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Chapter: Maternal and Child Health Nursing : Puerperium

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.”

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.”


Benefits of family planning

Barrier methods of contraception


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.


Chemical Methods



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.


Jelly, Cream or foam is aerosol container


Normally enclosed in special tubes and comes with applicators.


For aerosol contain foam always remember to shake the tube before filling the applicator.


Mechanical method

Diaphragms (Dutch cap)


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.


Mode of action

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.


Mode of action


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.


Female condom:


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 caps


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


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.


The pills


There are three main forms of oral contraception


Combined – Oestrogen and progesterone


Mine pills – Progesterone –only.


Combined pills

– 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


Mechanism of action


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.


Mini pill


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




Injections are culturally more acceptable. Decreases menstrual cramps.



May cause irregular bleeding


Return of fertility may be delayed


Norplant implant


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.


Mechanism of Action

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 devices


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


Mechanism of action


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.


Voluntary surgical contraception




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.


Client’s preparation


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.


Male sterilization – vasectomy


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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