ASSESSMENT FOR CONTRACEPTION OPTIONS AND POSSIBLE CONTRAINDICATIONS
Contraceptive Use Overview
-60% of potential pregnancies and 90% of unintended pregnancies in the U.S. use contraception
-Benefits: Reduces unintended adolescent pregnancies and elective terminations
Factors in Choosing Contraceptives:
-Personal values
-Ability to use a method correctly
-If the method will affect sexual enjoyment
-Financial factors
-If a couple's relationship is short term or long term
-Prior experiences with contraception
-Future plans
-Expectations about menstrual cycle patterns while on birth control
Importance of Counseling
-Understand how contraceptive methods work (benefits and disadvantages)
-Emphasize safer sex practices (STI and HIV protection)
-Condoms: only method that protects against STIs and HIV
Ideal Contraceptive Characteristics:
Safe and effective
Compatible with cultural/spiritual beliefs and personal preferences
Free of side effects and affordable
Convenient and not affecting future pregnancies
Pre-Contraception Assessments:
Vital signs, pregnancy test, hemoglobin
Pap smear and STI screening when necessary
Obstetric history and subjective assessment
Evaluate sexual practices and feelings about body image
NATURAL FAMILY PLANNING
-also called periodic abstinence methods
-are methods that involve no introduction of chemical or foreign material into the body.
Abstinence
-refraining from sexual relations
-has a theoretical 0% failure rate and is also the most effective way to prevent STIs.
Periodic Abstinence
-is a method to avoid pregnancy by avoiding sex on the days conception may be possible.
LACTATION AMENORRHEA METHOD
During breastfeeding, there is a natural suppression of both ovulation and menses (Fruhauf & Patel,
2021). Lactation amenorrhea method (LAM) is a safe birth control method (a failure rate of about 1%
to 5%) if:
An infant is:
-Under 6 months of age
-Being totally breastfed at least every 4 hours during the day and every 6 hours at night, and
-Menses has not returned
-Receiving no supplementary feedings
-After 6 months, or if the infant begins to receive supplemental feedings or isn't sucking well, the use
of LAM as an effective birth control method becomes questionable and an- other method of
contraception may be recommended
COITUS INTERRUPTUS
-Coitus interruptus (withdrawal) is one of the oldest known methods of contraception.
-The heterosexual couple proceeds with coitus(sex) until the moment of ejaculation. Then, the penis
is withdrawn and spermatozoa (matured sperm) are emitted outside the vagina.
POSTCOITAL DOUCHING
-the process of intravaginal cleansing with a liquid solution
-Douching following intercourse, 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, long
before douching could be accomplished.
FERTILITY AWARENESS METHODS
FERTILITY AWARENESS
-methods rely on detecting when a person will be capable of impregnation (fertile) so they can use
periods of abstinence during that time.
Calendar (Rhythym Method)
-The calendar method requires a person to obtain from coitus on
the days of menstrual cycle when they are most likely to conceive.
Cervical Mucus Method
-Another method to predict ovulation is to use the changes in cervical mucus that occur naturally with
ovulation.
(Ovulation Method)
Before ovulation:
Cervical mucus is minimal or dry during the beginning of the menstrual cycle
Approaching ovulation:
Mucus becomes sticky, cloudy, and starts to increase in quantity.
At ovulation:
Cervical mucus reaches its most fertile state—clear, slippery, stretchy, and similar to raw egg whites.
This fertile mucus creates an environment where sperm can survive and travel easily.
After ovulation:
The mucus becomes thick, sticky, and less present, marking the end of the fertile period.
Two-Day Method:
-To use a 2 day method, a person assess for vaginally secretions daily. If they feel secretions for 2 days
in a row, they avoid coitus that day and the day following as the presence of secretions suggests
fertility.
1. Did I notice any cervical mucus today?
2. Did I notice any cervical mucus yesterday?
Symptothermal Method:
-combines the cervical mucus and BBT methods (Simmons & Jennings, 2020).
The person takes their temperature daily, watch for the rise of temperature that marks ovulation.
Also analyzes their cervical mucus and observe for other signs of ovulation such as mittelschmerz(mid
cycle abdominal pain) or if the cervix feels softer than usual
-is more effective than either the BBT or the cervical mucus method alone
Standard Days Method: Cycle Beads
-Method is designed for people who have menstrual cycles between 26 and 32 days. A circle of beads
that helps predict fertile days.
-iCycleBeads - an app available in place of actual beads
Ovulation Detection:
-By the use of an over-the-counter ovulation detection kit
-These kits detect the midcycle surge of luteinizing hormone (LH) that can be detected in urine 12 to
24 hours before ovulation.
--98% to 100% accurate in predicting ovulation.
Marquette Model:
-This method combines the use of ovulation detection with other signs of ovulation (cervical mucus,
BBT, cervix position and softness) to avoid pregnancy during the fertile period.
Side Effects and Contraindications for Natural Family Planning
Natural family planning methods do not have side effects. If there is a
contraindication to their use, it would be the relatively high failure rate of all forms of about 25%.
Natural Family Planning and Its Effect on Pregnancy
Natural family planning methods have no effect if a person should get pregnant while using them as
well as no effect on future pregnancies.
Natural Family Planning and the Adolescent
Natural methods of family planning (with the exception of abstinence) are usually not the
contraceptive method of choice for adolescents as they require a great deal of thought and
persistence.
Natural Family Planning during Perimenopause
Perimenopausal people are good candidates for natural family planning methods because they may
not be able to use hormonal methods such as birth control pills because of risks related to
high blood pressure, thromboembolic disease, or cigarette smoking.
Natural Family Planning during Postpartal Period
After a successful pregnancy, most people are
interested in delaying their next pregnancy until
their new baby is older. This makes them good
candidates for natural family planning as they can
breastfeed with these methods without worrying
about hormonal contamination or a decrease in
breast milk associated with some hormonal
methods.
However, a postpartal person often
ovulates before their first menstrual cycle
and should be warned that they could
become pregnant even before their return
to menses.
