Family Planning Lecture Notes PDF

Field of Nursing Maternal and Child Health Nursing MCH 211 Lecture : (Family Planning) Dr : Aya Mohamed Date : 23 / 12 /2024 LEARNING OBJECTIVES To explore misbeliefs associated with contraception and the full range of contraceptive methods To know the main componen...

Field of Nursing Maternal and Child Health Nursing MCH 211 Lecture : (Family Planning) Dr : Aya Mohamed Date : 23 / 12 /2024 LEARNING OBJECTIVES To explore misbeliefs associated with contraception and the full range of contraceptive methods To know the main components of family planning and contraceptive services To provide quality counseling on contraception and contraceptive choices to women and gender non-conforming people who use drugs To identify the main barriers to accessing contraception and potential approaches to overcome the barriers  Outline: Definition: Objective: Types of Contraceptive Methods 1. natural Methods 2. Barrier Methods 3. Hormonal methods 4. Permanent Methods 5. Emergency contraceptive pills Considerations in Family Planning Challenges in Family Planning CONTRACEPTION  Family planning Is the conscious effort to regulate the number and spacing of children in a family through the use of contraception or other methods.  Objectives WHO “the use of a range of methods of a fertility regulation to help individuals or couples attain certain objectives: ⚫ Avoid unwanted birth. ⚫ To determine the number of children in the family ⚫ Regulate the intervals between pregnancies. ⚫ Control time at which birth occur. ⚫ To prevent pregnancy for women with serious illness in whom pregnancy would pose a health risk.  Types of Family Planning Methods Temporary Permanent Methods Methods 1. Natural methods. 1. Natural Surgical methods methods 2. Chemical methods. 2. Chemical 3. Mechanical methods. method 3. Mechanical 4. Hormonal methods. methods Surgical methods. 4. Hormonal 5. methods 5. Emergency 6. Emergency Methods. Methods  Natural Methods 1 Calendar Method 2 Safe Period 3 Fertility awareness method 4 Lactational Amenorrhea 5 Withdrawal Method (coitus interrupts) 6 Abstinence 7 Vaginal washing Chemical Methods 1 Vaginal Contraceptive Sponges 2 Vaginal Spermicides such as:- Foams. Cream. Jell. Suppositories. Mechanical (Barrier)Methods 1 Intrauterine Contraceptive Devices (IUCD) 2 Condoms (Male & Female) 3 Cervical Cap 4 Vaginal Diaphragm Hormonal Methods 1 Oral Contraceptive Pills Combined Pills Progesterone Only Pills 2 Injectable Contraceptive Combined Progesterone Only 3 Subcutaneous Implants 4 Skin Patches 5 Vaginal Rings. 6 Hormonal IUD Emergency Methods 1 Natural methods 2 Hormonal Methods 3 Intrauterine devices (IUDS)  Surgical Methods 1 Female:-Tubal Ligation 2 Male :-Vasectomy Types of Natural Methods Fertility Awareness–Based Methods Fertility awareness-based methods (FAMs) use physical signs and symptoms that change with hormone fluctuations throughout a woman’s menstrual cycle to predict a woman’s fertility. Abstinence Abstinence (not having vaginal intercourse) pregnancy cannot occur if sperm is kept out of the vagina. It also reduces the risk of HIV/AIDS and other STIs Withdrawal (Coitus Interruptus) In coitus interruptus, also known as withdrawal, a man controls his ejaculation during sexual intercourse and ejaculates outside the vagina.  Lactational Amenorrhea Method The lactational amenorrhea method (LAM) is a temporary method of contraception used by breast-feeding mothers. Continuous breast-feeding can postpone ovulation and thus prevent pregnancy. Breastfeeding stimulates the hormone prolactin, which is necessary for milk production, and also inhibits the release of another hormone, gonadotropin, which is necessary for ovulation. Breast-feeding as a contraceptive method can be effective for 6 months after delivery.  chemical contraceptive methods (Vaginal Spermicidal) Definition:- Chemical materials inserted into the vagina for killing the sperm before entering cervix and preventing pregnancy such as (cream- jell – suppositories – foam-films). Types of Chemical Methods Definition of Mechanical Methods ⚫ Mechanical barriers are devices that provide a physical barrier between the sperm and the ovum. ⚫ Examples of mechanical barriers include the male condom, female condom, vaginal diaphragm, cervical cap, and IUCD. ⚫ The condom is the only contraceptive method that helps to prevent sexually transmitted infections (STIs). Types of Mechanical Methods  1- Intrauterine Contraceptive Devices (IUCD) Definition:- It is a small flexible appliance T shaped made of polyethylene carrier with copper wire wounded around its vertical arm and 2 nylon threads attached to the lower end of the vertical arm for removal. It is inserted into the uterine cavity and remains in the uterus for as long as contraception is desired.  Mode of Action IUCD act as foreign body (copper) in the uterine cavity: 1. Attract macrophages:- Attack and phagocyte sperms or fertilized ova. 2. Unfavorable endometrium:-Increase Leucocyte infiltration and hyperemia and prevent fertilization.  Contraindications 1. Known or suspected pregnancy. 2. Active pelvic inflammatory diseases (PID). 3. Previous ectopic pregnancy. 4. Undiagnosed abnormal uterine bleeding (Menorrhagia →heavy menstruation) 5. Sever dysmenorrhea (painful menstruation). 6. Abnormal shape of uterine cavity as in fibroid or congenital malformation.  Nursing Instructions 1. Inform woman that she may experience mild pelvic cramps and mild bleeding after few days from insertion. 2. Told woman that menorrhagia is frequent during the first 3 months after insertion. 3. Woman is instructed to examine herself periodically after each period to feel the threads to be sure that the device is in place.  2- Condoms Definition:- Is a rubber sheath-shaped barrier used during sexual intercourse to reduce the probability of pregnancy or sexually transmitted infection (STI). There are both male and female condoms.  3- Cervical Cap ▪ Definition:- It is a small dome, shaped latex cup with flexible ring that fists over cervix by suction. It's remained at least six hours and not more than hrs after last act of intercourse. ▪ Size:-22-31 mm ▪ Action: Blocks sperm from entering the cervical canal.  Vaginal Diaphragm Definition:- It is a shallow, dome, shaped rubber device with flexible rim that lay across the cervix, vault and anterior vaginal wall. Size:- 70-80 mm Action:- Prevent the meeting of sperm with the ovum. Hormonal Methods They rely on estrogen and progestin or progestin alone to prevent ovulation. When used consistently, these methods are a most reliable way to prevent pregnancy. Hormonal methods include oral contraceptives, injectable, implants, vaginal rings, and transdermal patches. Oral Contraceptive Pills There are two types of oral contraceptives 1. Combined pills(COC):contain estrogen and progestin and most widely used. 2. Progestin only pills (mini-pills) :- contain progestin only no estrogen. It thickens cervical mucous to block sperm and egg from meeting and prevents ovulation. It is highly effective when taken correctly and consistently. Can be used while breastfeeding. Must be taken at the same time each day. Contraindication 1. Has known or suspected pregnancy 2. Abnormal vaginal bleeding 3. Has a benign or malignant liver tumor or acute or sever active liver, gall- bladder disease. 4. Woman who have family history of hypertension, D. M, stroke, Heart disease, osteoporosis, carcinoma of genital tract or breast. Nursing Instructions 1. The first pill should be taken on any of the first 5 days of menstrual cycle. 2. A pill should be taken every day at the same time of day preferably at night after meals for 21 days withdrawal bleeding usually starts 2or3days after stopping the tablets. 3. If vomiting occurs within one hour of pill intake, another pill is taken. 4. Missed pills If the woman forgets one pill, she should take it as soon as possible then next pill at the regular time. If the woman forgets two pills, she should take them as soon as possible she remembers and the next at its time. If the woman forgets three pills, a barrier method of contraception should be used and wait for the next period before restarting the pill after referral to the family planning center.  Injectable contraceptives Types of Injectable contraceptives:- 1. Progesterone only injectable ▪A-Depot- medroxy progesterone acetate, (DMPA) Depo- Provera →It's injected in dose 150 mg every 3 months subsequent 2. Combined injectable contraceptive Mesgyna: DMPA 50 mg +5 mg Estradiol valerate / 1 month Subcutaneous Implants Flexible plastic capsule inserted subcutaneously in the inner side of the upper arm under local anesthesia that slowly released hormones in blood stream. 1.Norplant: (6 cap ) of levonorgestrel contains 36mg for 5 years. 2.Norplant II: (2 cap) of levonorgestrel contains 30mg for 3 years 3.Implanon: (1 cap) of etonogesterol contains 68mg +Small amount of progesterone for 3 years Transdermal Contraceptive Patch Definition The birth control patch is a thin, plastic patch that sticks to the skin releases estrogen and progestin through skin for 7 days. Sites Vaginal rings (NuvaRing) ▪ The combined hormonal contraceptive vaginal ring is self-administered once a month. ▪ Leaving the ring in for three weeks slowly releases hormones into the body, mainly vaginally administered estrogen and progesterone. ▪ Worn continuously for three weeks followed by a week off. Post Coital (Emergency) Contraception Definition ▪ Emergency contraception (EC) are birth control measures that may be used after: Indications ▪ Unprotected sexual intercourse at any time during the menstrual cycle ▪ Failure of barrier methods , as when condom ruptures or vaginal diaphragm or cervical cap is displaced. ▪ Rape.  Methods 1. Natural Methods:- ▪ Immediate postcoital douching to dispel deposited semen from the vagina. 2. Intrauterine Device:-( within 5 days) ▪ It prevents implantations by changing the endometrial pattern 4. Hormonal Methods:- (within 3 days) ❑Combined oral contraceptive(COC): 2tablets taken once and repeated after 12 hours ❑Estrogens: 5 mg taken in divided doses within 24hours. ❑Progestins: 1tablet (0.75 mg) taken within 24hours after coitus and repeated after 12 hours.  SURGICAL METHODS: Sterilization Permanent contraception to block or Vasectomy cut the vas deferens tubes that carry sperm from the testicles. It keeps sperm out of ejaculated semen. Does not affect male sexual performance. Female Permanent contraception to block or cut the fallopian tubes. Sterilisation Eggs are blocked from meeting sperm. It is highly effective and informed choice is essential.