Contraception PDF

1/9/24, 2:49 AM Realizeit for Student Contraception The terms “contraception,” “family planning,” and “birth control” are used interchangeably when referring to the intentional prevention of pregnancy through the use of various devices, agents, drugs, sexual practices, and surgical procedures. In...

1/9/24, 2:49 AM Realizeit for Student Contraception The terms “contraception,” “family planning,” and “birth control” are used interchangeably when referring to the intentional prevention of pregnancy through the use of various devices, agents, drugs, sexual practices, and surgical procedures. In the United States, there are over 68 million women in their childbearing years (between the ages of 15 and 44), and throughout those years, a variety of contraceptive methods may be used. Types of Contraceptive Methods Contraceptive methods can be divided into four types: behavioral methods, barrier methods, hormonal methods, and permanent methods. Women must decide which method is appropriate for them to meet their changing contraceptive needs throughout their life cycles. Nurses can educate and assist women during this selection process. Box 4.5 outlines the contraceptive methods available today. BOX 4.5 OUTLINE OF CONTRACEPTIVE METHODS Reversible Methods Behavioral Abstinence Fertility awareness–based methods Withdrawal (coitus interruptus) Lactational amenorrhea method (LAM) Barrier Condom (male and female) Diaphragm Cervical cap Sponge Hormonal Oral contraceptive Injectable contraceptive Transdermal patch Vaginal ring Implantable contraceptive Intrauterine contraceptive Emergency contraceptive Permanent Methods Tubal ligation or Essure for women Vasectomy for men Sexual Abstinence Sexual abstinence (not having intercourse) is one of the least expensive forms of contraception and has been used for thousands of years. Pregnancy cannot occur if sperm is kept out of the vagina. It also reduces the risk of contracting HIV/AIDS and other STIs, unless body fluids are exchanged through oral sex; however, some infections, like herpes and human papilloma virus (HPV), can still be passed by skinto-skin contact. Dental dams can be used to prevent transmission, however. There are many pleasurable options for sex play without intercourse (“outercourse”), such as kissing, masturbation, erotic massage, sexual fantasy, sex toys such as vibrators, and oral sex. Many people have strong feelings about abstinence based on religious and moral beliefs. There are many reasons to choose abstinence. For some, it is a way of life, while for others it is a temporary choice. Some people choose sexual abstinence because they want to: wait to have sex until they are older. wait to have sex for a long-term relationship. avoid pregnancy or STIs. relieve feelings of depression or anxiety. follow religious or cultural expectations. Fertility Awareness–Based Methods https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 1/6 1/9/24, 2:49 AM Realizeit for Student Fertility awareness methods are based on identifying fertile days in a woman’s cycle and avoiding sexual intercourse during that time. FAMs use physical signs and symptoms that change with hormone fluctuations throughout a woman’s menstrual cycle to predict a woman’s fertility. Ovulation occurs on one day during each menstrual cycle, and the several days preceding ovulation are when intercourse is most likely to result in pregnancy. Collectively, the potentially fertile days up to and including the day of ovulation are called the "fertile window". Awareness of fertility is a better fertility-producing method than a contraceptive method. Fertility awareness-based methods rely on the following assumptions: A single ovum is released from the ovary 14 days before the next menstrual period. It lives approximately 24 hours. Women using this method must have regular menstrual cycles for it to be effective. Sperm can live up to 5 days after intercourse. The fertile period during the menstrual cycle is thus approximately 6 days—3 days before and 3 days after ovulation. Because body changes start to occur before ovulation, the woman can become aware of them and not have intercourse on these days or use another method to prevent pregnancy. The exact time of ovulation cannot be determined, so 2 to 3 days are added to the beginning and end to avoid pregnancy. Techniques used to determine fertility include the cervical mucus ovulation method, the basal body temperature (BBT) method, the symptothermal method, standard days method, and 2-day method (Jordan et al., 2019). Fertility awareness methods are moderately effective but are unforgiving if not carried out as prescribed. Fertility awareness-based methods can be used in combination with coital abstinence or barrier methods during fertile days if pregnancy is not desired. CERVICAL MUCUS OVULATION METHOD Cervical mucus is a jellylike vaginal discharge that comes from the cervix. The cervical mucus ovulation method is used to assess the character of the cervical mucus. Cervical mucus changes in consistency during the menstrual cycle and plays a vital role in fertilization of the egg. BASAL BODY TEMPERATURE METHOD The basal body temperature (BBT) refers to the lowest temperature reached on awakening. The woman takes her temperature orally before rising and records it on a chart. Preovulation temperatures are suppressed by estrogen, whereas postovulation temperatures are increased under the influence of heat-inducing progesterone. Temperatures typically rise within a day or two after ovulation and remain elevated for approximately two weeks (at which point bleeding usually begins). If using this method by itself, the woman should avoid unprotected intercourse until the BBT has been elevated for three days. Nurses should instruct women using the BBT method that it is important to keep in mind that illness and any drugs, including alcohol, can raise their body temperature and give a false reading. Other fertility awareness methods should be used along with BBT for better results (Fig. 4.6). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 2/6 1/9/24, 2:49 AM Realizeit for Student FIGURE 4.6 Basal body temperature graph. A. The woman's temperature dips slightly at midpoint in the menstrual cycle, then rises sharply, an indication of ovulation. Toward the end of the cycle (the 24th day), her temperature begins to decline, indicating that progesterone levels are falling and that she did not conceive. B. The woman's temperature rises at the midpoint in the cycle and remains at that elevated level past the time of her normal menstrual flow, suggesting that pregnancy has occurred. C. There is no pre-ovulatory dip and no rise of temperature anywhere during the cycle. This is the typical pattern of a woman who does not ovulate. SYMPTOTHERMAL METHOD The symptothermal method relies on a combination of techniques to recognize ovulation, including BBT, cervical mucus changes, alterations in the position and firmness of the cervix, and other symptoms of ovulation, such as increased libido, mittelschmerz (midcycle, lower abdominal pain at ovulation), pelvic fullness or tenderness, and breast tenderness (Clark et al., 2018). Combining all these predictors increases awareness of when ovulation occurs and increases the effectiveness of this method. A home predictor test for ovulation is also available in most pharmacies. It measures LH levels to pinpoint the day before or the day of ovulation. These tests are widely used for fertility and infertility regimens. THE STANDARD DAYS METHOD AND THE TWO-DAY METHOD The Standard Days Method (SDM) and the Two-Day Method are both natural methods of contraception developed by Georgetown University Medical Center's Institute for Reproductive Health. Both methods provide women with simple, clear instructions for identifying https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 3/6 1/9/24, 2:49 AM Realizeit for Student fertile days. Women with menstrual cycles between 26 and 32 days long can use the SDM to prevent pregnancy by avoiding unprotected intercourse on days 8 through 19 of their cycles. Most SDM users utilize a visual aid—CycleBeads—to assist their correct use of SDM. FIGURE 4.7 CycleBeads help women use the Standard Days Method. WITHDRAWAL (Coitus Interruptus) In coitus interruptus, also known as withdrawal, a man controls his ejaculation during sexual intercourse and ejaculates outside the vagina. It is better known colloquially as “pulling out in time” or “being careful.” It is one of the oldest and most widely used means of preventing pregnancy in the world and also one of the least effective methods in preventing pregnancy (Hatcher et al., 2018). The problem with this method is that the first few drops of the true ejaculate contain the greatest concentration of sperm, and if some pre-ejaculatory fluid escapes from the urethra before orgasm, conception may result. The typical failure rate is estimated at 18% to 22% (Jordan et al., 2019). This method requires that the woman rely solely on the cooperation and judgment of the man. Nurses might discuss the use of emergency contraceptives with this couple or use of a more effective method of contraception. LACTATIONAL AMENORRHEA METHOD The lactational amenorrhea method (LAM) is an effective temporary method of contraception used by breastfeeding mothers. It relies on physiologic changes associated with breastfeeding for contraception. Continuous breastfeeding can usually postpone ovulation and thus prevent pregnancy. Breastfeeding stimulates the hormone prolactin, which is necessary for milk production, and it also inhibits the release of another hormone, gonadotropin, which is necessary for ovulation. Breastfeeding as a contraceptive method can be fairly effective for up to 6 months after giving birth if: the woman has not had a menses since she gave birth. the infant is younger than 6 months of age. the woman breastfeeds her baby at least six times daily on both breasts. the woman breastfeeds her baby “on demand” at least every 4 hours. the woman does not substitute other foods for a breast-milk meal. nighttime feedings are provided at least every 6 hours. Also, pumping or manual expression of milk may reduce effectiveness. Women should not rely on this method after 6 months (Rivlin & Isley, 2018). Nurses can help couples make decisions about family planning options available in the postpartum period by discussing the advantages and disadvantages of each, taking into consideration the demands of the postpartum period. The options they may consider include lactational amenorrhea, combined oral contraception, progestin-only pills, implants, intrauterine systems, injectable methods, barrier methods, emergency contraception, and sterilization (Oyelowo & Johnson, 2018). BARRIER METHODS Barrier contraceptives are physical or chemical devices that prevent pregnancy by preventing the sperm from reaching the ovum. Mechanical barriers include condoms, diaphragms, cervical caps, and sponges. These devices are placed over the penis or cervix to physically obstruct the passage of sperm through the cervix. Chemical barriers called spermicides may be used along with mechanical barrier devices. They come in creams, jellies, foam, suppositories, and vaginal films. They chemically destroy the sperm in the vagina. These https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 4/6 1/9/24, 2:49 AM Realizeit for Student contraceptives are called barrier methods because they not only provide a physical barrier for sperm but also protect against STIs. Since the HIV/AIDS epidemic started in the early 1980s, these methods have become extremely popular. Progress has been made in society’s reaction to condom use as a disease prevention device now and not just as a contraceptive (Kwansa & Stewart-Moore, 2019). Many of these barrier methods contain latex. CONDOMS Condoms are barrier methods of contraceptives made for both males and females. The male condom is made from latex or polyurethane or natural membrane and may be coated with spermicide. Male condoms are available in many colors, textures, sizes, shapes, and thicknesses. The female or internal condom is a polyurethane or nitrile pouch inserted into the vagina to catch the male ejaculate. It consists of an outer and inner ring that is inserted vaginally and held in place by the pubic bone. Some women complain that the female condom is cumbersome to use and makes noise during intercourse. DIAPHRAGM The diaphragm is a soft latex dome surrounded by a metal spring. Used in conjunction with a spermicidal jelly or cream, it is inserted into the vagina to cover the cervix. The diaphragm may be inserted up to 2 hours before intercourse and must be left in place for at least 6 hours afterward. Diaphragms are available in a range of sizes and styles. The diaphragm is available only by prescription and must be professionally fitted by a health care provider. CERVICAL CAP The cervical cap is smaller than the diaphragm and covers only the cervix; it is held in place by suction. Caps are made from silicone or latex and are used with spermicide. The FemCap is the only cervical cap device currently available in the United States and comes in three sizes (Planned Parenthood, 2016). The cap may be inserted up to 36 hours before intercourse and provides protection for 48 hours. The cap must be kept in the vagina for 6 hours after the final act of intercourse and should be replaced every year of use. CONTRACEPTIVE SPONGE The contraceptive sponge is a nonhormonal, nonprescription device that includes both a barrier and a spermicide. It is a soft concave device that prevents pregnancy by covering the cervix and releasing spermicide. The sponge, made of polyurethane saturated with 1 g of nonoxynol-9, releases 125 mg of the spermicide over 24 hours of use. Unlike the diaphragm, the sponge can be used for more than one coital act within 24 hours without the insertion of additional spermicide, and it does not require fitting or a prescription from a health care provider (Kwansa & Stewart-Moore, 2019). While it is less effective than several other methods and does not offer protection against STIs, the sponge achieved a wide following among women who appreciated the spontaneity with which it could be used and its easy availability. To use the sponge, the woman first wets it with water, squeezes it until it is thoroughly wet and foamy, and then inserts it into the vagina with a finger, using a cord loop attachment. It can be inserted up to 24 hours before intercourse and should be left in place for at least 6 hours following intercourse. The sponge provides protection for up to 12 hours, but should not be left in for more than 30 hours after insertion to avoid the risk of TSS (Jordan et al., 2019). HORMONAL METHODS Several options are available to women who want long-term but reversible protection against pregnancy. These methods of contraception work by altering the hormones within a woman’s body. They rely on estrogen and progestin or progestin alone to prevent ovulation. When used consistently, these methods are a reliable way to prevent pregnancy. Hormonal methods include OCs, injectables, implants, vaginal rings, and transdermal patches. ORAL CONTRACEPTIVES OCs work primarily by suppressing ovulation by adding estrogen and progesterone to a woman’s body, thus mimicking pregnancy. This hormonal level stifles GnRH, which in turn suppresses FSH and LH and thus inhibits ovulation. Cervical mucus also thickens, which hinders sperm transport into the uterus. Implantation is inhibited by suppression of the maturation of the endometrium and alterations of uterine secretions (Webster et al., 2018). The combination pills are prescribed as monophasic pills, which deliver fixed dosages of estrogen and progestin, or as multiphasic ones. Multiphasic pills (e.g., biphasic and triphasic OCs) alter the amount of progestin and estrogen within each cycle. To maintain adequate hormonal levels for contraception and enhance adherence to the regimen, OCs should be taken at the same time daily. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 5/6 1/9/24, 2:49 AM Realizeit for Student OCs that contain progestin are sometimes called mini-pills. Progestin-only pills (POPs) have both advantages and disadvantages when compared to combined pills. The pill-taking regimen is simple and fixed; no pill color changes or days without pill-taking occur. These pills are appropriate for women who cannot or should not take estrogen in combined OCs, for example, a woman older than 35 years who smokes cigarettes. These OCs work primarily by thickening the cervical mucus to prevent penetration of the sperm and make the endometrium unfavorable for implantation. POPs must be taken at a certain time every 24 hours. Breakthrough bleeding and a higher risk of pregnancy have made these OCs less popular than combination OCs (Hatcher et al., 2018). Extended-cycle OC regimens have been used for the management of menstrual disorders and endometriosis and are attracting wider attention. INJECTABLE CONTRACEPTIVE Injectable contraception includes progestin-only and combination estrogen and progestin agents that provide safe and highly effective birth control for up to 3 months. Injectable agents are widely available and play an important role in family planning worldwide. They offer a discrete, convenient, reversible, and noncoital-dependent method of birth control. Recent research finds that allowing self-administration of injectable contraceptives can lead to improved contraceptive continuation rates and equivalent pregnancy prevention compared to provider administration (Kronemyer, 2019). Depo-Provera is the trade name for a 3-month intramuscular injectable of a progesterone-only contraceptive that works at the hypothalamic/pituitary level to stop the hormonal cycle. Depo-Provera works by suppressing ovulation and the production of FSH and LH by the pituitary gland, increasing the viscosity of cervical mucus and causing endometrial atrophy. A single injection of 150 mg into the buttocks acts like other progestin-only products to prevent pregnancy for 3 months at a time Sterilization Sterilization is a permanent, safe, and highly effective method of contraception for those who are certain they do not want any or any more, children. Vasectomy is the only highly reliable form of male contraception. Nursing Interventions Contraception is an important issue for all couples, and the method used should be jointly decided by the woman and her partner. Facilitate this process by establishing a trusting relationship with the client and by providing unbiased, accurate information about all methods available. As a nurse, honestly reflect on your feelings about contraceptives while allowing the client’s feelings to be paramount. Be aware of the practical issues involved in contraceptive use, and avoid making assumptions, making decisions on the woman’s behalf, and making judgments about her and her situation. To do so, it is important to keep up to date on the latest methods available and convey this information to clients. Encourage female clients to take control of their lives by sharing information that allows them to plan their futures. It is also important to clear up common misconceptions about contraception and pregnancy. Resolving misconceptions will permit new learning to take hold and a better client response to whichever methods are explored and ultimately selected. Some common misconceptions include: Breastfeeding protects against pregnancy. Pregnancy can be avoided if the male partner “pulls out” before he ejaculates. Pregnancy cannot occur during menses. Douching after sex will prevent pregnancy. Pregnancy will not happen during the first sexual experience. Taking birth control pills protects against STIs. The woman is too old to get pregnant. If female orgasm is not reached, conception is not likely. Irregular menstruation prevents pregnancy. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 6/6