107 Family Planning

FAMILY PLANNING
BASIC PRINCIPLES
FAMILY PLANNING – the voluntary

and moral management of all the
processes of family life including human
reproduction.
It must be moral so as not to allow

doubt & anxiety in man’s conscience by
the use of accepted scientific methods,
treatment for infertility, family life and
sex education.
2
BASIC PRINCIPLES
The nurse should be familiar with the
application, advantages and disadvantages of
the various methods of contraception available.
The most effective method is the one a woman

selects herself and will use consistently.
Women are entitled to contraceptive advice as

part of good health care without the burden of
moral judgment.
3
BASIC PRINCIPLES
Because family planning deals with people’s sexuality, a private
setting should be arranged whenever possible.
Feelings about contraception must be explored in a

nonjudgmental way and the variety of choices must be
summarized to allow selection of a method that fits the unique
circumstances of the person or couple
4
CONTRACEPTIVES
Contraceptives are products used to

prevent pregnancy by women and
men.
Each individual has their own choice

in what contraceptive they want to
use, so you must assess their
preference first before providing the
best contraceptive for them.
5
CONTRACEPTIVES
A pregnancy test must be performed

first to make sure that the woman
seeking for birth control is not presently
pregnant.
Assess for the OB history of the client,

any past sexually transmitted diseases,
the status of the past pregnancies, and if
they have used a family planning
method that did not turn out effective.
6
CONTRACEPTIVES
Assess subjectively the needs,

preferences, desires, and feelings of the
client regarding family planning.
Assess the sexual practices of the client,

the frequency, the number of their
sexual partners, and if they have any
allergies to latex.
7
TYPES OF FAMILY PLANNING
NATURAL FAMILY PLANNING
The natural family planning methods do
not include any chemical or foreign body
introduction into the human body.
Most people who are very conscious of

their religious beliefs are more inclined to
use the natural way of birth control.
Some want to use natural methods
because it is more cost effective.
8
A. PERIODIC ABSTINENCE
 This natural method involves

abstaining from sexual intercourse
and is the most effective natural
birth control method with ideally 0%
fail rate.
 Abstention from sexual intercourse

during fertile period of each cycle
9
 Usually depends on identification of fertile

period – usually 14 days before the next
menstrual period
 The most effective way to avoid STIs.
 Most people find it difficult to comply with

abstinence, so only a few use this method.
10
B. CERVICAL MUCUS METHOD

(BILLINGS METHOD)
 Requires a woman to examine the
mucus from her cervix to determine
her fertile period
 The consistency and amount of

cervical mucus changes as hormone
levels vary during the menstrual cycle
11
 Just before ovulation, the cervical mucus

becomes thin, watery, transparent and
copious
 During the peak of ovulation, the cervical
mucus becomes wet, slippery, abundant,
clear, stretchable like “egg white”
(SPINNBARKEIT), stretched to 2.5 cm and
normally from 8 – 10 cm; wet days and
signals UNSAFE days.
12
During ovulation, some women

experience localized lower
abdominal pain called
mittelschmerz which corresponds to
the release of the egg cell.
 After ovulation, the mucus becomes

thick, cloudy and sticky again, then
decreases or may be no mucus
13
The consistency of cervical mucus

can be affected by medications
such as antihistamines that change
mucus production throughout the
body, and by spermicides, sexual
intercourse, vaginal infections, or
the use of douches
14
The fertile days of a woman

according to this method is as
long as the cervical mucus is
copious and watery and a day
after it. Therefore, she must avoid
coitus during these days.
15
C. CALENDAR METHOD
The RHYTHM METHOD
Involves refraining from coitus during the
days that the woman is fertile.
According to the menstrual cycle, 3 or 4

days before and 3 or 4 days after
ovulation, the woman is likely to
conceive.
16
A woman keeps a record of at least 6

menstrual cycles and uses the record to
determine which days she is most likely to
be fertile during an average menstrual
cycle.
But fertile periods can vary from cycle to
cycle (irregular days) – exact time of
ovulation is hard to detect
17
According to the Ogino formula, the 1st
unsafe days (beginning of the fertile
period) can be determined by
subtracting 18 days from the length of
the shortest cycle
The last unsafe days (beginning of the

postovulatory safe period) can be
determined by subtracting 11 days
from the length of the longest cycle
18
If the shortest cycle is 24 days and the
longest is 30 days, application of the
formula is as follows
shortest cycle longest cycle

24 30
- 18 (constant) - 11 (constant)
______ ___
6th day 19th day
19
To avoid conception, the couple

would abstain during the “fertile”
period days 6 thru 19
If the woman has very regular

cycles of 28 days, compute both
with 28 days
20
D. BASAL BODY TEMPERATURE

The BBT method measures variations in
body temperature to determine when
ovulation has occurred.
Body temperature decreases slightly

just before ovulation and begins to rise
for several days afterward
21
Under the influence of progesterone,
24 – 48 hours after ovulation,
temperature rises from 3 – 6 °C,
remains slightly elevated until next
menstruation begins.
A woman takes her temperature

every morning before getting out of
bed using a basal thermometer
22
While this method is effective in determining
the ovulation, the beginning of a woman’s
fertile period may occur 2 days before
ovulation.
Since the sperm can live for up to 48 hours in

a woman’s body, a woman who had
unprotected sexual intercourse before
ovulation may become pregnant if the sperm,
still alive when the egg reaches the uterus
23
BBT may be ineffective if a

woman is sick or under stress
because lack of sleep and illness
can change a woman’s body
temperature
24
E. LACTATION AMENORRHEA METHOD
Through exclusive breastfeeding of the
infant, the woman is able to suppress
ovulation through the method of lactation
amenorrhea method.
It is also best to advise the woman that after

3 months of exclusive breastfeeding, she must
make plans of choosing another method of
contraception.
25
If the infant is not exclusively

breastfed, this method would
not be an effective birth control
method.
26
F. COITUS INTERRUPTUS
The withdrawal of the penis from the vagina
when ejaculation is imminent; effective when
mechanical devices are unavailable.
Contraindicated when male is not able to exert
self – control
Ineffective when premature ejaculation occurs

There is a psychological ill effect for both male
and female
27
G. COITUS RESERVATUS
Sexual intercourse without ejaculation
H. COITUS INTERFEMORA
Sexual intercourse where penis is wrapped
between femur
I. COITUS INTERMAMMAS
Sexual intercourse where penis is wrapped
28 between breasts
2. ARTIFICIAL FAMILY PLANNING
A. CONDOM
Thin stretchable rubber sheath worn over
the penis during intercourse
Widely available without prescription
Applied with room at tip to
accommodate ejaculate
Applied to erect penis before vaginal
penetration
29
Man is instructed to hold on to rim of

condom as he withdraws from the
female to prevent spilling of the sperm
30
B. DIAPHRAGM
 Shallow rubber dome fits over cervix,
blocking passage of sperm through
cervix
 Efficiency increased by use of
chemical barrier as lubricant
 Woman needs to be measured for
diaphragm, refitted after childbirth
or weight gain/loss of 10 lbs
31
32
 The device needs to be left in
place 6 – 24 hours after
intercourse
 Woman needs to practice
insertion and removal, and to be
taught how to check for holes in
diaphragm
 Device must be stored in cool
place
33
C. HORMONAL CONTROL THERAPY
(oral contraceptives, birth control pills)
Ingestion of estrogen and progesterone on

a specific schedule to prevent the release
of FSH and LH, preventing ovulation and
pregnancy
Usually taken starting on day 5 of the
menstrual cycle through day 25, then
discontinued
34
Can cause additional tubal, endometrial,

and cervical mucus changes
Withdrawal bleeding occurs within 2 to 3

days
Contraindicated to patients over 35 with

history of hypertension, diabetes or vascular
disorders and cigarette smoking
35
Women using OCP need to be sure to get

sufficient amount of vitamin B as
metabolism of this vitamin is affected.
Minor side effects may include weight

gain, breast changes, headache, nausea
and vaginal spotting. Vision changes must
be reported immediately.
36
If the woman has skipped one day of

taking the pill, she must take it the
moment she remembers it, than still follow
the regular use of the contraceptive.
If the woman has missed taking the pill for

more than one day, she and her partner
must consider an alternative
contraception to avoid ovulation.
37
D. CERVICAL CAP
Cup shaped device that is placed over cervical
os and held in place by suction
Has 4 sizes that need to be fitted to the client
Women need to practice insertion and

removal
Spermicidal increase effectiveness when left in

place for 24 – 48 hours
38
CERVICAL CAP
39
E. CONTRACEPTIVE SPONGE
Small, soft insert, with indentation on one side
to fit over cervix
Contains spermicide, moistened with water

and inserted with indentation snugly against
cervix, which may be left in place up to 24
hours
No professional fitting required; may also

protect against STDs
40
Should not be used by

women with history of toxic
shock syndrome
Problems include cost,

difficulty in removal, and
irritation
41
F. INTRAUTERINE DEVICE
Placement of plastic or noncreative device
into uterine cavity during menstruation or
after delivery
Mode of action thought to be the creation

of sterile endometrial inflammation,
discourages implantation (nidation) –
does not affect ovulation or conception
42
The device is inserted during or just after

menstruation while cervix is still open
It may cause cramping and heavy

bleeding during menses for several
months after insertion
The tail of IUD hangs into vagina

through the cervix
43
The woman is taught to feel for the

tail before intercourse and after each
menses
A distinct disadvantage is the

increased risk of pelvic infection (PID)
with use of IUD
44
G. STEROID IMPLANTS
Approved in 1990 by FDA;
biodegradable rods containing
sustained release, low dose
progesterone.
Inhibits LH release necessary for

ovulation
Effective over 5 – year time frame

45
It needs minor surgical procedure for

insertion and removal
Removal causes total reversibility of

effect
Injectable progestin
46
H. BIRTH CONTROL PILLS
Some birth control methods use

hormones. They will have either or both
and estrogen and a progestin or a
progestin alone. You need a prescription
for most hormonal birth control methods.
47
 Both hormones prevent a woman’s
ovary from releasing an egg during
her cycle. They do this by affecting
the levels of other hormones the body
makes.
 Progestin help prevent sperm from

making their way to the egg by
making mucus around a woman’s
cervix thick and sticky.
48
COMBINE PILLS
The pill works in several ways to prevent
pregnancy.
The pill suppresses ovulation so that an egg is not
released from the ovaries, and changes the
cervical mucus, causing it to become thicker and
making it more difficult for sperm to swim into
the womb.
The pill also does not allow the lining of the
womb to develop enough to receive and nurture
a fertilized egg.
49
This method of birth control offers no protection
against sexually transmitted diseases.
ADVANTAGES
It is 100% effective if taken regularly.
Easy to use and does not interfere with coitus.
Reduce the risk of anemia because menstrual
bleeding is lessened.
Reduce the risk of inflammatory disease, cyst and
uterine cancer.
50
DISADVANTAGES
Failure rate increase if taken irregularly.

Minor side effects like dizziness, nauseam
vomiting, headache, weight gain, etc.
Increases the risk of heart problems if women is
already at risk.
May increase the risk of gallbladder disease and
cervical cancer.
51
PROGESTERONE ONLY PILL
Also known as mini pill

It contains only progesterone and it thickens
the cervical mucus cavity.
Mini pills are taken throughout the menstrual
cycle and these are not used widely because
of its high failure rate.
52
INJECTABLE CONTRACEPTIVES
PROGESTIN ONLY INJECTABLE: two

preparations which are available.
DMPA (Depo-medroxy progesterone
acetate) – injection every 3 months
NET-EN (Norethiseterone enanthate) –
injection every 2 months
These have similar effectiveness, safety,

characteristics and eligibility criteria.
53
ADVANTAGES
It is easy to administer, highly effective and
irreversible, do not interfere with lactation
and does not cause any effect on the infant.
CONTRAINDICATION
Abnormal uterine bleeding, any malignancy
of the genital tract, suspected malignant
growth and breast cancer.
54
COMBINED INJECTABLE
CONTRACEPTIVES
These contains progesterone and estrogen
contraceptive also similar to progesterone
only injectable.
The injection is given once a month, 3 days
early or 3 days late.
Contraindicated in pregnancy, women,
having any other problem like diabetes with
complications, vascular disorder, suspected
malignancy.
55
3. PERMANENT FAMILY
PLANNING
Bilateral tubal ligation in female is

done by clamping or blocking the
isthmus of the fallopian tubes to
prevent the passage of ova, and is
done after menstruation.
56
Bilateral vasectomy in the male to

prevent the passage of sperm. Sperm
will be absorbed by the cells after
ligation.
Female will still menstruate but will not

conceive, and male will be incapable of
fertilizing his partner after all viable
sperm ejaculated from vas deferens
(6weeks or 10 ejaculations)
57
INFERTILITY
 pregnancy has not occurred after at
least 1 year of engaging in unprotected
coitus
 Inability to deliver a live infant after 3
consecutive pregnancies
PRIMARY: no previous conceptions;

SECONDARY: had a previous
conception but unable at present
 STERILITY: unable to conceive due to a
known condition
58
INFERTILITY
I. MALE INFERTILITY FACTORS
A. Inadequate sperm count – cryptorchidism
(undescended testes), increased scrotal heat,
chronic infection
B. Varicocele – varicosity of spermatic vein
C. Obstruction (adhesions) – infections like mumps
orchitis, epididymitis, gonorrhea
D. Anomalies of the penis – hypospadias,
epispadias
E. Erectile dysfunction
59
INFERTILITY
II. FEMALE INFERTILITY FACTORS
Anovulation – PCOS, Turner’s
A.
syndrome, hypothyroidism, ovarian
tumor, exposure to radiation, stress
B. PID
C. Tumors
D. Endometriosis – implantation of
endometrium or nodules that have
spread outside the uterus
60
INFERTILITY
E. Infection of the cervix –

causing thickening of the
cervical mucus
F. Infection of the vagina –
acidotic secretions
61
INFERTILITY
III. FERTILITY TESTING
A. Semen Analysis – abstinence for 2-4 days
before collection of specimen
> check appearance, motility, count
> average ejaculate: 2.5 – 5ml with
20 million/ml of seminal fluid or
50 million/ejaculation
B. Ovulation Monitoring – thru BBT for at
least 1 month or test strip (dip strip to
midmorning urine)
62
INFERTILITY
C. Tubal Patency
1) Sonohysterography – fill uterus with
saline and check for abnormalities
using transvaginal UTZ transducer
2) Hysterosalpingography – scheduled
immediately after menstrual flow;
iodine based radiopaque is introduced
> medium is thick, distending uterus
and tubes slightly,
causing momentary painful
uterine cramping
63
INFERTILITY
IV. INFERTILITY MANAGEMENT
a) Abstain for 7-10 days to increase sperm count

b) Ligation of varicocele
c) Treat infection according to causative agent
d) Administration of GnRH, clomiphene citrate (Clomid,
Serophene), human menopausal gonadotropins
(Pergonal) to stimulate ovulation – multiple ova could
mature
e) Conjugated estrogen (Premarin) for secretions that are
scant and tenacious
64
INFERTILITY
f) Surgery – removal of
tumor; take estrogen
for 3 months to
prevent adhesions
from reforming and
insert IUD to prevent
uterine sides from
touching
65
INFERTILITY
V. ALTERNATIVE
MANAGEMENT
A. Artificial Insemination –
instillation of sperm from
husband or donor into female
either into the cervix
(intracervical insemination)
or into the uterus
(intrauterine insemination) to
aid conception
66
INFERTILITY
> woman records BBT, assess cervical mucus to predict her
ovulation
> takes 6 months to achieve conception
B. In Vitro Fertilization – mature oocyte/s is removed by

laparoscopy and fertilized through exposure to sperm under
lab conditions outside a woman’s body
> if 2-3 zygotes are achieved, selective termination may be
recommended thru intraabdominal injection of KCl into
gestational sac to ensure success of pregnancy
67
INFERTILITY
68
INFERTILITY
C. GAMETE INTRAFALLOPIAN TRANSFER – obtain sperm and

ova but instilled in a matter of hours in a patent fallopian
tube
D. ZYGOTE INTRAFALLOPIAN TRANSFER – fertilization occurs

outside a woman’s body before transferring to a fallopian tube
69

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FAMILY PLANNING

FAMILY PLANNING – the voluntary

It must be moral so as not to allow

The most effective method is the one a woman

Women are entitled to contraceptive advice as

Feelings about contraception must be explored in a

Contraceptives are products used to

Each individual has their own choice

A pregnancy test must be performed

Assess for the OB history of the client,

Assess subjectively the needs,

Assess the sexual practices of the client,

Most people who are very conscious of

 This natural method involves

 Abstention from sexual intercourse

 Usually depends on identification of fertile

 The most effective way to avoid STIs.

 Most people find it difficult to comply with

B. CERVICAL MUCUS METHOD

 The consistency and amount of

 Just before ovulation, the cervical mucus

During ovulation, some women

 After ovulation, the mucus becomes

The consistency of cervical mucus

The fertile days of a woman

According to the menstrual cycle, 3 or 4

A woman keeps a record of at least 6

The last unsafe days (beginning of the

shortest cycle longest cycle

To avoid conception, the couple

If the woman has very regular

D. BASAL BODY TEMPERATURE

Body temperature decreases slightly

A woman takes her temperature

Since the sperm can live for up to 48 hours in

BBT may be ineffective if a

It is also best to advise the woman that after

If the infant is not exclusively

Ineffective when premature ejaculation occurs

Man is instructed to hold on to rim of

Ingestion of estrogen and progesterone on

Can cause additional tubal, endometrial,

Withdrawal bleeding occurs within 2 to 3

Contraindicated to patients over 35 with

Women using OCP need to be sure to get

Minor side effects may include weight

If the woman has skipped one day of

If the woman has missed taking the pill for

Has 4 sizes that need to be fitted to the client

Women need to practice insertion and

Spermicidal increase effectiveness when left in

Contains spermicide, moistened with water

No professional fitting required; may also

Should not be used by

Problems include cost,

Mode of action thought to be the creation

The device is inserted during or just after

It may cause cramping and heavy

The tail of IUD hangs into vagina