Family Planning

Family Planning and Contraception

Goal of Family Planning
To assist the clients with reproductive decision making, enabling the client to have control of the number of pregnancies, spacing the time between children, and to prevent pregnancy if desired

Decision to use a contraceptive

May be made by the individual man or woman or jointly as a couple

Legal Issues related to Family Planning and Contraception

May vary from state to state concerning sterilization,and abortions. Informed consent-need to document information provided and understanding of client -the nurse should use (BRAIDED)when counseling client on contraceptive methods decision about contraception should be made voluntarily with informed consent

BRAIDED

B- Benefits/Advantages R-Risks/Disadvantages A- Alternatives/Other methods available I-Inquiries/ Allow time for questions D-Decisions/opportunity to decide or change mind E-Explanation/about method/how to use D-Documentation /everything taught

What to teach about each method

What it is, How it is used , or How it works? advantages disadvantages effectiveness side effects risks contraindications long term effects

Assessment

Obtain a history to identify the client’s past and current health status and potential risks factors.Sexual historyReproductive healthFuture plans for childbearingPsychosocial data- lifestyle, motivation, religious beliefs,cultural influences,

Assessment

Financial factorsthese factors may affect the selection,access,and use of aparticular methodDon’t assume anything….ask.Knowledge of and concern about contraceptive methods need to be determined to identify deficits and need

Assessment

For accurate and additional information Identify actual or potential problems from the assessment. Provide privacy for assessment and discussion about contraceptive methods

Methods of Family Planning or Contraception

Natural methods- abstinence Coitus interruptus -(withdrawal) Fertility awareness methods-calendar method,basal body temperature (BBT), cervical mucus method

Methods of Family Planning and Contraception

Mechanical methods- Barrier methods- Condoms- Male/Female Diaphragm Spermicides Intrauterine device(IUD)

Methods of Family Planning and Contraception

Chemical Methods- Oral Contraceptives(birth control pills) Subdermal implants(Norplant) Long-acting progestin injections Postcoital contraception Surgical Methods-Vasectomy Tubal ligation

Natural methods

Safe Situational methods requiring increased self awareness Self control to be effective

Fertility Awareness Methods

Based on an understanding of the woman’s ovulation cycle and the timing of sexual intercourseAll methods attempt to identify the female fertility and to avoid unprotected intercourse during that time periodFree,safe,and acceptable to couple’s religious beliefs prohibit other methods

Female Reproductive Cycle

Cont.
Increases awareness of the woman’s bodyencourages communicationcan be used to prevent or plan a pregnancyRequires extensive counseling and educationdifficult with irregular cyclesno protection for STI’s

Calendar method

Rhythm method 75-91% effective shortest and longest cycles 18days from shortest cycle 11days from longest cycle avoid sex during fertile period


BBT
Based on the thermal shift in the menstrual cycle 75-97% effective drop prior to ovulation then raises0.5-1 degree with ovulation Avoid intercourse when temperature drops and for 3 days after.


Cervical mucus
Ovulation or Billing’s MethodBased on the cervical mucus changes that occur during the menstrual cycle75-97% effectiveCervical mucus changes in response to levels of estrogen and progesteroneAssess for amount, color,consistency, and viscosity

Symptothermal Method

Incorporates the assessment of multiple indicators of ovulation-BBT, and cervical mucus,increased libido,abdominal bloating,mittelschmerz ,breast tenderness,pelvic tenderness,pelvic or vulvar fullness,softer cervix located higher in the vagina 75-97% effective

Mechanical Methods

Male condom-86-97 % effectivewater based lubricantsproper technique to applyprotection from pregnancy and Std’sFemale condoms-79-95% effectiveProper technique to apply

Diaphragm

80-94% effective Dome- shaped appliance made of rubber with flexible rim that fits over cervix used with spermicidal jelly or cream physician will assess for size reassessment after birth of baby or weight loss or gain. Proper technique to apply

Spermicides

Chemical barrier to prevent pregnancy by killing sperm or neutralizing vaginal secretions 74-94% effective creams,jelly,melting suppositories, foaming tablets,foam,and films

Intrauterine device-IUD

A device placed in the uterus to prevent pregnancy 98.5-99.2 % effective Placed and removed by health professional check for side effects

Oral Contraceptives-Birth control pills

Act by inhibiting the release of an ovum,blocking the cyclical release of gonadotropin-releasing hormones and changing cervical mucus 95-99.5% effective combined oral contraceptives-estrogen and progestin progestin-only pill-minipill

Subdermal implant(Norplant)

Consist of 6 silastic capsules containing levonorgestrel-progestin 98.5-99.5% effective placed and removed by health care provider

Long-acting Progestin injection

Depo-Provera long-acting progestin that blocks lh surge,suppresses ovulation and thickens cervical mucus 97.7% effective Repeat every 80-90 days

Postcoital contraception

Emergency method-not to be used on a frequent or regular basis reduces pregnancy rates by 75-85% oral contraceptives-MAP (morning after pill) insertion of IUD abortions

Vasectomy

Male sterilization the vas deferens is resected through small incision in the scrotum resulting in blockage of the passage of the sperm Health care provider must do in clinic,office or hospital sperm count to check for sterility 99.5%effective

Tubal ligation

Surgical procedure done in hospital cuts, tied ,or cauterized the fallopian tubes preventing sperm from fertilizing ovum 99.2-99.6% effective