed as an
extended family member
(like a grandmother, or an
aunt.)
 Sleep Training
• In the West, we’ve become fairly accustomed to the concept
of sleep training. The idea that some parents take steps to
train, or to teach, their babies to sleep is understood and
accepted.
• "Cry it out" method
• However, in other countries around the world, the idea of
“teaching” a baby to sleep is a foreign
one.
• Many international parents report that in their home countries,
allowing a baby to cry, even for a moment, is considered
cruel and unnatural.
 Bed-sharing
• In a 2006 study, the United States reported 15% of
infants and toddlers 2 weeks to 2 years engage in
bed-sharing.
• India reported 93% of children bed-sharing.

• In many parts of the world, bed-sharing simply has

the practical benefit of keeping the child warm at
night.
• Supporters of bed-sharing believe it promotes
bonding, enables the parents to get more sleep and
facilitates breastfeeding. Older babies can
breastfeed
during the night without waking their mother.
 Opponents argue that co-sleeping is stressful
for the child when they are not co-sleeping and
promotes an unhealthy dependence of the
child on the parents.
 In addition, this may interfere with the parents'
own relationship, by reducing both
communication and sexual intercourse.
 Because children become accustomed to
behaviors learned in early experiences, bed-
sharing as an infant will also increase the
likelihood of these children to crawl into their
parent's bed later in childhood.
Counseling After
Childbirth
• Having a baby changes not only your day-to-day
life, but also your relationship with your partner.
• About two-thirds of couples become dissatisfied with
their relationship within three years of having a
child, according to research from the Gottman
Relationship Institute in Seattle.
• The financial burden of a child can put stress on a
relationship.
 n i n g
P l a n
m i l y
F a
 Family Planning

 The concept of enhancing the quality of

families w/c includes:

 Regulating & spacing childbirth

 Helping subfertile couples beget children
 Counseling parents and would-be
parents
 The privilege and the obligation of the
(married) couple exclusively to decide w/ love
when and how many children provided: the
motive is justified and the means are moral.
 Involves personal decisions based on each
individual’s background, experiences and
sociocultural beliefs. It involves thorough
planning to be certain that the method chosen
is acceptable and can be used effectively.
 Function of the Health
Professional in Family Planning
 To counsel, reassure, give information and
allow an individual/couple to decide
his/her/their course of action according to
what he/she think is appropriate for them
and in accordance to their own personal,
societal, religious beliefs & values
 FAMILY PLANNING SERVICES

 Temporary Conception Control

• Methods used to prevent

conception
• Methods used to prevent ovulation
• Methods used to prevent
implantation
 Sterilization/ Permanent Conception
Control
• Tubal Occlusion / Bilateral Tubal
Ligation
• Vasectomy or Vas Ligation
(never advice a permanent method of planning)
 METHODS USE TO PREVENT
CONCEPTION
1.Natural methods ( The only method accepted by
the catholic church)
 Coitus Interruptus (least effective method)
 Oldest type of birth control practiced by man.
 The premature withdrawal of the penis before ejaculation
during sexual intercourse
 Reliability is low because sperms are emitted in varying
quantities in the normal lubricating fluid secreted
throughout intercourse
 Psychological disadvantage
 Not accepted by the Catholic Church
 Coitus Reservatus
 Male does not reach orgasm and therefore no
ejaculation occurs
 Requires considerable control over the sexual
urge

 Coitus Interfemoris
 Thigh sex and interfemoral sex
 A type of non-penetrative sex where the penis
is placed between the receiving partner's
thighs and friction is generated via thrusting.
2. Rhythmic Abstinence
Identification of the periods of fertility and the
periods of sterility in the menstrual cycle of a
woman and the restriction of sexual intercourse to
the sterile periods or the time when the pregnancy
is unlikely because the woman is biologically
unprepared to conceive.
Also known as “safe or infertile period” technique
and “natural birth control” or NFP because there is
nothing artificial used to prevent conception.
o These methods are based on the following
principles:
 The human ovum is susceptible to fertilization for
approx. 18-24 hours after ovulation
 The sperms deposited in the vagina are ordinarily
capable of fertilizing the ovum for no more than 72
hours
 Present methods of determining ovulation time are
inexact and seldom sufficiently predictive (by at least 48
hours) so that in practice, it is necessary to avoid
intercourse for a far longer period of time than 72 hours
before ovulation and 24 hours after ovulation
3. Calendar Method
• The use of mathematical calculations to predict the probable time of
ovulation. “Ovulation most often takes place 14 days before the onset of the next
menstruation.”

 Ogino-knaus formula:
1. Determine the shortest and longest cycle
ex. Shortest cycle = 28 days
Longest cycle = 36 days
2. If the cycle is irregular, subtract 18 from the shortest and 11 from the
longest
ex. 28-18=10 ex. 25-18=7
36-11=25 29-11=18
3. The difference between the shortest cycle and 18 determines the earliest
time when ovulation occur.
4. The difference between the longest cycle and 11 determines the last day
when ovulation can occur
5. OVULATION CAN OCCUR ANYTIME IN BETWEEN.
6. In a regular 28 day cycle, abstinence should be observed from day 9 to day 17.
 Basal Body Temperature

• This relies on slight changes (0.3 to 0.6ºC) in basal body

temp. that may occur just before ovulation
• Pre-ovulatory temperature is low because of high
estrogen levels
• Post-ovulatory temp. rise is due to high progesterone
• The temperature is taken every morning at the same
time with the same thermometer just before arising and after
at least 4-6 hours of continuous sleep.
• 3 days of elevation indicate temperature change is due
to ovulation
• Abstinence should be observed 5 days before and 3 days
after temperature rise.
4. Billings or CERVICAL MUCUS METHOD
(Spinnbarkeit)
 A particular type of cervical mucus felt by the woman at
the vaginal opening is a signal of ovulation.
 Research shows this type of mucus appears necessary for
conception. Without the mucus, sperm transport is
impeded.
 Phases of Wetness/Dryness
1. Wet – menstruation
2. Dry – basic infertile pattern
 sequence of dry days (or days of unchanging mucus)
indicating low level of estrogen and present infertility
 duration is invariable, could be days, weeks, months or
zero (if cycle is short)
3. Wet – days of possible fertility
-changing mucus; non-slippery at first later becoming
slippery
-peak: last day of slippery mucus
-days 1-3 after the peak are part of fertile period
4. Dry – infertile days
-day 4 after the peak till the end of the cycle
-ends about 2 weeks after the peak
5. Lactational Amenorrhea Method
o LAM is based on scientific evidence that a woman is not
fertile and unlikely to become pregnant during full
lactation or exclusive breastfeeding. Full lactation
describes breastfeeding when no regular supplemental
feeding of any type is given (not even water) and the
infant is feeding both day and night with little separation
from the mother.
o LAM provides maximum protection as long as:
 Menstruation has not resumed and
 Bottle feeds or regular food supplements are not
introduced and
 Baby is less than 6 months of age.
6. Symptothermal Method (combination of
BBT & cervical. Best method )
Signs of Ovulation:

Mitlelschmerz
Spinbarkheit
Changes in vaginal mucus
Goodell’s sign
Mood changes
Breast tenderness
Increased levels of
progesterone
Change in basal body temp.
 Successful use of natural methods to
prevent pregnancy depends upon:

 The accuracy of the method in identifying the

woman's actual fertile days
 A couple's ability to correctly identify the
fertile time
 The couple's ability to follow the rules of the
method they are using
Advantages of Natural Family
Planning Method
 Safe and has no side-effects
 Inexpensive
 Acceptable to religious affiliations that do not
accept artificial methods of contraception
 Helpful for planning pregnancy and avoiding
pregnancy
 Promotes communication about family planning
and contraception between couples.
Disadvantages:

 Involves long preparation and intensive recording

before it can be used.
 There is a need to abstain on certain days which
may be inconvenient for the couple.
 Not ideal to women with irregular cycles.
 Not very reliable because of menstrual cycle
variations that may occur anytime.
 Testkits that measures the level of LH and
predict ovulation are now available in USA and
other countries.
 These kits detect the level of LH in the urine
w/c surges 12-24 hours before ovulation.
 It is 98 to 100% effective.
 When a woman sees that her LH level is high,
she should avoid coitus.
7. LOCAL BARRIER METHODS
CONDOM
 A thin stretchable rubber sheath worn over the penis by
the man during intercourse.
 Pregnancy rate is 7-28%
 Advantage:
o Gives highest protection against STD – female condom
 Disadvantages:
o Self-lubricated type breaks easily
o Penis must be withdrawn from the vagina before it becomes
flaccid
o Lessen sexual enjoyment by the male
Female Condoms
How to use the female condoms:
 Open the Female condom package carefully; tear at
the notch on the top right of the package. Do not
use scissors or a knife to open.

 The outer ring covers the area around the opening

of the vagina. The inner ring is used for insertion and
to help hold the sheath in place during intercourse

 While holding the Female condom at the closed

end, grasp the flexible inner ring and squeeze it with
the thumb and second or middle finger so it becomes
long and narrow
Choose a position that is comfortable for insertion – squat, raise one
leg, sit or lie down.

• Gently insert the inner ring into the vagina. Feel

the inner ring go up and move into place.

• Place, the index finger on the inside of the

condom, and push the inner ring up as far as it
will go. Be sure the sheath is not twisted. The
outer ring should remain on the outside of the
vagina.
• The female condom is now in place and ready for
use with your partner.

• When you are ready, gently guide your partner’s penis

into the condom's opening with your hand to make
sure that it enters properly – be sure that the penis is
not entering on the side, between the sheath and the
vaginal wall.

• To remove the Female condom, twist the

outer ring and gently pull the condom out

• Wrap the condom in the package or in tissue, and throw it in the garbage.
Do not put it into the toilet.
 Vaginal Diaphragm
• A shallow, dome-shaped rubber device with a flexible wire
rim that covers the cervix; maybe inserted several hours
before intercourse and left in place for at least 6 hours
after the last intercourse
• Initially fitted by a health professional
• Weight loss/gain of 15 lbs may require re-fitting
• Inserted before intercourse with the woman in squatting
or supine position, or with one leg elevated on a chair
• May cause cervicitis if left in place for too long
• Washed with mild soap & water, lasts for 2-3 years
• 97% efficiency
 Health Teaching:
 Proper hygiene
 Check for holes before use
 Must stay in place 6 – 8 hrs after sex
 Must be refitted especially if without wt change 15 lbs
 Spermicide – Chemical Barrier ex. Foam (most
effective), jellies, creams
o S/effect: Toxic shock syndrome
Alerts: Should be kept in place for about 6 – 8 hours
Cervical Cap
 Comes in 2 types: presized (S-M-L) and custom fitted
(a plastic cap fitted to conform to the individual
woman’s cervix made after making a mold of cervix
with non-toxic substance used to make contact
lenses)

 Contraindications:
o Pelvic Inflammatory Disease (PID)
o Cervicitis
o Cervical Cancer
o Vaginal bleeding
o An allergy to latex/spermicide
 Most durable than diaphragm no need to apply spermicide
 C/I: Abnormal pap smear
 Advantages:  Disadvantages:
 Can be inserted many  Does not protect against
hours before sex play. HIV/AIDS.
 Easy to carry around,  Requires a fitting in a
comfortable. clinic.
 Does not alter the  Some women cannot be
menstrual cycle. fitted.
 Does not affect future  Can be difficult to insert
fertility. or remove.
 May help you better  Can be dislodged during
know your body. intercourse.
 Possible allergic reactions.
7. Chemical Method

Intravaginal Contraceptives
(Spermicides)

 Side-Effects of Spermicides:
 You or your partner may be allergic to
materials in spermicide. This can cause genital
irritation, rash, or itchiness. If this happens
and your spermicide has nonoxynol-9, try a
spermicide without this chemical.
 Advantages:  Disadvantages:
 Does not protect against
 Available without a HIV/AIDS.
prescription.  Must be readily available and
 Lubrication may increase used prior to penetration.
pleasure.  Can be messy.
 Can have a bad taste during
 Use can be part of sex
play. oral sex.
 Possible genital irritation.
 Does not affect future  When used frequently
fertility. spermicides may irritate the
vagina making it easier to
catch HIV/STI
PREVENTION OF OVULATION

Use of Contraceptives:
 Pills
 Injectable
 Implant
 Contraceptive Pills
 Estrogen & progesterone prevent
pregnancy by inhibiting the
hypothalamus and anterior pituitary so
that ovulation does not occur. They
also inhibit fertility by:
 Altering the motility of the fallopian tubes
 Inadequately developing the endometrium
 Keeping cervical mucus unreceptive and
unsupportive of sperm
 Types of Pills
 Combination pills – contain both progesterone &
estrogen; taken from day 5 to day 25 of the
menstrual cycle
 Sequential
2 types of pills are taken:
 Contains estrogen alone – taken from day 5-19
 Contains progestin-taken from day 20-25
 All-progestin (minipill) – taken everyday
 Does not necessarily inhibit ovulation; prevents
implantation of the zygote
21 day pill- start 5th day of mens
28day pill- start 1st day of mens
missed 1 pill – take 2 next day
 Client Instructions on taking CPs
 Before starting CP, the woman must undergo physical examination,
pelvic exam and Pap smear to rule out contraindications. CP should be
prescribed by a physician.
 Must be taken on a Sunday following menses and abortion or the first
Sunday 2 weeks after delivery,she is to use condom on the first 7 days
of pill taking. They should be taken at the same time everyday.
 If she is taking 28 day pills, there is no rest day or interval. If she is
taking a 21 day pill, she ends on a Saturday and begin a new pack on
the next Sunday. Bleeding will occur around 4 days after stopping pills.
If she expected bleeding did not come, she should consult the doctor
before starting a new packet of pill.
 Minor side effects: nausea, weight gain, headache, breast tenderness,
breakthrough bleeding, yeast infections, mild hypertension, potential
depression
 If a woman forgets one pill, take one now and then the next on
the regular schedule of pill taking. If two pills, take two pills now
and two pills tomorrow and use back-up method for the next 7
days. If 3 pills, discard the remaining pack and start a new pack,
use back-up method for the next 7 days.
 OC users should have a check-up after 4 months then annual
check-ups to have pelvic exam, breast exam and Papsmear.
 Another contraceptive method should be used until a woman has
had 2 regular menstruations or wait for three months after
stopping taking OC before attempting pregnancy. There is usually
a 1-2 month delay in the resumption of menstruation after
discontinuing OC.
 Folic acid deficiency is common in long term user so that it is
advisable to take folic acid supplement
 If used by adolescent, they should have a regular menstruation for
at least two years before beginning OC use.
 Contraceptive Pills
 If accidentally taken by a child, side-effect is increased
blood clotting, stimulate vomiting by giving child syrup of
ipecac

 Danger signs:
 A- abdominal pain
 C-chest pain and dyspnea
 H- headache
 If forgotten for one day, immediately take the
 E-eye problems forgotten tablet plus the tablet scheduled that day.
 S- severe leg pain If forgotten for two consecutive days, or more
days, use another method for the rest of the cycle
and the start again.
Implant (Norplant)
6 tiny silicone rubber capsules or 2 rods
containing progestin (evonorgestiel),
surgically implanted under the skin of the
upper arm; removed surgically in about 5
years or when the woman wishes to
discontinue the method.
 Disadvantage if keloid skin
 As soon as removed – can become
pregnant
 Advantages:
 Long term reversible  Disadvantages:
contraception • Expensive
 Do not interfere with • Scarring at insertion
coitus site
 Has no estrogen related
side-effects  Contraindications:
 Can be used during • Pregnancy
breastfeeding • Desire to get pregnant
 Can be used by within 2 years
adolescents • Undiagnosed vaginal
 Rapid return of fertility bleeding
w/c occurs 3 months
after removal
Injectable Contraceptive
(Depo-provera, Noristerat, etc.)
 Synthetic progestin hormones injected into muscle:
administered every 3 months

- never massage injected site, it will shorten duration

 They exert their contraceptive effect by inhibiting

ovulation, altering cervical mucus and preventing
endometrial growth. The woman does not menstruate with
this contraception. It has the same advantages, disadv., and
contraindications as implants.
 Disadvantages:
 Fertility return is usually delayed by 6 months
 Higher risk for osteoporosis so advise to increase calcium
intake and engage in weight bearing exercise
 Impair glucose tolerance in women at risk for DM

 Client instructions:
 Advise client to have annual PE that includes breast
exam,pelvic exam, and Papsmear
 Report signs of leg pain or swelling, chest pain &
dyspnea,tingling and numbness of extremities, loss of
vision, severe headache, dizziness & fainting.
 Side-Effects:
 Thrombo-embolic disorders and other vascular problems
including CVA & MI
 Oral pills should be discontinued for 4-8 weeks before anticipated
surgery
 Alterations in metabolism,esp. of CHOs and B-vitamins
(pyridoxine & folic acid)
 Fetal effects after discontinuing the pill-evidence of
increased of chromosomal changes
 Amenorrhea after discontinuing the pill
 Neoplastic disease (breast, liver-hepatocellular adenoma)
 Hypertension
 Adverse drug interactions
 Estrogen Deficiency & Excess
 Estrogen Excess
• Nausea &
vomiting
• Dizziness
 Estrogen Deficiency
• Edema
• Early spotting (days 1-14)
• Leg cramps
• Hypomenorrhea
• Increase in
• Nervousness
breast size
• Atrophic vaginitis leading to
• Chloasma
painful intercourse
• Visual changes
• Hypertension
• vascular
headache
Progesterone Deficiency & Excess

 Progesterone Excess  Progesterone Deficiency

• Increased appetite • Late spotting and break-
• Tiredness through bleeding (days
• Depression 15-21)
• Breast tenderness • Heavy flow with clots
• Vaginal yeast infection • Decreased breast size
• Oily skin and scalp
• Hirsutism
• Postpill amenorrhea
 Safety measures in the use of pills
 Careful screening to detect women who are at
risk of developing problems
 Use of lowest possible dose for each women
 Careful follow-up should be done every 6-12
months to detect problems —complete health
assessment: should include history, PE, Pap smear
& lab studies
 Family History
 Vascular accident (stroke)
 DM

 Breast Ca
Contraindications: Physical Examination
Medical History Findings
• Hepatitis or hepatic  Pregnancy & Lactation
insufficiency  30 years old or older
• Thrombo-embolic disease  Presence of hormonal-
• Sickle-cell disease dependent tumors
• Moderate/severe  Breast nodules
hypertension  Fibrocystic disease
• Smoking more than 15
 Abnormal mammogram
cigarettes a day
• Psychic depression
 Varicose veins

History of conditions that can be aggravated by fluid retention

• Migraine
• Convulsive d/o
• Asthma
• Cardiac & renal insufficiency
 PREVENTION OF IMPLANTATION
 IUD (Intra-Uterine Device)
 An object made of plastic or non-reactive metal (nickel-chromium alloy)
that fits inside the uterine cavity
 Manufactured in several shapes (loop, coil, spiral)
 Causes a chronic inflammatory response in the endometrium, discouraging
implantation of a fertilized ovum
 Conception may occur; if implantation takes place, it causes early abortion
 Usually inserted during the menstrual phase
 IUDs come with increased risk of ectopic pregnancy and perforation of the
uterus and do not protect against sexually transmitted disease. IUDs are
prescribed and placed by health care providers.
 Types of IUD

 Non-medicated
 Lippes-Loop- available in 4 sizes (A-
small to D-large); has been
withdrawn from the market
 Saf-T-coil – available in 2 sizes
(small & large)
 Medicated
 Copper 7 (Cu 200) – copper has
direct spermicidal effect; has been  Health Teaching:
withdrawn from the market 1.) Check for string
 Copper-T (T-Cu 200, tatum copper- daily
bearing IUD) 2.) Monthly checkup
 Progestasert-T 3.) Regular pap smear
 Contraindications of IUD

 Any inflammatory condition or infection of the

reproductive tract or PID
 Abnormalities of the uterus
 Severe dysmenorrhea
 Uterine bleeding of unknown origin
 Suspected pregnancy
 Complications / Adverse Reactions
 Syncope during insertion
 Increased risk of PID w/c may result in
 Sterility or infertility
 Medical-surgical intervention for complications such as
twisted ovary, bowel obstruction, unilateral tubo-
ovarial abscess
 Perforation of the uterus
 Dysmenorrhea

 Increased blood loss (anemia)

 Ectopic pregnancy
 Expulsion
 IUD Danger Signs

 Period late (pregnancy suspected)

 Abnormal spotting or bleeding
o A bdominal pain or pain with intercourse
o I nfection (abnormal vaginal discharge)
o N ot feeling well, fever, chills
o S trings lost, shorter or longer
 STERILIZATION/ PERMANENT CONCEPTION
CONTROL

 Tubal Occlusion / Bilateral Tubal Ligation

 Involves tying, cutting or cauterizing the fallopian tbes
 Usually done immediately after delivery (within 24-48
hours) when the incidence of morbidity & failure are
lowest
 May also be done in any phase of the menstrual cycle
 Methods:
 Mini-laparotomy
 Laparoscopy or “band-aid surgery”
 Vaginal tubal sterilization

 HT: avoid lifting heavy objects

 Vasectomy / Vas ligation
 Accomplished without entry into the
abdominal cavity; twin incisions are made in
the area where the scrotum joins the body,
just over the vas deferens
 The
tubes are tied and seperated; portions
maybe excised
 Follow-up sperm counts maybe done after.
 After vas ligation, the man is considered sterile:
After 20 or more ejaculation, zero sperm count-
safe
2 outstanding needs of couples who come to
the fertility clinic
 Education about reproduction & procedures used
to evaluate fertility
 Counseling to help them maximize their potential
for conception
 Stages on Evaluating Infertile Couples:
 Complete physical assessment to rule out endocrine or
emotional problems and disease entities
 Evaluation of the reproductive capacity of the male
 Semen analysis
 Hormone analysis
 Testicular biopsy
 X-ray studies to identify blockage of sperm pathway
 Evaluation of the reproductive capacity of the female
 Ability to ovulate
 Endometrial biopsy
 Test for cervical mucus viscosity/analysis of cervical secretions
 Patency of the fallopian tubes
 Analysis of endometrial secretions
 Possible Management:
 Hormonal therapy
 Surgical intervention for obstructive cases
 Medical therapy for PID
 Success of treatment depends on:
 Ages of the couple
 Continued interest
 Cooperation
 Financial resources
 Other Family Planning Services
 Sex Education
 Itis a broad term used to describe education about
human sexual anatomy, sexual reproduction, sexual
intercourse, and other aspects of human sexual behavior.
Common avenues for sex education are parents or
caregivers, school programs, and public health
campaigns.
 Genetic Counselling
 Helping people faced with a diagnosis of genetic disease
to understand both the factual information about the
disease and the effect it will have on their lives, so that
they can reach their own decisions about the future.
 Research