Maternal Child Family Planning

• Basal body temp method
• Ovulation method
• Calendar rhythm method
• Symptothermal method
• Standard days method

• Abstinence
• Coitus interruptus
• Douching

• Male condom
• Female condom
• Diaphragm
• Cervical caps
• Vaginal sponge
• IUD (local inflam effect) 10 yrs
• Mirena LNG-IUS 5 yrs

• Combination Estrogen-progestin approaches:
• Combined oral contraceptives (COCs) (The Pill)
• Transdermal (Ortho-Evra patch)
• Vaginal contraceptive ring (Nuva Ring)

• Progestin Contraceptives:
• Progestin-only pills (minipill)
• Long-activing progestin contraceptives (Depo-Provera), (Implanon)

• Postcoital Emergency Contraception: (EC)
• Morning after pill (combined hormones)
• Plan B (progestin-only)

Medical abortion-inducing drug: mifepristone

• Vasectomy
• Tubal ligation

• Lipid metabolism alterations
• Breast s/s
• CVA (Stroke)
• Carbohydrate metabolism changes
• Chloasma
• Fluid retention, wt gain
• Ha
• Liver S/S
• HTN
• Cervical erosion
• Naus
• Nervous/Irritable
• Thromboembolic issues

• Acne, oily skin
• Breast s/s
• Decreased libido
• Decr HDL cholesterol levels
• Depression
• Fatigue
• Hirsutism
• Incr appetite, wt gain
• Incr LDL cholesterol
• Oligomenorrhea, amenorrhea
• Pruitus
• Sebaceous cysts

• Seasonale: 84 active, 7 blank
• Seasonique: 84 active, 7 reduced estrogen (less bleeding)

• Have 4 cycles of bleeding vs. 12
• Reduces side effects of other COCs: bloat, Ha, breast, cramps, swelling
• Less reliable in obese women

Day 1 start: 1st pill 1st day of cycle - prevents ovulation 1st cycle. No back-up needed

Sunday start: 1st pill Sunday following 1st day of cycle. Back-up needed 7 days.

Quick start: 1st pill in dr. office. Back-up needed 7 days.

Less effective in obese women.

• Estrogen component: Incr r/f MI, blood clots, stroke.
• Reduced EE for safer pill.
• Very low-dose pills: less risk, but more breakthrough bleeding.

• Pregnancy
• Hx thrombo
• Acute/chronic liver dz / abn liver fcn tests
• Estrogen-dependent carcinoma
• Undiagnosed uterine bleeding
• Heavy smoker
• Gallbladder dz
• HTN
• DM
• Migraine w/visual
• Hyper clotting
• Hyperlipidemia

• Migraine w/o visual
• Epilepsy
• Depression
• Oligomenorrhea
• Amenorrhea

• Relief s/s menstrual, premenstrual syndrome
• Less cramps, flow
• Regular cycle
• Mittelschmerz eliminated
• Less ovarian, endometrial, colorectal cx
• Less menstrual migrain, iron deficiency anemia
• Improved bone mineral density
• Less acne, hirsutism, pelvic pain (endometriosis)
• Perimenopausal changes (hot flashes) Tx

NO COCs if >35 and smoke.

• Depression
• Breast lump
• Jaundice
• Severe abd pain
• Severe chest pain
• SOA
• Severe Ha
• Dizziness, chg in vision
• Speech problems
• Severe leg pain

• Highly effective if <198lbs
• Wear 3 wks, off 1 wk
• Abd, buttocks, upper outer arm, trunk
• NOT breasts
• NOT w/skin disorders

Greater r/f venous thromboembolism (VTE) than COC.

MiniPill: Used by nursing mothers - doesn't interfere w/nursing, less effective than COCs, breakthrough bleeding.

• Long-acting:
• Depo-Provera - long-acting injection (q3mo)
• Implanon - capsule implant upper underarm (q3yr)

Suppress LH, ovulation, thickens cervical mucus to block sperm penetration.

S/E: Ha, irregular cycles, bldg, wt gain, lair loss, depression, breast s/s. May incr bone demineralization.

• Benefits (advts & success stories)
• Risks (disadv & failure rates)
• Alternatives (all options)
• Inquiries (opp to ask questions)
• Decisions (decides & can change mind)
• Explanations (how to use)
• Documentation (teaching & client understanding)

• Record cycles 6mo - know freq & duration
• Ovulation = 14 days before onset menses
• Calc abst. period: -18 from shortest cycle, -11 from longest cycle = window of abst.
• LEAST reliable method

• Special thermometer
• Temp/graph 3-4 months (on awakening)
• See drop followed by high = ovulation

• Add to BBT method
• Fertile mucus: thin, water, abundant, alkaline, Skinnbarkheit, Ferning

Affect mucus: Semen (spinnbarkheit), antihistamine (dries), gels/foams, infections (discharge), douches

Combine BBT + Female Sx:

• Increased libido
• Midcycle spotting
• Mittelschmerz
• Cervical softening
• Pelvic/vulvar fullness
• Temp drop followed by rise

Use to achieve or avoid conception

• Detect LH surge
• OTC
• Very reliable - not affected by variables

• Ovum can be fertilized x24hrs
• Sperm can fertilize x48hrs

• Fitted by Dr or Nurse PX
• Spermicide applied each use
• Wear >6hrs post coitus
• Refit w/10lb wt gain/loss or PG
• May incr r/f urethritis/cystitis (r/t prolonged wearing)

• Chgs endometrial lining
• Alters secretions
• Radiopaque
• Copper - 10 yrs
• Mirena - 5 yrs (progestin based)
• S/E: Incr bldg, r/t PID, uterine perf, PAINS**

• Pain
• Abnormal bldg
• Infection signs
• No string

Number times pregnant

Number viable (>20wks) births

Twin birth >20 wks counts as ONE Para

• A=Abd pain
• C=Chest pain/SOA
• H=Ha
• E=Eye probs
• S=Severe leg pain

Increased r/f perimenopausal Breast Cx

• Miss ONE pill: Take as soon as remembered
• Miss TWO+: Use another form protection that cycle

• Decrease effectiveness of:
• Oral hypoglycemic agents
• Oral anticoagulants
• (R/t estrogen thickens blood)

• Decreased effectiveness w/:
• Barbituates
• Anticonvulsives
• Antifungals
• Antibiotics

• <17yrs Rx required
• >17yrs OTC

• Take ASAP <72hrs of Coitus
• Emergency contraception
• Rape
• Contraception failure

Legal 1973 - Roe v Wade

• First tri: suction, D&C
• Second tri: D&C, hypertonic saline, prostaglandins

Complications: infections, bldg, cervical trauma

• Pills: Mifeprex (mifepristone) <49days
• Methotrexate w/misoprostol
• Follow by Prostaglandin (po or vag) to induce UC's
• Follow-up to verify goal