RESPONSIBLE PARENTHOOD (basta katong contraceptives na last gidiscuss ni mam)

RESPONSIBLE PARENTHOOD

- the will and ability of parents to respond to the needs and aspirations of the family/children.

RESPONSIBLE PARENTHOOD

--> desired number

--> spacing

--> timing of the children

- shared responsible of husband and wife to achieve the:

-->

-->

-->

1.) identification of the fertile and infertile periods of a woman

2.) observing the signs and symptoms throughout the menstrual cycle

3.) allowing the sexual intercourse to be timed

4.) either achieve or avoid pregnancy

NATURAL FAMILY PLANNING -

Fertility Awareness Based (FAB) Methods involve: (4)

- no side effects

- acceptable to all religions

- economical

- promotes communication between couples

- can be transferred to the next generation

5 ADVANTAGES of the Fertility Awareness Based methods (NATURAL FAMILY PLANNING):

- no Drugs

- no Injections

- no Device

- no Operations

FAB methods are no DIDO methods:

1. BASAL BODY TEMPERATURE (BBT)

2. MUCOS METHOD (MM)

3. SYMPTOTHERMAL METHOD

4. LACTATIONAL AMENORRHEA METHOD (LAM)

5. STANDARD DAYS METHOD (SDM)

--> Fertility Tracking Tool (FTT )

NATURAL FAMILY PLANNING - Fertility Awareness Based (FAB) Methods: (5)

Basal Body Temperature (BBT)

- temperature at rest after at least 3hrs of continuous sleep

- daily taking and recording

there is a shift in the woman's body temperature during the ovulation period

the explanation for BBT is because?

COVER LINE

How do you know WHEN is the FERTILE DAY (BBT)?

___________ - point of reference for determining the thermal shift that occurs during ovulation

- first 10 days

- first 5 days

- horizontal line; day 6 to 10

How do you know WHEN is the FERTILE DAY (BBT)?

DETERMINING THE COVER LINE:

1. Identify the temp for the __________

2. Disregard the temp for the __________

3. Find the highest temp from DAY 6 to DAY 10 (??). Disregard any temp that abnormally high due to illness.

4. Draw a __________ across the chart on the highest temp from _______.

- 3rd day of the thermal shift; end

- fertile

BBT - To postpone pregnancy:

- intercourse is allowed from the ________ until the ____ of the cycle

--> the first day of the menstrual cycle until the second day of the thermal shift are considered _________.

MUCUS METHOD

- cervical mucus changes indicate whether days are fertile or not

- MENSTRUAL PHASE

- PRE-OVULATORY PHASE

- OVULATORY

- POST-OVULATORY

MUCUS METHOD (MM) - Phases of Menstrual Cycle: (4)

MENSTRUAL PHASE

MUCUS METHOD (MM) - Phases of Menstrual Cycle:

- bleeding;

- no pregnancy

PRE-OVULATORY

MUCUS METHOD (MM) - Phases of Menstrual Cycle:

- mucus forms a plug

- includes all dry days after the menstrual bleeding stops

- relatively infertile phase

OVULATORY

MUCUS METHOD (MM) - Phases of Menstrual Cycle:

- one mature egg is released

- wet feeling with watery, slippery stretchy and clear mucus

- fertile phase

POST-OVULATORY

MUCUS METHOD (MM) - Phases of Menstrual Cycle:

- no egg is present

- mucus forms a plug again

- absolutely infertile phase

1. observing the mucus

2. recording mucus observations

2 SKILLS in Mucus Method:

WHO: woman

WHAT:

- what you feel (dry or wet)

- what you see (mucus)

WHERE: around the vaginal area

WHEN:

- everyday from first day of menstruation

- throughout the day

- before or after urinating

HOW:

- note if you feel wet or dry around the vaginal area

- see if there is mucus in the underwear

- pass a tissue around the vaginal area and see if there is mucus on tissue

MUCUS METHOD (MM) - Observing the Mucus:

WHO:

WHAT:

WHERE:

WHEN:

HOW:

WHO: the couple

WHAT:

- what woman feels

- what woman sees

WHERE: on mucus method chart

WHEN: end of day before going to bed

HOW:

- write what you feel

- write what you see

- use chart symbols

MUCUS METHOD (MM) - Recording Mucus Observations:

WHO:

WHAT:

WHERE:

WHEN:

HOW:

- wet; dry

- nothing; blood; mucus

--> sticky, pasty, crumbly

--> stretchy, slippery, clear, watery

GUIDE FOR RECORDING MUCUS OBSERVATIONS:

- WHAT YOU FEEL? (2)

- WHAT YOU SEE? (3)

--> mucus characteristics

R

D

X

Ⓧ

M

1,2,3

❤️

GUIDE FOR RECORDING MUCUS OBSERVATIONS - Chart Symbols:

___ - "regla" or menstruation; spotting

___ - dry, no mucus

___ - wet with slippery, stretchy, clear, or watery mucus

___ - Peak day, LAST day of wetness / wet mucus

___ - Dry with sticky, pasty, or crumbly mucus

___ - post peak days

___ - lovemaking

PEAK DAY

- is the LAST day of the wetness (i.e., wet feeling and/or wet mucus)

- 3 days

- dry and see no mucus; dry mucus

- 4th day

what is the PEAK DAY RULE:

1.) count ______ after the PEAK DAY

2.) on the post-peak days 1, 2 and 3, the woman will feel ______ and see no ______, or ______ if any

3.) on the ______ after the peak day, resume lovemaking day and night, until the next menstruation without it resulting in pregnancy.

EARLY DAYS RULE

- on dry days following menstruation, lovemaking is possible on alternate evenings only

women who have dry days after menstruation

WHO can use the EARLY DAYS RULE?

SYMPTOTHERMAL METHOD

- based on the combined technology of BBT and Mucus Method

- fully or nearly fully breasted

- menstrual period

- less than 6 months old

WHEN can a woman use LAM?

- her baby is _____ or _____ (every 4hrs during the day and every 6hrs at night)

- her _____ has not returned yet

- her baby is _____

- first 6 months

- 98%

EFFECTIVITY OF LAM:

- within the ________ after delivery

= ____%

MUCUS METHOD for Breastfeeding/ LAM interface

______________:

- used when any of the conditions for LAM is not applicable

--> determine Basic Infertile Pattern (BIP) for 2 weeks (abstain)

--> apply EDR

STANDARD DAYS METHOD (SDM)

--> Fertility Tracking Tool (FTT version ni mam for visually impaired)

- for women with cycle of 26-32 days

- Days 18-19 is the fertile window

- this 12-day fertile window includes:

--> lifespan of the sperm cell

--> ovulation time

--> life span of egg cell

--> six-day variation in the cycle range

= 26-32 days

= Days 18-19

--> lifespan of the sperm cell

--> ovulation time

--> life span of egg cell

--> six-day variation in the cycle range

STANDARD DAYS METHOD (SDM):

- for women with cycle of ____-____ days

- Days ____-____ is the fertile window

- this 12-day fertile window includes:

-->

-->

-->

-->

- no counting

- no charting

- no calculations

ADVANTAGES of Standard Days Method (SDM): (3)

Standard Days Method (SDM)

beads are used for tracking fertile and infertile days of cycle

1. ORAL CONTRACEPTIVES

2. SUBCUTANEOUS IMPLANTS

3. INTRAMUSCULAR INJECTIONS

--> Medroxyprogesterone acetate (DMPA or Depo-provera)

4. INTRAUTERINE DEVICE

ARTIFICIAL METHODS: (4)

ORAL CONTRACEPTIVES

- composed of varying amounts of estrogen and progesterone

= 99.5% effective

- monophasic

- biphasic

- triphasic

3 KINDS of Oral Contraceptives:

MONOPHASIC

3 KINDS of Oral Contraceptives:

- fixed doses of e and p throughout the 21 day cycle

BIPHASIC

3 KINDS of Oral Contraceptives:

- constant amount of estrogen but increased amount of progestin during the last 11 days

TRIPHASIC

3 KINDS of Oral Contraceptives:

- varying both estrogen and progestin content throughout the cycle

- closely mimic a natural cycle

- Sunday

- 2 tablets; tomorrow

- 2 tablets

ARTIFICIAL METHOD - Oral Contraceptive:

- start take pill 1 on a _______ following the beginning of a menstrual flow

- if you forgot to take the pill yesterday, take _______ today as soon as you remember. Resume pill taking ______

- if you forgot to take your pills for 2 days in a row, take ______ for 2 days.

- weight gain

- headache

- breast tenderness

- breakthrough bleeding (spotting)

- monilial vaginal infections

- mild hypertension

MAIN SIDE EFFECTS of Oral Contraceptive Pils:

- breastfeeding and < 6 weeks PP

- > 35 years old, smoking > 15 cigars/day

- BP of 160/100 mmHg and above

- deep vein thrombosis

- stroke

- migraine

- current breast cancer

- diabetes

- liver problems

CONTRAINDICATIONS to OCP:

- hypertension

A - abdominal pain

C - chest pain / SOB

H - headache, sever

E - eye problems

S - severe leg cramps

STOP OCPs when:

______ - immediate discontinuation

A -

C -

H -

E -

S -

- may cause permanent suppression of pituitary-regulating activity

- improve facial acne

- decrease dysmenorrhea

Use by adolescents of Pills:

- disadvantage

- benefits (2)

= 1-2 months; 6-8 months

- clomiphene citrate (Clomid)

DISCONTINUING USE of OCPs:

- woman may not become pregnant for __-__ months and possibly __-__ months

- if ovulation does not occur, it can be stimulated by _________ (_________)

MINI-PILLS

- no estrogen, only PROGESTERONE

- can be taken during breast-feeding

SUBCUTANEOUS IMPLANTS

- norplant consists of 6 silicone implants filled with synthetic progesterone

- 5 years protection

- inserted during menses and no later than day 7 of the menstrual cycle

- suppresses ovulation

- stimulates thick cervical mucus

- prevents implantation

- Norplant; 6 silicone implants; synthetic progesterone

- 5 years

- menses; day 7

- ovulation

- thick cervical mucus

- implantation

SUBCUTANEOUS IMPLANTS:

- _______ consists of _______ filled with _______

- ___ years protection

- inserted during _______ and no later than _______ of the menstrual cycle

- suppresses _______

- stimulates _______

- prevents _______

- expensive

- weight gain

- scarring

DISADVANTAGES and SIDE EFFECTS of subcut implants: (3)

- used safely with adolescents and breastfeeding mothers

- rapid return to fertility (3 months)

ADVANTAGES of subcut implants: (2)

- undiagnosed uterine bleeding

- infection at the insertion site

CONTRAINDICATIONS of subcut implants: (2)

INTRAMUSCULAR INJECTIONS

--> Medroxyprogesterone acetate (DMPA or Depo-provera)

- given every 12 weeks (3 months)

- nearly 100% effectively

- possible s/e:

--> spotting/breakthrough bleeding

--> headaches

--> weight fluctuations

Medroxyprogesterone acetate (DMPA or Depo-Provera)

- 12 weeks (3 months)

--> spotting/breakthrough bleeding

--> headaches

--> weight fluctuations

INTRAMUSCULAR INJECTIONS: _____ (_____)

- given every _____ (_____)

- nearly 100% effectively

- possible s/e:

-->

-->

-->

(Adv)

- can be used during breastfeeding

(DisAdv)

- must return to health care provider every 3 months

- fertility may be delayed for up to 6-12 months

ADVANTAGES and DISADVANTAGES of Depo-provera:

(Adv) 1

(DisAdv) 2

INTRAUTERINE DEVICE

- creates local sterile inflammatory process

- the copper impedes sperm movement

- prevents fertilization

- inserted before the client has coitus after a menstrual flow

- spotting or uterine cramping

- heavier than usual menstrual flow and dysmenorrhea

- ectopic (tubal) pregnancy and Pelvic Inflammatory Disease (PID)

SIDE EFFECTS of IUD:

- __________ or __________ the first 2 weeks after insertion (use vaginal foam)

- __________ and __________ for 2-3 months

- higher risk of __________ and __________ (PID)

- never been pregnant

- distorted uterus

- multiple sex partners

- Hx of pelvic inflammatory dse.

- severe dysmenorrhea

- menorrhagia

CONTRAINDICATIONS of IUD:

BARRIER METHODS:

1. SPERMICIDES

2. DIAPHRAGM

3. CERVICAL CAP

4. MALE CONDOMS

5. FEMALE CONDOMS

BARRIER METHODS

- no hormonal side affects

- but high failure rates and less enjoyment

SPERMICIDES

- spermicidal foam

- cream, gel, film

- suppository, sponge

- change the vaginal pH to strong acid level

- help protect against STDs (benefit)

- 80% failure rate (disadvantage)

- examples:

- gels or creams

- Films

- vaginal suppository

APPLICATIO of Spermicides:

- ______ :

--> inserted before coitus with an applicator

--> 1hr before and leave for 6hrs after

- ______:

--> folded and inserted vaginally

- ______:

--> insert 15 mins. prior

DIAPHRAGM

- before coitus, coat the rim with a contraceptive jelly

- squat, elevate one leg or lie in a supine position

- insert into vagina sliding along the posterior wall

- check if it is secure by palpating the cervical os.

- 6hrs after coitus

- anterior rim and withdraw

- mild soap and water

REMOVAL of Diaphragm:

- keep the diaphragm in place for at least ________. (not more than 24hrs)

- loosen the device by pressing the ________ and ________

- wash with ________ and ________ and store in container

--> bag-o nanganak

--> lost or gained 15lbs

--> have had cervical surgery and miscarriage

SPECIAL CONSIDERATIONS in using diaphragm:

- Have it refitted if: (3)

- history of UTI

- anatomical deviations of the cervix and uterus

- acute cervicitis

CONTRAINDICATIONS in using diaphragm: (3)

CERVICAL CAP

- soft rubber shaped like a thimble that fits snugly over the cervix; more easily dislodged

- abnormal cervix

- history of toxic shock syndrome

- history of cervical cancer

CONTRAINDICATIONS OF CERVICAL CAP:

MALE CONDOMS

- latex rubber or synthetic sheath that is places over an erect penis

- typical failure: 12%

- prevents the spread of STDs

- penile-vulvar contact

- loose at the tip

- flaccid

MALE CONDOMS:

- must be applied before any _________

- must be loose _________ to collect the ejaculate

- penis is withdrawn before it becomes _________

FEMALE CONDOMS

- has inner and outer rings

- should NOT be used together with male condom

1. VASECTOMY

2. TUBAL LIGATION

SURGICAL METHODS OF CONTRACEPTION: (2)

VASECTOMY

- simultaneous identification of each bas deferens

- vas injected with anesthetic

- small incision made over vas

- 6 months

--> 2 negative sperm reports

--> 10-20 ejaculations

= 45%

PATIENT TEACHING for VASECTOMY:

- sexual activity can be resumed within 1 week but spermatozoa remaining in the vas deferens remains viable for ________

- use another birth control method until:

-->

-->

- success rate for reanastomosis is ____%

TUBAL LIGATION

- cauterization of fallopian tubes

- fallopian tubes sealed shut

TUBAL LIGATION

- may be viewed as irreversible

- may be done laparoscopically

- no unprotected coitus before the procedure

- may resume sexual activities 2-3 days after