OB Module 6: Family Planning Flashcards
Nearly half of all pregnancies in the US are ___
unintended
Every year __% of women 15-44 yo who dont use birth control during vaginal intercourse become pregnany
85%
What are the most common forms of contraception in the US?
- Female Sterilization - 10.7 mil
- Oral Contraceptive Pills - 10.4 mil
- Male condoms - 7.9 mil
- Male Sterilization - 4.2 mil
Why is it interesting that the most common form of contraception is female sterilization by a large margin?
- There is a comparatively low rate of male sterilization
- This is due in part to women having to take ownership of the contraceptive use issue often
- It is an invasive procedure that opens the abdomen and uses anesthesia so there are hazards
OCs and BCPs
Oral Contraceptives and Birth Control Pills
Barrier Methods for contraception
condoms
diaphragms
contraceptive sponge
cervical cap
A shot or an implant like depo is what kind of contraceptive method?
Long Acting Hormonal Methods
IUD
Intrauterine Devices
What are the various contraceptives that one can use?
OCs and BCPs
Barrier methods
IUDs
Long Acting hormonal methods
spermicides
hormonal contraceptive patch
hormonal contraceptive vaginal ring
natural family planning
lactation amenorrhea method
surgical or procedural sterilization
emergency contraception
When is another name for emergency contraception
Plan B
What are the different types of contraceptive uses
Typical
Perfect
Typical Use
User effectiveness
the use of any given method by a typical couple
the typical user may not use the method with every act of intercourse or may not consistently or correctly use the product
Perfect Use
Theoretical Effectiveness
Method used consistently and correctly according to a specified set of rules or guidelines with very act of intercourse
statistics are based on the theory of perfect use
Rates of ___ use are lower than __ use
typical; perfect
Periodic abstinence like calendar, ovulation method, symptothermal, and post ovulation are what kind of contraception?
family planning
they have only typical use ratings rather than perfect
When is a pregnancy cap more effective
if it is a primiparous woman than a multiparous woman since the cervix will alter after L&D and the cap may not fit right
Why is withdrawal a bad method of contraception?
Pre ejaculate has sperm in it too in some amount
Pull out game weak regardless of what you do
Why does Nuvaring have only perfect use rates and not typical
it is put in and left in so there is not much typical use occurring
Why can male sterilization still have a failure rate?
Some guys are not good at going back until sperm levels hit zero while others do not always use protection in the meanwhile
Emergency contraception has the highest rate of prevention when…
it is started within 72 hours
the sooner started the higher the contraceptive success rate
Factors to Consider when Choosing a Contraceptive
She can be comfortable with
Her partner can be comfortable with
Is as effective as she needs for it to be effective
Is cost effective or low cost
Is easily hidden if need be
Prevents STD transmission if necessary
Separates the act of intercourse from contraception if needed
Allows for immediate use if spontaneity is an issue
May be easily reversible or permanent
What is one of the most cost effective contraceptives and why
IUD
the initial payoff is larger but you get protection for years
It ends up being a low cost in the long run but it must be aid upfront
It is also secretive and good for prevention in adolescents, abused women, and prevention of STDs
Factors to take into consideration while counseling regarding contraceptive choices?
Medical history and risk factors
effects an unwanted pregnancy would have at this point in the patients life
potential for multiple partners in reproductive life span especially in the next few years
patients comfort level touching her body and her lovers body
maturity level
frequency of intercourse
patients ability to understand instructions
patients access to the health care setting
methods used to date and her perceptions regarding these contraceptive methods as well
the patients weight
the patients ability to consistently use the method
If there is a need to prevent pregnancy and prevent STD transmission, what may the patient be advised to do?
Combine two methods to enhance pregnancy prevention but also prevent STD transmission
ex: Condoms and spermicidal foam or Condoms and OCs
What is important for the patient to know when starting a new method of contraception
that she is using the method on a trial basis and that if she finds that the method is not working well for her and her partner that she then needs to return for further counseling and a trial of another method
What should the provider do before the client leaves the clinic with a new barrier method of contraception
give clear and simple instructions on how to use the method
have the patient demonstrate the use of any barrier method before leaving the clinic setting as leaving something like a diaphragm in place could have risks
It will be important to __ __ with the patient how she will discuss contraception with her partner
role play
Why is it particularly important to act out discussion with a partner
this is especially important if the method will involve his cooperation or use at the time of sexual activity
How can cultural issues come into play when choosing a contraceptive
they can come into play regarding the mothers expectations for her daughter in contrast to the cultural norms in the culture they are now acclimating to
the cultural issues and this patients beliefs and values regarding health and the potential impact of chemicals introduced into the body effect her choices regarding birth control
How does the patients education level impact choosing a method of contraception? What does it not impact?
it affects her ability to comprehend explanations regarding methods and anatomy with ease
but it does not insure her having a comfort level touching her own body or that of her lover in a sexual context
OTC Contraceptive Methods
Condoms Female Condoms Sponge Contraceptive Film Spermicide
Barrier Methods of Contraception
Condoms
Diaphragms
Contraceptive sponges
Cervical Caps
What is the major advantage of condom use
the additional barrier of STDs
they are often recommended for this use in addition to other methods for this very purpose
What is the rate of conception like with condoms?
Not great when condoms are used along
14% failure rate for typical use and 3% perfect use
more protection can be gleaned though when used with a spermicide foam, cream, jelly, suppository or film however.
Why has male condom use rose in recent years?
generally it is used more over the concern of AIDS or STDs
incidence increased in all ages but particularly in 20-24 year range and 25-29 year range
How does the Female Condom work
The same way as a male one - a barrier to sperm
Thin polyurethane acting as a sheath with 2 soft flexible rings at either end and is worn internally by the woman during coitus
Polyurethane covers one ring sitting against the cervix and acting as an anchor, the second is larger and remains outside the body and covers part of the peritoneum and labia
When can the female condom be inserted and when can it be removed?
it can be inserted as much as 8 hours prior to sex and should be removed immediately after sex
Never use a female condom with …
a male condom
Diaphragm
made of thin flexible silicone rubber and looks like a small dome or cup
Has a flexible ring around the edge
Inserted into the vagina prior to sexual intercourse
What should be used alongside the diaphragm and why?
Should be used with spermicidal cream or jelly to increase its effectiveness
A diaphragm needs what before use?
to be fitted by a health care provider
How often should the diaphragm be fitted and why
provider should be checking the fit every year in case the patient gained or lost weight, became pregnant, or gave birth as the diaphragm would likely no longer fit
How does the diaphragm work
by creating a barrier between sperm and the uterus
Where is the diaphragm placed
behind the pubic bone to completely cover the cervix
this prevents sperm deposited in intercourse from entering the cervix
any spermicide placed inside of the dome and around the rim of the diaphragm also helps kill any sperm that comes into contact with it
When can diaphragms be inserted and how often should spermicide be added?
Diaphragm can be put in 6 hours prior to intercourse
Spermicide will need to be added in the vagina every 2 hours or each time she has intercourse
How long can a diaphragm be left in and why
no more than 24 hours
if left longer there is risk for Toxic Shock Syndrome (TSS)
Advantages of using a diaphragm
easy to insert and remove
inexpensive and reusable
if inserted correctly, diaphragm cannot be felt by either partner
does not effect future fertility or the patients menstrual cycle
Disadvantages of the diaphragm
if left for longer than 24 hours you have TSS risk
continual use of spermicide can be irritating to the lining of the vagina and possibly increase risk of STD contraction
can increase the likelihood of bladder infections - because of push on urethra and urinary stasis that can occur as a result
does not protect against STDs - to do that she would need a condom everytime she has sex
How does the cervical cap work
like a diaphragm, it is a dome covering the cervix with a brim holding the cap in place tightly and a groove that can hold spermicidal jelly or cream
It prevents sperm from entering the uterus
however unlike the diaphragm, it is smaller and fits more tightly around the cervix when in place
What is a cervical cap made of?
silicone rubber
A cervical cap must be …
fitted by a health care provider
When does/can the cervical cap be inserted?
it must be done just prior to intercourse
How much spermicide is applied to a cervical cap
about a half teaspoon will need to be applied on the groove
a small amount is also applied to the bowl and brim of the cap
How long can a cervical cap be left in place and how often is spermicide applied
Can be left in place for 48 hours
spermicide does not need to be reapplied every time the patient has sex
HOWEVER the cap must be left in place for at least 8 hours post intercourse
