Presentation on theme: "Contraception; the role of the midwife"— Presentation transcript:
1Contraception; the role of the midwife Dr Catherine Angell
2Aims of this session Discuss the midwife and public health Debate the importance of contraception discussions with womenIdentify the issues relating to discussing contraception with women at this timeConsider important considerations for women relating to contraception Discuss breastfeeding and contraceptionUse a series of case studies to consider role of midwife and the appropriateness of different methods for different women
3The midwife and public health ‘You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support’(NMC, The Code, 2007)‘More than ever it is essential that midwives understand their pivotal and life enhancing role in public health’(Edwards and Byrom, 2007)
4Contraception as a personal and a public health issue Personal issues:Family size - money, housing, etcAge gap between childrenRecovery from last pregnancy and birthFamily and relationship changesPublic health issues:Population growthInfant feeding behavioursChild healthWoman’s long term healthSexual health
5‘To make choices women need information’ Critical thinkingGet into groups of 4-5. Discuss one of these statements in relation to the midwife’s role and contraception.‘To make choices women need information’(Evans, 2005)‘Discussing contraceptive choices is a matter of finding the ‘least worst’ option’(Belfield et al., 2009)‘During pregnancy and the postpartum period women may be more receptive to different methods of contraception’(Cwiak et al, 2004)
6What happens in practice Only 4% of women had opportunity to discuss contraception antenatallyHospital postnatal discussions before discharge often very briefFew women leave hospital with contraceptive suppliesMost definitive advice given at ‘6 week check’Missed opportunity, especially for young or vulnerable women with limited previous use of contraception(Evans, 2005)
7Issues relating to contraceptive discussions What barriers can you think of for women when seeking contraceptive advice?Time, energy, embarrassmentLack of understanding of fertility and reproductionSocial, cultural, religious issuesChanges in body and sex life after child birthGap between knowing about and acting onLack of continuity of care/interprofessional working
8Fertility after birthIt is impossible to predict the return of fertilityOvulation occurs before the first period in most womenFor non breastfeeding women the earliest time women are likely to ovulate again is 25 days after birth...the average is 45 daysFeeding method is the most important determinant of return of fertility50% of couples have had penetrativesex within 6 weeks of birth...
9What are the options?Get into groups of 4 or 5. List as many contraceptive methods as you can in 2 minutes....
10What did you find? Combined pill Progesterone only pill Emergency contraceptionContraceptive injectionContraceptive patchContraceptive implantIntrauterine system (IUS) or MirenaVaginal ringMale/female condomsIntrauterine device (IUD)DiaphragmCapSterilisation – male/femaleNatural methodBreastfeeding
11Knowledge gridEach group has an information sheet from NHS website, FPA or Brook on one method. Read the sheet.Note key points to feed back to the class and put onto our knowledge gridLook at issues ofReliabilitySTI protectionWhen to use after childbirthCombining with breastfeedingA major advantageA major disadvantage
12An extra note about breastfeeding Breastfeeding is the most widely used form of contraception in the worldBreastfeeding can be up to 98% effective in preventing pregnancyBUT breastfeeding must beExclusiveRegularBaby under 6 months old
13Important considerations for women What do you think is important for women when choosing contraceptive methods? What and who influences their decisions? Are some issues more important than others? Are everyone’s priorities the same? In your groups write down as many considerations as you can
14Influences on women’s choices Pregnancy preventionSTI preventionHealth considerationsBreastfeedingMechanical v. HormonalPrevious infertilityFuture plansEase of useCostLifestyleRememberingEmbarrassmentPartner’s viewsHealth care providersReligious views?
15Contraception for individuals... everyone is different Get into groups of 4 or 5Read the scenario you have been givenDiscuss the scenario. You may want to focus on:What is important to that woman?What health needs does she have?What methods might be appropriate for her?What care can you offer her?
16FionaFiona has just had a normal birth. This was her 4th baby in 6 years. She had a PPH and is anaemic and very tired. She is breastfeeding. She is in a stable relationship with a long term partner. They have not decided whether their family is complete yet.
17GeraldineGeraldine met her partner when she was 38 and he was 49. She is now 42. She has some difficulty conceiving and had IVF for this pregnancy. Geraldine has just had her first baby by LSCS. She is breastfeeding but wants to combine this with formula as soon as possible. She and her partner do not anticipate having another child.
18HelenHelen is 22. She has just had her first baby at home. She is breastfeeding. She conceived her baby whilst on a year working in the Caribbean. She was taking the pill at the time. She came home to stay with her parents for the birth but plans to go abroad again with her baby to live and work in the surf shop that she left prior to coming home. She has no partner there but lots of friends who can support her.
19IzzyIzzy has just had her 2nd child. She is 19 and lives in temporary council accommodation. She took the pill for a while when she had a regular partner but didn’t like going to see her GP and her prescription ran out. She sometimes uses condoms. She has no partner at present and has no plans to start a relationship.
20JenniferJennifer has just had her 3rd baby, and her 3rd LSCS. She has had pre-eclampsia twice, which was worse on this occasion. She is very keen not to have more children. She and her husband are both 40 and are in a stable and long term relationship.
21KarenKaren has just had her second baby. She is breastfeeding at present and hopes to continue for a while. She and her partner did not use contraceptives between pregnancies and they have not thought about contraception yet. Although they might want another baby Karen wants something fairly reliable for the time being. She thinks that she gets side effects, such as weight gain, from hormone based methods.
22FeedbackDid you end up with a single choice or a range of choices for each woman?Was there one or numerous factors that might influence her choice?Do you think your own views or experiences influenced the choices you thought would be suitable?
23What do you think is the midwife’s role... The role of the midwifeWhat do you think is the midwife’s role...Encouraging planning of contraception?Discussion of the options?Referral?
24A note about folic acid...Taking folic acid prior to conception is beneficial in reducing neural tube defectsDiscussing this with women may encourage use of folic acid when they plan next pregnancyThis is an important aspect of family planning
25Final thought...safe sex in pregnancy Women may not worry about the risk of pregnancy in the antenatal period... BUT for some having unprotected sex in pregnancy may leave them at risk from STIs