Birth control/family planning
methods
WHO’s
Definition of Birth Control. “It is a way of thinking and living that is
adopted by individuals or couples in other to promote the health and welfare
voluntarily upon bases of knowledge, attitude and responsible decision of the
family and to contribute to the advancement of the community.”
Barrier
methods are the oldest means of contraception and have been in use for
centuries.
Diaphragms
and cervical caps are much in the same way as the various halves of various
fruit skins. Barrier method offers an alternative to prolong pill or IUCD use
for those who delay child bearing to later age.
Many
providers recommend it for the advantages and diversity of these simple
methods. Clients also prefer it because they do not act systematically thus
have fewer side effects.
There are
two common barrier methods:
·
Chemical – prevents spermatozoa from entering the w
omb by chemical action e.g. spermicides.
·
Mechanical – keeps sperm from entering the womb e.g
.condoms, cervical caps, sponge diaphragm. Mechanism of action involves
creating a barrier between the spermatozoa and the ovum which prevents the two
live units from meeting thus prevents fertilization.
Creams,
Jellies, Foams, Aerosol foam, Vaginal foaming tablets, Vaginal suppositories.
·
Do not require medical intervention
·
Readily available over the counter
·
Simple, easily understood by the user.
·
Serve as lubricant for intercourse.
·
Has higher failure rate compare with some others.
·
Require interference with the genital tract which
some users.
·
Some couples find spermicides to be messy and
aesthetically unpleasant.
Normally
enclosed in special tubes and comes with applicators.
For
aerosol contain foam always remember to shake the tube before filling the
applicator.
This is a
mechanical barrier method of birth control. It is a dome shaped latex cup or
rubber cup with flexible metal-rim. It is introduced into the vagina before
intercourse to prevent pregnancy.
Prevent
sperm from entering the cervix
It is
portable, has no systemic effect, and inexpensive if well taken care of.
Must be
measured and fitted by a Provider, must be in situ for 6-8 hours after
intercourse before removal.
Condom is a thin sheath that is worn over the erect penis before intercourse they act asbarrier preventing semen from entering the vagina. Condoms are known by a host of popular names such as: Rubber, English cap, Durex, raincoat, French letter etc.
It acts
as a mechanical barrier between the penis and the vagina and prevents the sperm
from entering the vagina.
·
Highly effective when correctly and consistently
used – 90% effective.
·
Permit active involvement and responsibility of the
male partner.
·
Widely available.
·
Failure – due to spilling, breaking and leaking.
·
Decreased sexual enjoyment for some couple
·
Interrupts fore play.
·
Allergic reaction to rubber.
·
Some men can not maintain erection with it.
Is made
of polyurethane sheath. It is a woman method of protection against STDS. It is
made up of thin, transparent soft plastic.
Similar
to male condoms and to other vaginal methods If used correctly and consistently
failure rate is low.
·
Designed to prevent both pregnancy and STDs
·
No apparent side effect.
Cervical
cap is a thinble shaped cup – a miniature diaphragm with tall dome. There are
three types, though they are not widely used: -Cavity Rim Cap, Vimule Cap,
Duma’s or vault Cap,
New
devices, not very common in use.Designed to provide effective barrier. It is
inserted like the Diaphragm against the
cervix.
It acts as mechanical barrier and the spermicide kills sperm.
Its
effectiveness is as high as that of the Diaphragm.
Hormonal
contraceptives are synthetic compounds that resemble human hormones used in
various forms to prevent pregnancy. They contain two main female hormones
Oestrogen and Progesterone. When single, contain progesterone alone, the
combine are usually taken by mouth while the progesterone only may be given by
intramuscular injection (injectables) or by implantation underneath the skin
(Norplant Implant) or as oral pills (Minipills).
1. Oral contraceptives: Popularly
known as “The Pill” e.gcombined, mini, and sequential.
There are
three main forms of oral contraception
Combined
– Oestrogen and progesterone
Mine
pills – Progesterone –only.
– 150
Microgram of oestrogen and 1-10mg of Prog estin
·
Highly effective if used correctly – it is the most
effective reversible method.
·
Client can discontinue independently.
·
Suitable for young (under 35 yrs).
·
Regularizes irregular periods.
·
Has to be taken daily.
·
May cause some minor side effects Nausea, vomiting,
spotting.
·
Do not protect against STI’s and HIV/AIDS
They are
thought to inhibit ovulation by blocking the production and release of FSH and
LH. The oestrogen suppresses the FSH production so retards development of ovum.
The
combine pill reduces cervical mucus thus blocking passage of sperm into the
uterus. Also makes endometrium lining oedemataus and unfavourable for ovum
implantation.
They come
in different forms and packages – 21 days plus Placebo for 7 days.
21 days
only. Taken from the 5th day of menstruation.
Placebo –
Iron tablet contains 75mg per tablet to m aintain continuity or regime and
supply extra iron.
Decreases
menstrual Cramps does not disturb breast milk production chances of PID are
probably reduced. Less likely to cause headaches or raised B/P. No increased
risk of cardiovascular complications.
Must take
the pill every day. Slightly less effective than combined pills Barrier method
must be used for more effectiveness.
May cause
infrequent menstrual period more likely to cause irregular bleeding although
many clients have normal cycle. Ectopic pregnancy is some what more common with
mini pill users.
Suitable
for women over 35 years
Safe for
breastfeeding mothers who have been well counseled.
These are
long-acting contraceptive containing progestogen only which are given by
intramuscular injection.
Highly
effective
Long-acting
Injections
are culturally more acceptable. Decreases menstrual cramps.
May cause
irregular bleeding
Return of
fertility may be delayed
The
Norplant is an implant which consists of six plastic–like tubes (containing the
Progestin Levonorgestrel) which are inserted under the skin of the upper arm by
a minor operation.
Inhibition
of ovulation
Thickening
of the cervical mucus.
It is a
very safe, effective and reversible contraceptive.
It
becomes effective within 24hrs
Spotting
and irregular vaginal bleeding
Minor
procedure is required to insert or remove Norplant.
Intrauterine
contraceptive device is an object inserted in the uterine cavity to prevent
unwanted pregnancy. It is made of plastic, stainless steel, or flexible
polyethylene nylon. They are of varied sizes, shapes and types.
There are
two types of IUCDS : Medicated and Non-medicated
They are
made of inert plastic material (e.g. lippers loop Saf – T coil.)
Copper T
(Cup T200, Cu – T220c, Cu-T 380A),
Copper 7
(Gravigard), Multiload (cu-250 and Cu-375), Progestasert – Contains
progesterone, Norgestrel – T contains levonorgestrel and Nova Postpartum T cu
200
The mode
of action of the IUCDs is not really known, but there, are some satisfactory
explanations that have been observed in human beings. It does not disturb
normal functioning of menstrual cycle and there is no alteration of ovulation.
Most widely accepted explanation are:
Leucocytosis:
Multiplication of white cells – exces s white cells that treat sperm and ova
Blastocyst as bacteria by engulfing and dissolving them, copper affect
endometrium enzymes making the lining hostile to implantation. Hence there is
increase in the mid cycle vaginal discharge.
This is a
minor surgical operation performed on a male or female to stop his or her
ability to have more children.
In the
past such operations were performed only for therapeutic purposes. But in the recent
years the phenomenon has become more common in the U.S. In Africa countries the
method is still not very popular among couples due to cultural beliefs.
Both
partners should be fully involved and the decision should be a joint one. It should
be a voluntary decisions, should have general knowledge about the operation.
Give accurate information about the procedure. If possible give written
material to read.
Emphasis
on – Irreversibility, Psychological Side effect – Regret (divorce death etc)
Complication – Emotional involvement Ambivalent emotion.
·
Provides permanent contraception
·
Highly effective method of contraception
·
Cost effective
·
Does not protect against STDs
·
Irreversible
·
Requires a minor operation.
·
Reversal is expensive; require special skills for
operation and the results is uncertain.
Assessment:
To determine client’s fitness for sterilization identify any condition that may
increase risks associated with it. Check that preliminary screening has been
done (e.g. history, physical examination investigation etc.
It
involves cutting of the vas deferens which carries spermatozoa from the
testicles. It is much simpler and safer procedure than female sterilization. It
is as effective as that of female. It is rapidly gaining popularity and is a
direct male contribution to family planning. The influence of cultural factors
varies from country to country.
Female
sterilization tubal ligation—this is ligatio n of the fallopian tube. It is
done through a small incision through the abdominal wall .It is very effective
Puerperium
is a period when the woman recuperates from the strain of pregnancy and labour.
Adequate rest is imperative during this period. It is the period when a good
foundation of relationship is laid between her and her baby. Midwife must
ensure that this period is uneventful through careful assessment and supportive
care.
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