REPRODUCTIVE FAMILY PLANNING
● It includes all decision an
individual and couple make about:
○ whether and when to
have children
○ How many children to
have
○ And how they are spaced
IMPORTANCE OF REPRODUCTIVE
FAMILY PLANNING
● Some couples you will meet
○ Wants counseling and
how to avoid conception
○ Want information on
increasing fertility and
about their ability to
conceive
○ Others need counseling
because contraceptives
have failed.
PURPOSES OF
REPRODUCTIVE FAMILY PLANNING
● Raising a child child requires
significant amounts of resources
such as:
○ Time
○ Social
○ Financial
○ Environmental
● Planning can assure that
resources are available.
● To the health of the mother and
child
● Helping to prevent HIV/AIDS
IMPORTANT CONSIDERATION
● Personal Value
● Ability to use method correctly
● If the method will affect the sexual
enjoyment
● Financial factors
● The couple’s relationship
○ Long term
○ Short term
● Prior experiences with
contraception
OTHER CONSIDERATION
● It is necessary to understand
various methods of contraception.
○ Work and compare benefits
and disadvantages
● In assessing which best option a
couple may choose.
○ Safe sex practices must be
advised
● Although there are many
contraceptive methods reliable to
avoid contraception. Condoms
provide protection against STD.
○ This is a special
consideration if the
relationship is a
monogamous one.
● Because the method of
contraception offers 100%
protection against pregnancy, it is
important to answer questions
carefully.
WHAT TO ASSESS BEFORE BEGINNING
OF A NEW METHOD
● VITAL SIGNS such as:
○ PAP smear
○ Pregnancy Test
○ Gonococcal and
Chlamydial Screening
○ HGB detection for anemia
● OBSTETRICS HISTORY for STDs
● SUBJECTIVE ASSESSMENT OF
THE PATIENT
○ Desires
○ Needs
○ Feelings
 ○ Understanding of
contraception
● Sexual practices
CRITERIA IDEAL FOR CONTRACEPTIVE
● It should be safe to use
○ Means free from any side
effects
● It should be reliable and effective
● It should be easy to administer
and convenient
● It should be cost effective
● It should be culturally feasible and
acceptable
● Free of bothersome side effects
● Free of effects on future
pregnancies
TYPES OF
REPRODUCTIVE FAMILY PLANNING
● NATURAL FAMILY PLANNING
○ ABSTINENCE
○ COITUS INTERRUPTUS
○ LACTATION
AMENORRHEA METHOD
(LAM)
○ CALENDAR METHOD
○ BASAL BODY
TEMPERATURE
○ CERVICAL MUCUS
METHOD
○ SYMPTOTHERMAL
METHOD
● BARRIER METHOD
○ PHYSICAL BARRIERS
○ CHEMICAL BARRIERS
● HORMONAL METHODS
● INTRAUTERINE DEVICES
● SURGICAL METHODS
○ VASECTOMY
○ TABH-SO
NATURAL FAMILY PLANNING
● Also known as PERIODIC
ABSTINENCE
● Involves to introduce or use
chemical or foreign materials into
the body of the female and the
male.
● Its effectiveness varies from 2%
ideal failure rate to 25% failure
rate depending mainly on the
couple from having coitus on fertile
days.
ABSTINENCE
● This involves completely refraining
from coitus and 0% failure.
● However, due to natural human
desire, couples may find it difficult
to adhere to abstain.
● It has very high failure rate
ADVANTAGES
● Acceptable to all religious group
DISADVANTAGES
● Requires high motivation and also
self discipline
COITUS INTERRUPTUS
● One of the oldest methods of
contraception.
● The penis is withdrawn from the
vagina before ejaculation.
● Coitus Interruptus is only about
82% effective and should be used
with caution.
ADVANTAGE
● No cost
● Does not require any device
● With self control and discipline, it
can be fairly effective.
DISADVANTAGES
● Requires a great deal of self
control
● Failure rate is very high
 ● Slightest delay in withdrawal can
lead to pregnancy.
LACTATION AMENORRHEA METHOD
● A breastfeeding woman has
natural suppression of both
ovulation and menses
● It could be considered safe if:
○ An infant is under 6 months
of age.
○ Being totally fed every 4
hours during the day and
every 6 hours at night.
○ No supplementary
○ Menses has not returned.
FERTILITY AWARENESS METHOD OF
NATURAL FAMILY PLANNING
● CALENDAR METHOD
● BASAL BODY TEMPERATURE
METHOD
● CERVICAL MUCUS METHOD
● SYMPTOTHERMAL METHOD
CYCLE BEADS
● Red bead first day of pregnancy
● Dark brown beads, tells you if your
cycle is shorter than 26 days.
● Brown beads, pregnancy is very
unlikely
● White beads, pregnancy is most
likely.
BASAL BODY TEMPERATURE
● This method is used by monitoring
or taking the woman’s body
temperature everyday upon
waking up.
● Before the day of ovulation: the
woman’s temperature is 0.5F.
● On the day of ovulation: the
woman’s temperature.
● To make sure it is effective, it
should be combined with a
calendar method.
DISADVANTAGE
● Many factors affect basal body
temperature.
○ Illness
○ Physical activity.
CERVICAL MUCUS METHODS
● Change in cervical mucus that
naturally occurs with ovulation.
● A way to identify fertile times to
help you gauge the best days to
have or avoid unprotected days.
HOW DOES IT WORK
● Before ovulation each month, the
cervical mucus is thick and does
not stretch.
● Just before ovulation , mucus
secretion increases.
● On the day of ovulation, cervical
mucus becomes thin, copious,
watery, and transparent.
○ SPINNBARKEIT
■ Cervical mucus
stretches at least
1 inch before the
strand breaks.
● All the days that the cervical
mucus is copious (3 to 4 days after
ovulation) are considered fertile
days where a woman should
abstain from coitus.
ADVANTAGES
● Inexpensive
● Does not have side effects
DISADVANTAGE
● The feel of vaginal secretion is
unreliable since the seminal fluid
of the male has watery
consistency and can be confused
with ovulatory consistency.
● High failure rate because of
difficulty interpreting mucus status.
 BARRIER METHODS
● Forms of birth control that place a
chemical or latex between the
cervix and entering sperm into the
uterine cavity.
SPERMICIDES
● Agent that kills spermatozoa
before they can enter the cervix.
● It changes the vaginal pH to a
strong acid level which is not
conducive to sperm survival.
ADVANTAGES
● May be purchased without
prescription
● When used together with other
contraceptives they increase the
other methods of effectiveness.
● There are various forms to choose
from such as:
○ Gel
○ Creams
○ Sponges
○ Films
○ Foams
○ Vaginal Films
CONTRAINDICATION
● Vaginallly inserted spermicides
are contraindicated with women
with acute cervicitis
● Bothersome for women because
they are sticky.
MALE CONDOM
● A latex or rubber or synthetic
material placed over the erect
penis before coitus to trap the
sperm.
● It has a failure rate of 15%
ADVANTAGES
● Available in pharmacies and
convenience stores
● No health visit of prescription
needed
FEMALE CONDOM
● Made of latex polyurethane
pre-lubricated with spermicide
● The inner ring covers the cervix
and the outer ring rests against the
vaginal opening.
DIAPHRAGMS
● A circular rubber disk that is
placed over the cervix before
intercourse to mechanically block
the passage of the sperm.
● After coitus, diaphragm must
remain for 6 to 24 hours because
sperm is still viable.
CONTRAINDICATION
● May not be effective if the uterus is
prolapsed, retroflexed, or
anteflexed which displaces the
cervix
● Diaphragms may cause UTI’s
● Should not be used in cases of
○ Acute Cervicitis,
○ Herpes Virus Infection
○ Papillomavirus Infection
○ Allergy to rubber or
spermicides
● Do not leave diaphragm in place
for more than 24 hours
● Do not use it during menstruation
HORMONAL CONTRACEPTIVES
● Combined oral contraceptive pills
● PROGESTIN-ONLY ORAL
CONTRACEPTIVE PILLS
● INJECTABLES
(DEPO-PROVERA/DMPA)
● IMPLANTS
(NORPLANT,JADELLE)
● Hormonal contraceptives are, as
the name implies, hormones that
 cause such fluctuations in a
normal menstrual cycle that
ovulation does not occur
COMBINED ORAL CONTRACEPTIVES
(COC’s)
● Composed of varying amounts of
synthetic estrogen combined with
a small amount of synthetic
progesterone (progestin).
● 92% effective, and 99% effective if
taken correctly and continuously
PHYSIOLOGY
● The estrogen acts to suppress
follicle stimulating hormone
(FSH) and LH, thereby
suppressing ovulation.
● The 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 also interferes
with tubal transport and
endometrial proliferation to such
degrees that the possibility of
implantation is significantly
decreased.
WHO CAN USE IT?
● If you are healthy and do not
smoke, you can keep taking the
pill safely for many years.
● You should not use this pill if you
have:
○ Had Heart Attack, Stroke,
or Blood Clot in you legs or
lungs
○ A family member has a
blood clot in their legs or
lungs
○ You are over 35 and
smokes
○ You are overweight
○ You have migraines
○ You have some types of
medication or herbal
medicines.
MONOPHASIC COC’s
● Provide fixed doses of both
estrogen and progestin throughout
a 21-day cycle.
BIPHASIC COC’s
● Deliver a constant amount of
estrogen throughout the cycle but
an increased amount of progestin
during the last 11 days.
TRIPHASIC COC’s
● Triphasic preparations vary in both
estrogen and progestin content
throughout the cycle.
● Types more closely mimic a
natural cycle, thereby reducing
breakthrough bleeding (bleeding
outside the normal menstrual
flow).
EXTENDED CYCLE PILLS
● These are typically used in a
13-week cycle.
○ You take active pills for
12 weeks, and during the
last week of the cycle,
you take inactive pills
and have your period.
■ As a result, you
have your period
only three to four
times per year.
NOTE
● Typical pills have 28-pill
dispensers
 ○ Of which 21 active pills and
7 placebo pills)
BENEFITS OF COCs
● Oral contraceptives have
noncontraceptive benefits such as
decreased incidences of:
○ Dysmenorrhea, because
of lack of ovulation
○ Premenstrual dysphoric
syndrome and acne,
because of the increased
progesterone levels
○ Iron deficiency anemia,
because of the reduced
amount of menstrual flow
○ Acute pelvic
inflammatory disease
(PID) and the resulting
tubal scarring
○ Endometrial and ovarian
cancer, ovarian cysts, and
ectopic pregnancies
○ Fibrocystic breast
disease
○ Possibly osteoporosis,
endometriosis, uterine
myomata (fibroid uterine
tumors), and progression
of rheumatoid arthritis
○ Colon cancer
(Stubblefield, Carr-Ellis, &
Kapp, 2007)
PROGESTIN-ONLY PILLS
(MINI PILL)
● Also called the Mini Pill.
● The mini pill prevents pregnancy
using progestin alone, instead of
combining with estrogen.
○ Low dose of progestin
actively thickens mucus
to prevent sperm from
fertilizing the egg released
each month.
○ This hormone also thins
the endometrial lining to
make it inhabitable for a
fertilizing egg, just in case
the sperm penetrates the
egg’s barrier.
■ Thinning your
uterine directly
reduces the
menstrual flow to
provide you with
relief from heavy
periods.
● To ensure the pill retains its
effectiveness in preventing
pregnancy, you must take it at
the same time every day.
SIDE EFFECTS/ CONTRAINDICATION OF
ORAL CONTRACEPTIVE
● Nausea
● Weight gain
● Headache
● Breast tenderness
● Breakthrough bleeding (spotting
outside the menstrual period)
● Monilial vaginal infections
● Mild hypertension
● Depression
● Advise all women taking COCs to
notify their health care provider if
symptoms of myocardial or
thromboembolic complications
occur. These are:
○ Chest pain (pulmonary
embolism or myocardial
infarction)
○ Shortness of breath
(pulmonary embolism)
○ Severe headache
(cerebrovascular accident)
 ○ Severe leg pain
(thrombophlebitis)
○ Eye problems such as
blurred vision
(hypertension,
cerebrovascular accident)
SUBDERMAL HORMONE IMPLANTS
● This is a progestin-filled minature
rod not bigger than a matchstick,
estrogenol implant.
○ This can be inserted under
the skin on the inside of the
upper arm.
○ This slowly release
progestin over a period of 3
years which also
suppresses ovulation,
thicken cervical mucus,
and change the
endometrium lining which
make implantation difficult.
○ The rod is inserted by the
trained Physician under
local anesthesia not later
than 7 days after menstrual
period to be certain the
woman is not pregnant.
SIDE EFFECTS/ CONTRAINDICATIONS
● Weight Gain
● Breakthrough Bleeding
● Amenorrhea
● Scar on the insertion site
● Contraindication is when the
couple desire pregnancy within
one year and undiagnosed uterine
bleeding.
● Infection can also occur on the
insertion site.
INTRAMUSCULAR INJECTION
HORMONE (DEPO-PROVERA)
● A single intramuscular injection of
depot medroxyprogesterone
acetate (DMPA) is a
progesterones given every 12
weeks or 3 months which also has
the same effects as hormonal pills.
● The effectiveness rate of this
method is almost 100% making it
a popular contraceptive method.
● Because it only contains
progesterone, it can be used
during breastfeeding, although
women should wait 6 weeks after
birth before the first injection
● ADVANTAGE:
○ Reduction of:
■ Ectopic Pregnancy
■ Endometrial Cancer
■ Endometriosis
SIDE EFFECTS
● Irregular heavy menstrual bleeding
for the first year and no menstrual
bleeding after the first year.
● It also impairs glucose tolerance in
women at risk for diabetes so it
must be used cautiously for these
women.
● It increases the risk for
osteoporosis for loss of bone
mineral density.
○ Calcium supplements must
be advised.
● It is not advisable for use for more
than 2 years.
INTRAUTERINE DEVICE (IUD)
● A small plastic device that is
inserted into the uterus through
the vagina, IUD’s can either be
hormonal or non hormonal.

● Although it has been used for
contraceptive purposes thousands
of years back (used in camels) the
mechanism is still not fully
understood.
○ But it is used to prevent
fertilization and to increase
sterile inflammatory
process to prevent
implantation
● It is inserted by a trained
OB/Midwife/ or nurse.
● The following must be considered:
○ Before insertion:
■ Pelvic examination
■ Clearance must be
performed
■ Contraindicated for
women with high
risk of STI’s
■ It must be inserted
after menstrual flow
and advised no
coitus before
insertion.
TYPES OF IUD
● COPPER T380
○ The copper triggers your
immune system to prevent
pregnancy.
○ It can cause your periods
to be heavier, especially at
first.
■ ParaGard last
longer than IUD’s
○ It is effective for 10 years.
● MIRENA/LILETTA IUD
○ LEVONORGESTREL
■ Releasing
intrauterine system
52 mg.
■ This contains a
drug reservoir of
progesterone in the
stem which diffuses
into the uterus
which prevents
endometrial
proliferation and
thickens the
cervical mucus.
■ It has also potential
to reduce
endometrial cancer
○ It is effective for 5 years
● SKYLA IUD
○ LEVONORGESTREL
■ Releasing
intrauterine system
13.5 mg
○ It has a lower dose of
progesterone.
○ It is effective for 3 years.
 CESAREAN BIRTH
● It is a procedure where birth is
accomplished through abdominal
incision into the uterus.
● It is one of the oldest types of
surgery and one with few
complications.
● It is a latin word which means “to
cut”
INDICATION FOR C/B
MATERNAL FACTORS
● Genital Herpes
● Cephalo-Pelvic Disproportion
(CPD)
● Disabling condition of the mother.
○ Severe HPN
○ Heart Conditions
● Previous C/S
PLACENTAL FACTORS
● Placenta Previa
● Premature Separation of the
Placenta
● Umbilical Cord Prolapse
FETAL FACTORS
● Macrosomic Fetus in Fetal Lie
● Extreme Low Birth Weight
● Fetal Distress
● Fetal Anomalies
● Multigestation or Conjoined Twins
● Transverse Fetal Lie
TWO TYPES OF C/S
SCHEDULED
● There is time for thorough
preparation for the experience
throughout the antepartal period.
EMERGENT
● Emergent cesarean births are
done for reasons such as placenta
previa, premature separation of
the placenta, fetal distress, or
failure to progress in labor.
NURSING RESPONSIBILITIES FOR
WOMAN ANTICIPATING A C/B
● All women talk about their fears
PRE OPERATIVE
● Obtain Health History before
administration of anesthesias.
○ Previous Surgeries
○ Secondary illness
○ Allergic Reactions or
Reaction to food and drugs
○ Reaction to anesthesia
○ Bleeding Problems
○ Current Medications taken
by the woman
○ Women's knowledge about
the procedure
○ Length of hospitalization
○ Post-Surgical Equipment
(IC/IVF)
○ Special Precautions
necessary for her infant.
EFFECTS OF SURGERY ON A WOMAN
STRESS RESPONSE
● Either physical or psychological
● The body responds to preserve
functions of the major body.
○ Increased Epinephrine and
Norepinephrine could
cause:
■ Increased Heart
Rate and Bronchial
Dilation
■ Increase Blood
Sugar
■ Peripheral
Vasoconstriction
■ Increased Blood
Pressure.
● These stress related changes
minimize blood supply to lower
 extremities could lead to
thrombophlebitis.
INTERFERENCE IN BODY RESPONSES
● The skin as the first line of defense
is compromised.
● Strict aseptic technique must be
observed following the days after
the surgery to compensate for this
defense
● If Cb is done after the membranes
have ruptured, the increased risk
of infection such as endometritis
may take place.
INTERFERENCE WITH CIRCULATORY
FUNCTION
● Blood loss that occurs with surgery
may result in hypovolemia and
hypotension.
● Ineffective tissue perfusion of all
body tissues
● Normal blood loss during CB is
500-1000 ml
INTERFERENCE WITH BODY FUNCTION
● Increased flow of fluid of the
surgical wound also disrupts
function
● Displacement of the urinary
bladder leads to loss of sense of
filling.
● Pressure on the intestine causes
paralytic ileus/halting intestinal
function.
● Thrombophlebitis
○ Impaired lower extremities
blood flow.
INTERFERENCE WITH SELF-MAGE OR
SELF-ESTEEM
● Presence of incision scar
● CB also marks her as a woman
less than others because she was
not able to give vaginal birth.
OPERATIVE RISKS FOR A WOMAN
POOR NUTRITIONAL STATUS
● Obesity interferes with wound
healing
○ Fatty tissue is difficult to
heal.
● Prolonged healing may result to
infection or rupture of incision
(dehiscence)
● Increased workload for the heart of
the woman
● Pneumonia
○ Lack of lung expansion
causes Pneumonia.
● Vitamin Deficiency
○ Vitamin C and D
○ Protein deficiency is also a
risk for healing
AGE VARIATION
● Old aged women is high risk for
CB
ALTERED GENERAL HEALTH
● Persons that is high risk for
surgical procedures:
○ Diabetes Mellitus
○ Heart Disease
○ Anemia
○ Kidney Disease
FLUID AND ELECTROLYTE IMBALANCE
● Lower than normal blood pressure
may be felt by a mother more than
one with normal blood volume.
FEAR
● Extreme worry or anxiety about
the surgery may need a detailed
explanation before the operative
procedure
CB PUTS NEWBORN AT RISK THAN
VAGINAL BIRTH
● Inadequate respiration
● Infection
 PREOPERATIVE
DIAGNOSTIC PROCEDURES
● Assess the heart, kidney,
circulatory and fetal heart rate.
○ Vital Signs determination
○ Urinalysis
○ CBC
○ Coagulation Time and
Partial PT
○ Electrolyte and pH Balance
○ Blood Typing and Cross
Matching
○ Ultrasound to determine
Fetal presentation and
maturity
PREOPERATIONAL TEACHING
● Assess how much a woman
already knows about the surgery
○ Refresh the mother if she
already had post-CS
● NPO
● DBE after the operation
● Indwelling Catheter and IVF
● Early Ambulation
PREOPERATIONAL MEASURES
● Informed Consent
● Overall Hygiene
● Gastric emptying to decrease
gastric secretions
● Baseline I&O
● Hydration
● Preoperative medication
● Patient Chart
○ Documentation must be
completed
PREVENTION OF COMPLICATION
● Deep Breathing Exercises
● Turning side to side
● Early ambulation after 4-6 hours
for lower extremities circulation
DISCHARGE PLAN
● Mother must be aware of the
restrictions in exercise or activity
such as:
○ Do not lift heavy objects
more than 10lbs
○ Do not walk upstairs more
than once a day for the first
2 weeks
● Report or recognize possible
complications
○ Redness or discharge the
incision line
○ Lochia with heavier than
menstrual flow
○ Abdominal pain other than
the suture line or after pain
discomfort.
○ Elevated body temperature
○ Frequency on urination
○ Burning sensation
BLEEDING
PRIMARY CAUSES OF BLEEDING IN
PREGNANCY
FIRST TRIMESTER
● Uterine Abnormalities
● Chromosomal Problems
● Unknown Causes
● Infection
● Deficient Progesterone
● Metabolic Disorder
ANATOMIC DEFECTS OF THE UTERUS
BLEEDING DURING FIRST TRIMESTER
CLASSIFICATION
● Threatened Miscarriage
● Imminent
● Missed Miscarriage
● Incomplete Miscarriage
● Complete Miscarriage
● Ectopic Pregnancy
SECOND TRIMESTER
● Hydatidiform Mole
● Premature Cervical Dilatation.
THIRD TRIMESTER
● Placenta Previa
● Abruptio Placenta
● Preterm Labor
ABORTION
● The National Center for Health
Statistics, the Center for Disease
Control and Prevention (CDC),
and the World Health Organization
(WHO) define abortion as
pregnancy termination prior to 20
weeks gestation or a fetus
weighing less than 500g
○ Despite this, definitions
vary widely according to
state laws
○ Fetus weighing less than
500 grams
○ Before the 20th completed
week of gestation
○ Early abortion and late
abortion
○ 15% of clinically evident
pregnancies
○ 80% of abortions prior to
12 weeks gestation
MISCARRIAGE
● Abortion is the removal of
pregnancy tissue, products of
conception or the fetus and
placenta from the uterus
● Miscarriage is when an embryo or
fetus dies before the 20th week of
pregnancy
● Miscarriage usually happens early
in your pregnancy.
○ 8 out of 10 miscarriages
happens in the first 3
months
PATHOPHYSIOLOGY OF MISCARRIAGE
1. DUE TO ETIOLOGIC FACTOR
LIKE GENETIC
2. TRISOMY CHROMOSOMES ARE
THE MOST COMMON
CHROMOSOMAL ANOMALIES
3. INSUFFICIENT HORMONAL
LEVEL
4. RESULT IS SPONTANEOUS
MISCARRIAGE BEFORE 10
WEEKS OF GESTATION
PATHOLOGY OF ABORTION
FIRST 8 WEEKS GESTATION
● Separation of decidua basalis and
expulsion of the ovum
○ If retained within the
uterus, the ovum becomes
surrounded by decidua and
blood clot
8 TO 12 WEEKS OF GESTATION
● Rupture of the decidua capsularis
and expulsion of the product of
conception
AFTER 12 WEEKS
● Rupture of the membranes
followed by expulsion of the
product of fetus and the placenta
in the uterus.
PATHOLOGY
● Hemorrhage into the decidua
basalis
● Necrosis and inflammation IMMINENT MISCARRIAGE/ INEVITABLE
● Uterine contraction and cervical
dilatation
● Expulsion of most or all the
products of conception
ETIOLOGY
● Abnormal karyotype:50%
● Maternal Factors
○ TORCH
○ Infection
○ Immunologic factors
○ Maternal Systemic
Diseases
○ Anatomic Defects
○ Trauma
● Toxic Factors
CHARACTERISTICS
THREATENED ABORTION
● Usually bright red spotting
● Without cervical dilation
● Without expulsion of products of
conception
MANAGEMENT
● Mother must visit the OB for FHB
assessment and ultrasound
● Blood is drawn for Hcg testing
repeated again after 48 hours
○ If placenta is still intact
● CBR is not necessary,
○ It may cause pooling of
blood and bleeding again
when the mother
ambulates
○ Bleeding must stop within
24 hours
○ Restrict coitus for 2 weeks
after the bleeding episode
to prevent infections and
avoid further bleeding.