Responsible Parenthood

Responsible Parenthood:

Responsible Parenthood

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Reproductive life planning – includes all the decisions an individual or couple make about having children. **An individual’s or a couple’s choice of contraceptive method should be made carefully, with complete knowledge about the advantages, disadvantages, and side effects of the various options.**

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Contraceptives Characteristics: Safe 100% effective Free of side effects Easily obtainable Affordable Easy to use and acceptable to both user and sexual partner. Free of effects on future pregnancy

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Abstinence The most effective way to protect against conception . 0% failure rate Most effective way to prevent STDs Adolescents may find it difficult to comply with In moments of passion, responsible people may fail to consider this as an option.

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Natural Family Planning These are methods that do not involve chemical or foreign material being introduced into the body. The effectiveness of these methods varies greatly, depending mainly on the couple’s ability refrain from having sex on fertile days. Failure rates usually range from 10% to 20% If pregnancy should occur, the continued use of these methods poses no risk to the fetus.

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Fertility Awareness Method Rely on detecting when the woman will be capable of impregnation (fertile) and using periods of abstinence or contraceptive use during that time. There are a variety of ways to determine a fertility period. Calendar (Rhythm) Method Basal Body Temperature Cervical Mucus Billings Method Symptothermal Method Ovulation Awareness Lactating Amenorrhea Method Coitus Interruptus

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Calendar (Rhythm) Method Requires a couple to abstain from coitus on the days of a menstrual cycle when the woman is most likely to conceive (3 or 4 days after ovulation) A woman should keep a diary of six menstrual cycle. To calculate “safe” days, she subtracts 18 from the shortest cycle documented. This number represents her 1 st fertile day. She subtracts 11 from her longest cycle. This is her last fertile day. To avoid pregnancy, she should avoid coitus during these days.

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Basal Body Temperature Method The basis of the BBT method is that just before the day of ovulation, a woman’s BBT falls about half a degree. At the time of ovulation, her BBT rises a full degree. The higher level is then maintained for the rest of her menstrual cycle. The woman takes her temperature each morning immediately after waking, before she undertakes any activity. This is her BBT. As soon as she notices a slight dip in temperature followed by an increase, she knows she has ovulated. She refrains from having sex for the next 3 days. (the life of the discharged ovum) Works well if combined with the calendar method.

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Cervical Mucus (Billings) Method Before ovulation each month, the cervical mucus is thick and does not stretch when pulled between the thumb and finger (known as the spinnbarkeit). Just before ovulation, cervical mucus increases. With ovulation (the peak day), cervical mucus becomes copious, thin, watery, and trnsparent. It feels slippery and stretches at least 1 inch before the strand breaks. All these days the mucus is copious and the 3 days after the peak day are considered to be fertile days – woman should abstain from sex

Legend:  - Menstrual Flow - Days of Abstinence - Peak Mucus Day :

S e p t e m b e r SUN MON TUE WED THU FRI SAT 1  2  3  4  5  6  7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29  30   Legend:  - Menstrual Flow - Days of Abstinence - Peak Mucus Day 

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Symptothermal Method Combines the Cervical Mucus and the BBT methods. The woman takes her temperature daily, watching for the rise in temperature that marks ovulation. She also analyzes her cervical mucus daily. The couple must abstain 3 days after the rise in temperature or the 4 th day after the peak of mucus change because these are the woman’s fertile days. This method is more effective than BBT or Cervical Mucus Method alone.

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Ovulation Awareness Is the use of an over the counter ovulation detection kit. The kits detect the midcyle surge of luteinizing hormone that can be detected in urine 12 t 24 hours before ovulation. Such kits are about 98% to 100% accurate in predicting ovulation. Expensive. Lactating Amenorrhea Method As long as a woman is breast-feeding an infant, there is some natural suppression of ovulation. Not dependable. Must be advised to choose another method.

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Coitus Interruptus Is one of the oldest known methods of contraception. The couple proceeds with coitus until the moment of ejaculation. The man withdraws and spermatozoa are emitted outside the vagina. Ejaculation may occur before withdrawal is complete and, despite care used, spermatozoa may be deposited in the vagina. (sperm might be present in the pre-ejaculation fluid) Needs control and experience to work

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Oral Contraception Commonly known as the pill or COCs (combination oral contraceptives) Are composed of varying amounts of synthetic estrogen combined with a small amount of synthetic progesterone. Must be prescribed after a pelvic examination and a Papanicolaou smear. Are 99.7% effective in preventing conception. Typical failure rate is 8%

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Benefits of Oral Contraception - decreased inccidence of the following: Decreased incidence of dysmenorrhea Premenstrual dysphoric syndrome, Iron defeciency anemia PID Endometrial and ovarian cancer and cyst Fibrocycstic breast disease Possibly osteoperosis and uterine myomata (fibroid uterine tumors) Colon cancer

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COCs are packed 21 to 28 pills to a container. Generally economically recommended that the 1 st pill be taken on a Sunday (1 st Sunday after the beginning of menstrual flow) After child birth, the woman should start 2 weeks after delivery; after an abortion, 1 st Sunday right after the procedure. Pills are not effective on the 1 st 7 days. In a 21 day cycle brand, a pill must be taken everyday at the same time for 21 days. Then she would not take any pills for 1 week. She should restart on a Sunday 1 week after she stopped taking the pills.

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28 day cycle brands are packed with 28 pills. 21 active pills and 7 placebo pills. A woman who does not want to have menstrual flow may choose to eliminate it by beginning a new 21 day cycle of pills immediately after finishing the first one rather than waiting the usual 7 days to begin a new cycle. Side effects: Nausea  Monilial vaginal infections Weight gain  Mild hypertension Headache  Depression Breast tenderness Breakthrough bleeding

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Estrogen/ Progesterone Patch Slowly but continuously release a combination of estrogen and progesterone. Patches are applied 1x a week for 3 weeks During the week at which the woman is patch free, a menstrual flow will occur. May be less effective in women who weight more than 90kgs. Patches may be applied to one of four areas: Upper outer arm Upper torso (front or back, excluding the breasts) Abdomen Buttocks

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Patches can be worn in the shower, while bathing, or while swimming. If a patch comes loose, the woman should remove it and immediately replace it with a new patch. No additional contraception is needed if the woman is sure that the patch is loose for less than 24 hours. If she is not sure how long the patch has been loose, she should remove it and start a new 4 week cycle. She should use a back up method of contraception on the 1 st week.

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Vaginal Rings Is a silicone ring that surrounds the cervix and continually releases a combination of estrogen and progesterone. The ring is inserted by the woman and left in place for 3 weeks, then removed for 1 week. Menstrual bleeding occurs during the ring-free week. Efficiency 99.7% equal to COCs Fertility returns immediately after removal of the ring. Women is advised to make out a calendar that they post conspicuously to remind themselves to remove and replace the ring.

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Emergency Postcoital Contraception Are often referred as “morning after pills” Yuptze regimen consist of the administration of 2 fixed dose combination pills (usually Ovral) 2 pills must be taken within 72 hours after unprotected intercourse Followed by 2 additional pills 12 hours later. Causes almost always nausea and vomiting Pretreatment of antiemetic may be given to decrease possibility of vomiting. (if vomiting should occur 2 hours after administration, the pill should be repeated)

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The especially designed kit (Preven) contains a urine pregnancy kit, and 4 pills that contain concentrations of estrogen/progesterone. Over all rate of effectiveness is between 75% and 85% “Plan B” – is a progestin-only method. Contains 2 pills. 1 pill taken immediately and 1 pill taken 12 hours later.

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Subcutaneous Implants (Norplant) consists of 6 nonbiodegradable Silasmic implants, about the width of a pencil lead, that are filled with levonorgestrel and embedded just under the skin on the inside of the upper arm. They stimulate the veins for the next 5 years, slowly releasing hormones thereby suppressing ovulation, stimulating thick mucus, and changing the endometrium so that implantation is difficult. The implants are inserted under local anesthetic during the menses or no later than day 7 of the menstrual cycle. Can be inserted immediately after an abortion or 6 weeks after the birth of a baby. Failure rate is less than 1% At the end of 5 years the implants are removed.

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Disadvantages: It costs around $500 Weight gain Irregular menstrual cycle (spotting, breakthrough bleeding, amenorrhea, prolonged periods) Hair loss Depression Scarring at the insertion site Need for removal Contraindications: Pregnancy Desire to be pregnant within 1 to 2 years Undiagnosed uterine bleeding

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Intramuscular Injection A single injection of medroxyprogesterone acetate (Depo-Provera) is given every 12 weeks or injections of Lunelle (synthetic estrogen/progesterone) given every 30 days inhibit ovulation, alter the endometrium, and change the cervical mucus. Effectiveness: almost 100% Depo-Provera can be used during breast-feeding. Potential side effects: Irregular menstrual cycle Headache Weight gain Depression Increases the risk of developing osteoporosis

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Advantage: No visible sign that a birth control measure is being used. Long term reliability w/o many of the side effects and contraindications associated with COCs. Disadvantages: Women must return to health care provider for a new injection every 4-12 weeks for the method to remain reliable. Fertility is often delayed by about 6-12 months A reminder system, such as postcard mailed by the prescribing agency may be necessary to be certain the woman return on time for the next injection.

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Intrauterine Device (IUD) Is a small plastic object that is inserted into the uterus through the vagina. The woman will not feel the IUD once it is in place Rate of IUD use in the US is only 1%, world wide is 20%. Contributed to the increased incidence of PID Side Effects and Contraindications: Increased risk for PID Some might experience more dysmenorrhea than other women do. Heavier than usual menstrual flow for 2 or 3 mos. Risk of developing toxic shock syndrome from the use of tampoons

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Not recommended with women who have multiple sex partners – risk of STI’s Not recommended to women who have never been pregnant History of PID Distorted uterus Not advised for women with severe dysmenorrhea, menorrhagia, history of ectopic pregnancy Women with anemia are not considered good candidates Rarely prescribed for adolescents

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Barrier Methods Are forms of birth control that works by the placement of a chemical or other barier between the cervix and advancing sperm so that sperm cannot enter the uterus or fallopian tubes and fertilize the ovum. Advantage: Lack hormonal side effects associated with COCs Disadvantages: Failure rates are higher Sexual enjoyment may be lessened

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Vaginal Inserted Spermicidal Products Spermicidal agents cause the death of spermatozoa before they can enter the cervix. Are not actively spermicidal but also change the vaginal pH to a strong acid level, Advantages: Can be purchased w/o a prescription Lower costs When used with another contraceptive, can increase the other method’s effectiveness Various preps are available: gels, creams, sponges, films, foams, suppositories. Disadvantage: the woman should do this more than an hour before coitus and should not douche for 6 hours after coitus.

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Contraindications: Not recommended for women near menopause Acute cervicitis Inappropriate for couples who do not want the responsibility of children – Failure rate is 20% Some women find the vaginal leakage after use of these products bothersome. Effects: If the couple have hesitations it may interfere with sexual enjoyment Inconvenience of insertion Some couples may find foam or moisture irritating to vaginal and penile tissue during coitus On pregnancy: None. Fetus will not be affected.

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Diaphragms Is a circular rubber disk that is placed over the cervix before intercourse It forms a barricade against the entrance of spermatozoa Use of spermicidal gel and diaphragm combines a chemical method of contraception. Failure rate: 6%-16% Prescribed and fitted by physician Must be refitted when pregnancy, miscarriage, cervical surgery (D&C), or therapeutic abortion occurs or if she gains or loses 15 lbs

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Should be kept in place for at least 6 hours after coitus but not more than 24 hours. Can be removed vaginally Cleaned with mild soap and water, and dried before storing in its protective case Will last for 2-3 years. Side Effects: Increase risk of UTI’s Must not be used in women with cervicitis Contraindications: Women with history of TSS (Toxic Shock Syndrome) Allergy to rubber or spermicides History of recurrent UTI’s

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To prevent Toxic Shock Syndrome Wash hands with soap and water before insertion or removal Do not use during menstrual period Do not leave it in place longer than 24 hours Beware of symptoms of TSS Elevated temperature Diarrhea Vomiting Muscle aches Sunburn-like rash If symptoms should occur, immediately remove it and call your health care provider Use of vibrators during coitus may dislodge it

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Offers some protection against STI’s Allows for sexual relations during menses No risk of harm to fetus Placement: Some may not know where their cervix is. Continuing pelvic examinations are necessary to check placement

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Cervical Caps Are made of soft rubber, are shaped like a thimble, and fit snugly over the uterine cervix. Failure rate: 26% ideal, 32% typical use Manu cannot use this method because their cervix is too short for the cap to fit properly. Tends to get dislodge more readily than diaphragms Can remain in place longer than diaphragms, but must not exceed longer than 48 hours to prevent cervical irritation Must be fitted by health care provider.

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Contraindications: Abnormally short or long cervix Previous abnormal pap smear History of TSS Allergy to latex or spermicide History of PID, cervicitis, or papillomavirus infection History of cervical cancer Undiagnosed vaginal bleeding

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Male Condoms Is a latex rubber or synthetic sheath that is placed over the erect penis before coitus begins Ideal failure rate 2%, typical – 15% Advantage: one of the few male “responsibility” birth control measures available Additional potential in preventing STI’s Contraindications: none except sensitivity to latex Effect: some men find that condoms dull enjoyment of coitus.

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Female Condoms Are latex sheaths made of polyurethane and prelubricated with a spermicide. The inner ring covers the cervix and the outer ring rest against the vaginal opening. Inserted anytime before sexual activity begins and then removed after ejaculation Intended for one time use Protects against STI/ STD But more expensive than male condoms Failure rate 5-21%

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Surgical Methods Have no effect on sexuality Are the most effective methods of contraception Should be chosen with great thought and care and are considered permanent Techniques to reverse both male and female sterilization are more complicated and expensive than sterilization itself.

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Vasectomy A small incision is made on each side of the scrotum. The vas deferens at this point is then cut and tied, cauterized, or plugged, blocking the passage of spermatozoa. Can be done under local anesthesia in an ambulatory setting. 99.5% effective The man can resume sexual intercourse 1 week after the procedure. Spermatozoa present in the vas deferens may remain viable 6 mos = 10-20 ejaculations to eliminate. The man can still ejaculate seminal fluid but no sperms.

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Complications: Hematoma at the surgical site Reanastomosis is only 70-80% successful Development of urolithiasis (kidney stones) Postvasectomy pain syndrome Can be relieved by having the procedure reversed Tubal Ligation Fallopian tubes are occluded by cautery, crushing, clamping, or blocking and thereby preventing passage of both ova and sperm. Has 99.5% effectiveness rate Women must have no unprotected sex before the procedure to avoid ectopic pregnancy May return to having coitus 2-3 days after the procedure