Contraception
Nursing Role
Care
Management
Coitus
Interruptus
Fertility
Awareness
Methods (FAMs)
CONTRACEPTION OVERVIEW
Intentional prevention of pregnancy
Birth control is the device or practice to decrease the
risk of conceiving
Family planning is the conscious decision on when to
conceive or avoid pregnancy
May still be at risk for pregnancy
Nearly half of all U.S. pregnancies are unplanned
Assess womans & partners knowledge about
contraception and commitment to particular method.
Assess womans level of comfort with touching her
genitals & cervical mucosa.
Determine religious and cultural factors.
Counter myths and present facts.
A multidisciplinary approach to assist the woman in
choosing an appropriate contraceptive method
Ideally the method should be
o Safe, simple
o Available, Acceptable
o Economical
Contraceptive choice must meet personal, social,
cultural, and interpersonal needs
Church
Failure rate is 25% during 1st year use.
Low cost
Women must understand the 3 phases of the
menstrual cycle:
o Infertile phase before ovulation
o Fertile phase: 5-7 days midcycle
o Infertile phase after ovulation
Standard days method
Calendar rhythm method
Basal body temperature method
Cervical mucus ovulation-detection method
Symptothermal method
Predictor test kits for ovulation
o Marquette Model
o Creighton Model
Two Day method
Breast-feeding (lactation amenorrhea)
Calendar
Rhythm Method
Basal Body
Temperature
Method
Definition of BBT
Use of BBT to determine ovulation
A slight drop (0.5*C) occurs at Ovulation, followed by
an increase (0.4-0.8 * C)
Abstinence during fertile period
Not necessarily good when used alone
Can be used with cervical mucous method
Cervical
Mucous Method
(Billings
Method)
Spermicides
Male Condoms
Female
Condoms
Cervical Cap
Contraceptive
Sponge
Diaphragm
Oral
Contraceptive
Pills
intercourse
Risk for TSS
Shallow dome-shaped rubber device
Woman needs to be fitted (+/- 10 pounds)
Must remain in place at least 6 hours after intercourse
Spermicide needed with additional acts of coitus
Failure rate:12% in first year
Contraindicated for those with poor vaginal muscle
tone or recurrent UTIs
o
o
o
o
o
Nursing
Considerations
Fluid retention
Chloasma
Bleeding irregularities
Liver disease
Associations between long term OCP use & CA
(long term use prior to first full term
pregnancy, > 5 years)
May increase breast, liver, cervical cancer
Breast tenderness
CVA
Chloasma
Fluid retention
Headache
Nausea
Nervousness
Irritability
Thrombophlebitis
Breast tenderness/fullness
Decreased high density choles
Depression
Decreased libido
Fatigue
Increased appetite/weight gain
Pruritus
Alopecia/Hirsutism
Sebaceous cysts
Teaching must include insert information
Directions related to missing 1-2 pills
Discussion of break through bleeding
Signs of potential complications
No protection against STIs or HIV
ACHES
o A Abdominal pain: may indicate a problem
with the liver or gallbladder
o C Chest pain or shortness of breath: may
indicate possible clot problem within lungs or
heart
o H Headaches (sudden or persistent): may be
caused by cardiovascular accident or
hypertension
o E Eye problems: may indicate vascular
Contraindication
s to OCPs
Progestin Only
Pills
Injectable
Progestin
accident or hypertension
o S Severe leg pain: may indicate a
thromboembolic process
o
Pregnancy
Previous Hx of thrombophlebitis or thromboembolic
disease
Acute or chronic Liver or Gallbladder disease,
Presence of estrogen dependent carcinomas
Undiagnosed uterine bleeding
Heavy smoking
Hypertension
Diabetes
Hyperlipidema
Epilepsy
Mini-pill contains low dose of progestin
Taken same time every day (if later than 3 hours,
need backup method)
Some irregular bleeding occurs
Failure rate is 8% in first year of use
Caution: Hx of depression
DMPA (Depo-Provera)
o Given subq or IM
o Begun during 1st5 days of cycle
o Administered every 11-13 weeks
o Causes a decrease in bone mineral density
o Delay in return to fertility may take 18 months
o Failure rate is 3% in first year of use
Side Effects
o Abdominal pain
o Acne
o Breast tenderness
o Decreased libido
o Depression
o Headaches, Dizziness
o Irregular menses and bleeding
o Weakness and fatigue
o Weight gain
o Nervousness
o Bone loss
o Alopecia
Subdermal
Implants
Transdermal
Contraception
(Patch)
Vaginal Ring
Emergency
Contraception/P
ost-coital
Methods
IUD
Sterilization
Occlusion:
Essure
Nursing
Considerations
Medical Abortion
Performed anytime
Third trimester abortions are legal and are performed
Cervix must be dilated
Cannula is used to suction out fetus and placenta;
curette may also be used.
Nursing Care
o Monitor vital signs
o Emotional support
o Analgesic administration
o Post-op monitoring
o Follow-up