Family Planning & Contraception
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Outline
Overview
- Family planning consists of multiple ways to plan or prevent pregnancy from occurring.
Nursing Points
General
- It is important to remember the patient’s preferences are most important and the below factors may influence choices of family planning
- Goal-oriented in selection of method
- Prevention versus planning
- Factors that may influence contraceptive selection:
- Religious, cultural, personal influences
- Age
- Smoker or nonsmoker
- Goals for family planning
- Level of compliance (for example, will she take an oral contraceptive every day?)
- Frequency of intercourse (for example, if someone is frequently having intercourse, will they use a condom every time or would an oral contraceptive or IUD be more appropriate?)
- Currently breastfeeding
- Goal-oriented in selection of method
- The only method that is 100% proven to prevent pregnancy or STI’s is abstinence
Assessment
- Assess their current lifestyle / habits
- Identify their family planning goals
Therapeutic Management
- Pregnancy prevention
- Oral contraceptives, intrauterine devices, cervical caps, diaphragm
- Pregnancy and STI prevention
- Condoms
- Trying to get pregnant
- Ovulation tracking
- Basal Body Temperature
- Ovulation Predictor Kits
- Calendar Method
- Infertility
- Meds
- Surgical procedures
- To fix whatever the problem is ie: blockage in the tubes carrying the sperm
- In vitro fertilization
- Intrauterine insemination
- Surrogacy
- Embryo hosts
- Adoption
- Ovulation tracking
- Finished having children and want to permanently prevent future pregnancy
- Tubal ligation (female)
- Vasectomy (male)
Nursing Concepts
- Reproduction
- Patient education
Patient Education
- Birth control pills should be taken at the same time every day
- Antibiotics and other meds may decrease the effectiveness of contraceptives – use other form of protection
- It is important to take a prenatal vitamin when trying to conceive – should include folic acid
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Transcript
So what does Family Planning actually mean? Well with this it just means that it could be a person is either trying to prevent a pregnancy from occurring or someone that’s trying to plan a pregnancy. So we are going to talk about several different considerations that need to be taken in and then also how to make them successful in what they have chosen for themselves.
So let’s first talk about the patient that wants contraception so this patient is not trying to get pregnant. What are the considerations that we need to take into account when trying to help her with this? So there are a few big things I’ll write out for you. We need to know if she has any religious or cultural preferences because that could affect our choice and decision with her. We need to know her age. Some medications or contraception such as the oral contraception pills are not going to be good for somebody that is older because of hormones and blood clot risk. Also we need to know if she’s a smoker, why? Same thing the oral contraception won’t be good for that type of patient because we worry with oral contraception about blood clots forming and so someone that smokes is going to be at an increased risk. We also need to know if she has risky sexual behavior and by this we mean someone that has multiple partners. Somebody that has risky sexual behaviors would not be the best patient have something like an intrauterine device(IUD) placed as birth control because we worry about pelvic infections with these patients and those that have multiple partners are more at risk for STI and pelvic infections so adding that to the fact that they have a foreign body implanted would put them more at risk. And the last consideration is is this patient breastfeeding? So maybe they’ve had a child already and they are breastfeeding them and they need birth control because they don’t want to have another baby quite yet. For them the best option is going to be something called the mini pill and this is just like a progesterone only pill that won’t to hinder their milk supply. When contraception is being discussed with a patient we need to find what is going to best work for them and for their situation but the one thing that always needs to be stressed to the patient is that the only way to be 100% effective in preventing pregnancy or from getting an STI would be abstinence.
Now you have a patient that actually wants to be pregnant and needs advice on how to do this. There’s a few different ways that women can track ovulation because if they know when they ovulate and have intercourse around that time then hopefully they’ll be more successful getting pregnant. The first way we’ll talk about is the basal body temperature tracking. This patient will track her temperature every day now it has to be at the same time everyday before rising out of bed okay so that’s the basal body temperature tracking. When she takes her temperature and it’s ovulation time her body temperature is going first drop and then rise about 0.4-1 degree higher than what it had been. This temperature rise means that ovulation has occurred. So let’s review what your basal body temperature needs to be taken everyday at the same time before rising out of bed you will notice that your temperature range is about the same and then you will have a drop in temperature right as the egg is being released from the ovary and then the temperature will rise and that means ovulation has occurred. There are also ovulation predictor kits that women can buy from a drugstore where they void on a stick and it lets them know whether or not they are ovulating. and the last method for women that are trying to track for pregnancy would be the calendar method. With the calendar method they’re going to track their menstrual cycles over several months to get an idea of when ovulation is occurring based on how long their cycles are and knowing that ovulation occurs around the 14th day of a cycle.
Let’s compare now some more permanent methods for contraception. First we have vasectomy so here the vas deferans is cut and cauterized so that the male become sterile. It is important to know that this is not an instant fix it’s about three months before they will say that the male is sterile. And he will need to undergo to sperm counts to verify that there are no more working sperm there. This is outpatient and he will just need to ice and take it easy for a few days. For the woman she can have a tubal ligation or sometimes also called tubes tied so with this the fallopian tubes are clamped and tied so this way no egg can travel through the tube and this will sterilize the woman. Female this is a little bit more of an intense procedure where she’s going to need a lot more rest time to some women will do this after they’ve had their last baby if they delivered by C-section since the doctors already in there but otherwise this will cause a lot more pain and recovery in comparison to a vasectomy being done.
There are a few key points to try to remember. It is important to always consider the patient’s lifestyle in any type of family planning to know what’s best going to work for them. What is the patient trying to do what is their ultimate goal? Do they want to plan a pregnancy or prevent pregnancy? Based on their ultimate goal there are many options for them so it is our job to find what is going to be best for them and that they can stick with.
Reproduction and patient education will be the nursing concepts for this. Obviously with family planning we are talking about reproduction either how to make it happen or how to prevent it. And there is a lot of patient education that goes into this. With family planning they have to be able to be compliant and use the right things to be preventative if that’s what they wish and then also education on becoming pregnant.
Make sure you check out the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing.
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