Family Planning and Related Nursing Care

Family planning refers to methods used to plan when pregnancy occurs, and includes natural family planning methods, contraceptive devices and medications, and surgical procedures.

Natural family planning involves fertility awareness methods to predict fertile and infertile days to either avoid pregnancy or to conceive when pregnancy is desired.

One method involves using a basal thermometer to monitor basal temperature, which is the body’s temperature first thing in the morning before getting out of bed.

During ovulation, the temperature will rise around 0.4 degrees F, or 0.2 degrees C, and stay elevated until menstruation.

The temperature is tracked for several months until a pattern is established, which helps predict when ovulation is likely to occur.

Next, the Billings method involves monitoring changes in cervical mucus. A few days before ovulation, the amount of mucus increases, and it changes from thick and sticky to thin and slippery.

Lastly, the calendar method, sometimes called the rhythm method, is used for those with regular menstrual cycles. It involves charting monthly cycles on a calendar for up to 12 months to estimate when ovulation is likely to occur, which is usually around the 14th day before the next menstrual cycle.

Contraceptive devices are reversible methods of contraception. First, there are barrier methods, like male condoms, cervical caps, and contraceptive sponges that prevent sperm from entering the uterus.

Male condoms are a thin stretchable sheath, commonly made of latex, that’s applied over the erect penis. They are single use and applied immediately prior to intercourse.

The effectiveness of condoms is enhanced when used together with spermicides, which are chemical-based formulations that destroy sperm cell membranes and reduce sperm motility, reducing their ability to reach the cervix.

Spermicides can come pre-applied to condoms and are also available as foams, tablets, suppositories, vaginal films, creams, or gels.

These formulations should be inserted deep into the vagina about 15 minutes before intercourse and must be reapplied before repeat intercourse since they're only effective for about an hour.

Cervical caps are soft silicone cups that are inserted deep into the vagina to cover the cervix. They are most effective when used with a spermicide.

There are also vaginal sponges, which are circular pieces of foam that contain spermicide, which trap and immobilize sperm.

The sponge is moistened with water and then inserted against the cervix prior to intercourse. All barrier method devices have advantages and disadvantages.

The advantages are that they’re inexpensive, relatively easy to use, and effective when applied properly. In terms of disadvantages, male condoms offer effective protection against sexually transmitted infections, or STIs, while other barrier devices and spermicides offer no protection.

Another contraceptive device is an intrauterine device, or IUD, which is a small T-shaped device inserted by a healthcare provider through the cervix and into the uterine cavity.

Some IUDs prevent fertilization by releasing small amounts of progestin, while others are made of copper. Both progestin and copper create an environment that decreases sperm motility, making them less likely to penetrate an egg.

Progestin also thins the lining of the uterus, so if an egg does become fertilized, it’s harder for it to implant. Advantages of IUDs include long-term contraception, since depending on the type and brand they can be left in place for 3 to 10 years.

Potential disadvantages of IUDs are that they can cause complications like uterine perforation, as well as ectopic pregnancy or spontaneous abortion, if pregnancy does occur.

Now, certain types of medications, such as pills, implants, and injections are also reversible types of contraception. They contain progestin or a combination of estrogen and progestin, and work by inhibiting ovulation, thickening cervical mucus to prevent sperm motility, and making the endometrium unfavorable for implantation.

Medications can also be delivered through a contraceptive implant, which is a flexible rod that’s inserted subdermally in the upper inner arm by a healthcare provider to continuously release progestin, which provides up to 3 years of contraception.

There are also injectable progestins that are administered either intramuscularly or subcutaneously. Effectiveness lasts for 15 weeks, and injections are typically repeated every 3 months.

Oral contraceptives and contraceptive implants allow for return of fertility immediately after removal, whereas injectable progestins may delay fertility up to 10 months after the last injection.

Oral contraceptives also provide health benefits, like reducing the risk of ovarian and uterine cancer and improved premenstrual symptoms.

However, they may also increase the risk of venous thromboembolism, myocardial infarction, stroke, migraines, hypertension, and gallbladder disease.

Other disadvantages include unwanted side effects like irregular menstrual bleeding and weight gain, and they don’t offer STI protection.

Now, emergency contraception refers to methods of preventing pregnancy after unprotected intercourse or a contraception failure.

These include an oral progestin called levonorgestrel which is available without a prescription and is effective when taken within 72 hours of unprotected intercourse; and the progesterone receptor modulator, ulipristal acetate, which requires a prescription and is effective when taken within 5 days.

Lastly, copper IUDs can also be used as an emergency contraceptive if placed within 5 days after unprotected intercourse.

Permanent contraception is achieved through surgical procedures and includes male sterilization, called vasectomy, and female sterilization, called tubal ligation.

These are offered to patients who are sure they don’t want a pregnancy now or in the future. During a vasectomy, both vas deferens, which are the tubes through which sperm travel from the testes to the urethra, are cut through small incisions made in the scrotum.

Back-up contraception should be used until an analysis confirms there is no sperm in the semen, usually 1 to 3 months following the procedure.

Tubal ligation is a procedure in which the fallopian tubes are clipped or cauterized to keep eggs from reaching the uterus.

Advantages are that the risk for pregnancy is nearly zero, and disadvantages may include regret and potential complications from surgery, like infection.

Alright, as a quick recap…Family planning refers to methods used to plan when pregnancy occurs. These can include natural methods, like fertility awareness; contraceptive devices, like condoms, cervical caps, and sponges; medications, like oral contraceptives, implants, and IUDs; and surgical procedures,