CONTRACEPTION AND PLANNING FOR PREGNANCY Contraceptive methods for family planning, the health benefits and risk factors associated with birth control choices and pregnancy CONTRACEPTION AND PREGNANCY 1 CONTRACEPTIVE CHOICES • • • • • • • • • ABSTINENCE FERTILITYAwarenes CALENDAR BASAL Body Temp. SYMPTOTHERMAL WITHDRAWAL BARRIER METHOD Spermicides Condoms • • • • • • • • • Diaphragm Cervical Cap HORMONAL Oral Contraceptives Norplant Depo- Provera IUD Emergency Contraception STERILIZATION CONTRACEPTION AND PREGNANCY 2 ABSTINENCE • This is the only sure method of birth control to prevent an unintended pregnancy or unwanted STD’s • Abstinence from intercourse does not necessarily equate with being nonsexual • It is possible to attain a level of intimacy without risking pregnancy • Many young adults decide to delay sexual intercourse for a variety of reasons CONTRACEPTION AND PREGNANCY 3 FERTILITY AWARENESS • This method helps women understand their menstrual cycle better • It requires a high level of motivation and cooperation by both partners • These methods have a high user failure rates • Not recommended for couples who could not tolerate a pregnancy • Offer no protection against STD’s CONTRACEPTION AND PREGNANCY 4 CALENDAR METHOD • Also referred to as the rhythm method • This requires abstinence during ovulation • Should be supplemented with another option if pregnancy cannot be tolerated • This could be effective if a women knew the exact day of her ovulation • To be safest abstinence is necessary from day11to 21 of woman’s cycle • The egg can by fertilized anytime between the release by the ovary and its exit from the fallopian tube • There is a 30% failure rate CONTRACEPTION AND PREGNANCY 5 BASAL BODY TEMPERATURE METHOD • Designed to determine when a woman is ovulating • BBT drops slightly 1 to 2 days before ovulation • Then rises sharply by approximately ½-1 degrees during ovulation • Sexual activity should be stopped for 3 to 4 days after temperature elevates • Intercourse before ovulation carries a greater risk than post ovulation • Sperm can remain viable for up to 72 hours CONTRACEPTION AND PREGNANCY 6 SYMPTOTHERMAL METHOD • Combination of BBT and cervical mucus monitoring • During ovulation mucus becomes watery • Sexual intercourse should be avoided until mucous thickens or dries • This is works better than the calendar method • It has a 20% failure rate CONTRACEPTION AND PREGNANCY 7 WITHDRAWAL • Also referred to as coitus interruptus • Leads to many unintended pregnancies • Pre ejaculate carries sperm that may be released into the vagina before withdrawal • This method requires an inordinate amount of self control by both partners • Has an extremely high failure rate CONTRACEPTION AND PREGNANCY 8 BARRIER METHODS • Barrier methods have become increasingly popular because of the protection they provide against HIV and other STD’s • High failure rates among young women • • • • SPERMACIDES CONDOMS DIAPHRAGMS CERVICLE CAPS CONTRACEPTION AND PREGNANCY 9 SPERMACIDES • Are a chemical method of contraceptive use • Come in a variety foams, creams, gels, and suppositories • Prevent contraception by killing sperm before they reach uterus • Serve as a lubricant • Can be used alone or with another barrier method • Highly effective when used with a condom • Contain nonoxynol-9 which is somewhat effective in preventing gonorrhea, HIV, Chlamydia, herpes simplex 2, • Need to be reapplied before every sexual act to insure effectiveness CONTRACEPTION AND PREGNANCY 10 MALE CONDOM • Increased use of latex types • Protect against HIV, herpes simplex 2, Chlamydia, and cytomegalovirus • Reduce transmission of gonorrhea, HBV2, trichomonas vaginalis • Is 86-90% effective when used alone and 98% effective when used with spermicide • Use can cause possible allergic reaction • CONTRACEPTION AND PREGNANCY 11 FEMALE CONDOM • One size fits all barrier method • Consists of a pre-lubricated pouch 6” in length with two flexible rings • One ring is inserted into the vagina to cover the cervix • The other ring partially covers the labia • Lab tests demonstrate that the HIV and other STD viruses cannot permeate the polyurethane pouch • Controlled by the woman • Failure rate is @ 26% usually user failure CONTRACEPTION AND PREGNANCY 12 DIAPHRAGM • An oval dome shaped device with a flexible spring at the outer edge • Needs to be fitted by a clinician • A spermicide is applied into the dome and a small amount is spread around the rim • Should be left in place for 6-8 hrs after intercourse and then removed • Failure rate ranges from 3-16% CONTRACEPTION AND PREGNANCY 13 CERVICAL CAP • It is designed to fit tightly over the cervix • Should be filled with spermicide before intercourse • A clinician must fit the cap to fit each woman • Can remain in place up to 48 hrs. with no additional spermicide • The smaller size makes it more difficult to ensure coverage of cervix CONTRACEPTION AND PREGNANCY 14 HORMONAL METHODS • • • • • THEY INCLUDE: Oral contraceptives Norplant Depo-Provera They provide no protection against HIV and other STD’s CONTRACEPTION AND PREGNANCY 15 ORAL CONTRACEPTIVES • They are the second most popular form of birth control in the US • Most women the pill with both synthetic estrogen and a derivative of progesterone • A progestin only pill is available to women who cannot take estrogen • They provide protection against ovarian and endometrial cancer • Risks of ectopic pregnancy and PID are lowered • Reduced menstrual flow with shorter periods • Side effects include nausea, breast soreness, fluid retention, breast cancer, CVD, and liver cancer CONTRACEPTION AND PREGNANCY 16 NORPLANT • A progestin only implant (levonorgestrel) • Consists of flexible, matchstick-like capsules filled with LVG • Inserted under the skin of the upper arm • Dissipate after 5 years and need to be removed and replaced • Suppresses ovulation • Major side effects include irregular menstrual periods • Headaches, nausea, dizziness, acne, hair loss, increase in facial or body hair and breast tenderness CONTRACEPTION AND PREGNANCY 17 DEPO-PROVERA • Most widely used progestin injection • Injected into the gluteal or deltoid muscle every 3 months • Like Norplant is has a very low failure rate and also suppresses ovulation • Side effects include amenorrhea, weight gain, headache, nervousness, dizziness, stomach cramps and decreased sex drive CONTRACEPTION AND PREGNANCY 18