POST PARTUM

DACANAY, Nicole Paula

REFUGIA, Erica
ACOSTA, Ma Jessica
LAPIDANTE, Jay Franklin
RULLAN, Jamaica

 Post partal period or puerperium (from the Latin puer, “child”and

parere “to bring forth”)

 refers to the 6-week period after childbirth.

 time of maternal changes that are:

o ~ retrogressive (involution of the uterus and vagina)

o ~ progressive (production of milk for lactation, restoration of the

normal menstrual cycle, and beginning of a
parenting role).

 fourth trimester of pregnancy.

 SPECIFIC BODY CHANGES ON THE MOTHER

 Retrogressive physiologic changes occurring during the postpartal

period include the related specifically to the reproductive system and other
systemic changes (Harrison, 2000)

 Reproductive System Changes

o Involution is the process whereby the reproductive organs
return to their non-pregnant state. The woman is in danger of
hemorrhage from the uterus until involution is complete.

 The Uterus
 Involution involves 2 main processes

 1. The area where the placenta was implanted sealed off, preventing
bleeding.

o The sealing of the placenta site is accomplished by rapid

contraction of the uterus immediately after the delivery of the
placenta. The contraction pinches the blood vessels entering the 7 cm
wide area denuded by the placenta and controls bleeding.

 2. The organ is reduced to its approximate pregestational size.

o The main mechanism that reduces the bulk of the uterus,

however, is the contraction. For this reason, the post partal period, like
pregnancy, is not period of illness, of necrosing cells being evacuated,
but primarily a period of healthy change.

o With involution, the uterus will never completely return to its

prepregnancy state. However, its reduction in size is dramatic.

 Uterine Involution may be delayed by a condition such as:

o Birth of multiple fetuses

o Hydramnios

o Exhaustion from prolonged labor or a difficult birth

o Grand multiparity

o Physiologic effects of excessive analgesic.

 Involution will occur most dependably in a woman who is well

nourished and who ambulates early after birth (gravity may play a role).

 In some women, the contraction of the uterus after birth causes

intermittent cramping similar to that accompanying a menstrual period.
These are termed afterpain.

 LOCHIA

 The separation of the placenta and membranes occur in the spongy

layer or outer portion of the decidua basalis.

 By the second day after birth, the layer of decidua remaining under the
placental site and throughout the uterus differentiates into two distinct
layers.
 o 1. The inner layer attached to the muscular wall of the uterus
remains, serving as the foundation from which a new layer of
endometrium will be formed.

o 2. The layer adjacent to the uterine cavity will become necrotic,

being cast off as a uterine discharge similar to a menstrual flow.
CHARACTERISTICS OF A LOCHIA
TYPE OF LOCHIA COLOR DURATION (DAY) COMPOSITION
LOCHIA RUBRA RED 1-3 BLOOD, FRAGMENTS
OF DECIDUA, AND
MUCUS
LOCHIA SEROSA PINK 3-10 BLOOD, MUCUS AND
INVADING
LEUKOCYTES
LOCHIA ALBA WHITE 10-14 (MAY LAST 6 LARGELY MUCUS;
WEEKS) LEUKOCYTE COUNT
HIGH

The Cervix

 soft and malleable

 Both the internal and external os are open.

 The process in the cervix does involve the formation of new muscle
cells.

 Like the fundus, however, the cervix does not return exactly to its
prepregnant state.

 The internal os will close as before, but assuming that the birth was
vaginal, the external os will usually remain slightly open and appear slitlike or
stellate (star-shaped), when previously it was round.

 The Vagina

 soft with few rugae.

 The hymen is permanently torn and heals with small separate tags of
tissue.

 Thickening of the walls also appears to depend on renewed estrogen

stimulation from the ovaries; a woman who is breastfeeding and in whom
ovulation is delayed may continue to have a thin-walled or fragile vaginal
cells that cause slight vaginal bleeding during sexual intercourse until about 6
weeks time.

 Like the cervix, the vaginal outlet will remain slightly more distended
than before; if the woman practices Kegel Exercises, the strength and tone of
the vagina will increase more rapidly.

 The Perineum

 Due to the great pressure experienced during birth, the perineum

responds by developing edema and generalized tenderness.

 Portions of the perineum may show ecchymosis from the rupture of

surface capillaries.

 The labia majora and labia minora typically remain atrophic and
softened in a woman, never returning to their prepregnant state.

 PSYCHOLOGICAL CHANGES OF THE POSTPARTAL PERIOD

 A transition is a movement or passage from, one position or, concept

to another. It is a pause between what was and what is to be or the internal
process experienced, by people when change occurs.

 People move through several predictable stages during transition:

 1. the act of ending old ways of thinking or believing (letting go);

 2. a neural zone during which the old way is gone but the new way is
not yet comfortable;

 3. a new beginning during which new ideas and concepts are put into
action

 The immediate postpartal period is a neural time during which the

couple tries out the new role and attempts to “fit” their expectation for that
role.


 PHASES OF THE PUERPERIUM

 She viewed the first of these, called the taking-in phase, as

encompassing the first 2 or 3 days.

 The subsequent phases, called taking-hold and letting-go, are times

of renewed action and forward movement.

 At the time that these phases of the puerperium were identified,

women were hospitalized for 5-7 days after childbirth and moved in a paced
manner from one step to the next.

 TAKING-IN PHASE

 a time of reflection for a woman.

 During this period, the woman is largely passive.

 This dependence is due partly to her physical discomfort from possible

perineal stitches, after pains, or hemorrhoids; partly to her uncertainty in
caring for a newborn; and partly from the extreme exhaustion that follows
childbirth.

 As a part of thinking and pondering about her new role, a woman

usually wants to talk about her pregnancy especially about her labor and
birth.

 She needs time to rest and regain her physical strength and to calm
and contain her swirling thoughts.

 TAKING-HOLD PHASE

 a woman begins to initiate action.

 During the taking-in period, a woman may have expressed little

interest in caring for her child. Now, she begins to take a strong interest.

 Although a woman’s actions suggest strong independence during this

time, she often still feels insecure about her ability to care for her new child.
 Do not rush a woman through the phase of taking-in or prevent her
from taking hold when she reaches that point. For many young mothers,
learning to make decisions about their child’s welfare is one of most difficult
phases of motherhood.

 LETTING-GO PHASE

 the woman finally redefines her new role.

 This process requires some grief work and readjustment of

relationships similar to what occurred during pregnancy.

 It is extended, and continues during the child’s growing years. A

woman who has reached this phase is well into her new role.

 VITAL SIGN CHANGES

 Vital sign changes in the postpartum period reflect the internal

adjustments occuring as the woman's body begins its return to its pregnancy
state.

 TEMPERATURE

 orally or tympanically because of the danger of vaginal contamination

and the discomfort involved in rectal intrusion.

 may show a slight increase in temperature during the first 24 hours

due to dehydration occurring during labor.

 When oral temperature rises above 100.4 °F (38°C), excluding the first
24-hour period, it is considered febrile, and a postpartal infection should be
suspected.

 on the third or fourth day, when the breasts fill with milk, the woman's
temperature rises because of the increased vascular activity involved.

 PULSE
 slightly slower than normal.

 After birth, stroke volume increases to accommodate the increased

blood volume returning to the heart. The increased blood volume reduces the
pulse rate to between 60 and 70 bpm.

 As diuresis diminishes, the blood volume and blood pressure fall, and
the pulse rate increases accordingly. By the end of the first week, the pulse
rate has returned to normal.

 Pulse rate should be evaluated carefully in the post partal period

because a rapid and thready pulse is a possible sign of hemorrhage.

 BLOOD PRESSURE

 A reading above 140 mm Hg systolic or 90 mm Hg diastolic may

indicate hypertension

 Oxytocics, drugs to achieve uterine contraction, cause contraction of

all smooth muscles, including blood vessels that can increase blood pressure.

 If blood pressure is over 140/90, notify the physician or nurse-midwife

to prevent hypertension and possible cerebrovascular accident.

 Episiotomy

 Assess using REEDA

 Lacerations:

 ○ 1st degree: perineal skin and vaginal mucous membrane

 ○ 2nd degree: includes the fascia and perineal muscles

 ○ 3rd degree: extends into the rectal sphincter-no suppository

 ○ 4th degree: Extends through the anterior rectal mucosa exposing the
rectal lumen-no suppository

 Emotional responses
Postpartum blue
● Transient period of depression
● Occurs first few days after delivery
● Mother may experiences tearfulness, anorexia, difficulty sleeping, feeling of
letdown

 Postpartum psychosis

 Hallucinations, delusion, agitation, inability to sleep, bizarre or

irrational

Postpartum depression

 occurs in about 10-20% of all postpartum patients

 Symptoms include:

 ○ Intense, pervasive sadness

 ○ Labile mood sings

 ○ Intense fear, anger, and anxiety

 ○ Unable to care for self or infant

 ○ Irritability which may progress to violent outbursts

 ○ Rejection of infant

 ○ Obsessive thoughts

Possible complications during post partum: bleeding and infection

 Postpartum infections, (including uterine, bladder, or kidney infections)

 Excessive bleeding after delivery

 Pain in the perineal area (between the vagina and the rectum)

 Vaginal discharge
 problems, such as swollen breasts, infection and clogged ducts

 Stretch marks

 Hemorrhoids and constipation

 Urinary or fecal (stool) incontinence

 Hair loss

 Postpartum depression

 Discomfort during sex

 Difficulty regaining your pre-pregnancy shape

 NURSING CARE OF MOTHER DURING POST PARTUM

 Obtain vital signs every 15 minutes for the first hour.

 Pulse and respirations may be fairly rapid immediately after birth.

 Blood pressure might be slightly elevated due to excretion and

excitement of the moment or recent oxytocin administration.

 Wash the perineum with the agency-designated solution and apply a

perineal pad.

 Palpate a woman's fundus for size, consistency, position and observe

the amount and characteristics of lochia each time you record vital signs.

 Offer a clean gown and warmed blanket.

 ASSESSMENT:

 *Health History

 *Family Profile

 *Pregnancy History

 *Labor and Birth History

 *Infant Data

 *Postpartal cause
 *Laboratory Data

 PHYSICAL ASSESSMENT:

 *Estimation of nutrition and fluid state

 *Energy level

 *Presence or absence of pain

 *Breast health

 *Fundal height and consistency

 *Lochia amount

 *Perineal integrity

 *Circulatory adequacy

 Provision of adequate clothing

 Clothes That Stretch

 Nursing Bra- breasts will be sensitive, sore, and probably be leaky so

getting a good quality one is a great investment

 Underwear- Cotton is still the best kind of fabric. Dark colors are great
while you are still bleeding.

 Dresses- best type of postpartum clothing to have especially if you had

a c-section

 Episiotomy Care

o Continue sitz baths (sitting in just a few inches of water and

covering the buttocks, up to the hips, in the water) using cool water for
the first few days, then warm water after that. Squeeze the cheeks of
your bottom together when you sit to avoid pulling painfully on the
stitches. Sitting on a pillow may be more comfortable than sitting on a
hard surface.

o Use a squirt bottle with warm water to wash the area with water
 when you use the toilet; gently pat dry. After a bowel movement, wipe
from front to back to avoid infection. Reduce swelling with ice packs or
chilled witch hazel pads. Local anesthetic sprays also can be helpful.

 Talk to your doctor about taking an anti-inflammatory drug like

ibuprofen to help with the pain and swelling.

 COMFORT MEASURES

 Exercise increase your energy and sense of well-being, and reduce

constipation. Begin slowly and increase gradually.

 Pelvic Tilt

LACTATION

 WHO Recommendations

 ▪Early and uninterrupted skin-to-skin contact between mother's and

infants should be facilitated and encourage as soon as possible after birth.

 ▪All mothers should be supported to initiate breastfeeding within the

first hour of delivery.

 ▪Mothers should receive practical support to enable them to initiate

and establish Breastfeeding and manage common breastfeeding difficulties.

 ▪Mother should be couched on how to express breast milk a means of

maintaining lactation on the event of their being separated temporarily from
their infants.

 RELIEF OF DISCOMFORTS

 Breast Engorgement

 What you might experience?

 ▪Your breast may painfully engorged for several days when your milk
 comes in and your nipples may be sore.

 How to relief?

 ▪The main treatment to relief the tenderness and soreness of breast

engorgement is when the infant sucking the milk that comes from nipples of
mother.

 ▪Good support from bra also offers a degree of relief.

 ▪Medication treatment such as synthetic oxytocin nasal spray.

 Nipple sore

 ▪Allow some breast milk to dry on your nipples

 ▪Let your nipples air-dry after each feeding

 ▪Apply cool compresses to your nipples after breastfeeding. Gel pads

can also be use on dry

 HYGIENIC MEASURES

 Perineal Hygiene
▪Take a bath once or twice daily after every voiding or bowel movement
▪Squirting warm water durjng urination, when finished urinating gently pat
the perineum dry.

 Breast Hygiene

 ▪Keep your nipples clean-Take a daily shower

 ▪Handwashing with soap water before a feed and after changing the
baby should be done

 ▪Keep our clothes clean

Maintaining adequate Nutrition

 ▪After a hospital discharge, a woman needs to eat a nutritious diet such

as fresh vegetables, fruits and balanced with proteins and carbohydrates.
 ▪Encourage the mother to eat and drink frequently such as every 2 to 3
hours while awake.

 Measures to prevent complications:

early ambulation

o A technique of postoperative care in which a patient gets out of

bed and engages in light activity (such as sitting, standing, or walking)
as soon as possible after an operation

 SUPPORT FOR PSYCHOSOCIAL OF MOTHER

 Woman experience a range of psychological stressors in the

postpartum period. Social support have been shown to be effective in helping
women to cope with these stressors.


 PSYCHOSOCIAL RISK

 ▪Postpartum Depression

 ▪Pospartal Psychosis

 HEALTH TEACHING NEEDS FOR MOTHER, NEWBORN AND FAMILY

 Explain to the mother that:

 Breast milk contains exactly the nutrients a baby needs

 After birth, let the baby rest comfortably on the mother's chest in skin-
to-skin contact.

 DO NOT force the baby to take the breast.

 DO NOT interrupt feed before baby wants.

 DO NOT give any other feeds or water.

 DO NOT use artificial teats or pacifiers.

  IMPORTANT ISSUES TO DISCUSS WITH WOMEN AND THEIR FAMILIES,
IMMEDIATELY FOLLOWING BIRTH

 ∆ The importance of having someone nearby for the first 24 hours.

 ∆ The importance and recommended timing of postnatal visits.

 ∆ The importance of the new mother eating more and healthier foods –
discuss in the context of local practices and taboos to ensure women have
access to good nutrition. The new mother should also drink plenty of clean,
safe water.

 ∆ The importance of rest and sleep and the need to avoid hard physical
labour.

 ∆ Discussion of normal postpartum bleeding and lochia – discuss with

women how much blood loss they can expect, for how long. When bleeding is
more than normal, they should seek care urgently.

 ∆ Discuss the danger signs for the woman and baby and the
importance of seeking help quickly.

 ∆ Personal hygiene in the context of local practices and the

environment.

 ∆ Discuss with women the type of pads they will use and their disposal,
and care of episiotomy in the context of home conditions. Hand washing is
particularly important to prevent infections. It is also important not to insert
anything into the vagina

 ∆ Talk to them about when they can resume sexual relations and the
importance of condom use to prevent STI and HIV transmission (see Sessions
12 and 14). Sexual intercourse should be avoided until the perineal wound
heals. Discuss the importance of birth spacing and counsel on the use of a
family planning method.

 ∆ Discuss infant feeding and breast care and the importance of only
taking prescribed medicines when breastfeeding.

 ∆ Discuss the importance of the home environment for promoting the

health of the baby and recovery of the mother. For example, discuss the need
for warmth, good ventilation and hygiene for both mother and baby.

 ∆ In an area with malaria, discuss the importance of mother and baby

sleeping under an insecticide-treated bednet.
Health beliefs & practices of different cultures in:
PREGNANCY
 ƒ According to some Filipino beliefs, cravings for food during pregnancy
should be satisfied.
ƒ Some pregnant women may avoid eating black foods to avoid the birth of
an infant with a dark skin tone.
ƒ Some pregnant women may place great emphasis on being tidy and
beautiful, believing that these practices will influence the beauty of their
child.
ƒ Unpleasant emotions experienced by pregnant women may be blamed for
causing birthmarks.

Labor delivery
ƒ The most common birthing position is to lie down. Some women may
prefer a squatting position.
ƒ In some regions of the Philippines, it is believed that putting squash
leaves on the abdomen of a labouring woman can facilitate labour.
ƒ Some women believe that drinking coconut water can facilitate a fast
labour.
ƒ Some fathers may prefer to be close to their labouring wife, so they can
bury the placenta.

Puerperium
ƒ In some regions a father is responsible for the burial of the placenta. He
usually buries the placenta very quickly, because the burial of the placenta
indicates the end of the labour, and therefore the end of pain and blood loss
experienced by the labouring woman.
ƒ women should not bathe for about ten days after giving birth and during
menstruation. Bathing during these times is seen as a cause of ill health and
rheumatism in old age. Sponge baths and steam baths could be used as
alternatives.
ƒ In the Philippines when a woman has a baby, she usually rests while her
relatives do all the housework and cooking.
ƒ Postpartum women may be massaged with coconut oil, with the aim of
restoring their lost health, expelling blood clots from the uterus, returning the
uterus into a normal position, and promoting lactation.
ƒ Some Filipinas bind their abdomen tightly, believing that this practice
helps to prevent bleeding and helps the uterus to retract.
ƒ New and lactating mothers are often given rice porridge
 ƒ Traditionally, after labour, women wear heavy clothes or wrap themselves
in blankets to prevent exposure to ‘cold’ and ‘wind’.

Current trends in maternal and child care

 The health of mothers and children is interrelated and affected

by multiple factors.1 Millions of pregnant women, new mothers, and children
experience severe illness or death each year, largely from preventable or
treatable causes.

 Maternal Health: The health of mothers during pregnancy, childbirth,

and in the postpartum period.

 Child Health: The health of children from birth through adolescence,

with a focus on the health of children under the age of five. Newborn health is
the health of babies from birth through the first 28 days of life.
MATERNAL MORTALITY

 More than a quarter (27%) of all maternal deaths are due to severe
bleeding, mostly after childbirth (postpartum hemorrhage).

 Sepsis (11%), unsafe abortion (8%), and hypertension (14%) are other
major causes. Diseases that complicate pregnancy, including malaria,
anemia, and HIV, account for about 28% of maternal deaths.

 Inadequate care during pregnancy and high fertility rates, often due to
a lack of access to contraception and other family planning/reproductive
health (FP/RH) services, increase the lifetime risk of maternal death.

 While the percentage of pregnant women receiving the recommended

minimum number of four antenatal care visits has been on the rise, it is 52%
in developing countries and lower still in sub-Saharan Africa and Southern
Asia.
NEWBORN AND UNDER-FIVE MORTALITY
Complications due to premature births account for more than a third (35%) of
newborn deaths, followed by delivery-related complications (24%), sepsis (15%),
congenital abnormalities (11%), pneumonia (6%), tetanus (1%), diarrhea (1%),
and other causes of death (7%).12 Low birth weight is a major risk factor and
indirect cause of newborn death.13

 Newborn deaths account for most child deaths (46%), followed

 by pneumonia (13%), diarrhea (8%), injuries (6%), malaria (5%), HIV/AIDS
(1%), measles (1%), and other causes of death (21%).14 Undernutrition
significantly increases children’s vulnerability to these conditions, as does
the lack of access to clean water and sanitation.15

 Family planning

 allows people to attain their desired number of children and

determine the spacing of pregnancies. It is achieved through use of
contraceptive methods and the treatment of infertility

 The concepts of natural family planning methods

 Natural family planning (NFP) is the method that uses the

body’s natural physiological changes and symptoms to identify the fertile
and infertile phases of the menstrual cycle. Such methods are also known as
fertility-based awareness methods.
Advantages

 Natural family planning methods are generally the preferred

contraceptive method for women who do not wish to use artificial methods of
contraception for reasons of religion, or who, due to rumours and myths, fear
other methods.
Disadvantages

 Natural family planning methods are unreliable in preventing

unwanted pregnancy. It takes time to practise and use them properly, which
adds to their unreliability. Additionally, natural family planning methods do
not protect against sexually transmitted infections (STIs), including the
human immunodeficiency virus (HIV). You should advise couples to use
condoms to protect against STIs.

Effectiveness

 The effectiveness of any method of natural family planning can

vary from couple to couple, and all these methods are less effective for
couples who do not follow the method carefully

Periodic abstinence (fertility awareness) methods

 During the menstrual cycle, the female hormones estrogen and

progesterone cause some observable effects and symptoms:
  Estrogen produces alterations in the cervical mucus, which changes
from thick, opaque and sticky to thin, clear and slippery as ovulation
approaches.

 Progesterone produces a slight rise in basal body temperature

(temperature at rest) after ovulation. Otherwise, the function of progesterone
on the cervical mucus is just the opposite effect of estrogen — it makes the
cervical mucus thick, opaque and sticky.

 Observation of these changes provides a basis for periodic abstinence

methods. There are three common techniques used in periodic abstinence
methods, namely:

 A. Rhythm (calendar) method

 B. Basal body temperature (BBT) method

 C. Cervical mucus (ovulation) method.

Calendar or rhythm method

 This method is the most widely used of the periodic abstinence

techniques. The calendar method is a calculation-based approach where
previous menstrual cycles are used to predict the first and the last fertile day
in future menstrual cycles. This method requires a good understanding of the
fertile and infertile phases of the woman’s menstrual cycle. It is based on
the regularity of the menstrual cycle and the fact that an ovum (egg) can
only be fertilised within 24 hours of ovulation.
Advantages

 This method does not require daily monitoring of fertility

indicators.
Disadvantages

 It is associated with a high failure rate and can be difficult to use

in the case of irregular menstrual cycles. It also takes a long time to learn and
use it properly.
Effectiveness

 This method is about 95% effective if a woman uses it correctly.

2. Basal body temperature (BBT) method

Advantage

 No side-effects for this method.

  Encourages discussion about family planning between couples.
Disadvantages

 *High failure rate if the couple do not clearly understand the method.

 * Requires several days of abstinence.

 * Needs a longer duration to practice, understand and use properly.

 * False interpretation or indications in the case of fever, as this may

mislead the result of BBT.

 * A special thermometer may be required.

3. Cervical mucus method (CMM)

 The cervical mucus method (or Billings method) is based on the

recognition and interpretation of changes in cervical mucus and sensations in
the vagina, due to the effect of changes in estrogen levels during the
menstrual cycle. This method is also an ovulation method used by women
trying to get pregnant and have a child.

 Using this method, these are the times when it is safe to have sexual
intercourse:

 After menstruation ends the dry days (absence of cervical

secretions) will start, and during these days it is safe to have sexual
intercourse every other night until a woman starts to feel wet in her vagina.
Every other night is suggested, as it will help women from confusing semen
with cervical mucus.

Lactational amenorrhoea method (LAM)

 The lactational Amenorrhoea Method (LAM) is the use of
breastfeeding as a contraceptive method. Lactational means breastfeeding
and amenorrhoea means not having monthly bleeding. In this case, there is a
delay in ovulation caused by the action of prolactin hormone from the effect
of lactation or breastfeeding. An infant’s suckling of the nipple sends neural
signals to the mother’s hypothalamus (part of the brain), which influences
the anterior pituitary gland to secrete prolactin to stimulate the breast for
milk production. This, in turn, inhibits the secretion of follicle stimulating
hormone (FSH) and luteinizing hormone (LH), and as a result ovulation does
not occur. While women are exclusively breastfeeding, prolactin continues to
be secreted and pregnancy is unlikely. When prolactin levels decrease, the
woman’s monthly bleeding may return, and if she continues to have
unprotected sexual intercourse she may get pregnant.
Advantages
  Effectively prevents pregnancy for at least six months.

 Encourages the best breastfeeding pattern.

 Can be used immediately after birth.

 Does not interfere with sexual intercourse.

 No hormonal side-effects.
DISADVANTAGES

 Not a suitable method if the mother is working outside the home.

 No protection against STIs including HIV.

 If the mother has HIV, there is a small chance she may pass it to her
baby in breastmilk.

 Not effective after six months.

Coitus interruptus or withdrawal

 is a traditional family planning method in which the man
withdraws or pulls out his penis from his partner’s vagina and ejaculates
outside, keeping his semen away from her genitalia.

Mechanism of action of withdrawal method

 Coitus interruptus prevents fertilisation by stopping contact

between spermatozoa in the sperm and the ovum or egg.

Advantages of withdrawal method

 It is important for you to teach this method as part of natural

family planning methods. It costs nothing and requires no devices or
chemicals. It is available in any situation and can be used as a back-up
method of contraception.

 Disadvantages of withdrawal method

 It has several disadvantages. Interruption of the excitement of

sexual intercourse may result in the incorrect or inconsistent use of this
method, as well as decreasing sexual pleasure for both partners. A high
failure rate may be due to a lack of self-control, and semen containing sperm
may leak into the vagina before the person ejaculates. There is a further
possibility of premature ejaculation by the man. In addition, the couple is not
 protected from STIs, including HIV.

What is Standard Days Method (SDM)?

 SDM is a simple, modern, fertility awareness-based method of
family planning. SDM identifies a fixed set of days in each menstrual cycle
when a woman can get pregnant if she has unprotected intercourse. If the
woman does not want to get pregnant, she and her partner avoid
unprotected intercourse on days 8 through 19 of her cycle.

 A woman can use CycleBeads, a color-coded string of beads, to

help track the days of her menstrual cycle and see which days she is most
likely to get pregnant. Effectiveness

 In an efficacy study, SDM was found to be more than 95%

effective. That means that out of 100 women using the method for one year,
fewer than five of them would get pregnant if they used SDM correctly.

ARTIFICIAL METHOD

Barrier Methods
 Barrier methods of birth control physically stop the sperm from
getting to the egg. Condoms, the sponge, diaphragms and spermicides are all
barrier methods. Male and female condoms can help prevent the
transmission of sexually transmissible diseases, including HIV, herpes,
gonorrhea and chlamydia. Male and female condoms and spermicides are
available at any pharmacy and many discount stores and are relatively low in
price. Diaphragms are available only with a prescription.

Hormonal Methods

 Some birth control works by altering the woman's hormones to

make pregnancy unlikely or impossible. The birth control pill, the birth control
shot (Depo-Provera), the birth control patch, the vaginal ring and some IUDs
are examples of hormonal family planning options. These all require a
doctor's prescription and a medical exam before use. Hormonal birth control
is very effective when used correctly, but some women cannot use them for
health reasons.

Permanent Methods
 Surgical birth control is considered permanent, and is only for
people who do not want any or any more children. Men can have a
vasectomy, which is a procedure that is done on an outpatient basis in a
doctor's office. Women can have a tubal ligation, which is done under general
 anesthesia in a hospital. A newer method of non-surgical permanent
sterilization for women is called Essure. This procedure can be done in the
doctor's office in many cases (see Resources).

Emergency Methods

 If you do not use birth control, or if your birth control method

fails, you have the option of utilizing emergency contraception in the days
immediately following unprotected sex. This usually consists of taking a large
dose of hormones that are found in many birth control pills. Some brands are
available over the counter at your pharmacy, and others are available only
with a doctor's prescription.