1. Family planning

2. family planning helps every one :
1- women :
-.protect women from unwanted pregnancies .
-save lives from high risk pregnancies & abortion .
- decrease numbers of maternal death ,&help in prevention of certain diseases as cancer & STIs.
2- children :
-save lives of children by spacing birth .

3. 3-men :
- helps men care of their families (provide better life ).
4- families:
-it improves family wellbeing (better food ,clothing ,housing, schooling ).

4. * Types of family planning :
1-natural method .
2-mechanical method .
3- hormonal method .
4- barrier method .
5- female & male sterilization .

5. ** natural method :
@ breast feeding : prolactein hormone which is secreted by anterior pituitary gland eject milk to the lactiferous duct , thus suppress ovulation ,so functional amenorrhea developed .
this method effective especially if the mother is complete breast feeding ,does not depend on bottle feeding ,also this method is highly effective in the 1st 6 months of child birth .

6. @ safe period : calculate the period of ovulation to avoid sexual intercourse to prevent pregnancy ,after 5 days of menstruation ovulation take place about 48 hours .
-no hormonal side effect ,but it is not accepted with couple & it need good control , with high failure rate .

7. @ observation of cervical mucous : following menstruation ,thick mucous block the cervical canal & act as barrier to spermatozoa .
around the time of ovulation , the mucous becomes transparent ,slippery ,and stretching between finger and thumb ,this sign of ovulation & sexual intercourse should be avoided .

8. - @ Basal body temperature :
-around the time of ovulation temp. increase 0.3 to 0.5 c due to progesterone effect ,so instruct her how to measure her temp.
@ sympto- thermal method : combination between temp. charting & observation cervical mucous .
@coitus inter-ruptus :
withdrawal of the penis before ejaculation .
high failure rate .
@ vaginal douching : -immediately after sexual intercourse to do vaginal douching , it will not prevent pregnancy as spermatozoa can reach internal os within 90 seconds .

9. Intra uterine contra-ceptive device
IUCD
-it is device inserted into uterus ,that contains copper .
-it like T shape .
-it is the most popular one , reversible method .
-it is small flexible plastic frame ,has copper sleeves.
- all type have one or two strings.
* actions:
-cause local inflammatory process , which destroy spermatozoa & ova .
-copper effect made endometrial unsuitable media for implantation .
- prevent sperm & egg from meeting .
-reduce the ability of the sperm to fertilize ova .

10. ** advantages:
long term prevention of pregnancy .
long lasting ( 5-10 years).
Very effective , no need to remember .
Does not interfere with sex .
No hormonal side effect with copper .
Does not affect the quality or quantity of breast milk .
No interaction with medication .
Decrease risk of ectopic pregnancy .
Immediately reversible

11. **disadvantages:
common side effect :
-menstrual changes in the first three months & lesson after that .
-longer & heavier menstrual period .
More cramps or pain during period .
uncommon side effect & complication :
-sever cramps & pain beyond the 1st 3-5 days after insertion .
- heavy menstrual bleeding or bleeding between period .
-perforation of the wall of uterus .
3- does not protect against STIs.
4-PID is more likely to follow STIs( infertility ).
5- procedure of IUCD insertion including pelvic exam ( woman faint ).
6-some pain & bleeding immediately after IUCD insertion ( goes away in day or two ).
7-should be removed by health practitioner .
8-may come out of uterus .
9-doesnot protect against ectopic pregnancy .

12. * using IUCD:
- at any time during menstrual cycle ,& it is certain that woman is not pregnant .
-some prefer to insert IUCD during menstruation due to :
@ to rule out the possibilities of pregnancy .
@insertion is easier , less pain .
@less upsetting to woman (minor bleeding , accompanied menstruation ), but it is harder to identify signs of infection .
-some prefer to insert IUCDimmediately after delivery ( any time within 48 hours after childbirth ) .
-the health provider should have special training .
-others prefer to insert IUCD at 6 weeks after childbirth .
- after miscarriage immediately if no infection present

13. Privacy should be maintained .
midwifery role :
during insertion :
good counseling ,the midwife listens ,answers questions ,give clear practical information about side effect as bleeding & pain after insertion .
proper sterile technique before & during IUCD insertion (cleaning of the cervix & vagina with poliydine ).
Privacy should be maintained .
Ask woman if she feels pain or discomfort during insertion ( mild analgesia may be given as trofine ).
Conduct pelvic examination ( speculum & bimanual ) before IUCD insertion .
Working slowly & gently ,ask woman if she feels dizzy ,or she has pain ,let woman lie quietly for 5-10 minutes .

14. B-after insertion :
-plan with woman to come back in 3-6 weeks for check up & pelvic examination .
-be sure that woman knows what kind of IUCD she has ,what is looks like .
-give woman written record of the date of IUCD insertion ,& when to be removed .
-teach woman about vulvae care .
-teach woman to check IUCD (it may out without woman feeling ).
- she should check it once week ,after insertion & each menstrual period .
-diet rich in iron should be encouraged , & describe iron tablet if needed .
-inform woman to come back to clinic at any times & for any reason

15. ** when should woman see the midwife or Dr ?
missed menstrual period .
abnormal vaginal bleeding .
abdominal pain or abdominal tenderness & fainting .
missed strings , shorter or longer strings .
some thing hard in the vagina or at cervix .
woman wants another family planning method .
wants IUCD to be removed ,for any reason , or at any time .
when IUCD has reached the end of its effectiveness

16. Barrier method
** condoms:
It is sheath or covering of the latex rubber to fit on the erect penis.
Different size, shape, color and textures are available, some condoms are coated with spermicide.

17. Mechanism of actions :
it helps prevent both pregnancy and sexually transmitted disease by keeping the sperm and any disease organisms in semen out of vagina.
it prevents any disease organisms from entering the penis

18. Advantages :
prevent STIs, includes HIV/AIDS and pregnancy when used correctly with every intercourse.
help protect against condition caused by STIs (pelvic inflammatory disease, chronic pain, cervical cancer, and infertility in both genders.
used to prevent STD during pregnancy.
do not affect breast milk.
safe, no hormonal side effect.
help prevent ectopic pregnancy.
can be stopped at any time, and can be used by men at any age.
easy to obtain and available in many places.
can be used without se eking health provider.
enable man to hold responsibility for preventing pregnancy and disease.
increase sexual enjoyment (no need to worry about pregnancy).
help prevent premature ejaculation (help man lasts longer during sex.

19. Disadvantages :
may cause itching and allergy (latex condom).
may decrease sensation make sex less enjoyable for both partner or either one.
take time to put condom on the erect penis.
supply must be ready.
possibility of condom to slip off or break during sex.
condoms are affected by duration of storage, humidity, temperature (break during use).
man's cooperation is needed.
poor reputation (people connect condom with illegal or immoral sex).
embarrassment to buy, use, ask questions about condom.
no medical conditions prevent the use of condoms except severe allergy to latex rubber.
Any one can use condom safety and effectively if not allergic to latex.

20. Starting condom and follow up:
midwife listens to clients (woman's ) concern answer questions and give clear practical information
explain how to use condom (to be put on erect penis before each sexual intercourse and it is used once only).
Lubricant can be used as spermicidal and glycerin to help keep condoms from tearing during sex.
Avoid using lubricant made of oil as mineral oil or Vaseline (They damage condom).
when taking off condom, be careful not to spill semen into vagina and throw it away from children reach.
if condom breaks, insert spermicide immediately into vagina, also washing both penis and vagina with soap and water should minimize the risk of pregnancy.
some people will use emergency oral contraception to prevent pregnancy.
give client a 3 months supply of condoms and give client spermicides for extra protection.
explain specific reasons to see midwife or doctor as:
the need of more condoms.
Symptoms of STIs as pain with urination, sores on the genitals.
Has an allergic reaction to condoms.
For any question or problems, the desire of discontinuing the use of condoms.

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