Chapter 7 FAMILY PLANNING and CONTRACEPTION: At the end of this Chapter, the students will be able to: 1.

Define Family Planning 2. Explain the importance of Family Planning 3. Discuss the available family planning methods by their classification, description and Mechanism of action 4. Discuss the nature of Contraceptive method of family planning; their advantages, disadvantages, as well as their limitations. 5. Guide the couple in selecting a method of control that best meets their needs.

Introduction: The concept of family planning and contraception is often interpreted solely as a means of keeping families small. Although the basis purpose is to regulate family size and to affect a more judicious spacing of children, there are also indications on why contraception should be used. These include some medical reasons such as advanced diabetes, cancer, or some inherited conditions. Content: Lesson 1 The Family Planning

A. Family Planning- Achieving desired family size and proper birth spacing. [ Spacing pregnancies (2-3 years between pregnancies) to ensure the health of the mother and child. [ Optimal birth spacing is having children born at least 3-5 years apart. B. Importance: [ Helps regain strength lost in last pregnancy [ Helps avoid unplanned, high-risk pregnancies [ Devote more quality time to herself, her husband or her community [ Helps prevent illegal abortion that may lead to complications or even death of the mother. [ Proper child care/rearing. [ Reduction in infant/ child deaths C. Principles: the success of family planning program depends to a great extent on the motivation of both husband and wife. D. Types: 1. Natural Contraceptive Methods- Abstinence from coitus during the fertile days of the menstrual cycle; the only method accepted by Catholic Church a. Billing method/Cervical mucus method [ Assessment of cervical mucus during the menstrual cycle; [ Spinnbarkeit test is usually used. [ Sensory and visual observation of cervical mucus (when it becomes thin and watery) the intercourse is avoided 3-4 days after spinnbarkeit.

b. Basal Metabolic Temperature: [ As soon as the temperature drops slightly and then increases (it means ovulation has taken place).Counts 3-4 days to abstain from intercourse. [ Requires predictable menstrual cycle [ Also called rhythm or calendar method [ Can also be used to predict ovulation Considerations:     Temperature must be taken upon waking Always use the same route Basal thermometer used Can also check for cervical mucus

c. Symptothermal - Combination of Billings and BBT [ Couple needs to record cycle days, coitus, mucus changes, inc. libido, mittelschmerz, BBT. [ Most effective natural method of family planning

d. Standard Days Method [ Cycles is within 26-32 days

[ Fertile days occurs on 8th -19th days of the cycle [ Use cycle beads [ 32 colored beads in these order  1 red 1st day of menstruation  6 brown infertile  12 white- fertile  13 brown- infertile

e. Lactational Amenorrhea Method (LAM ) [ During breastfeeding, the prolactin inhibits ovulation [ Menstruation resumes: 2-3 months for bottle feeding mothers and 4-6 months for breast feeding mothers. 2. Social Method a. Coitus Interruptus (Withdrawal): Removal of penis before ejaculation. The least effective method due to premature ejaculation. b. Coitus reservatus- sex without ejaculation, popular among sex workers. c. Coitus interfemura- penis rub between the femur d. Coitus intramammas- penis rubbed in between the breast

3.

Biological Method- known as calendar method identifies the fertile and infertile phases and abstains from sexual intercourse during fertile phase.

[ Rhythm- effective if the mother has regular cycle. Determine the cycle then subtract 14 days from the beginning of the next cycle. (Ovulation occurs 14 days before the next menstruation). From the ovulation day, subtract 4-5 days and add 4-5 days then the result will be the unsafe days and abstinence is required. [ Origoknause formula applicable for woman with irregular menstrual cycle. [ The woman charts her menstrual cycles for 12 continuous months in order to determine the shortest and the longest cycles. [ The 1st fertile day is determined by subtracting 18 from the shortest cycle and 11 from the longest cycle. E.g. 26 - 18 _____ 8 32 - 11 _____ 21

The fertile period would be from the 8th day to 21st day of her cycle. Avoid sexual contact during these days.

4.

Physiological Method a. Low Dose Combined Oral Contraceptives contains estrogen and progestin in low doses inhibits ovulation (release of eggs from the ovaries) thickens the cervical mucus 21-pill pack- contains 21 active pills 28-pill pack- contains 21 active pills and 7 placebo pills  Monophasic - all active pills containing fixed dosages of estrogen and progestin (e.g. Nordiol, Marvelon)  Biphasic- 21 active pills containing two different estrogen: progestin ratios (e.g. Gracial)

Triphasic - 21 active pills containing three different estrogen: progestin ratios (e.g. Trinordiol, Logynon)

b. Progestin Only Oral Contraceptives       Does not reduce breast milk production No estrogen side effect Women take one pill everyday with no break Less risk of acne and weight gain Temporary Alters estrogen and progesterone levels (prevents ovulation)

Considerations:    S/E: bloating, nausea, weight gain Adverse effects: leg cramping/pain, HA, abdominal apin Not recommended for patients who smoke or coagulation problems If dose is missed, take 2 tablets that day; if more than one dose is missed, must stop pill cycle and start a new pack Failure is due to incorrect usage Use additional contraception for the first 7 days

 

c. Emergency Contraception: The Morning-After Pill a. Take between 2-5 pills within 72 hrs after intercourse and take 2nd dose 12 hrs after 1st dose d. Subcutaneous implants (Norplant) 6 match sticks like rod implanted subdermally y Time-release dosage of progesterone y Suppresses ovulation y Inserted subQ during menses

y May remain in for up to 5 years y Decreased menses y Adverse reaction: y Irregular bleeding, headaches, weight gain, depression

e. Subcutaneous injections (Depo-Provera) a. Continuous release of medroxyprogesterone acetate b. Suppresses ovulation c. Considerations:  Must be repeated every 3 months  Can be given 5 days postpartum if not breastfeeding  Can be given 6 weeks post partum if breast feeding  Adverse effects: irregular bleeding, headaches, weight gain, depression

5. Mechanical method and Chemical Barriers a. Intrauterine Device y Temporary Loop/coil inserted into uterus during menstrual cycle y Outpatient procedure y Prevents fertilized egg from implanting

y Interventions: y Teach woman to check for string y Teach woman spotting and dysmenorrhea are common y Yearly pelvic exams y Must use additional BC method for 2-3 weeks y Signs of potential problems PAINS Period late/abnormal Abdominal pain

Infection Not feeling well String missing b. Diaphragm: Barrier Method

1. Use with spermicidal cream/jelly 2. Do not remove for at least 6 hours after ejaculation 3. Add additional spermicidal if repeated intercourse 4. Check for holes regularly 5. Clean with warm soapy water and dry 6. May need new fitting after weigh gain/loss (10 lbs) or pregnancy 7. Cannot use if with latex allergy 8. Adverse effects: cramps/rectal pressure, s/s TSS. Key warning signs of TSS Sudden fever Hypotension Rash

c. Cervical Cap- more durable than diaphragm    Can stay in place for than 24 hours No need to reapply spermicides Contra indicated in abnormal Pap smear

d. Condom (Barrier Method) The only method that prevents STDs 1. Must be used before penetration 2. Leave space at the tip 3. Single use only

6. Surgical Methods a. Tubal ligation

    

Permanent (may be reversed in some cases) Must have a 30-day consent Ovulation and menstruation continues Laparoscopic procedure Sexual activity resumes 2-3 days after procedure

b. Vasectomy

y Permanent y Considerations: 1. Must use additional BC methods for 6 weeks 2. Doses not alter performance