NCM 107: Care of Mother, Child, and Adolescent Module 3 - Reproductive Life Planning PDF

NCM 107: CARE OF THE MOTHER, CHILD, 1. An infant is under 6 months of age and AND ADOLESCENT exclusive breastfeeding with no supplementary feedings. MODU...

NCM 107: CARE OF THE MOTHER, CHILD, 1. An infant is under 6 months of age and AND ADOLESCENT exclusive breastfeeding with no supplementary feedings. MODULE 3 – REPRODUCTIVE LIFE 2. Menses have not returned PLANNING Note: Ø Supplementary Feeding – Breastfeeding with REPRODUCTIVE LIFE formula The decisions/plan an individual or couple Ø Complementary Feeding – Breastfeeding or make about having children. formula with solid food HOW DOES A COUPLE PLAN? MILK PRODUCTION When to have children Nipple Stimulation by the baby o Pregnancy must always be planned | will send signal to the How many children to have? Hypothalamus o 2-3 usually | the hypothalamus will release The length of time between having Prolactin Releasing Factor children | will work on the o According to WHO, it must be at least Anterior Pituitary Gland 18 months | to release Prolactin (Milk Producing Hormone) WHAT IS AN IDEAL CONTRACEPTIVE? Inhibits production of FSH and LH that is why there is no pregnancy) Safe | will work on the Effective Acinar Glands (Milk Producing Gland) Compatible with both beliefs and | milk produced to be stored at the preferences (both partners) Lactiferous Ducts (near the nipples) Free from bothersome side effects Convenient to use and easy to obtain 3. COITUS INTERRUPTUS Affordable and easy to use Also called as withdrawal method Free from effects on future pregnancies Oldest methods of contraception 35% failure rate and 82% effective COMMONLY USED BIRTH CONTROL It can lead to STIs METHODS In this method, coitus happens until ejaculation occurs. A. NATURAL FAMILY PLANNING Once ejaculation occurs, the man will also called periodic abstinence methods withdraw and emit the spermatozoa outside No introduction of chemical or foreign the vagina. materials into the body. Unfortunately, ejaculation may occur before The effectiveness of these methods varies withdrawal is completed greatly from a 2% ideal failure rate to about Spermatozoa might be present in pre- 25% failure rate ejaculation fluid Fertilization may occur even if withdrawal 1. ABSTINENCE seems controlled. Theoretically, it has 0% failure rate. However, it is difficult for many couples to 4. FERTILITY AWARENESS METHOD avoid abstinence that is why this method has A method that requires detecting when a a high failure rate woman will be fertile Most effective way to prevent STIs During fertile times, abstinence should be used 2. LACTATION AMENOREHEA METHOD Fertile period is determined through (LAM) calendar, body temperature, consistency Prevents breast cancer of cervical mucus Ø Too much exposure to estrogen makes A fertile period exists from about 5 days us more prone to breast cancer before ovulation to 3 days after Ø It is possible to get pregnant even if there S/S OF OVULATION is no menstruation. Thus, ovulation 14 days before the end of menstrual cycle occurs even without menses. Ø Safe to have coitus: Before Increase of body temperature menstruation and Ischemic phase (post o Below 0.5 °F Day before ovulation ovulation) o On the day of ovulation: Above 1°F Ø Life span of sperm cells = 3 days Cervical mucus changes = Spinnbarkeit Ø Life span of egg cells = 2 days (stretchy/slippery) There is a natural suppression of both Mittelschmerz – unilateral pelvic pain ovulation and menses when a woman is (RLQ) breastfeeding. Breast tenderness This method’s failure rate is about 1% to Mood changes 5% FERTILITY AWARENESS METHOD: This method is applicable if: CALENDAR (RHYTHM) METHOD  Requires the couple to abstain from coitus Spermicidal foam, cream, jelly, and on the days of a menstrual cycle when a suppository capsules are over the counter woman is fertile (OTC) contraceptives. This method requires a woman to note her 6 It has a failure rate of 21% menstrual cycles to calculate for her safe It must be used together with other family days by subtracting 11 from her longest planning methods to increase its cycle and 18 from shortest cycle effectiveness Example: Spermicides can cause local irritation in o Days of cycles (6): 28, 25, 26, 29, 29, 27 the vagina or on the penis. The irritation Ø Shortest: 25 – 18 = 7 can cause tiny cracks that provide portals Ø Longest: 29 – 11 = 18 of entry for infection. Ø Fertile Period: 7th – 18th day of the menstrual cycle 2. CONDOMS FERTILITY AWARENESS METHOD: BASAL MALE CONDOMS BODY TEMPERATURE are sheaths of thin latex, polyurethane, or Below 0.5 °F (0.2 °C) Day before ovulation natural membrane worn on the penis On the day of ovulation: Above 1°F during intercourse. The rise of the temperature is caused by the Collects semen before, during, and after thermogenic hormone progesterone ejaculation. However, many factors affect BBT such as They come in various styles, such as warm environment, which could be ribbed, lubricated, and colored, and with or mistaken as sign of ovulation without spermicide. As soon as the woman noticed the rise in Are single-use, low cost, and available over BBT, coitus must be refrained for 3 days the counter FERTILITY AWARENESS METHOD: MALE CONDOMS: LATEX CONDOMS CERVICAL MUCUS METHOD Provide some protection from STIs Month before ovulation: cervical mucus is MALE CONDOMS: NATURAL MEMBRANE thick and does not stretch CONDOMS Before ovulation: mucus secretion Does not prevent the passage of viruses increases Water-soluble lubricants should be used to On the day of ovulation: It becomes prevent condom breakage or if the vagina is copious, thin, watery, transparent, slippery, dry. and stretchy (Spinnbarkeit) FEMALE CONDOMS All the days on which cervical mucus is Has the same purpose as male condoms copious, and for at least 3 to 4 days Two flexible rings, one that fits into the afterward, are considered to be fertile days. vagina and one that remains outside, This method has a potentially high failure connected by a polyurethane sheath. because of difficulty in interpreting mucus They are pre-lubricated, single-use items status that are available OTC. Must be combined with the calendar method SIDE EFFECTS AND FAILURE RATE? to be more safe Side effects of and contraindications to FERTILITY AWARENESS METHOD: condom use are rare. SYMPTOTHERMAL METHOD If either or the partners are allergic to latex, Combination of cervical mucus and BBT in which case a polyurethane or natural method membrane condom can be used The couple then abstain coitus until 3 days successfully. after the rise in temperature or the fourth The failure rate is 18%. day after the peak of mucus change Known to be more effective than BBT or 3. DIAPHRAGM AND CERVICAL CAP cervical mucus method alone are rubber domes that fit over the cervix Failure rate: 25% and are used with spermicides to kill sperm that pass the mechanical barrier. B. BARRIER METHODS OF A health care provider fits the diaphragm CONTRACEPTION and cervical cap. Places a chemical or latex barrier on the The woman must learn how to insert and cervix and advancing sperm so sperm remove the diaphragm or cervical cap and to cannot reach and fertilize an ovum verify proper placement. 1. SPERMICIDES Before insertion, the woman should check Causes death of the spermatozoa before they the device for weak spots or pinholes by can enter the cervix holding it up to the light. It is a chemical barrier method and is often Typical failure rate: 12% used in combination with other physical DIAPHRAGM CAP barrier methods Should be removed 6 hours after sexual It changes the vagina pH to a strong acid intercourse but not longer than 24 hours level to inhibit sperm survival DIAPHRAGM CAP CONTRAINDICATIONS It does not protect against STIs  History of toxic shock syndrome (TSS; a It could also affect milk production for woman staphylococcal infection (staphylococcus who are breastfeeding as estrogen level aureus) introduced through the vagina increases in taking pills, milk production Allergy to rubber or spermicide lowers History of recurrent UTI COMMON SIDE EFFECTS OF OCs During menstrual period Nausea Headache CERVIVAL CAP Breast tenderness Should be removed 6 hours after sexual Weight gain intercourse but not longer than 48 hours o Pills causes sodium and water The diaphragm must be refitted: (1) after retention that causes weight gain each birth or (2) after a weight change of And spotting between periods or amenorrhea 10 pounds or more. The cap must be refitted yearly and after WOMEN WITH THIS FF. DISORDERS birth, abortion, or surgery. SHOULD NOT TAKE OR TAKE OCs WITH User misplacement, especially of the small CAUTION cervical cap, is a common reason for Thromboembolic disorders (blood clots) unintended pregnancy. Cerebrovascular accident or heart disease CERVICAL CAP CONTRAINDICATIONS Breast cancer Abnormally short or long cervix Smoking of more than 15 cigarettes a day for Abnormal pap smear women older than 35 years History of TSS (toxic shock syndrome) Impaired liver function History of latex or spermicide allergy Confirmed or possible pregnancy History of cervicitis or cervical cancer Undiagnosed vaginal bleeding Undiagnosed vaginal bleeding Diabetes mellitus Breastfeeding and less than 6 weeks postpartum C. HORMONAL CONTRACEPTIVES SOME MEDICATIONS RECUDE THE Prevents ovulation EFFECTIVENESS OF OCs INCLUDE: Makes the cervical mucus thick and resistant Some antibiotics (ampicillin, tetracycline) to sperm penetration Anticonvulsants Make the uterine endometrium less Rifampin, barbiturates hospitable if a fertilized ovum does not WARNING SIGNS (ACHES) arrive Abdominal pain (severe) 1. ORAL CONTRACEPTIVES Chest pain, dyspnea, bloody sputum Increases estrogen and progesterone levels Headache (severe), weakness, or numbness of Best time to take at night the extremities Commonly known as pills Eye problems (blurring, double vision, vision (OC) for oral contraceptives or (COC) for loss) combination oral contraceptives Severe leg pain or swelling, speech disturbance are composed of varying amounts of natural estrogen which acts to suppress the follicle 2. HORMONE IMPLANTS stimulating hormone (FSH) and luteinizing Subcutaneous (not sure) hormone (LH) A progestin-filled miniature rod no bigger than a it is composed of small amount of synthetic matchstick, levonorgestrel implant (Nexplanon) progesterone (progestin) to cause a decrease can be embedded just under the skin on the in the permeability of cervical mucus so inside of the upper arm limits sperm motility and access to ova It slowly releases progestin over a period of 3 Progesterone also interferes with tubal years transport and endometrial proliferation to The implant suppresses ovulation, thickens such an extent the possibility of implantation is cervical mucus, and changes the decreased. endometrium lining, making the implantation COC are available in 21 or 28 day pack difficult. If a woman takes a 21-day pack, she needs to stop at the 21st day to have menstruation 3. INTRAMUSCULAR INJECTION If a woman takes a 28-day pack, she will take A single intramuscular injection of depot all 28 pills each day. But the last 7 pills are medroxyprogesterone acetate or DMPA considered placebo which are usually iron (Depo- Provera), a progesterone supplements Given every 12 weeks (3 months) If a woman did not stop taking the pills has a It gives almost 100% effectiveness rate risk of blood clot (Dislodge clots that can The injection is made deep into major muscle travel into different parts of the body such as before the fifth day after the beginning of a brain) menstrual flow In DM patients, pills could increase glucose The woman should not massage the injection levels that is why it requires close monitoring site after the administration so the drug can be absorbed slowly form the muscle.  D. INTRAUTERINE DEVICE 2. LAPAROSCOPIC SURGERY Is a small plastic device that is inserted into the is similar to minilaparatomy but the tubes are uterus through the vagina by a healthcare identified, and ligated tube called provider. laparoscope. Can either be hormonal or non-hormonal 3. THE TRADITIONAL APPROACH It prevents fertilization is performed during abdominal surgery, It creates a local sterile inflammatory usually a cesarean birth reaction that prevents implantation Has a failure rate of 0.1% and reversible No specific actions are required related to intercourse Replaced every 3 to 6 years Cramping and bleeding are likely to occur with insertion. Increased menstruation and dysmenorrheal may occur Does not protect against STIs WARNING SIGNS (PAINS) Period which late, heavy or prolonged Abdominal pain Increased body temperature (or any signs of infection) Noticeable vaginal discharge (foul-smelling) String is missing, shorter and longer E. SURGICAL METHOD OF REPRODUCTIVE PLANNING Are often called sterilization 99.5% effectiveness 1. VASECTOMY A small puncture would referred to as no- scalpel technique is made on the scrotum The vas deferens on each side are then pulled forward, cut, and tied, cauterized, or plugged blocking the passage of spermatozoa Considered as minor surgery Can be done under local anesthesia Spermatozoa can be viable as long as 6 months after the surgery the man can resume sexual intercourse 1 week an additional method should be used until 2 negative sperm reports at about 6 to 10 weeks have been obtained 10 to 20 ejaculations are required to eliminate the sperms in the vas deferens 2. TUBAL LIGATION Minor surgery The fallopian tubes specifically the (ISTHMUS PORTION) are occluded by cautery, crushed, clamped, or blocked, preventing passage of both sperm and ova 3. FIMBRIECTOMY Removal of the fimbria at the distal end This technique is not commonly used THREE METHODS USED FOR TUBAL LIGATION/FIMBRIECTOMY 1. MINILAPARATOMY uses an incision near the umbilicus in the immediate postpartum period or just above the symphysis pubis at other times The surgeon makes a tiny incision, brings each tube through it, and ligates, and cuts the tube.