Reproductive Life Planning PDF

CHAPTER 6: REPRODUCTIVE LIFE PLANNING PREPARED BY FUCN LEVEL II FACULTY REPRODUCTIVE LIFE PLANNING ▪ Includes all the decisions an ▪ Things to consider are individual or couple make about Personal Values having children. ...

CHAPTER 6: REPRODUCTIVE LIFE PLANNING PREPARED BY FUCN LEVEL II FACULTY REPRODUCTIVE LIFE PLANNING ▪ Includes all the decisions an ▪ Things to consider are individual or couple make about Personal Values having children. Ability to use method correctly ▪ An individual or couples choice of contraceptive method should How the method will affect sexual be made carefully with complete enjoyment knowledge about the advantages, disadvantages, and Financial factors side effects of the various Status of couple’s relationship options. Prior experiences Future plans NURSING PROCESS OVERVIEW ▪ ASSESSMENT- ask pts. if they want more information or need any help with reproductive life planning as part of obtaining a basic health history. ▪ NURSING DIAGNOSIS Readiness for enhanced knowledge regarding contraception options related to a desire to prevent pregnancy Deficient knowledge related to use of a diaphragm Spiritual distress related to partner’s preferences for contraception Decisional conflict regarding choice of birth control because of health concerns Decisional conflict related to unintended pregnancy Powerlessness related to failure of chosen contraceptive Altered sexuality pattern related to fear of pregnancy Risk for ineffective health maintenance related to lack of knowledge about natural family planning methods ▪ PLANNING AND IMPLEMENTATION- when establishing expected outcomes for care in this area, be certain plans are realistic for each couple. Be certain when counseling to be sensitive to a couple’s spiritual, cultural, and moral beliefs before suggesting possible methods. ▪ OUTCOME AND EVALUATION- evaluation is important in reproductive life planning because anything that causes patients to discontinue or misuse a particular method will leave them at risk of pregnancy. Reassess early (within 1 to 3 weeks) after a couple begins a new method of contraception to prevent such an occurrence. Evaluate not only whether a chosen method is effective but also whether the woman and her partner are satisfied or have further questions. Examples of expected outcomes include: Patient voices confidence in chosen contraceptive method by next visit. Patient expresses satisfaction with chosen method at follow-up visit. Patient consistently uses chosen method without pregnancy for 1 year. ASSESSMENT FOR CONTRACEPTION OPTIONS AND POSSIBLE CONTRAINDICATION Important things to consider when helping a couple choose a method that will be right for them include: Personal values Ability to use a method correctly If the method will affect sexual enjoyment Financial factors If a couple’s relationship is short term or long term Prior experiences with contraception Future plan AN IDEAL CONTRACEPTIVE SHOULD BE: Safe Effective Compatible with spiritual and cultural beliefs and personal preferences of both the user and sexual partner Free of bothersome side effects Convenient to use and easily obtainable Affordable and needing few instructions for effective use Free of effects (after discontinuation) on future pregnancies  INFORMATION THAT NEEDS TO BE ASSESSED: 1. Vital signs, possibly a Pap smear, pregnancy test, gonococcal and chlamydial screening, and perhaps hemoglobin for detection of anemia 2. Obstetric history, including STIs, past pregnancies, previous elective abortions, failure of previously used methods, and compliance history with previously used methods 3. Subjective assessment of the patient’s desires, needs, feelings, and understanding of conception (a teen may believe she is too young to get pregnant; a woman in the immediate postpartum period may believe she cannot conceive immediately, especially if she is breastfeeding) 4. Sexual practices, such as frequency, number of partners, feelings about sex, and body image FAMILY PLANNING METHODS 1. Natural Methods of Reproductive Life Planning 2. Artificial Methods of Reproductive Life Planning 3. Surgical Methods of Reproductive Life Planning 4. Abstinence NATURAL METHODS OF REPRODUCTIVE LIFE PLANNING ABSTINENCE Refraining from sexual relations, has a theoretical 0% failure rate and is also the most effective way to prevent STIs. SUGGESTIONS FOR PROMOTING ABSTINENCE Q. Dana, 17 years old, asks you, “How can I avoid being pressured into unwanted sex?” A few suggestions are: Discuss with your partner in advance which sexual activities you will permit and 272 which you will not. Try to avoid high-pressure situations such as a party with known drug use, excessive alcohol consumption; for teenagers: no adult supervision. Be certain your partner understands when you say, “No,” you mean it. Make it clear your partner understands you consider being forced into relations against your wishes the same as rape, not simply irresponsible conduct. Do not accept any drug to “help you relax” or “be cool,” as such a drug could impair your judgment. The drug could also be the “date rape” drug flunitrazepam (Rohypnol), which causes loss of memory for recent events.  NATURAL METHODS OF REPRODUCTIVE LIFE PLANNING Lactation Amenorrhea - As long as a woman is breast- feeding an infant , there is some natural suppression of ovulation. - However, the method is not dependable because a woman may ovulate but not menstruate. - After 6 months of breast-feeding the woman should be advised to choose another method of contraception.  NATURAL METHODS OF REPRODUCTIVE LIFE PLANNING Coitus Interruptus - The couple proceeds with coitus until the moment of ejaculation. The man withdraws and spermatozoa are emitted outside the vagina. - Unfortunately, ejaculation may occur before withdrawal is complete and despite the care used, some spermatozoa may be deposited in the vagina. - It offers little protection against conception.  NATURAL METHODS OF REPRODUCTIVE LIFE PLANNING Calendar/ Rhythm Method - Requires a couple to abstain from coitus on the days of a menstrual cycle when the woman is most likely to conceived (3 to 4 days before and 3 to 4 days after ovulation). - Woman should keep a diary of six menstrual cycles. - To calculate “safe days “ she subtracts 18 from the shortest cycle and 11 from her longest cycle documented.  NATURAL METHODS OF REPRODUCTIVE LIFE PLANNING Basal Body Temperature Method - Before the day of ovulation, a woman’s BBT falls about half a degree and at the time of ovulation, her BBT rises a full degree because of the influence of progesterone. - To use the method, a woman takes her body temp. each morning immediately after waking before she undertakes any activity  NATURAL METHODS OF REPRODUCTIVE LIFE PLANNING Cervical Mucus (Billings) Method - Uses the changes in cervical mucus that occur naturally with ovulation. Before ovulation each month, the cervical mucus is thick and does not stretch when pulled between the thumb and finger (Spinnbarkeit). - Just before ovulation, mucus secretion increases. - With ovulation (the peak day), cervical mucus before copious, thin, watery and transparent. It feels slippery and stretches at least 1 inch before the strand breaks.  NATURAL METHODS OF REPRODUCTIVE LIFE PLANNING Two-Day Method - A woman assess for vaginal secretions daily. If she feels secretions for 2 days in a row, she avoids coitus that day and the day following as the presence of secretions suggests fertility. - The method requires conscientious daily assessment.  NATURAL METHODS OF REPRODUCTIVE LIFE PLANNING Symptothermal Method - Combines the cervical mucus and BBT methods  NATURAL METHODS OF REPRODUCTIVE LIFE PLANNING Fertility Beads/ Cycle Beads 26-32 days! - A hands-on visual tool used by millions of women worldwide, Cycle Beads is the original way to identify your fertile days using the Standard Days Method® of family planning. - Cycle Beads is a color-coded string of beads representing a woman's menstrual cycle. It helps a woman track her cycle, identify when are fertile days and non-fertile days, and monitor that her cycles are in range for effective use of this family planning method. - A woman can plan or prevent pregnancy easily and effectively with this easy to use tool.  NATURAL METHODS OF REPRODUCTIVE LIFE PLANNING Ovulation Awareness - This is the use of over-the- counter ovulation detection kit. It detect the midcycle surge of luteinizing hormone that can be detected in urine 12 to 24 hours before ovulation. ARTIFICIAL METHODS OF REPRODUCTIVE LIFE PLANNING BARRIER METHODS SPERMICIDES SPERMICIDES CONTAIN CHEMICALS TO STOP SPERM FROM GETTING TO AN EGG. THEY COME IN SEVERAL DIFFERENT FORMS: CREAM, GEL, FOAM, FILM, AND SUPPOSITORIES.  ARTIFICIAL METHODS OF REPRODUCTIVE LIFE PLANNING Male Condoms - A latex rubber or synthetic sheath that is placed over the erect penis before coitus. - Prevents pregnancy by depositing the spermatozoa in the tip of the condom.  ARTIFICIAL METHODS OF REPRODUCTIVE LIFE PLANNING Female Condom - Latex sheaths made by polyurethane and lubricated by nonoxynol-9. - The inner ring (closed end) covers the cervix and the outer ring (open end) rests against the vaginal opening. - Male and female condom should not be used together.  ARTIFICIAL METHODS OF REPRODUCTIVE LIFE PLANNING Diaphragms - A circular rubber disc that is placed over the cervix prior to intercourse. - They should be left in place for 6 hours afterwards. - Should not be place longer than 24 hours  ARTIFICIAL METHODS OF REPRODUCTIVE LIFE PLANNING Cervical Caps - Caps are made of soft rubber, are shaped like a thimble and fit snugly over the uterine cervix. - Many women cannot use cervical cap because their cervix is too short for the cap to fit properly. - It can remain longer than diaphragms because they do not put pressure on the vaginal walls or urethra. - Length of time should not exceeds to 24- 48 hours. BARRIER METHODS AND THEIR EFFECTS 1. Pregnancy 2. Sexual Enjoyment 3. Adolescent-girls: uses spermicide,fitted for diaphrams or cervical cap 4. Boys: Condom (never reused) 5. Perimenopuase: cervical caps not ideal HORMONAL CONTRACEPTION HORMONAL METHODS OF BIRTH CONTROL (CONTRACEPTION) CONTAIN EITHER ESTROGEN PLUS PROGESTIN OR PROGESTIN ONLY; THEY ARE A SAFE AND RELIABLE WAY TO PREVENT PREGNANCY FOR MOST PEOPLE  ARTIFICIAL METHODS OF REPRODUCTIVE LIFE PLANNING Oral Contraceptives / Pills - Composed of varying amount of synthetic estrogen combined with small amount of progesterone. - Commonly packed in 28 pills (21 active pill and 7 placebo pills) - Estrogen suppresses LH and FSH 1. Sunday start 2. Quick Start 3. First Day 4. After Childbirth  ARTIFICIAL METHODS OF REPRODUCTIVE LIFE PLANNING Mini Pills - Known as the progestin only pills. Progestin not allowed the endometrium to develop - Taken by women who cannot take an estrogen-based pill because of the danger of thrombophlebitis. - Risk for clotting due to increased estrogen  ARTIFICIAL METHODS OF REPRODUCTIVE LIFE PLANNING Estrogen/Progesterone Transdermal Patch - Refers to the patches that slowly, but continuously release a combination of estrogen and progesterone. - 3 weeks applied on, 4th week to take it out - May be applied to one of four areas: upper outer arm, upper torso (front or back, excluding the breast), abdomen or buttocks.  ARTIFICIAL METHODS OF REPRODUCTIVE LIFE PLANNING Vaginal Rings - Commonly known as the NuvaRings - Consist of a thin, flexible plastic ring that contains a combination of estrogen and progestin. - Inserted in the vagina and left in place for 21 days then removed for 7 days.  ARTIFICIAL METHODS OF REPRODUCTIVE LIFE PLANNING Subcutaneous/ Subdermal Implants - The implants slowly release the hormone, suppressing ovulation, stimulating thick cervical mucus, and changing the endometrium so that implantation is difficult. - Inserted and removed using local anethesia. - Costly  ARTIFICIAL METHODS OF REPRODUCTIVE LIFE PLANNING Intramuscular Injections - A single injection of medroxyprogesterone acetate (DMPA or Depo-Provera). - Given every 12 weeks to inhibit ovulation, alter the endometrium and change the cervical mucus. HORMONAL CONTRACEPTION AND ITS EFFECTS ▪ Estrogen/progestin combination ▪ Progestin impregnated rings or progestin patches ▪ Subdermal implants ▪ DMPA  ARTIFICIAL METHODS OF REPRODUCTIVE LIFE PLANNING Intrauterine Devices - A small plastic device inserted into the uterus through the vagina. IUD INSERTION & REMOVAL SURGICAL METHODS OF REPRODUCTIVE LIFE PLANNING  SURGICAL METHODS OF REPRODUCTIVE LIFE PLANNING a. Vasectomy - A small incision is made in each side of the scrotum. The vas deferens is then cut and tied , cauterized or plugged, blocking the passage of spermatozoa. - Done in an ambulatory setting such as physician’s office or reproductive life planning clinic.  FOR YOUR INFORMATION VASECTOMY DOES NOT INTERFERE WITH THE PRODUCTION OF SPERM; THE TESTES CONTINUE TO PRODUCE SPERM AS ALWAYS, BUT THE SPERM SIMPLY DO NOT PASS BEYOND THE PLUGGED VAS DEFERENS AND ARE ABSORBED AT THAT POINT. THE MAN WILL STILL HAVE FULL ERECTION CAPACITY AND CONTINUE TO PRODUCE TESTOSTERONE. BECAUSE HE ALSO CONTINUES TO FORM SEMINAL FLUID, HE WILL EJACULATE SEMINAL FLUID; IT WILL JUST NOT CONTAIN SPERM  SURGICAL METHODS OF REPRODUCTIVE LIFE PLANNING b. Tubal Ligation - The fallopian tubes are occluded by cautery, crushing, clamping or blocking the tubes (Essure), thereby preventing passage of both sperm and ova. - Should not be undertaken unless the woman does view it as a permanent irreversible procedure. SURGICAL METHODS OF REPRODUCTIVE LIFE PLANNING Effects on Sexual Enjoyment  Step 1 Step 2 THANK YOU