You are on page 1of 60

Family Planning

Family Planning
 What is family planning?
 The prevention of having children until choosing if and when to have children  Recognizing many women learn of contraceptives from friends, the media, magazines, internet, etc.  Realizing that if both partners are fertile, 90% will conceive with in one year

Family Planning
 Unintended pregnancies may result in
economic hardship, interfere with educational or career plans, etc.  Most women choose a variety of birth control before they reach menopause  The average woman must consider the use of contraceptives for up to 35 years of her life!!

Role of the FP Nurse
 Health care provider, counselor, educator,
advocate  Initial teaching involves selection of a contraceptive method, considering the clients individual lifestyle, not to persuade  Reinforcing teaching  Provide opportunity to ask questions

Role of the FP Nurse
 Nurses must feel confident and
comfortable discussing methods, and coitus-SEX  Be sensitive to woman's concerns and feelings  Avoid being bias, judgmental and personal choices/beliefs  Focus needs to be the needs and feelings of the patient and her partner

Role of the FP Nurse
 The nurse must provide individualized FP
information to woman in every situation in which it is appropriate:
   Teenage years Child bearing years 20-30+ Career/ peri-menopausal years

Considerations
 Safety  STD protection  Effectiveness  Acceptability  Convenience  Education needed  Benefits

Considerations
 Side effects  Interference with spontaneity  Availability  Expense  Preference  Religious and Personal Beliefs  Culture

Contraceptive Methods
 The perfect method does not exist
 Abstinence-practiced perfectly

 Contraceptives methods change based on
the clients circumstances  30% of married and 61 % of unmarried females change methods within 2 years  Careful consideration of all factors can help a woman choose the best method

Sterilization
 Bilateral Tubal Ligation (BTL)
2nd leading method of birth control Performed in between pregnancies or after childbirth, same day surgery  The fallopian tubes are occluded by clips, band, rings, or destroying portion of the tubes with electro-coagulation  Rest 24 hrs and no heavy lifting nor intercourse x 1 week  

Sterilization
 Vasectomy
 Local anesthesia used, office visit  Vas deferens ligation and removal of section of the vas or cautery  Semen no longer contains sperm  Lower morbidity rates than BTL  Lower cost than BTL  May take up to 3 months for completion with 2 negative samples

Advantages vs. Disadvantages
 Ends contraception issues, less 1% pregnancy risk  Initially high cost, low long term cost  Reversal is difficult, expensive, most likely unsuccessful  Surgery complications  No STD protection

Oral Contraceptives
 Leading method in the U.S.  Combined: estrogen & progesterone  Progesterone only pill (POP)  Mode of action:
 Increases thickening of cervical mucous to block sperm  Inhibits maturation of follicles and ovulation  8% failure rate

Oral Contraceptives
 Advantages
Unrelated to coitus Highly effective Reduces ovarian and endometrial cancer, cramping, blood loss and anemia  Regulates cycle  Return to fertility 3-6 months   

Oral Contraceptives
 Disadvantages
 Taken everyday near same time, especially POP  BTB  Headaches  Breast tenderness  Weight gain?  Melasma  Mood swings Requires Rx No STD protection Caution:  antibiotics  herbals  anticonvulsants  antituberculosis  antifungal  BUM necessary   

Oral Contraceptives
 21 day, 28 day  Triphasic, Monophasic  Extended Regimen
 84 active, 7 placebo  4 cycles a year

 Continuous regimen

Oral Contraceptives
 Decreases:
    ovarian cysts PID Ectopic Pregnancy Benign breast dz

 Improves:
       Acne Endometriosis PMS sx Dysmenorrhea Fibroid bleeding PCO Hirsutism

Oral Contraceptives
 Risks
       Women who smoke over 35 years of age DVT PE MI Stroke HTN Migraines

Vaginal Ring
 NuvaRing
Combined: estrogen & progesterone OCP mode of action Self placement Flexible ring placed intravaginally for 3 weeks and 1 free week.  95% effective, when used correctly    

Vaginal Ring
 Advantages
     Unrelated to coitus Easy placement Private No fitting necessary No weight restriction

 Disadvantages
 Must be comfortable with insertion  SE like OCPs  Rx only  Expulsion risks  No STD protection

Transdermal Patch
 Ortho Evra Patch
Combined: estrogen & progesterone OCP mode of action Absorbed via the skin Apply to clean, dry skin not tattooed, broken skin.  Place on abdomen, buttock, arm, upper back/shoulder-NEVER near breasts  99% effective, when used correctly.    

Transdermal Patch
   
Advantages Unrelated to coitus Easy to place Convenient

 Disadvantages
 Rx only  Weight restriction  198 lbs  May come off  SE like OCPs  Difficult to conceal  Skin irritation for some  No STD protection

Intrauterine Device (IUD)
 T shaped device  5 years Mirena-levonorgestrel (LNG-IUS)
 Failure rate <0.1%  More effective than sterilization

 10 years-Para Guard IUD- copper T 380A
 Failure rate <0.8%

Intrauterine Device (IUD)
 Action
 Para guard  copper changes the uterine/ tubal fluids to impair
sperm function.

 Mirena  thickens cervical mucous  Inhibits sperm function  Causes the endometrium to react to the foreign
body  Only small amt of systemic hormone absorbed

Intrauterine Device (IUD)
 Advantages
      Very safe Insert any time; medically placed Can be inserted 6 wks pp Low long-term cost Unrelated to coitus Fertility returns promptly

Intrauterine Device (IUD)
 Disadvantages
       Some complain of feeling the string (rare) No STD protection Rx…Mexico? Initially high up front cost Must be surgically placed Can be expelled without the woman’s knowledge Menorrhagia  infection, ectopic pregnancy,  Abortion, perforation
 educate the on the signs

Intrauterine Device (IUD)
 Check strings monthly after cycle  Know infection signs  hCg when necessary  Check for anemia with heavy cycles  Limit sexual partners to reduce PID risks

Depo Provera
     
Progesterone hormone IM injection 1st 5 days of cycle or restart protocol Prevents ovulation Do not massage the site 97% effective

Depo Provera
 Advantages
    Unrelated to coitus Eventual amenorrhea Very effective Cost effective over time

Depo Provera
 Disadvantages (possible)
    Prescription only Irregular menstrual Spotting / BTB 30-50% amenorrheic at 1 year

Depo Provera
     Weight gain, 4-5 lbs annually, etc Headaches Decreased libido Depression Nervousness

Depo Provera
 BMD risks  2 year limit  Dexa scan  Ca+ use daily 1000-1200mg/Vit D 400iu  Increase weight bearing exercises

Implanon
 Awaiting FDA approval ?  4 cm long, must be surgically implanted  Releases progestin over 3 years  NO pregnancies were reported in clinical
trials  SE c/w progestin only methods  Fertility returns completely after removal

Mechanical Barrier & Chemical Methods
 Chemical Spermicides  Condoms  Diaphragm  Cervical cap

Spermicides: Foam, films, suppositories
 Chemicals that kill sperm  Cream, foam, gel based, tablets  To be used WITH barrier methods  29% effective used alone
 not recommended

Spermicides: Foam films, suppositories
 Advantages
     Quick and easy to use No Rx Inexpensive Increases lubrication Increase effectiveness of condom use  97%

 Disadvantages
       Related to coitus Interrupts spontaneity Can be messy New application 1 hr effectiveness No STD protection Can be irritating  micro-ulcerations
 STD risk?

Condoms
 Mechanical Barrier
 Latex/ plastic /lambskin  Available in various colors, textures, flavors

 Placed over penis to prevent passage of sperm
to the uterus  The ONLY male contraceptive  15% failure rate
 When used alone

 Never use 2 condoms at the same time

Condoms
 Check expiration
dates  Use only water soluble lubricants  Avoid:
   Vaseline Baby oil Lotions

 Apply correctly to
prevent breakage
 Demonstration

Condoms
 Advantages
     Good STD protection Quick and easy to use No Rx Inexpensive Increase effectiveness with spermicidal use  97%

 Disadvantages
 New condom with repeat coitus  Possible sensitivity  Can slip or break  Some complain of decrease coital sensation  Check for holes/expiration

Female Condom
 Plastic pouch that fits over the cervix like a
diaphragm and another ring that extends outside the vagina which partially covers the perineum  21 %failure rate  Do NOT use in combination with male condom

Diaphragm
 A latex dome surrounded by a spring coil  Spermicidal gel is placed in the dome
facing the cervix  Prevents sperm from entering the cervix and kills additional sperm  Must be fitted by HCP

Diaphragm
 Weight gain or loss, must re-fit  Replace q 2 yrs  No oil based lubricants  16% failure rate  No STD protection

Cervical Cap
 FemCap
 Silicone cap placed over the cervix w/ spermacide on both side  No pressure on the bladder  Can remain in place for 48 hrs  Cap has loop device to help with removal

Cervical Cap
     Cap size dependent on gravida Replace after 2 years No oil based lubricants 16% failure rate No STD protection

Natural Family Planning
 Calendar  Standard Days Method  Basal Body Temperature  Cervical mucous  Symtothermal method

Natural Family Planning
 Based on knowledge of how the female
body and menstrual cycle works  Uses the physiological cues to predict ovulation  Ovum may be fertilized for 24 time frame  Sperm can live up to 3-5 days, 7days in some studies

Calendar
 Based on timing ovulation 14 days before
menses.  Keep track of cycles at least 6 months to determine pattern  Must abstain or use barrier method during fertile times  Can be unreliable

Standard Days Method
 String of beads that is color coded to keep
track of days/fertile days.  Designed for women that have cycles that vary from 26-32 days  Coitus is allowed on days 1-7 and 20 to the end of the cycle  Days 8-19 are considered fertile days

Basal Body Temperature
 The woman charts her oral temperature
each am, before getting out of bed  During ovulation, temperature rises 0.4-0.8 F  Coitus the day before the temperature rise may well result in pregnancy  Keep track of cycles at least 6 months to monitor temperature changes

Cervical Mucous
 Billings/ Ovulation Method
 This method is based on changes in the cervical secretions caused by a rise in the estrogen levels during the follicular phase of the cycle  Wiping from the vaginal orifice with tissue each day  Couples must avoid intercourse from time clear stretchy mucus is first present to 4 days after the end of slippery mucus  Spinnbarket

Symtothermal method
 Combines the
calendar, BBT, and cervical mucus methods AND  Paying close attention to symptoms like weight gain, bloating, mittelschmertz -Ovulation is near!

Natural Family Planning
 Advantages
 Acceptable to most religious groups  Avoids drugs, chemicals and devices  Can use barrier method during fertile times

 Disadvantages
 COUPLES must be highly motivated  Abstinence is a vital piece to the success  Perfect use 95-98% effective…typical 75%  Method is very unforgiving  NO STD protection

Abstinence
 Avoidance of sexual intercourse and any
activity that may allow sperm to enter the vagina.  Requires perfect use to be effective  Most women are not abstinent for all of their productive lives.

Abstinence
 Advantages
 100% no pregnancy/STDs  No cost  No hormones  No SE’s  No medical risks

 Disadvantages
 Must be highly motivated  Stress-for some

Lactation Amenorrheic Method LAM
 Breastfeeding inhibits ovulation
 Sucking and prolactin interfere w/ secretion of gonadotropin-releasing hormone and LH  No bottle, solid foods can be given

LAM
 Menses resumes in 6 months regardless,    
then another method must be used Must be highly motivated Low risk pregnancy only if used right No STD protection Least reliable

Coitus Interruptus
 Withdrawal
 Removal of the penis from the vagina prior to ejaculation  Failure rate 27%  Men must have great control  May be unsatisfying for some couples  Misjudging timing may cause pregnancy  Pre-ejaculant ??  Educate and do not judge  Least reliable

In Summary
 Contraceptive failures often occurs
because lack of knowledge/understanding or method is not suited to their needs  Consider the bio-psycho-social-spiritual consequences of unintended pregnancy  Lack of understanding can increase risk for STD’s as well.

In Summary
 Nurses role in family planning
      Educate Provide accurate information & counseling Advocate Support Be patient Be non-judgmental