FAMILY PLANNING

FAMILY PLANNING
• Couple decides on the number and spacing of children and timing of
births

• OBJECTIVE
1. Avoid unwanted pregnancies through contraception
2. Regulating intervals between pregnancies
3. Deciding on the number of children that will be in the family
4. Controlling the time at which birth occurs
5. Preventing pregnancy for women with serious illness in whom
pregnancy would pose a health risk
OBJECTIVES
6. Assisting the couples in choosing a method of family
planning by describing the method available for reproductive
planning, explaining the advantages and disadvantages of the
various methods
7. Discussing the risk factors associated with each methods
8. Over all goal of nursing intervention in family planning is to
improve general maternal, neonatal and family health
CHARACTERISTIC OF THE IDEAL
CONTRACEPTIVE METHOD
For any couple, an ideal contraceptive should be:
1. Safe
2. Free of undesirable side effects
3. 100% effective
4. Easily obtainable
5. Affordable
6. Acceptable to the user and sexual partner
7. Free of effects on future pregnancies
CONTRACEPTION METHODS
• NATURAL METHODS
1. ABSTINENCE
 most effective method for preventing conception and also to prevent
STD
2. CALENDAR METHOD ( rhythm)
 Fertile periods are calculated by recording 12 consecutive menstrual
cycles, the subtracting 18 days from the end of the shortest cycle and
subtracting 11 days from the end of the longest cycle to determine
the fertile period
 Advantages are that it is inexpensive and convenient, no side effects,
encourages communication, is ethically and morally noncontroversial,
and is appropriate for sexual education programs
• Disadvantages are that, it requires long period of abstinence and self-
control, correct calculations and regular menstrual periods to be
effective, in addition, confusing irregular uterine bleeding with a
menstrual periods may lead to incorrect calculations. Effectiveness is
unreliable and depends on many variables
3. BASAL BODY TEMPERATURE (BBT) method
 Uses the single sign of a rise in BBT to predict ovulation ( the fertile
period) and to begin abstinence. In general, abstinence begins with
the 1st days of menses and continues until the 3rd day of temperature
elevation.
 BBT is measured by taking and recording the temperature orally each
morning before arising after at least 3 hours of sleep. BBT drop before
ovulation and rises 0.4 to 0.8 F with ovulation (in response to
progesterone production from the corpus luteum)
• Advantages are, it is inexpensive, no side effects, encourages
communication, it is ethically and morally noncontroversial,
• Disadvantages are , it is not effective as other methods, temperature
elevation may result from conditions other than ovulation, it requires
regular and accurate record keeping.
4. CERVICAL MUCUS METHOD
 Uses the appearance, characteristics, and amount of cervical mucus
to identify ovulation. Because of the activity of estrogen and
progesterone in the ovulatory period, cervical mucus is clear and
slippery (like an egg white) and more abundant. In the preovulatory
and post ovulatory periods, cervical mucus is yellowish, less
abundant, and thick and sticky, thereby inhibiting sperm motility
 Advantage are it is inexpensive, has no side effects
 Disadvantage is it is not as effective as other methods
5. SYMPTOTHERMAL METHOD
 Couple uses a combination of the above mentioned techniques to
determine the fertile period
 Advantages are, it is inexpensive, provides the couple with more
information, encourages communication, and no side effects
 Disadvantages are, it is more complex and difficult to learn, requires
regular and daily effort
6. MITTELSCHMERZ
 Between menstrual cycles, some women experience pain when the
ovary releases an egg. Rarely the pain maybe accompanied by scant
vaginal spotting. Some couples use this symptom as the signal of the
beginning of the fertile period and avoid sexual intercourse until the
fertile period passes
• Advantages are it is convenient and inexpensive
• Disadvantages are it requires reliable and identifiable pain and
differentiation among like symptoms, it is not as reliable as other
methods
COITUS INTERRUPTUS
1. This method requires withdrawal of the penis from the vagina
before ejaculation
2. It is highly ineffective because sperm exist in pre-ejaculatory fluid.
Effectiveness depends on the man’s ability to withdraw before
ejaculation.
3. Advantages are it is inexpensive and medically safe
4. Disadvantages are, it is unreliable, interrupts sexual excitation or
plateau, and diminishes satisfaction
LACTATION AMENORRHEA METHOD
• Breast feeding woman who choose to breast feed her new born
exclusively, the return to normal ovulatory and menstrual cycles will
be delayed for weeks and even months
• Women rely on breast feeding as a contraceptive method. It is most
effective if the woman is exclusively breastfeeding with no
supplemental use by the infant
• Client must be amenorrheic
ARTIFICIAL METHODS
SPERMICIDES
1. Vaginal jelly, cream, suppository, or foam preparations
interfere with sperm viability and prevent sperm from
entering the cervix. The active chemical ingredient destroys
the sperm cell membrane
2. Advantages are that it is available without prescription, are
useful when other methods are inappropriate or
contraindicated, have few or no side effects
3. Disadvantages are they have a lower effectiveness than
other methods, may irritate tissues (alum) . One dose of
most spermicides is effective for 1 hour. If a longer time has
passed, a new application of spermicide is required
BARRIER METHODS
1. FEMALE CONDOM ( vaginal pouch)
 This is a long polyurethane sheath that inserts manually into the
vagina with flexible internal ring forming the cervical barrier and a
wide outer ring extending to cover the perineum.
 Advantages are it protects against STDs and conception, allows the
woman to control protection, is inexpensive for single use and
disposable
 Disadvantages are it is esthetically unappealing, requires dexterity, is
expensive for frequent use, may cause sensitivity to sheath material
and decreases spontaneity
2. MALE CONDOM
 This is a rubber sheath that fits over the erect penis and prevents
sperm from entering the vagina
 Advantages are it helps prevent conception and transmission of STDs,
has no side effects, in addition, the condom helps men maintain
erections longer, prevent premature ejaculation, prevents sperm
allergies, and is easily and discretely carried by men or women
 Disadvantage are it may decrease spontaneity and sensation, and
should be used with vaginal jelly if the condom or vagina is dry, male
condom cannot be used in cases of latex allergy in the man or woman
 “natural” (animal skin) condoms are available, but they are expensive
and do not protect against most STDs
3. CERVICAL CAP
• A small rubber or plastic dome that fits snugly over the cervix
• Effectiveness depends on parity.
• Advantage is it provides continuous protection for 48 hours, no
matter how many times intercourse occurs, additional spermicide is
not necessary for repeated acts of intercourse
• Disadvantage are it may dislodge, must be filled with spermicide,
must be fitted individually by a health care provider, and may not be
used if the woman has anatomic abnormalities or an allergy to plastic,
rubber or spermicide. Wearing for longer than 48 hours is not
recommended because of the risk of toxic shock syndrome
• Side effect trauma to the cervix or vagina, pelvic infection, cervicitis,
and abnormal Pap test results. Odor problems may occur with
prolonged use
4. DIAPHRAM
 A flexible ring covered with a dome- shaped rubber cap that inserts
into the vagina and covers the cervix. The posterior rim rest on the
posterior fornix and the anterior rim fits snugly behind the pubic
bone. It is used with spermicide in the dome and around the rim, is
applied no more than 2 hours before intercourse, and is left in place
for 6 hours after coitus, but no longer than 12 hours.
 Advantages are it is reusable and inexpensive with use over several
years
 Disadvantage are it requires dexterity to insert, it must be fitted
individually and must be refitted after a weight loss. Wearing for
longer than 24 hours is not recommended because of the risk of toxic
shock syndrome
 Side effect include toxic shock syndrome, cystitis, cramps or rectal
pressure, and allergic reaction to spermicide or rubber
INTRAUTERINE DEVICE (IUD)
1. A flexible device inserted into the uterine cavity. It alters tubal and
uterine transport of sperm so that fertilization does not occurs
2. Advantage are it is inexpensive for long term use, reversible, has no
systemic side effects, may be used in breast- feeding women, and
requires no attention other than checking that it is in place ( by
feeling for the attached string in the vaginal canal)
3. Disadvantage are there are possibly serous side effects. The device
is available only through a health care provider and cannot be used
if the woman has an active or chronic pelvic infection, postpartum
infection, endometrial hyperplasia or carcinoma or uterine
abnormalities. It should not be used by women who have an
increased risk of STDs and with women with multiple sexual
partners
4. Side effects include dysmenorrhea, increase menstrual flow, spotting
between periods, uterine infection or perforation, and ectopic
pregnancy. Danger signs to report to the physician include late or
missed menstrual period, severe abdominal pain, fever and chills, foul
vaginal discharge, and spotting, bleeding or heavy menstrual periods.
ORAL CONTRACEPTIVES
 Combined estrogen and progesterone preparation in tablet form
inhibits the release of FHS, LH, and an ovum. The tablets are taken
daily .
 Advantages are they are among the most reliable contraceptive
methods and are convenient to use. In addition, they are protective
against ovarian and endometrial cancer, benign breast disease,
ovarian cysts, ectopic pregnancy, pelvic inflammatory disease(PID)
and anemia. Oral contraceptives also tend to decrease menstrual
cramps and pain
• Disadvantages are they should not be used by women who smoke or
with a history of thrombophlebitis, circulatory disease, varicosities,
diabetes, estrogen dependent carcinomas, or liver disease
• Side effect include breakthrough bleeding, nausea, vomiting,
susceptibility to vaginal infections, thrombus formation, edema,
weight gain, irritability and missed periods, danger signs indicating
complications include abdominal pain, chest pain or shortness of
breath, headache, blurred or loss of vision, and pain in the calf or
thigh.
• Contraindication include breast feeding and diabetes mellitus, history
of liver disease, undiagnosed vaginal bleeding
• SUBCUTANEOUS INJECTION
• Medroxyprogesterone (DMPA or Depo- Provera) is an intramuscular
injection given every 3 months that works like subdermal implants
• Advantages are it is highly effective and requires little attention
except for returning to the health care provider for injection every 3
months. It maybe used by breastfeeding
• Disadvantages are the risk of breast cancer and osteoporosis may be
increased, there maybe a delayed return to fertility up to 18 months,
and bone density may be decrease
• Side effect are primarily spotting, headache, weight gain, amenorrhea
particularly after the first year
STERILIZATION
VASECTOMY
• Surgical ligation of the vas deferens terminates sperm
passage through the vas completely after residual sperm
clear the male reproductive tract
• Advantages are it is highly effective and usually permanent
• Disadvantages are it requires surgery and may be
irreversible. Reversal success rates vary; anatomic success is
40% to 90%; clinical success is 18% to 60%. Vasectomy offers
no protection against STDs
TUBAL LIGATION
 The fallopian tubes are surgically ligated or cauterized
through either minilaparotomy or laparoscopy
 Advantages are it is highly effective and usually permanent.
May be performed immediately postpartum
 Disadvantages are it is an invasive procedure and may be
irreversible. Tubal reconstruction has 50% to 70% successful
reversal rate; there is a high risk of ectopic pregnancy after
reversal.
NURSING PROCESS
ASSESSMENT
1. Health history
 Determine the type of contraception the woman or couple desires
 Obtain a through medical, surgical, menstrual, and obstetric history to
identify any contraindication to the desired method
2. Physical examination
 Perform a precontraception physical examination to include reast and
pelvic examination, vital signs, and aspects as appropriate
3. Laboratory and diagnostic studies
a. Pap smear – used to detect cervical or to validate that lesions from
infections are healing
b. Serologic- used to detect syphilis or gonorrhoea
c. Cultures – used to detect gonorrhoea or other sexually transmitted
infections
d. Urinalysis – used to detect urinary tract infections
e. Complete blood count – used to determine anemia or infection and
estimate clotting ability
NURSING DIAGNOSES
1. Knowledge Deficit
2. Decisional Conflict
3. Spiritual Distress
4. Health – Seeking Behaviour
5. Powerlessness
6. Ineffective Sexuality Pattern
PLANNING AND OUTCOME IDENTIFICATION

1. The woman or couple will identify possible

methods of contraception that will fit their
lifestyle
2. The woman or couple will choose an
appropriate contraceptive method
IMPLEMENTATION
1. Provide client and family education
a. Evaluate the woman or couple’s knowledge of available
contraceptive methods, provide information to correct
misconceptions
b. Teach the woman or couple about the chosen method, including
Insertion and removal
Application and removal for condoms
Dosage schedule for oral contraceptives
Techniques for natural methods
2. Assist the woman or couple in choosing an appropriate method of
contraception
a. Counsel the couple about safer sex practices such as using a
condom during intercourse
b. Provide an atmosphere of non-judgmental discussion and
information sharing
c. Because this is a highly personal decision, obtain the couple’s view
of contraception, and their beliefs and attitudes
d. Discover the couple’s fear and concerns related to birth control
e. Educate the couple about the correct use of the various methods
available
OUTCOME EVALUATION
1. The woman or couple explains how to use the selected method,
and any danger signs associated with method selected
2. The woman or couple demonstrates the correct use of the
contraceptive method chosen
3. The woman or couple verbalizes satisfaction with the selected
contraceptive method
QUIZ
1 to 3 -Give 3 natural contraceptive methods.
4 to 5 - Give 2 permanent sterilization methods
6 to 8 - Give 3 possible contraindication of oral
contraceptive use
9 to 10 - Give 2 barrier methods for family planning