Family Planning

Dr. Shahnaz Ayasrah

Associate professor

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Family Planning
Involves choosing the time to have children.
It includes contraception(prevention of
pregnancy) as well as method to achieve
pregnancy
The nurse’s role in family planning is counselor
and educator

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Consideration when Choosing a
Contraceptive Method
Safety
Protection from STDS
Effectiveness
Acceptability
Convenience
Education needed
Benefits

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Consideration when Choosing a
Contraceptive Method
Side effects
Effect on Spontaneity
Availability
Expense
Preference
Religious and Personal beliefs
Culture

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Methods of Contraception
1.Sterilization:
A. Tubal Sterilization (Tubal Ligation or
Female Sterilization)
Fallopian tubes may be cut or occluded so
that fertilization cannot occur
Procedure can be done during C/S or the
first 48 hours after vaginal birth (fundus is
located near umbilicus)

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B.Vasectomy :(Male Sterilization)
Making small puncture or incision in the
scrotum & cutting, tying, removing a
section , or cauterizing the vas deference
which carries the sperm from the testes to
the penis.
After vasectomy, sperm no longer pass
into the semen
Performed under local anesthesia

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2.Hormonal Contraceptives
A. Hormone Implant :
A single rod implant (Implanon) is now
available
Inserted subcutaneously into upper inner
arm
It is 2mm *4cm and release progestin
continuously to provide protection for 3 years
It acts by inhibiting ovulation and thickening
cervical mucus

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Hormone Implant
Side effects:
Irregular menstrual bleeding
Amenorrhea
Advantages : safe during lactation
and fertility returns promptly when
implants is removed

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2.Hormonal Contraceptives
B.Hormone Injections
Depo-Provera birth control shots –
contain progesterone
(Medroxyprogesterone acetate or
DMPA) is an injectable progestin
Prevent ovulation for 12 weeks.

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Advantages of hormone injections

Convenient, free of estrogen, Can be

used at any age if woman in a good
health.
Can be used by breast feeding
mothers.
Injection started 6 weeks after delivery
Return of Fertility in approximately 10-
18 months (9-12).

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General considerations
Women who should not use hormonal
contraceptive should not also use Depo Provera.
Given I.M deeply & site of injection should not
be massaged (accelerate absorption & decrease
period of effectiveness).
Injection is best given within 5 days of menstrual
period
Women who use Depo-Provera injections should
get adequate amounts of calcium and vitamin D
and should increase weight bearing exercise

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Disadvantages of injections
Menstrual irregularities
Spotting and break through bleeding
Amenorrhea in 50%
Weight gain around 2Kg/year
Headache, depression, hair loss.
Decreased bone density with long term
use

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3.Oral Contraceptives (OCs) :

Has two types:

A. Combination Pills :Estrogen and
Progesterone combination
Action:
Inhibit maturation of follicle due to the
increased level of Estrogen & Progesterone.
Movement of sperm is inhibited by the thick
vaginal secretions & endometrium become
less hospital for implantation.
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B. Mini Pills (Progestin only):
Action:
They are less effective in inhibiting ovulation
but causes thickening of cervical mucus which
helps prevent penetration by sperm & makes
the endometrium lining un favorable for
implantation.
Advantage :
These pills reduce the side effects associated
with estrogen

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Benefits of oral contraceptives

Decreased premenstrual syndrome

Reduce acne
Improve bone density
Cycle control that make periods regular and
minimal bleeding
Improve endometriosis, Dysmenorrhea,
polycystic ovary syndrome and hirsutism
Decrease incidence of benign breast disease,
ovarian cysts, pelvic inflammatory disease,
salpingitis and ectopic pregnancy
Reduce ovarian and endometrial cancer 16
 Side effect of Oral Contraceptives
Nausea
Headache
Breast tenderness
Breakthrough bleeding
Weight gain
Fluid retension
Amenorrhea
Cholasma
Mood swings
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Using of oral contraceptives
• Take 1 pill every day for 21 days (3 weeks) in a
row. Then don't take any pills for seven days
(week 4). The woman will get her period during
the fourth week as she is not taking any
hormone-pills. As a reminder (hormone-free)
pills almost added after the 21 hormone-pills.
• Notes:
-Missing one tablet usually does not require use
of another contraceptive method. The woman
should take the pill as soon as remembered.
Take the next dose at the usual time.
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Using of oral contraceptives
A woman who misses more than one
tablet should use another form of
contraception to avoid pregnancy.
Intervention will differ according to the
time she missed these dose and the
preparation she used

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 Intrauterine Devices :
Intrauterine devices are inserted into the
uterus to provide continuous pregnancy
prevention.
IUD are considered very safe at this time.
Types:
Copper T(ParaGard)
Levonorgestrel System (Mirena)
Often inserted at the 6-week postpartum
check up & safe during lactation.

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Action

IUD causes a sterile inflammatory response

resulting in a spermicidal intrauterine
environment , they don’t cause abortion. Very few
sperm reach the fallopian tube.

• The IUD works by preventing fertilization. The

copper IUD releases copper ions into the uterine
cavity which are toxic to the sperm entering the
uterus and fallopian tubes. The hormonal IUD
releases 20 micrograms of levonorgestrel each day
which thickens the cervical mucus and inhibits
sperm movement and viability
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Effectiveness
ParaGard produces changes in the
uterine and tubal fluids to impair sperm
function, it remains effective for 10 years

Mirena contain progestin which causes

thickening in cervical mucus preventing
sperm penetration, inhibits sperm
motility and prevent implantation, its
action lasts 5 years
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Side effects for IUD :
1. Cramping & bleeding a few days after insertion
2. Menorrhagia & Dysmenorrhea are common reasons
for removal (mostly occurs with copper IUD ).
3. Vaginal spotting : Spotting between periods ( may
occur during the early months but may be followed by
less bleeding with periods or amenorrhea ( mostly
occurs with Levonorgesterl system also called LNG-
IUS Mirena ).
4. Cramps or a backache Irregular periods (hormonal
IUD)
Note : Ibuprofen relieve cramping,& iron supplement for
prevention of anemia. 24
 Complications
1. Infection. One of the most serious complications that can
arise because of an IUD is infection. it can lead to pelvic
inflammatory disorder.
2. Expulsion. Expulsion occurs when the IUD has moved from
its intended position at the top of the uterus.The two types
of expulsion are complete (PUSHING OUT) and partial
(PUSING IN TO THE TOP OF UTERUS).
3. Perforation. Perforation (the IUD pushing into or through
the muscle of the uterus) is rare, occurring in 1–2 per 1,000
IUD insertions. This typically occurs during the insertion
process

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Teaching about IUD

Nulli parous women, recent or recurrent pelvic

infections , history of ectopic , bleeding disorders
or abnormalities of the uterus should choose
another contraceptive method.

Report signs of infection such as unusual vaginal

discharge, pain or itching, low pelvic pain & fever.
Report signs of pregnancy.
Advice woman to do Pap smear yearly , & check for
anemia if menses are heavy.

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•Barrier Methods :
1.Chemicals
2.Mechanical (devices)

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1.Chemical Barriers :
Chemicals that kill sperm are called
spermicides creams,gels are generally
used with mechanical barriers such as
diaphragm or cervical cap.
Foams , foaming tablets, suppositories,
vaginal films are used alone.

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They are inserted deep into vagina just
before intercourse, vaginal suppositories
and films must melt before they become
effective which takes about 15 minutes
They are effective for less than one hour
and as long as 8 hours depending in the
type used
Woman should not douche for at least 6
hours after intercourse

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• Note:
Should be used with condoms to increase
lubrication and decreasing the risk of condom
breakage.
Helpful during lactation or in menopausal
woman when vaginal secretions are decreased.
Readily available, inexpensive and easy to use
Do not protect against STDS
Frequent use or sensitivity to the products
may cause genital irritation which increases
susceptibility to infection.

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Mechanical Barrier
Are devices placed over the penis or cervix to prevent
sperm from entering the uterus.
Types:
1.Condom(male & female)
2.Diaphragm
3.Cervical Cap

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• Male condom:
 It is one of the most popular
contraceptive methods in USA.
It prevent sperm from entering
the vagina.

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Advantage of Condom:
Readily available
Inexpensive
Protect from STD

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 Natural Family Planning
Also called fertility awareness, or periodic abstinence
methods.
Woman uses the physiologic cues to predict ovulation &
avoid coitus when conditions are favorable for fertilization.
Also can be used by the woman who wishes to become
pregnant.

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Types of Natural Method of Family
Planning
1. Calendar Method
2. Basal Body Temperature
3. Cervical Mucus(ovulation or Billing's
method)
4. Sympto-thermal Method
5. Abstinence
6. Breast Feeding

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 1.Calendar Method:
Based on the timing of ovulation ,approximately
14 days before the onset of menses.
Tract length of the cycle for 6 months then
substract 18 days from the shortest cycle and 11
days from the longest cycle to predict the time
when fertilization is possible.
Disadvantage :
• Un reliable because many factors such as illness
or stress can affect time of ovulation.

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• 2.Basal Body Temperature:
Woman charts her oral temperature each
morning before getting out of bed.
Temp. may drop slightly before ovulation and
then rise approximately 0.2-0.4 c with ovulation
.Then temp. remains higher throughout the
second half of the cycle.
The woman is no longer fertile on the night of
the third day after the rise in temp.

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