Family Planning

Family Planning

• The concept of enhancing the quality of families w/c includes:

• Regulating & spacing childbirth

• Helping subfertile couples beget children

• Counseling parents and would-be parents

• The privilege and the obligation of the (married) couple exclusively to decide w/ love when and how many children provided: the motive is justified and the means are moral.

• Involves personal decisions based on each individual’s background, experiences and sociocultural beliefs. It involves thorough planning to be certain that the method chosen is acceptable and can be used effectively.

METHODS USE TO PREVENT CONCEPTION

Natural methods ( The only method accepted by the catholic church)

Coitus interruptus (least effective method)

• Oldest type of birth control practiced by man.

• The premature withdrawal of the penis before ejaculation during sexual intercourse

• Reliability is low because sperms are emitted in varying quantities in the normal lubricating fluid secreted throughout intercourse

• Psychological disadvantage

• Not accepted by the Catholic Church

Coitus reservatus

• Male does not reach orgasm and therefore no ejaculation occurs

• Requires considerable control over the sexual urge

Coitus interfemora – “ipit” (kaskas lang)

Rhythmic abstinence

• Identification of the periods of fertility and the periods of sterility in the menstrual cycle of a woman and the restriction of sexual intercourse to the sterile periods or the time when the pregnancy is unlikely because the woman is biologically unprepared to conceive.

• Also known as “safe or infertile period” technique and “natural birth control” or NFP because there is nothing artificial used to prevent conception.

• These methods are based on the ff. principles:

• The human ovum is susceptible to fertilization for approx. 18-24 hours after ovulation

• The sperms deposited in the vagina are ordinarily capable of fertilizing the ovum for no more than 72 hours

• Present methods of determining ovulation time are inexact and seldom sufficiently predictive (by at least 48 hours) so that in practice, it is necessary to avoid intercourse for a far longer period of time than 72 hours before ovulation and 24 hours after ovulation

Calendar method

• The use of mathematical calculations to predict the probable time of ovulation. “Ovulation most often takes place 14 days before the onset of the next menstruation.”

• Ogino-knaus formula:

1.Determine the shortest and longest cycle

ex. Shortest cycle = 28 days

Longest cycle = 36 days

2.If the cycle is irregular, subtract 18 from the shortest and 11 from the longest

ex. 28-18=10 ex. 25-18=7

36-11=25 29-11=18

3. The difference between the shortest cycle and 18 determines the earliest time when ovulation occur.

4. The difference between the longest cycle and 11 determines the last day when ovulation can occur

5. OVULATION CAN OCCUR ANYTIME IN BETWEEN.

6. In a regular 28 day cycle, abstinence should be observed from day 9 to day 17. (count 5 days before the earliest ovulation and 3 days after the last day)

Basal Body Temperature

• This relies on slight changes (0.3 to 0.6ºC) in basal body temp. that may occur just before ovulation

• Pre-ovulatory temperature is low because of high estrogen levels

• Post-ovulatory temp. rise is due to high progesterone

• The temperature is taken every morning at the same time with the same thermometer just before arising and after at least 4-6 hours of continuous sleep.

• 3 days of elevation indicate temperature change is due to ovulation

• Abstinence should be observed 5 days before and 3 days after temperature rise.

Billings or CERVICAL MUCUS METHOD

• A particular type of cervical mucus felt by the woman at the vaginal opening is a signal of ovulation

• Research shows this type of mucus appears necessary for conception. Without the mucus, sperm transport is impeded.

Lactational Amenorrhea Method

• LAM is based on scientific evidence that a woman is not fertile and unlikely to become pregnant during full lactation or exclusive breastfeeding. Full lactation describes breastfeeding when no regular supplemental feeding of any type is given (not even water) and the infant is feeding both day and night with little separation from the mother.

• LAM provides maximum protection as long as:

• Menstruation has not resumed and

• Bottle feeds or regular food supplements are not introduced and

• Baby is less than 6 months of age.

Successful use of natural methods to prevent pregnancy depends upon:

• The accuracy of the method in identifying the woman's actual fertile days

• A couple's ability to correctly identify the fertile time

• The couple's ability to follow the rules of the method they are using

Advantages of natural family planning method

• Safe and has no side-effects

• Inexpensive

• Acceptable to religious affiliations that do not accept artificial methods of contraception

• Helpful for planning pregnancy and avoiding pregnancy

• Promotes communication about family planning and contraception between couples.

Disadvantages

• Involves long preparation and intensive recording before it can be used.

• There is a need to abstain on certain days which may be inconvenient for the couple.

• Not ideal to women with irregular cycles.

• Not very reliable because of menstrual cycle variations that may occur anytime.

LOCAL BARRIER METHODS

CONDOM

Disadvantages:

• Self-lubricated type breaks easily

• Penis must be withdrawn from the vagina before

it becomes flaccid

• Lessen sexual enjoyment by the male

Vaginal Diaphragm

• A shallow,dome-shaped rubber device with a flexible wire rim that covers the cervix; maybe inserted several hours before intercourse and left in place for at least 6 hours after the last intercourse

• Initially fitted by a health professional

• Weight loss/gain of 15 lbs may require re-fitting

• Inserted before intercourse with the woman in squatting or supine position, or with one leg elevated on a chair

• May cause cervicitis if left in place for too long

• Washed with mild soap & water, lasts for 2-3 years

• 97% efficiency

Cervical Cap

• Comes in 2 types: presized (S-M-L) and custom fitted (a plastic cap fitted to conform to the individual woman’s cervix made after making a mold of cervix with non-toxic substance used to make contact lenses)

• Contraindications: hx of TSS, PID, cervicitis, cervical Ca, vaginal bleeding, an allergy to latex/spermicide

• most durable than diaphragm no need to apply spermicide

C/I: abnormal pap smear

Side-Effects of Spermicides • You or your partner may be allergic to materials in spermicide. This can cause genital irritation, rash, or itchiness. If this happens and your spermicide has nonoxynol-9, try a spermicide without this chemical.

Intravaginal contraceptives (spermicides)

Advantages

• Available without a prescription.

• Lubrication may increase pleasure.

• Use can be part of sex play.

• Does not affect future fertility.

Disadvantages

• Does not protect against HIV/AIDS.

• Must be readily available and used prior to penetration.

• Can be messy.

• Can have a bad taste during oral sex.

• Possible genital irritation.

• When used frequently spermicides may irritate the vagina making it easier to catch HIV/STI

Contraceptive pills

• Estrogen & progesterone prevent pregnancy by inhibiting the hypothalamus and anterior pituitary so that ovulation does not occur. They also inhibit fertility by:

1. Altering the motility of the fallopian tubes

2. Inadequately developing the endometrium

3. Keeping cervical mucus unreceptive and unsupportive of sperm

Implant (Norplant)

• 6 tiny silicone rubber capsules or 2 rods containing progestin (evonorgestiel), surgically implanted under the skin of the upper arm; removed surgically in about 5 years or when the woman wishes to discontinue the method.

• disadvantage if keloid skin

• as soon as removed – can become pregnant

Advantages:

• Long term reversible contraception

• Do not interfere with coitus

• Has no estrogen related side-effects

• Can be used during breastfeeding

• Can be used by adolescents

• Rapid return of fertility w/c occurs 3 months after removal

Disadvantages:

• Expensive

• Scarring at insertion site

Contraindications:

• Pregnancy

• Desire to get pregnant within 2 years

• Undiagnosed vaginal bleeding

Injectable contraceptive (Depo-provera, Noristerat, etc.)

• Synthetic progestin hormones injected into muscle: administered every 3 months

They exert their contraceptive effect by inhibiting ovulation, altering cervical mucus and preventing endometrial growth. The woman does not menstruate with this contraception. It has the same advantages, disadv., and contraindications as implants.

Disadvantages:

• Fertility return is usually delayed by 6 months

• Higher risk for osteoporosis so advise to increase calcium intake and engage in weight bearing exercise

Impair glucose tolerance in women at risk for DM

Prevention of Implantation

IUD (Intra-Uterine Device)

Ø An object made of plastic or non-reactive metal (nickel-chromium alloy) that fits inside the uterine cavity

Ø Manufactured in several shapes (loop, coil, spiral)

Ø Causes a chronic inflammatory response in the endometrium, discouraging implantation of a fertilized ovum

Ø Conception may occur; if implantation takes place, it causes early abortion

Ø Usually inserted during the menstrual phase

IUDs come with increased risk of ectopic pregnancy and perforation of the uterus and do not protect against sexuallytransmitted disease. IUDs are prescribed and placed by health care providers.

STERILIZATION/ PERMANENT CONCEPTION CONTROL

Tubal Occlusion / Bilateral Tubal Ligation

- Involves tying, cutting or cauterizing the fallopian tbes

- Usually done immediately after delivery (within 24-48 hours) when the incidence of morbidity & failure are lowest

- May also be done in any phase of the menstrual cycle

methods

Vasectomy / Vas ligation

• Accomplished without entry into the abdominal cavity; twin incisions are made in the area where the scrotum joins the body, just over the vas deferens

• The tubes are tied and seperated; portions maybe excised

• Follow-up sperm counts maybe done after.

After vas ligation, the man is considered sterile: After 20 or more ejaculation, zero sperm count