1. Family Planning

2. Contraceptives Nursing plays a primary role in providing education about contraceptive choices and teaching about the use of different methods

3. Contraceptives Educate about “safe sex” practices Be sure to F/U in 1 – 3 weeks on the effectiveness of the method chosen

4. The Ideal Method Should Be Safe 100% effective Free of SE Easily obtainable Affordable Acceptable to the user & sexual partner Free of effects on future pregnancies

5. Abstinence Compliance 0 % failure rate Most effective way to prevent STD

6. Oral Contraceptives “The Pill” Prevents ovulation; mimics the hormonal state of pregnancy –Increased estrogen--- Diminishes hypothalamic effect on GrHR--- Inhibits the release of FSH / LH------NO OVULATION OCCURS –Progestin Affects cervical mucus & endometrial lining

7. Oral Contraceptives “The Pill” Monophasic –Provides fixed doses of both estrogen and progestin throughout the 21 day cycle Triphasic –Vary both estrogen / progestin throughout the cycle –Mimics woman’s natural hormonal pattern

8. Oral Contraceptives “The Pill” Side effects & contraindications –P. 107 Pillitteria –Absolute –Possible “ACHES” – Should call health care provider immediately

9. Oral Contraceptives Client Education A= Abdominal pain C= Chest pain H= Headache (severe) E= Eye problems (loss or blurring) S= Severe leg pain (calf or thigh)

10. Oral Contraceptives Client Education Missed pills Drugs (barbiturates, griseofulvin, isoniazide, penicillin, tetracycline decreases the effectiveness of the pill Avoid if BF’ing until milk supply is well established Discontinue if pregnancy occurs

11. Oral Contraceptives Client Education Adolescent girls should have well established menstrual periods (2 years) prior to starting the pill When to start pills –1 st Sunday after beginning period; after childbirth Sunday 2 weeks post delivery; post Ab – 1 st Sunday after procedure

12. Emergency Contraception “morning after pill” 75% effectiveness rate Combination estrogen/progestin Progestin only –< NV –89% effective

13. Emergency Contraception Can be taken immediately and up to 72 hrs Taken 2 doses; 2 nd dose taken 12 hrs first Major SE – Nausea –Call health care provider if severe – may prescribe antiemetics Next period should begin within 2 – 3 weeks START IMMEDIATELY WITH AN ACCEPTABLE METHOD OF BIRTHCONTROL

14. Norplant Implants Long acting hormonal method 6 silastic membrane capsules filled with 35 mg progestin Inserted upper arm Last for 5 years

15. Norplant Implants Effective within 24 hours after insertion Mode of action: suppress ovulation, thicken cervical mucus, creates a thin atrophic endometrium, causes more rapid tubal transport of ovum

16. Norplant Implants Does not suppress lactation Side Effects –Menstrual irregularities –Amenorrhea after a few months –Abdominal pain –H/A –Hair growth / hair loss

17. Norplant Implants Contraindications –Liver Dz –Pregnancy –Unexplained vaginal bleeding –Breast CA –Hx thrombophlebitis

18. Depo- Provera (DMPA) Medroxyprogesterone Acetate Injectable progestin Mode of action: prevents ovulation, thickens cervical mucus

19. Depo- Provera (DMPA) Dose 150 mg single dose vial IM – Do Not massage (hastens absorption and shortens the period of effectiveness Given with 5 days of onset of period Within 5 days from delivery

20. Depo- Provera (DMPA) Contraception begins immediately and last for 3 months Instruct client to F/U for injection 2 weeks before 3 months is up Usually will not have period after 1 year of use

21. Depo- Provera (DMPA) Side effects and contraindications same as Norplant 99.7 percent effective ***May be used during lactation Women who plan to get pregnant within 6 – 9 months suggest another method

22. Intrauterine Device Progestasert & Paragard 380A Device inserted into uterus Mode of action –Inhibits migration of sperm –Speeds ovum transport –Local inflammatory response in uterine cavity- endotoxins are releases that destroys sperm –Cervical mucus

23. Intrauterine Device Side Effects –Increased Bleeding (anemia) –Dysmenorrhea –Pelvic Infections –Ectopic Pregnancy –Uterine perforation

24. Intrauterine Device Contraindications –Multiple sexual partners (risk for STD’s) –Active, recent, or chronic pelvic infection –Postpartum endometritis or septic abortion –Pregnancy –Endometrial or cervical malignancy –Valvular heart disease –Immunosuppression

25. Intrauterine Device – Client Education Palpating string – check before intercourse and after each period Inspect pads and tampons for an expelled IUD Advise alternate contraception 1 st month after insertion

26. Intrauterine Device – Client Education Teach PAINS P – period late, abnormal spotting or bleeding A – abdominal pain, pain with intercourse I – infection exposure, abnormal vaginal discharge N – not feeling well, fever, chills S – string missing, shorter or longer

27. Intrauterine Device – Client Education Advise to wait 3 months after removal before becoming pregnant – this reduces the risk of ectopic pregnancy Annual F/U

28. Diaphragm Mechanical Barrier to entry of sperm into the cervix Used with a spermicide cream or jelly provides additional protection

29. Diaphragm Safe Flexibility according to frequency of intercourse Used with spermicide protects against STD

30. Diaphragm Complications –Toxic Shock Syndrome –Pg 1442 – 1443 Pillitteri

31. Diaphragm Contraindications –Hx of TSS –Allergy to latex or spermicide –Recurrent UTI –Inability to learn insertion technique (mentally or physically challenged) –Abnormalities of vaginal anatomy that prevents a good fit or stable placement – uterine prolapse, extreme retroversion

32. Diaphragm – Client Education S/S TSS Annual visits Needs to be refitted after significant weight gain > 10 lbs, pelvic surgery, full term delivery (after pregnancy should wait about 12 weeks PP before using the diaphragm)

33. Diaphragm – Client Education May be left in place up to 12 – 24 hrs Must be left in place 6 hrs after intercourse May be inserted up to 2 hrs before intercourse Must be fitted by MD or NP

34. Cervical Cap Barrier method; soft rubber dome with a flexible rim Shaped like a thimble Filled with spermicide Inserted prior to intercourse & should be left in place at least 8 hours Should not be worn longer than 24 hours

35. Cervical Cap Complications –Cervical trauma Client should have F/U 3 months then annually Contraindications – p. 114

36. Cervical Cap – Client Education Practice insertion & removal Cap should not be worn during periods Cleaning – mild soap & water Check for tears Do not use petroleum products Schedule RTC 3 months Should be refitted after delivery, gyn surgery, significant weight gain / loss

37. Male Condom Covers penis acts as a mechanical barrier to prevent sperm from entering the vagina Protects against STD’s Inexpensive & available without a prescription

38. Male Condom Contraindications –Allergy to latex or collagenous tissue –Inability to maintain erections –Inability to use properly

39. Male Condom – Client Education Application and removal – put on before vaginal penetration; leave space in tip Should not be lubricated with petroleum Store in cool dry place (not wallet) To maximize protection against STD’s use with spermicide

40. Female Condom Vaginal Pouch Flexible ring that fits over cervix Provides some protection against STD’s May be inserted up to 8 hours before intercourse Expensive One time use

41. Vaginal Spermicides Creates a physical barrier and also kills sperm secondary to a chemical action Safe & Simple Preps include: jellies, creams, foam, suppositories, tablets, thin square film

42. Vaginal Spermicides Inserted into the vagina about 5 – 10 minutes before intercourse; usually are effective for 2 hours Tablets and suppositories take longer to dissolve – insert 10 – 30 minutes prior to intercourse

43. Vaginal Spermicides Available without a prescription Protects against STD’s

44. Vaginal Spermicides Contraindications –Allergy to spermicidal –Inability to use consistently at the time of intercourse –Physical / mental delays –Cervicitis

45. Vaginal Spermicides – Client Education Consistent use Times of insertion Good contraceptive to use during the immediate PP period Need to add more if intercourse is repeated

46. Breast Feeding Prolongs anovulation for a certain period of time, but is not always effective and ovulation may return before menstruation reoccurs and PREGNANCY may result Not an absolutely reliable method

47. Fertility Awareness Methods Rely on ovulation prediction by the couple Important points –Ovulation occurs 14 days before the beginning of the next menses –Ovum can be fertilized for 24 hours; sperm are viable for 72 hrs –Regular cycles can vary by +/- 2 days

48. Fertility Awareness Methods Important points –Period of abstinence must be at least 8 days due to variability of menstrual cycles –*Risk of fertility is often 15 or more days, or about half the cycle

49. Fertility Awareness Methods Calendar Method Basal Body Temperature Method Cervical Mucus Symptothermal Method Ovulation Predictor Test

50. Withdrawal – Coitus Interruptus Male ejaculates outside vagina Sperm are contained in pre-ejaculatory fluids Interfere with sexual satisfaction of both partners **LEAST reliable method of contraception