Chapter: 12th Nursing : Chapter 7 : Midwifery Nursing

Reproductive Health Care and Family Planning

Reproductive Health Care : Ability to reproduce and regulate fertility

Reproductive Health Care and Family Planning

Definition Reproductive Health Care

· Ability to reproduce and regulate fertility

· Safe motherhood – safe pregnancy and child birth with resultant safe mother and infant

· Safe sex with no fear of pregnancy and of controlling diseases.

Definition Family Planning

Practices that help individuals or couples achieve the following:

Avoid unwanted pregnancy

· Achieve wanted pregnancy and child birth

· Spacing the pregnancies

· Determine the number of children in the family

· Choose the age for becoming pregnant

Contraception

Measures designed to prevent pregnancy due to coital act either temporary or permanenty

Temporary Methods Of Contraception

I. Natural Method

Rhythm Method:

The menstrual cycle is divided into three phases for purpose of assessment of likelihood of conception.

Phase-1: relatively infertile phase last from onset of menstruation until the time of preovulation.

Phase-2: fertile phase. last from seven days preovulation to 48hrs post ovulation.

Phase-3: absolutely infertile phase lasts from 48hrs after ovulation until the onset of menstrual, bleeding about 10 – 16 days.

Methods to determine the phase of the cycle:

Testing cervical mucus:

During phase 1 and 3, the mucus is scanty , thick and breaks quickly when stretches. During phase 2, the mucus is more abundant thick and clear and stretches easily.

Measuring basal body temperature:

Basal body temperature should be measured in the morning. A sustained rise of temperature of 0.2 to 0.6 C indicates that ovulation has occurred

Abstinence Complete abstinence

Coitus interruptus - During sex the man withdraws his penis from the vagina before he ejaculates

Lactational Amenorrhoea Method

It suppresses ovulation and thickens cervical secretions. It is effective in women less than 6 weeks of postpartum, who are breastfeeding.

Emergrncy Contraception

It reduces sperm transport and changes the endometrium thus unfavorable for fertilization. It is effective for women who have had unprotected intercourse within 72 hours and for victims of sexual assault.

Advantages of natural methods

· Natural method that does not require devices or medicine in the body.

· There are no side effects.

· No cost. Is morally and culturally acceptable.

· Better than not using any birth control method

II. Barrier Methods

Condoms:

Types: -Latex (plain or treated with spermicide)

· The spermicide will immobilize or kills sperm providing added protection if breakage or leaks occur.

Direction of use:

The condom should be applied before vaginal penetration and should cover the entire length of the erected penis. Adequate lubrication should be used and the condom should be removed immediately after ejaculation and disposed properly.

Diaphragm:

Types:

i) flat spring ii) Coil spring iii) Arching spring

The diaphragm should lie just posterior to symphysis pubis and deep into the cul-de-sac, so that the cervix is completely covered and behind the centre of the membrane. Spermicide should be applied before each coital act. The diaphragm should left in place for a maximum of 8 hrs after the last coital act.

Cervical Cap

· It is a dome shaped cup that fits over the cervix.

· It cannot be left in the cervix for more than 48 hours.

· Only women with normal pap smear can use.

Spermicide

They are agents that cause destruction of the sperm cell membrane; thereby affecting mobility.

· Aerosol foams

· Creams and Jellies

· Vaginal suppositories

· Films & sponges

All contain spermicidal agents usually nontoxic.

III Iucd- Intra Uterine CONTRACEPTIVE Devices

Modern Methods

They are flexible plastic device medicated with slowly released hormones. Copper – released devices interferes with the ability of sperm to pass through the uterine cavity.

Progestin releasing device thicken the cervical mucus and thin the endometrial lining thus prevents conception.

Types:

Copper

· Copper - T 380 A

· Nova T

· Multiload 375

Silastic

Hormone releasing

· Progestasert

· Levonova / Mirena

Insertion:

· Bladder empty, lithotomy position.

· Posterior vaginal speculum is introduced in vagina and cervix are cleansed by antiseptic lotion.

· Anterior lip grasped by Allis forceps. Uterine sound passed through the cervical canal to normal position of uterus and length of cavity.

· Insert the device through the cervical Os up to the fundus and after positioning, inserter is withdrawn keeping the plunger in position.

· Excess of nylon thread is to be cut.

Side effects

· Cramping

· Abnormal menstrual bleeding

Complications

· Uterine and pelvic infection

· Expulsion

· Uterine perforation

· Ectopic pregnancy

IV. Hormonal Contraceptives

Combined oral contraceptives

They consist of synthetic oestrogen and progestin preparations, act by suppressing lactation, thickening of cervical mucus and alteration of endometrium.

Contraindication

Side effects

· Amenorrhoea

· Breast fullness or tenderness

· Depression, severe vascular headache

· Hypertension

· Spoting or intermenstrual bleeding

Missed pills

· If one pill is missed, instruct the patient to take two pills at the next scheduled time and complete the pack as usual.

· If two or more consecutive pills are missed, instruct the patient to finish the package of pills.

Progestron Only Pills

They cause suppression of ovulation, thickening of cervical mucus and alteration of the endometrium.

Progestron only Injectable Contraceptives

They cause suppression of ovulation, thickening of cervical mucus, alteration of endometrium and change in tubal motility.

Implants (Norplant)

It consists of thin, flexible capsules filled with levonorgestrel that are inserted under the skin of women’s arm. They cause suppression of ovulation, thickening of cervical mucosa, alteration of the endometrium and change in tubal motility.