Chapter 7

FAMILY PLANNING and CONTRACEPTION:

At the end of this Chapter, the students will be able to:

1. Define Family Planning

2. Explain the importance of Family Planning

3. Discuss the available family planning methods by their classification, description and Mechanism of action

4. Discuss the nature of Contraceptive method of family planning; their advantages, disadvantages, as well as their limitations.

5. Guide the couple in selecting a method of control that best meets their needs.

Introduction:

The concept of family planning and contraception is often interpreted solely as a means

of keeping families small. Although the basis purpose is to regulate family size and to affect a

more judicious spacing of children, there are also indications on why contraception should be

used. These include some medical reasons such as advanced diabetes, cancer, or some inherited

conditions.

Content:

Lesson 1 The Family Planning

A. Family Planning- Achieving desired family size and proper birth spacing.

Spacing pregnancies (2-3 years between pregnancies) to ensure the health of the mother and child.

Optimal birth spacing is having children born at least 3-5 years apart.

B. Importance: Helps regain strength lost in last pregnancy

Helps avoid unplanned, high-risk pregnancies

Devote more quality time to herself, her husband or her community

Helps prevent illegal abortion that may lead to complications or even death of the

mother.

Proper child care/rearing.

Reduction in infant/ child deaths

C. Principles: the success of family planning program depends to a great extent on the

motivation of both husband and wife.

D. Types:

1. Natural Contraceptive Methods- Abstinence from coitus during the fertile

days of the menstrual cycle; the only method accepted by Catholic Church

a. Billing method/Cervical mucus method

Assessment of cervical mucus during the menstrual cycle;

Spinnbarkeit test is usually used.

Sensory and visual observation of cervical mucus (when it

becomes thin and watery) the intercourse is avoided 3-4 days after

spinnbarkeit.

b. Basal Metabolic Temperature:

As soon as the temperature drops slightly and then increases (it means ovulation has taken place).Counts 3-4 days to abstain from intercourse.

Requires predictable menstrual cycle

Cervical Mucus Method

Also called rhythm or calendar method Can also be used to predict ovulationConsiderations:

Temperature must be taken upon waking

Always use the same route

Basal thermometer used

Can also check for cervical mucus

c. Symptothermal - Combination of Billings and BBT

Couple needs to record cycle days, coitus, mucus changes, inc. libido, mittelschmerz, BBT.

Most effective natural method of family planning

d. Standard Days Method

Cycles is within 26-32 days Fertile days occurs on 8th -19th days of the cycle Use “cycle beads” 32 colored beads in these order

1 red – 1st day of menstruation 6 brown – infertile 12 white- fertile

13 brown- infertile

e. Lactational Amenorrhea Method (LAM )

During breastfeeding, the prolactin inhibits ovulation Menstruation resumes: 2-3 months for bottle feeding mothers and

4-6 months for breast feeding mothers.

2. Social Method

a. Coitus Interruptus (Withdrawal): Removal of penis before

ejaculation. The least effective method due to premature ejaculation.

b. Coitus reservatus- sex without ejaculation, popular among sex

workers.

c. Coitus interfemura- penis rub between the femur

d. Coitus intramammas- penis rubbed in between the breast

3. Biological Method- known as calendar method identifies the fertile and

infertile phases and abstains from sexual intercourse during fertile phase.

Rhythm- effective if the mother has regular cycle. Determine the cycle

then subtract 14 days from the beginning of the next cycle. (Ovulation

occurs 14 days before the next menstruation). From the ovulation day,

subtract 4-5 days and add 4-5 days then the result will be the unsafe days

and abstinence is required.

Standard Days Method (SDM)

Origoknause formula – applicable for woman with irregular menstrual

cycle.

The woman charts her menstrual cycles for 12 continuous months in order

to determine the shortest and the longest cycles.

The 1st fertile day is determined by subtracting “18” from the shortest

cycle and “11” from the longest cycle.

E.g. 26 32

- 18 - 11

_____ _____

8 21

The fertile period would be from the 8th day to 21st day of her cycle. Avoid

sexual contact during these days.

4. Physiological Method

a. Low Dose Combined Oral Contraceptives contains estrogen and

progestin in low doses inhibits ovulation (release of eggs from the ovaries)

thickens the cervical mucus

21-pill pack- contains 21 active pills

28-pill pack- contains 21 active pills and 7 placebo pills

Monophasic - all “active” pills containing fixed dosages of

estrogen and progestin (e.g. Nordiol, Marvelon)

Biphasic- 21 active pills containing two different estrogen:

progestin ratios (e.g. Gracial)

Triphasic - 21 active pills containing three different estrogen:

progestin ratios (e.g. Trinordiol, Logynon)

b. Progestin Only Oral Contraceptives

Does not reduce breast milk production

No estrogen side effect

Women take one pill everyday with no break

Less risk of acne and weight gain

Temporary

Alters estrogen and progesterone levels (prevents ovulation)

Considerations:

S/E: bloating, nausea, weight gain

Adverse effects: leg cramping/pain, HA, abdominal apin

Not recommended for patients who smoke or coagulation problems

If dose is missed, take 2 tablets that day; if more than one dose is missed, must stop pill cycle and start a new pack

Failure is due to incorrect usage

Use additional contraception for the first 7 days

c. Emergency Contraception: The Morning-After Pill

a. Take between 2-5 pills within 72 hrs after intercourse and take 2nd dose 12 hrs after 1st dose

d. Subcutaneous implants (Norplant)

6 match sticks like rod implanted subdermally

Time-release dosage of progesterone

Suppresses ovulation

Inserted subQ during menses

May remain in for up to 5 years

Decreased menses

Adverse reaction:

Irregular bleeding, headaches, weight gain, depression

e. Subcutaneous injections (Depo-Provera)

a. Continuous release of medroxyprogesterone acetate

b. Suppresses ovulation

c. Considerations:

Must be repeated every 3 months

Can be given 5 days postpartum if not breastfeeding

Can be given 6 weeks post partum if breast feeding

Adverse effects: irregular bleeding, headaches, weight gain, depression

5. Mechanical method and Chemical Barriers

a. Intrauterine Device

Temporary Loop/coil inserted into uterus during menstrual cycle

Outpatient procedure

Prevents fertilized egg from implanting

Interventions:

Teach woman to check for string

Teach woman spotting and dysmenorrhea are common

Yearly pelvic exams

Must use additional BC method for 2-3 weeks

Signs of potential problems

“PAINS”

Period late/abnormal

Abdominal pain

Infection

Not feeling well

String missing

b. Diaphragm: Barrier Method

1. Use with spermicidal cream/jelly

2. Do not remove for at least 6 hours after ejaculation

3. Add additional spermicidal if repeated intercourse

4. Check for holes regularly

5. Clean with warm soapy water and dry

6. May need new fitting after weigh gain/loss (10 lbs) or pregnancy

7. Cannot use if with latex allergy

8. Adverse effects: cramps/rectal pressure, s/s TSS.

Key warning signs of TSS

Sudden fever

Hypotension

Rash

c. Cervical Cap- more durable than diaphragm

Can stay in place for than 24 hours

No need to reapply spermicides

Contra indicated in abnormal Pap smear

d. Condom (Barrier Method)

The only method that prevents STDs

1. Must be used before penetration

2. Leave space at the tip

3. Single use only

6. Surgical Methods

a. Tubal ligation

Permanent (may be reversed in some cases)

Must have a 30-day consent

Ovulation and menstruation continues

Laparoscopic procedure

Sexual activity resumes 2-3 days after procedure

b. Vasectomy

Permanent

Considerations:

1. Must use additional BC methods for 6 weeks

2. Doses not alter performance