Maternal Family Planning PDF

Reproductive life planning includes all the decisions an individual or couple make about whether and when to have children, how many children to have, and how they are spaced Contraception is the act of preventing pregnancy. This can be a device, a medication, a procedure or a behavior. Contracepti...

Reproductive life planning includes all the decisions an individual or couple make about whether and when to have children, how many children to have, and how they are spaced Contraception is the act of preventing pregnancy. This can be a device, a medication, a procedure or a behavior. Contraception allows a woman control of her reproductive health and affords the woman the ability to be an active participant in her family planning. Contraceptive products to prevent pregnancy) Important things to consider when doing this are:  Personal values Ability to use a method correctly  How the method will affect sexual enjoyment  Financial factors  Status of a couple’s relationship  Prior experiences  Future plans An ideal contraceptive should be:  Safe  One hundred percent effective  Compatible with religious and cultural beliefs and personal preferences of both the user and sexual partner  Free of side effects  Convenient to use and easily obtainable  Affordable and needing few instructions for effective use  Free of effects after discontinuation and on future pregnancies Natural Family Planning Methods Natural family planning (NFP) involves tracking fertility signals to avoid or achieve pregnancy without the use of hormonal contraceptives or devices. Key methods include: Rhythm Method: This calendar-based approach estimates fertile days based on the menstrual cycle. Typically, ovulation occurs around day 14 in a 28-day cycle, making days 8 to 19 the most fertile. Couples avoid unprotected intercourse during this window. Cervical Mucus Method: This method tracks changes in cervical mucus, which becomes clear and stretchy during ovulation. Observing these changes helps identify fertile days. Basal Body Temperature (BBT) Method: Women measure their body temperature daily upon waking. A rise in temperature indicates that ovulation has occurred, helping to identify the fertile period retrospectively. Symptothermal Method: This combines multiple indicators, such as BBT and cervical mucus observations, for a more accurate assessment of fertility. Lactation Amenorrhea Method (LAM): Exclusively breastfeeding can suppress ovulation for up to six months postpartum, making it a temporary form of NFP. Coitus interruptus is one of the oldest known methods of contraception. The couple proceeds with coitus until the moment of ejaculation. Then the man withdraws and spermatozoa are emitted outside the vagina. Postcoital Douching. Douching following intercourse, no matter what solution is used, is ineffective as a contraceptive measure as sperm may be present in cervical mucus as quickly as 90 seconds after ejaculation Artificial Family Planning Methods Artificial family planning methods involve medical or surgical interventions to prevent pregnancy. These methods include: Hormonal Contraceptives Oral Route - Oral contraceptives, commonly known as the pill, OCs (for oral contraceptive), or COCs (for combination oral contraceptives), are composed of varying amounts of synthetic estrogen combined with a small amount of synthetic progesterone (progestin). The estrogen acts to suppress follicle stimulating hormone (FSH) and LH, thereby suppressing ovulation. The progesterone action complements that of estrogen by causing a decrease in the permeability of cervical mucus, thereby limiting sperm motility and access to ova. Transdermal contraception refers to patches that slowly but continuously release a combination of estrogen and progesterone (Fig. 6.3). Patches are applied each week for 3 weeks. No patch is applied the fourth week. During the week on which the woman is patch free, a menstrual flow will occur. After the patch-free week, a new cycle of 3 weeks on/1 week off begins again Vaginal Insertion A vaginal ring (NuvaRing) is a silicone ring that surrounds the cervix and continually releases a combination of estrogen and progesterone (Fig. 6.4). The ring was FDA approved in 2001. It is inserted vaginally by the woman and left in place for 3 weeks, then removed for 1 week (Roumen, 2007). Menstrual bleeding occurs during the ring-free week. The hormones released are absorbed directly by the mucous membrane of the vagina, thereby avoiding a “first pass” through the liver, as happens with COCs; this is an advantage for women with liver disease. Implantation Once embedded, the implants appear as irregular lines on the skin, simulating small veins. Over the next 3 to 5 years, the implants slowly release the hormone, suppressing ovulation, stimulating thick cervical mucus, and changing the endometrium so that implantation is difficult ,A disadvantage of the implant method is its cost and side effects such as: o Weight gain o Irregular menstrual cycle such as spotting, breakthrough bleeding, amenorrhea, or prolonged periods o Depression o Scarring at the insertion site o Need for removal Injection A single intramuscular injection of medroxyprogesterone acetate (Depo-Provera [DMPA]), a progesterone, given every FIGURE 6.4 A vaginal ring. Both estrogen and progesterone are gradually released to be absorbed by the vaginal walls. 12 weeks inhibits ovulation, alters the endometrium, and changes the cervical mucus the effectiveness rate of this method is almost 100%, making it an increasingly popular contraceptive method Intrauterine device (IUD) is a small plastic object that is inserted into the uterus through the vagina. Prevent fertilization as well as creating a local sterile inflammatory condition that prevents implantation. When copper is added to the device, sperm mobility appears to be affected as well. This decreases the possibility that sperm will successfully cross the uterine space and reaches the ovum Barrier Methods are forms of birth control that work by the placement of a chemical or other barrier between the cervix and advancing sperm so that sperm cannot enter the uterus or fallopian tubes and fertilize the ovum. A major advantage of barrier methods is that they lack the hormonal side effects associated with COCs. However, compared with COCs, their failure rates are higher and sexual enjoyment may be lessened. Chemical Barriers a spermicide is an agent that causes the death of spermatozoa before they can enter the cervix. Such agents are not only actively spermicidal but also change the vaginal pH to a strong acid level, a condition not conducive to sperm survival. They do not protect against STIs. In addition to the general benefits for barrier contraceptives, the advantages of spermicides include: They may be purchased without a prescription or an appointment with a health care provider, so they allow for greater independence and lower costs. When used in conjunction with another contraceptive, they increase the other method’s effectiveness. Various preparations are available, including gels, creams, sponges, films, foams, and suppositories. Diaphragm is a circular rubber disk that is placed over the cervix before intercourse (Fig. 6.7). A Lea’s Shield, made of silicone rubber and bowl shaped, is a new design. Although use of a spermicide is not required for diaphragms, use of a spermicidal gel with a diaphragm combines a barrier and a chemical method of contraception. With this, the failure rate of the diaphragm is as low as 6% (ideal) to 16% (typical use) (Cunningham et al., 2008). Cervical cap is yet another barrier method of contraception. Caps are made of soft rubber, are shaped like a thimble with a thin rim, and fit snugly over the uterine cervix.Cannot use cervical caps because their cervix is too short for the cap to fit properly. Also, caps tend to dislodge more readily than diaphragms during coitus. An advantage is that cervical caps can remain in place longer than diaphragms, because they do not put pressure on the vaginal walls or urethra; however, this time period should not exceed 48 hours, to prevent cervical irritation. Cervical caps, like diaphragms, must be fitted individually by a health care provider. They include a small strap, which can be grasped for easy removal. They are contraindicated in any woman who has:  An abnormally short or long cervix  A previous abnormal Pap smear  A history of TSS  An allergy to latex or spermicide  A history of pelvic inflammatory disease, cervicitis, or papillomavirus infection  A history of cervical cancer  An undiagnosed vaginal bleeding Male Condoms a condom is a latex rubber or synthetic sheath that is placed over the erect penis before coitus to trap sperm Condoms have an ideal failure rate of 2% and a typical failure rate of about 15%, because breakage or spillage occurs in up to 15% of uses A major advantage of condoms is that they are one of the few “male responsibility” birth control measures available, and no health care visit or prescription is needed. Latex condoms have the additional potential of preventing the spread of STIs, and their use has become a major part of the fight to prevent infection with human immunodeficiency virus Female Condoms for females are latex sheaths made of polyurethane and prelubricated with a spermicide. The inner ring (closed end) covers the cervix, and the outer ring (open end) rests against the vaginal opening. The sheath may be inserted any time before sexual activity begins and then removed after ejaculation occurs. Like male condoms, they are intended for one-time use and offer protection against both conception and STIs Vasectomy, a small incision or puncture wound is made on each side of the scrotum. The vas deferens at that point is then located, cut and tied, cauterized, or plugged, blocking the passage of spermatozoa Tubal Ligation removal of the uterus or ovaries (hysterectomy), where the fallopian tubes are occluded by cautery, crushing, clamping, or blocking, thereby preventing passage of both sperm and ova. laparoscopy. After a menstrual flow and before ovulation, an incision as small as 1 cm is made just under the woman’s umbilicus with the woman under general or local anesthesia. A lighted laparoscope is inserted through the incision. Carbon dioxide is then pumped into the incision to lift the abdominal wall upward and out of the line of vision. The surgeon locates the fallopian tubes by viewing the field through a laparoscope. An electrical current to coagulate tissue is then passed through the instrument for 3 to 5 seconds, or the tubes are clamped by plastic, metal, or rubber rings, then cut or filled with a silicone gel to seal them (Fig. 6.12). The procedure provides immediate contraception. Culdoscopy A new system, Essure consists of a spring-loaded mechanism that, when inserted through the vagina and uterus into the outer end of a fallopian tube (a hysteroscopy procedure), releases a soft micro -insert into the tube that effectively seals the tube (Pavone & Burke, 2007). This can be done as an office procedure. Women must use a second form of contraception afterward until at 3 months, when a hysterosalpingogram is done to confirm that the fallopian tubes are blocked. A woman may return to having coitus as soon as 2 to 3 days after the procedure Elective termination of pregnancy is a procedure performed to end a pregnancy before fetal viability. Such procedures are also referred to as therapeutic, medical, or induced abortions. Having such a procedure is a woman’s choice; nurses employed in health care agencies where induced abortions are performed are asked to assist with and offer support as a part of their duties. In the United States, although drugs are availabl e, elective termination of pregnancy is still mainly a surgical procedure. Elective termination of pregnancy should not be viewed as a method of reproductive planning but as remediation for failed contraception.  It is requested to end a pregnancy:  That threatens a woman’s life such as pregnancy in a woman with class IV heart disease  That involves a fetus found on amniocentesis to have a chromosomal defect  That is unwanted because it is the result of rape or incest  Of a woman who chooses not to have a child at this time in her life for such reasons as being too young, not wanting to be a single parent, wanting no more children, having financial difficulties, or from failed contraception. Medically induced termination, commonly known as medical abortion, is a procedure used to end a pregnancy through medication rather than surgery. Involves using prescription pills to terminate an early pregnancy, typically within the first trimester (up to 12 weeks). The most common regimen includes two medications:  Mifepristone: Taken first, it blocks progesterone, halting the growth of the pregnancy.  Misoprostol: Taken 1-2 days later, it induces uterine contractions to expel the pregnancy. Procedure 1. Mifepristone: A single dose is taken orally. 2. Misoprostol: Administered either orally or vaginally to prompt cramping and bleeding. Effectiveness  The combination of mifepristone and misoprostol is about 98% effective in terminating a pregnancy. Follow-Up  A follow-up appointment is typically scheduled within 2-5 weeks to confirm that the abortion was successful. Considerations  Contraindications: Medical abortion is not recommended for women with certain conditions, such as:  Ectopic pregnancy  An intrauterine device (IUD) in place  Severe medical conditions or allergies to the medications  Side Effects: Common side effects include cramping, bleeding (similar to a miscarriage), nausea, and diarrhea. Advantages  Medical abortion offers a non-surgical option with less risk of uterine damage compared to surgical methods.