Family Planning

2nd

WHAT IS CONTRACEPTION?

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A controversial political and ethical issue in many cultures and religions Fertility control An integral part of health care No perfect method exists Every couple should have a method that suits their needs CONTRACEPTION = FERTILITY CONTROL

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MAKING INTELLIGENT CHOICES Information Advise from medical care provider - Know the effectiveness - Know the shortcomings - Know the dangers - know the expense

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BIRTH CONTROL METHODS Celibacy or Sexual Abstinence Withdrawal Method Barrier Method  Condom  Diaphragm  Lea’s Shield  Cervical Cap  Contraceptive Sponge Chemical Method • Combined estrogen & progesterone:

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Combined oral contraceptive pill ("The Pill")  Contraceptive patch  Contraceptive vaginal ring  Lunelle (monthly injection) • Progesterone used alone:  Progesterone only pill ( Morning after or POP)  Depo Provera (injection every three months)  Implants (such as Norplant or Implanon) Intrauterine Methods • Intrauterine Device ("IUD") which may also be used for emergency contraception • IntraUterine System ("IUS") Fertility Awareness (sometimes called Natural Family Planning) • Rhythm Method • Basal body temperature • Billings ovulation method • Creighton Model LactationalAmenorrhea Method (LAM) • Most breastfeeding women have a period of infertility after the birth of their child. The Lactational Amenorrhea Method, or LAM,

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FCM III Family Planning shar, viki, maqui Shifting/August 15, 2008

gives guidelines for determining the length of a woman's period of breastfeeding infertility. Surgical Sterilization • Tubal ligation for women • Vasectomy for men CELIBACY OR ABSTINENCE voluntarily refraining from some or all aspects of sexual activity. to prevent conception To prevent STD transmission

WITHDRAWAL METHOD (COITUS INTERRUPTUS) • a method of contraception in which, during sexual intercourse , the man removes his penis from the woman's vagina just before he ejaculates. • That way, the emission of semen is not in the vagina but elsewhere. • This method has been widely used for at least 2,000 years and was used by an estimated 38 million couples worldwide in 1991. • Effectiveness: • Among couples who use withdrawal as their sole method of birth control, but do not use it consistently or correctly ("typical use"), there is a 27% per year failure rate. • Advantages: • Can be used by people who: - have religious objections -do not have access to other forms of contraception • No cost • No physical side effects • No devices used • • •

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BARRIER METHODS The most popular barrier method is the male condom, a latex sheath placed over the penis The condom is also available in a female version, which is made of polyurethane. The female condom has a flexible ring at each end - one secures behind the pubic bone to hold the condom in place, while the other ring stays outside the vagina. Advantages: o Easily available o Easy to use o Prevents STDs Failure Rate: o Condoms have a typical failure rate of 3% - 15% Diaphragm, caps, and shields

MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY KC JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU RACHE ESTHER JOEL GLENN TONI

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The diaphragm is a shallow, dome shaped cup with a flexible rim. It fits securely in the vagina to cover the cervix. FemCap is a silicone cup shaped like a sailor's hat. It fits securely in the vagina to cover the cervix. Lea's Shield is a silicone cup with an air valve and a loop to aid in removal. It fits snugly over the cervix. Each method must be used with spermicide cream or jelly. They block the opening to the uterus. The contraceptive cream or jelly stops sperm from moving. Effectiveness:

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Sixteen out of 100 women the diaphragm will pregnant during the first typical use.*Six will pregnant with perfect use.**

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Fourteen out of 100 women who have never been pregnant or given birth vaginally and use FemCap will become pregnant during the first year of typical use.

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Of 100 women who have given birth vaginally and use FemCap, 29 will become pregnant during the first year of typical use.*** Effectiveness rates for perfect use are not available.

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Fifteen out of 100 women who use the shield will become pregnant during the first year of typical use. Effectiveness rates for perfect use are not available.

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who use become year of become

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Oral contraceptives are chemicals taken by mouth to inhibit normal fertility. All act on the hormonal system. Female oral contraceptives have been on the market since the early 1960s, and enjoy great popularity. Use: o The Pill must be ingested daily, within 12 hours of the same time each day (for progesterone/estrogen pills — as opposed to within 3 hours for Progesterone only pills). Most brands are packaged with 21 days of active (hormone-containing) pills Action: o Pills contain different synthetic estrogens and progestins, chemical analogues of the natural female hormones o The combined Pill prevents pregnancy primarily by preventing ovulation. Effectiveness: o Failure rate of 2 – 8% Benefits:

Disadvantages/Effectiveness  Side effects of the patch are very similar to other synthetic hormone contraceptives such as the pill o Advantages:  Easier to use  No missedpill Vaginal Rings o Vaginal rings (also known as intravaginal rings, or V-Rings) are 'doughnut-shaped' polymeric drug delivery devices designed to provide controlled release of drugs to the vagina over extended periods of time. Progesterone Pill o Progesterone Only Pills or Progestin Only Pills (POP) are contraceptive pills that only contain progestins (synthetic hormones similar to progesterone) and do not contain estrogen. o They are colloquially known as mini pills. o Action:  Progesterone-only pills usually work by thickening the cervical mucus. Less often, they prevent ovulation. The hormones in POPs also thin the lining of the uterus. In theory, this could prevent pregnancy by interfering with implantation of a fertilized egg. o Lacking the estrogen of combined pills, they are not associated with increased risks of DVT, breast cancer or heart disease. o The low dose of progesterone, and absence of estrogen, make the minipill safe to use o

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CHEMICAL METHOD (ORAL CONTRACEPTIVE PILLS)

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Regulates period Causes lighter and less painful periods Reduced endometrial cancer May treat acne, PCOS, endometriosis The Contraceptive Patch o A woman applies her first patch onto her upper outer arm, buttocks, abdomen or thigh on either the first day of her menstrual cycle (day 1) or on the first Sunday following that day, whichever she prefers. o The day of application is known from that point as patch change day. Seven days later, when patch change day comes again, the woman removes the patch and applies another in its place. o This process is repeated again on the next patch change day. o On the following patch change day, the patch is removed and not replaced. o The woman waits 7 days without a patch in place, and on the next patch change day she applies a new patch. o Action:  Contraceptive patches are synthetic hormone contraceptives, similar in action to the contraceptive pill. o o o

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during breastfeeding it may increase the flow of milk. Side Effects:

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No breaks in usage and effectiveness depends on user compliance  With no break in the dosage, bleeds do not initially occur at a predictable time.  light spotting at approximately regular intervals.  May cause mastalgia or mood swings. Depo Provera o Synthetic progestin, without estrogen, and is administered to women in the form of an intramuscular injection once every 11 to 13 weeks. o Depo-Provera causes the ovaries to stop releasing eggs, and is 99.7% effective at preventing pregnancy o Potentially intolerable side effects:  loss of interest in sexual activity,  infertility,  severe headaches,  constant bleeding (metrorrhagia),  weight gain,  panic attacks,  muscle pain,  heart palpitations,  pain during sex, and  acne.  Side effects of Depo-Provera may persist up to 24 months after the last injection. o Benefits  Unlike oral contraceptive pills which have to be taken at roughly the same time each day (Combined Oral Contraceptive Pill within 12 hours and Progesterone only pill within 3 hours), the effectiveness of Depo Provera is not dependent upon the ability to remember to take daily doses. The only continuing action is to book subsequent follow-up injections every twelve weeks. o Disadvantages and Side Effects:  many women stop having a regular menstrual cycle while on the drug.  Recent research has shown that DepoProvera significantly decreases bone density Norplant o Norplant is a form of birth control released in 1991 by Wyeth Pharmaceuticals, consisting of a set of six small, silicone capsules filled with levonorgestrel, a synthetic progestin o Norplant works by preventing ovulation, which means that no eggs are released for fertilization o Norplant has been shown to be 99% – 99.95% effective at preventing pregnancy,

INTRAUTERINE DEVICE

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An intrauterine device (intra meaning within, and uterine meaning of the uterus) is a birth control device also known as an IUD or a coil world's most widely used and inexpensive method of reversible birth Depending on the type, IUDs can usually remain effective for 2, 5 or 10 years. Effectiveness o The hormonal IUD is as effective as the contraceptive pill at preventing pregnancy; and the copper IUDs effectiveness ranges from 98% to over 99% depending on the brand. IUDs can not protect from STDs, and if an infection is caught while using an IUD it may be more likely to spread to the uterus. Benefits: o No need for daily doses o Longterm use o Used for emergency contraception

FERTILITY AWARENESS (NATURAL FAMILY PLANNING) • Rhythm Method • Basal body temperature • Billings ovulation method • Creighton Model • Natural Family Planning (NFP) is a set of Catholic-sanctioned methods of family planning, which help women to achieve or avoid pregnancy by identifying times of infertility and potential fertility • Most methods of NFP track various indicators of fertility, including Basal body temperature, cervical mucus observations (eg. Billings, Creighton), cervical position observations, or a combination of one or more of the above (eg. Sympto-Thermal). • Other methods make statistical estimates as to when a woman is fertile (eg. Rhythm Method, Standard Days Method). • Common usage failure rate is 14-25% • Basal Body Temperature o One of the many changes that take place in a woman's body during her menstrual cycle is an increase in body temperature at the onset of ovulation. o During the first part of a woman's cycle, the body temperature is lower. o With ovulation, the body temperature rises, usually within 24 to 48 hours (to create a more fertile environment for the fertilized egg) and remains higher until the beginning of a woman's next cycle. o If the temperature doesn't go up and stay up then it's unlikely that there was ovulation. • Billings Ovulation Method o Billings ovulation method is a form of natural family planning. o Users track fertility by paying attention to the sensation at the vulva and the appearance of any vaginal discharge.

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This information can be used to achieve or avoid a pregnancy by choosing when to have intercourse and when to abstain. Creighton Model o The Creighton Model teaches women to observe certain biological signs to monitor their own gynecological health, and to identify times of fertility and infertility. o These biological signs include cervical mucus and bleeding patterns, and can be observed and analyzed in all types of menstrual cycles. o These signs are charted daily to give a picture of the woman's individual cycle. Rhythm Method o also known as the Calendar Method or the Knaus-Ogino Method (named after Hermann Knaus and Kyusaku Ogino), o a method of natural birth control that involves counting days of a woman's menstrual cycle and avoiding unprotected sex during the woman's predicted fertile period. o It can also be used by those trying to achieve pregnancy to time intercourse when the woman is most fertile. Standard Method (Modified Rhythm)

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LACTATIONAL AMENORRHEA METHOD (LAM)

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Most menstrual cycles have several days at the beginning that are infertile (preovulatory infertility), a period of fertility, and then several days just before the next menstruation that are infertile (postovulatory infertility). The first day of red bleeding is considered day one of the menstrual cycle. The formula for Calendar Rhythm requires the woman to know the length of her menstrual cycles. To find the length of the pre-ovulatory infertile phase, nineteen (19) is subtracted from the length of the woman's shortest cycle. To find the start of the post-ovulatory infertile phase, ten (10) is subtracted from the length of the woman's longest A woman whose menstrual cycles ranged in length from 30 to 36 days would, according to the Rhythm Method, be infertile the first 11 days of her cycle (30-19=11), be fertile

Lactational Amenorrhea Method (LAM) is a method of avoiding pregnancies which is based on the natural postpartum infertility that occurs when a woman is amenorrheic and fully breastfeeding. If not combined with chemicals or devices, LAM may be considered natural birth control or natural family planning. Also called breastfeeding infertility SURGICAL STERILIZATION

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on days 12-25, and resume infertility on day 26 (36-10=26). When used to avoid pregnancy, the Rhythm Method has a perfect-use failure rate of 9% per year. The Standard Days Method may only be used by women whose cycles are always between 26 and 32 days in length. In this system, days 1-7 of a woman's menstrual cycle are considered infertile. Days 8-19 are considered fertile. Infertility resumes beginning on day 20. When used to avoid pregnancy, the Standard Days Method has a perfect-use failure rate of 5% per year.

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Sterilization is a surgical technique leaving a male or female unable to procreate. It is a method of birth control. Vasectomy in males. o The vasa deferentia, the tubes which connect the testicles to the prostate, are cut and closed. o This prevents sperm produced in the testicles to enter the ejaculated semen (which is mostly produced in the seminal vesicles and prostate). o Although the term 'vasectomy' is established in the general community, the correct medical terminology is deferentectomy, since the structure known as the 'vas deferens' has been renamed the ductus deferens. Tubal ligation in females o Popularly known as having one's "tubes tied". o The Fallopian tubes, which allow the sperm to fertilize the ovum and would carry the fertilized ovum to the uterus, are closed. o Tubal ligation is a permanent, but sometimes reversible form of female sterilization, in which the fallopian tubes are severed and sealed, in order to prevent fertilization. o In women, a tubal ligation can be done in many forms:  through a vaginal approach  through laparoscopy  minilaparotomy ("minilap")  through a regular laparotomy.

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Also, a distinction is made between postpartum tubal ligation and interval tubal ligation, the latter not being done after a recent delivery. There are a variety of tubal ligation techniques; the most noteworthy are the Pomeroy type that was described by Ralph Pomeroy in 1930

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the Falope ring that can easily be applied via laparoscopy, and

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tubal cauterization done usually via laparoscopy.  In addition, a bilateral salpingectomy is effective as a tubal ligation procedure. A tubal ligation can be performed as a secondary procedure when a laparatomy is done, i.e. a cesarean section. Any of these procedures may be sometimes referred to as having one's "tubes tied." Reversal  Generally tubal ligation procedures are done with the intention to be permanent, and most patients are satisfied with their sterilizations. However, some types of procedure can be reversed with surgery, notably those that leave a sizable amount of tubal tissue in place, i.e. the Pomeroy type of tubal ligation or the Falope ring application. In contrast, tubal ligation with the use of cautery, or a salpingectomy are generally poor or no candidates for reversal. However, in vitro fertilization can overcome fertility problems in patients with tubal occlusion due to any type of tubal ligation. Effectiveness  The most effective methods in typical use are those that do not depend upon regular user action. Surgical sterilization and intrauterine devices (IUDs) both have failure rates of less than 1% per year.

These are from a book called Disorder in the Court. These are things people actually said in court, word for word, taken down and now published by court reporters who had the torment of staying calm while these exchanges were actually taking place !!! these are great !! Q. What is your date of birth? A. July 15th Q. What year? A. Every year. ------------ --Q. What gear were you in at the moment of the impact? A. Gucci Sweats and Reeboks ------------ --Q. This myasthenia gravis, does it affect your memory at all? A. Yes.

Q. And in what way does it affect your memory? A. I forget. Q. You forget? Can you give us an example of something that you've forgotten? ------------ --Q. How old is your son? The one living with you? A. 38 or 35 I can't remember which. Q. How long has he lived with you? A. 45 years. ------------ --Q. What was the first thing your husband said to you when he woke up that morning? A. He said where am I, Cathy? Q. And why did that upset you? A. My name is Susan. ------------ --Q. Do you know if your daughter has even been involved in voodoo or the occult? A. We both do. Q. Voodoo? A. We do. Q. You do? A. Yes, Voodoo. ------------ --Q. Now, doctor, isn't it true that when a person dies in his sleep, he doesn't know about it until the next morning? ------------ --Q. The youngest son, the twenty two year old, how old is he? ------------ --Q. Were you present when your picture was taken? ------------ --Q. So the date of conception (of the baby) was August 8th? A. Yes. Q. And what were you doing at that time? ------------ --Q. She had 3 children, right? A. Yes Q. How many were boys? A. None Q. Were there any girls? ------------ --Q. How was your first marriage terminated? A. By death. Q. And by whose death was it terminated? ----------- --Q. Can you describe the individual? A. He was about medium height and had a beard. Q. Was this male, or a female? ------------ --Q. Is your appearance here this morning pursuant to a deposition notice which I sent to your attorney? A. No, this is how I dress when I go to work. ------------ --Q. Doctor, how many autopsies have you performed on dead people? A. All my autopsies are performed on dead people. ------------ --Q. All your responses must be oral, ok? What school did you go to? A. Oral ------------ --Q. Do you recall the time that you examined the body? A. The autopsy started at around 8.30pm Q. And Mr. Dennington was dead at that time? A. No, he was sitting on the table wondering why I was doing an autopsy. ------------ --Q. Are you qualified to give a urine example? ------------ --Q. Doctor, before you performed the autopsy, did you check for a pulse? A. No Q. Did you check for blood pressure?

FCM III Family Planning Page 6 of 6 A. No. Q. Did you check for breathing? A. No. Q. So then it is possible that the patient was alive when you began the autopsy? A. No Q. How can you be sure, Doctor? A. Because his brain was sitting on my desk in a jar. Q. But could the patient have still been alive, nevertheless? A. Yes, it is possible that he could have been alive and practicing law somewhere.