2. Respect for Life. The 1987 Constitution states that the government protects the sanctity of life. Abortion is not a FB method.

3. Birth Spacing refers o the interval between pregnancies, which is ideally 3 years and informed choice.

4. includes all decisions by an individual or couple pertaining to having children

5. which means that each family has the right and duty to determine the desired number of children they might have and when they might have them

6. responsible parenting which is the proper upbringing and education of children so that they grow up to be upright, productive and civic-minded citizens

7. it enables women to recover their health, improves women’s potential to be more productive and to realize their personal aspiration and allows more time to care for children and spouse/husband

8. that is upholding and ensuring the right of couples to determine the number and spacing of their children according to their life’s aspirations and reminding couples that planning size of their families have a direct bearing on the quality of their children’s and their own lies

9. Conception=fertilization (meeting of egg and sperm)

11. Birth control

13. Status of couple’s relationship

14. Ability to use method correctly

15. Financial factors

16. How methods affect sexual life

17. Prior experiences

18. Future plans

19. Legal and ethical considerations

20. Diagnoses:

21. Health seeking behaviors regarding contraception ooptions R/T desire to prevent pregnancy

22. Deficient knowledge RT use of

23. Ineffective sexuality patterns

24. Planning- realistic, sensitive, and appropriate goals

25. Implementation:

26. Health teachings on FP options

27. Ideal contraception:

28. Safe

29. 100% effective

30. Free from side effects

31. Easily obtainable

32. Affordable

33. Acceptable

34. Free from side effects on future pregnancies

36. Advantage: Most effective way, 0% failure rate, most effective n preventing STDs

37. Disadvantage: not realistic

38. Natural family planning- involves no chemical or foreign material being introduced into the body

39. Utilizes fertility awareness methods- detecting fertile days

40. Natural, poses no risk for occurring or future pregnancies; cost effective; theoretical failure rate 1-2%

42. Gather diary of 6 consecutive menstrual cycles (if cycle is 28 days, ovulation is on the 14th, 30days, 16th) [rule: length of menstrual cycle- 14days= ovulation day)

43. Fertile days (fertile window of days 8-19):

44. Shortest documented, subtract 18 = first fertile day

45. Longest, subtract 11= last fertile day

46. “Cycle beads” or “vertical beads”:

47. Red- first day of menstruation

48. Green- fertile days

49. Brown- infertile days

50. Chocolate (dark) brown- if menstrual cycle is shortened/lengthened

51. Important points:

52. Menstrual cycle length is below 26, above 32- the first time this happens, ct. takes note and marks ct. card; 2nd time around, change to another family planning method

53. If 42 days or more, ct. is advised to take a pregnancy test

54. Return during 1st week of next menstrual period

55. Who can use?

56. Women with menstrual cycles between 26-32 days

57. Couples who want to space childbirth at this time

58. Couples who can avoid sexual intercourse during fertile days

59. Couples at low risk of STDs (monogamous)

60. Women who can count and remember the length of her cycle

61. When was her last menstrual period LMP

62. When will be the next NMP

63. When was the previous PMP

64. Assessing women with special/unusual situations (hormone is not stable yet ):

65. Postpartum and breastfeeding women

66. Recent user of pills (alters ovulation cycle), injectables (DMPA)

67. For women who just had an IUD removed

68. For woman who recently had a miscarriage or abortion (8-12weeks birth spacing)

69. Basal Body temp BBT- is the temp at rest after at least three hours of continuous sleep or rest

70. Based on woman’s menstrual cycle

71. It entails the daily taking and recording of the woman’s temp after 3 hrs of continuous sleep

72. 98% effective rate

73. Materials: thermometer, basal body temp method chart

74. Process:

75. Shake the thermometer to 35C or below in the evening and place at bedside

76. Starting on the first day of menstruation, take the temp upon waking up every morning

77. Take temp under tongue or axilla for 5 mins

78. Cover line- the point of reference for determining the thermal shift that occurs during ovulation

79. Identify the temp reading of the first 10 days of cycle

80. Disregard the temp of the first five days

81. Find the highest temp from 6-10

82. Draw a horizontal line from 6th to 10th day

83. Thermal shift- watch for 3 consecutive temp recordings above the cover line

84. Count these 3 consecutive temp above the cover line, and mark them as days 1,2,3

85. Draw vertical line between 2 and 3

86. Going to the right- infertile days, left- fertile

87. Follow up: not later than 3rd week after menstrual period

88. Billings Ovulation Method (BOM) or (CMM ) Cervical Mucus Method- (OM, MM) ovulation/mucus method

89. Based on observation of the changes in the mucus secretions of the woman

90. Has 98 % effectivity rate

92. This named two-day because the

93. Effectivity rate

94. Who can use?

95. Wives that can observer her mucus secretion

96. Wives that has normal mucus secretions (mucus secretion must be at least 5 days and will not exceed 14 days)

97. Wives that have ample time in observing mucus secretions

98. Couples that can record mucus observations at the end of the day (all throughout the day)

99. Couples who want to space childbirth at this time

100. Couples who can avoid sexual intercourse during fertile days

101. Couples at low risk of STDs

102. Assessing women with special/unusual situations: same with standard methods

103. After menstruations, there may be days without secretion after which, a little secretion may be noticed. At the start you need to pay a lot of attention to notice it.

104. How does mucus look like?

105. Mucus does not appear the same at all tines

106. In the first phases of secretion only a little mucus will be observed, this demands a careful observation

107. All the days with mucus secretion marks the fertile days

108. How do I know if I have secretions??

109. Mucus can be seen and felt by the wife

110. You can check it when you go to the toilet:

111. By wiping yourself with tissue before passing urine

112. Looking at underwear

113. Touching genital area with clean fingers

114. You can feel it when there is dampness of the genitals?

115. Without interrupting what you are doing, think if you feel some dampness or not. E conscious.

116. What days can you get pregnant?

117. If you had secretions today or yesterday, abstain from intercourse today

118. For couples whose intention is to space childbirth, abstain from sexual intercourse during fertile days

119. Symptothermal Method STM- temperature changes and cervical mucus changes (BBT-CMM)

120. Combines the observations made of the cervical mucus, temperature records, and other signs of ovulation to determine the fertile and infertile phases

121. Has 99% effectivity rate

122. Using symbols

123. Rules:

124. The first fertile day is identified on the first onset of mucus following dry days after menstruation. Follow the early days rule (EDR)

125. On dry days following menstruation, lovemaking will be on alternate evenings only

126. If there are no dry days following menstruation, EDR cannot be applied

127. The post ovulatory phase is determined to be following both BBT and MM rules. However, when there is a difference, follow what comes later, whether the peak day or thermal shift.

128. Lactation Amenorrhea Method LAM- breastfeeding can be used as a family planning method by women who are fully or almost breastfeeding, have no menstruation yet during their first six months from delivery

129. Temporary introductory method of a family planning based on the physiological

130. Lactation

131. Exclusive of fully breastfeeding

132. Almost exclusive or almost fully bf

133. Feeding interval should not exceed four hours during the day and six hours at night

134. Amenorrhea

135. women’s menstruation has not yet returned (this does not include the spotting that occurs 56 days postpartum [6weeks after birth])

136. Method-

137. LAM has proven to be more than 98% effective if woman meets the 3 criteria established for use of the method

138. criteria:

139. she is amenorrheic

140. fully or nearly fully breastfeeding her infant

141. Infant is less than 6 months old

142. Uses symbols for chart

143. Return visit- once the menstruation returns, no longer breastfeeding, infant is 6 months

144. Coitus Interruptus- withdrawal

145. One of the oldest known methods

146. Coitus until moment of ejaculation

147. Man withdraws and spermatozoa are emitted outside the vagina

148. Disadvantage- ejaculation may occur before withdrawal is complete

150. Hormonal methods (e.g., birth control pills, injectables, patch)

152. Disadvantage- inc. failure rates, decrease sexual enjoyment

153. Male condoms- latex/rubber or synthetic sheath placed over an erect penis before coitus; removed after ejaculation

154. Space at tip

155. Not to reuse, even a pinpoint hole can allow thousands of sperm to escape

156. Discard old stock

157. Effectiveness: 98%

158. Contraindicated: latex allergy

159. Female condoms

160. Latex sheaths made of polyurethane and lubricated with nonoxynol-9 (treat STDs)

161. Inner (closed end covers the cervix) and outer ring (open end @vaginal opening)

162. Be placed before coitus

163. Failure rate- 15%

164. IUD- small flexible plastic frame inserted into a woman’s vagina through her uterus

165. Can be inserted immediately after childbirth

166. Two types:

167. ParaGard, a copper IUD- Spermicidal, lasts for 12yrs; 99.2% effective

168. Mirena- contains a synthetic hormone called levonorgestrel- cervical mucus thickening; 99.l9% effectiveness rate; lasts 5yrs

169. More convenient, decrease incidence of endometrial cancer

170. Not effective at preventing STDs, just pregnancy

171. S/E and contraindications:

172. Unprotected intercourse in the first 2-3 weeks after insertion

173. Use of tampons- staphylococcal infection

174. Those who haven’t been pregnant

175. Multiple sex partners: PID

176. Distorted uterine shape

177. Severe dysmenorrheal

178. With history of ectopic pregnancy, valvular heart disease

179. Anemia

180. Diaphragm

181. Circular rubber disk with r without coated rim with spermicide

182. To be prescribed and fitted by medical practitioner

183. Supine position, by fingers insert 2 hours prior to coitus, retained 6 hours or up to or 24 hours post ejaculation; lasts up to two years- reusable

184. S/E and contraindications

185. Easy losing or gaining weight

186. UTIs

187. Uterine: prolapsed, retroflexed, or anteflexed- cervix is displaced

188. Presence of cystocele or rectocele (almuranas)

189. Cervical cap

190. Soft rubber, thimble0shaped, fit snugly in the cervix

191. Unlike diaphragm, however, the cervical cap is much smaller and fits more tightly around the cervix when in place

192. Placed not >24hrs

193. Easily dislodged

194. Failure rate

195. CX

196. Abnormally short/long cervix

197. Previous papsmear

198. A hx of toxic shock syndrome

199. Allergy to latex or spermicide

200. A hx of PD

201. Vaginal spermicides

202. Gels, creams, films, foams, suppositories

203. Dec. pH

204. Nonoxynol- 9( prevent STDs)

205. Becoming not conducive for sperm survival

206. Done 1 hour prior to coitus to last up until 6 hours post coitus

207. Cx- cervicitis, discomfort on vaginal leak

208. Failure rate- 20%

209. Vaginal rings

210. Thin flexible plastic ring about 2 inches across

211. With very low content of estrogen and progestin

213. Subcutaneous implants

214. Intramuscular injections

215. Intracervical/intrauterine devices

216. Estrogen is high- suppresses FSH, LH

217. Progesterone is high- decreases permeability of cervical mucus, dec. sperm motility, dec. endometrial proliferation

218. Non-contraceptive benefits

219. Decreased incidence of dysmenorrheal

220. Premenstrual dysphoric syndrome

221. IDA (iron deficiency anemia)

222. Acute PID (pelvic inflammatory disease ) with tubal scarring

223. Endometrial and ovarian cancer, ovarian cysts

224. Fibrocystic disease

225. Combined pill or OCs

226. Monophasic- Fixed dose of both e. and p. in 21 days

227. Biphasic- Constant amt. of e. throughout the cycle but p. inc during the last 11 days

228. Triphasic- vary both e. and p. content throughout the cycle; mimics the natural cycle

229. Schedule:

230. After childbirth: Sunday closest to the 2weeks postpartum

231. If abortion: 1st Sunday after the procedure

232. 1st 7 days not as effective- use other form

233. Take pills at the same time of the day for 21 days

234. Place at area of plain sight e.g. at bathroom counter

235. S/E and Contraindication

236. Nausea

237. Weight gain

238. Headache to stroke

239. Breast tenderness

240. Breakthrough bleeding

241. Mild HPN

242. Chest pain; SOB

243. Depression

244. Thrombophlebitis

245. Breastfeeding

246. Family hx of CVA or CAD

247. Hx of liver disease

248. Undiagnosed vaginal bleeding

249. Age 40+

250. DM

251. Hypertension

252. Migraine

253. Smoking

254. 1st 2yrs after menarche

255. If ct. forgets to take 1 pill, take it as soon as possible, taking 2 pills in 1 day

256. If ct. forgets to take 2 consecutive pills, take 2 pills as soon as remembered, then continue the following day

257. If 3 or more consecutive pills, discard start anew, use alternative contra in the 1st 7 days

258. When can the woman get pregnant after discontinuation?

259. Recovery period- 1-2 months

260. To induce ovulation- clomiphene citrate

263. First 2 pills are given after 72 hours of unprotected sex (sexual assault), then 2 additional pills after 12 hours

264. Very high estrogen- cause vomiting, if within two hours of administering, repeat

265. 98% effective

266. Plan B- progestin only, Levonogestrel

268. Nearly 100% effective

269. Can be used while breastfeeding

270. s/e- almost similar with pills and an increase in the risk of for osteoporosis

271. a single injection of medroxyprogesterone acetate given as an intramuscular injection every three months, or Lunelle injection

272. Noristerat q8 weeks IM

274. embedded under the upper ant aspect of forearm

275. can be inserted anytime after abortion or 6 weeks post partum

276. 1-3% failure rate

277. Reversible, good for 5 years

278. Ad- long term, reversible, sexual enjoyment not inhibited

279. Can be used during breastfeeding

280. Can be use by adolescents

282. The fallopian tubes may be tied, cut, cauterized, clamped, or blocked (silicone-gel, reversible)

283. This serves to prevent sperm from joining the unfertilized egg

284. Permanent

285. Women should have no unprotected coitus few hours before the procedure

286. Can be done as soon as 4-6 hours following birth of a baby or abortion

287. 99.9% effective

288. Vasectomy

289. The vas deferens is surgically blocked by tying and cutting it, thus the sperm cannot escape from the testes

290. Permanent, 99% effective

291. Doesn’t interfere with the production of spermatozoa

292. But the latter cannot pass through the severed vas deferens

293. Take effect only after 10-20 ejaculations, when the 2 sperm reports are negative. Since sperms in the vas deferens remain viable for 6 months