Lesson 8 Family Planning and Contraception

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 !"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.

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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. c ! 
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&'Achieving desired family size and proper birth spacing. èp pacing pregnancies (2-3 years between pregnancies) to ensure the health of the mother and child. èp Optimal birth spacing is having children born at least 3-5 years apart. ["p $
# èp relps regain strength lost in last pregnancy èp relps avoid unplanned, high-risk pregnancies èp Devote more quality time to herself, her husband or her community èp relps prevent illegal abortion that may lead to complications or even death of the mother. èp Proper child care/rearing. èp `eduction in infant/ child deaths c"p #the success of family planning program depends to a great extent on the motivation of both husband and wife. ="% !"

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#(  ' Abstinence from coitus during the fertile days of the menstrual cycle;   only method accepted by Catholic Church
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$#$  èp Assessment of cervical mucus during the menstrual cycle; èp pinnbarkeit test is usually used. èp ensory and visual observation of cervical mucus (when it becomes thin and watery) the intercourse is avoided 3-4 days after spinnbarkeit.

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 èp As soon as the temperature drops slightly and then increases (it means ovulation has taken place).Counts 3-4 days to abstain from intercourse. èp `equires predictable menstrual cycle èp Also called rhythm or calendar methodp èp Can also be used to predict ovulation c
 Vp Temperature must be taken upon waking Vp Always use the same route Vp [asal thermometer used Vp Can also check for cervical mucus

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 - Combination of [illings and [[T èp Couple needs to record cycle days, coitus, mucus changes, inc. libido, mittelschmerz, [[T. èp Most effective natural method of family planning  "*

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èp Fertile days occurs on 8th -19th days of the cycle èp Úse '#%# 
+  èp 32 colored beads in these order Vp 1 red ± 1st day of menstruation Vp 6 brown ± infertile Vp 12 white- fertile Vp 13 brown- infertile

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  , - èp During breastfeeding, the prolactin inhibits ovulation èp Menstruation resumes: 2-3 months for bottle feeding mothers and 4-6 months for breast feeding mothers. ð"p *#
   a.p c (Withdrawal): `emoval of penis before ejaculation. The least effective method due to premature ejaculation. b.p c(
- sex without ejaculation, popular among sex workers. c.p c$
- penis rub between the femur d.p c
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- penis rubbed in between the breast

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

èp `hythm- 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. èp Origoknause formula ± applicable for woman with irregular menstrual cycle. èp The woman charts her menstrual cycles for 12 continuous months in order to determine the shortest and the longest cycles. èp The 1st fertile day is determined by subtracting ³18´ from the shortest cycle and ³11´ from the longest cycle. E.g.

26

32

- 18

- 11

_____

_____

8

21

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

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#( contains estrogen and progestin in low doses inhibits ovulation (release of eggs from the ovaries) thickens the cervical mucus p 21-pill pack- contains 21 active pills p 28-pill pack- contains 21 active pills and 7 placebo pills Vp Monophasic - all ³active´ pills containing fixed dosages of estrogen and progestin (e.g. Nordiol, Marvelon) Vp [iphasic- 21 active pills containing two different estrogen: progestin ratios (e.g. Gracial)

Vp Triphasic - 21 active pills containing three different estrogen: progestin ratios (e.g. Trinordiol, Logynon) "p &%
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#( Vp Does not reduce breast milk production Vp No estrogen side effect Vp Women take one pill everyday with no break Vp Less risk of acne and weight gain Vp Temporary Vp Alters estrogen and progesterone levels (prevents ovulation) c
 Vp /E: bloating, nausea, weight gain Vp Adverse effects: leg cramping/pain, rA, abdominal apin Vp Not recommended for patients who smoke or coagulation problems Vp ›f dose is missed, take 2 tablets that day; if more than one dose is missed, must stop pill cycle and start a new pack Vp Failure is due to incorrect usage Vp Úse additional contraception for the first 7 days #"p $&#%c
#  &'  a.p Take between 2-5 pills within 72 hrs after intercourse and take 2nd dose 12 hrs after 1st dose "p * #
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- 6 match sticks like rod implanted subdermally ïp Time-release dosage of progesterone ïp uppresses ovulation ïp ›nserted subQ during menses

ïp May remain in for up to 5 years ïp Decreased menses ïp Adverse reaction: ïp ›rregular bleeding, headaches, weight gain, depression

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a.p Continuous release of medroxyprogesterone acetate b.p uppresses ovulation c.p Considerations: VpMust be repeated every 3 months VpCan be given 5 days postpartum if not breastfeeding VpCan be given 6 weeks post partum if breast feeding VpAdverse effects: irregular bleeding, headaches, weight gain, depression

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=(# ïp Temporary Loop/coil inserted into uterus during menstrual cycle ïp Outpatient procedure ïp Prevents fertilized egg from implanting

ïp ›nterventions: ïp Teach woman to check for string ïp Teach woman spotting and dysmenorrhea are common ïp ÷early pelvic exams ïp Must use additional [C method for 2-3 weeks ïp igns of potential problems ' *+ eriod late/abnormal bdominal pain

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

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'more durable than diaphragm Vp Can stay in place for than 24 hours Vp No need to reapply spermicides Vp Contra indicated in abnormal Pap smear

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  - The only method that prevents TDs 1.p Must be used before penetration 2.p Leave space at the tip 3.p ingle use only

      

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       Vp Permanent (may be reversed in some cases) Vp Must have a 30-day consent Vp Ovulation and menstruation continues Vp Laparoscopic procedure Vp exual activity resumes 2-3 days after procedure "p o
#$%         ïp Permanent ïp Considerations: 1.p Must use additional [C methods for 6 weeks 2.p Doses not alter performance