Download Lecture 6

February 23, 2015
NURS 330
Human Reproductive Health
Agenda
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Review 2.16.15 In-Class Assignment
Quiz
Group Project Review & Preparation
Contraception Lecture
No In-Class Assignment
Quiz
Group Project
• Project and presentation due on 3/2/15
• Assign order of presentation
• Q &A
CONTRACEPTION
Methods of Contraception and Birth
Control
 Birth
control
 any
means of preventing a birth from taking
place; includes contraception and abortion
 Contraception
 The
prevention of conception
 Technique designed to either prevent the release
of an ovum, prevent the fertilization of an ovum,
or prevent a fertilized ovum from implanting in
the uterine wall
Alternatives to Intercourse
Abstinence-refraining from sexual intercourse
(vaginal, oral, & anal)
Celibacy-not engaging in any kind of sexual activity
Outercourse-a method of birth control using all
avenues of sexual intimacy except sexual intercourse
Choosing a Method
Best method is the one
you will use consistently
Theoretical effectiveness
User/Typical
effectiveness
Failure Rates
• Typical use failure rate
– Percentage of typical users of a contraceptive
method who will get pregnant within one year
• Theoretical use failure rate
– Percentage of users of a contraceptive method who
will get pregnant within one year while using the
method perfectly each time
Chance
• Not a “method” at all
• Withdrawal (aka: Coitus interruptus)
• Douching
• Assumption: cleanses the vaginal canal by squirting
a liquid into the vagina
• Actuality: Not recommended for any use; no good
purpose and can promote infections
• Urination after intercourse
METHODS
BARRIER
HORMONAL
LONG-TERM
NATURAL FAMILY
PLANNING
Cervical Cap
Depo-Provera
Lunelle
Female
Sterilization
Basal Body
Temperature
Diaphragm
Emergency
Contraception
IUD
Cervical Mucus/
Ovulation Method
Male
Sterilization
Rhythm Method
Female Condom Implants
Male Condom
Patch
The Sponge
Pill
Ring
Hormonal Methods work by..
• Preventing the release of an ovum
• Can also cause the cervical mucus to thicken
which prevents sperm from entering the uterus
• The ingestion or injection of estrogen or
progestin or a combination of the two.
Emergency Contraception
Emergency
contraceptive pill (EC)
 Also
known as Plan B
 Estrogen and progesterone or just progestin.
 For use within 72 hours of unprotected sex. No later
than 5 days.
“morning
 Must
after pill” is not an appropriate name
be taken well BEFORE implantation.
Oral Contraceptives (OC)–
The Pill
 Two
forms of pills
 Estrogen
& Progestin (the combination pill)
Most
women choose this method
Side effects from estrogen include severe headaches and
high blood pressure
 Progestin
Mostly
(the mini pill)
selected due to side effects experienced from
estrogen in the combo pill
Combo pill is best for:
• Any woman (including those over 35) with no
risk factors that preclude OCs.
• Women with mild headaches or migraines
• Women who have diabetes without any blood
vessel related complications
• Women with a history of abnormal,
precancerous Papsmears (displasia).
Implants
Works by inserting progestin rods under the
skin and continuously release tiny amounts of
progestin into the bloodstream
– Norplant (used five rods and lasted five years)
• is no longer available in the United States
– Replaced by implanon
• Uses one rod
• Provides protection against pregnancy for up to three years
– Can be removed at anytime
– After removal, can resume menstruation in one month
Injectibles
under a clinician's supervision
• Depo-Provera
– Progestin
– Administered four times a year
• Lunelle
– Estrogen + Progestin
– Administered every 4 weeks
Ortho Evra Patch
• Estrogen and Progestin
• A once-a-week birth control option that's as effective as
the Pill.
• It is the first weekly, non-invasive form of reversible
contraception
• How does it work?
• What are advantages and disadvantages?
Nuva Ring
• NuvaRing® delivers steady low-dose
contraceptive hormones around the
clock.
– Progestin and Estrogen
• One ring is used each month. The ring
stays in for 3 weeks and then is
removed for one week. Then you insert
a new NuvaRing®.
Barrier Methods work by…
• Preventing fertilization of an ovum
• Providing a physical barrier between the semen
and the cervix in order to prevent sperm from
reaching the egg cell
Condoms
• Male
• Female
• Use either one or the other at one time
– Never both at the same time
Today Sponge
• Back on the US market
• blocks sperm from entering
the uterus and absorbs and
kills off the sperm.
• Intended to be used with
spermicide
Diaphragm
Cervical cap
• Work to prevent sperm from entering the uterus
– Intended to be used with spermicide
• Diaphragm
– a flexible ring around the top, the diaphragm is inserted into
the vagina prior to sexual intercourse.
• Cervical Cap
– smaller and fits more tightly around the cervix when in place
– must be fitted by your doctor and then purchased from a local
pharmacy
– can leave the cervical cap in place for up to 48 hours
Spermicides
Spermicide - substance toxic to sperm
 Contraceptive foam
 Contraceptive film
 Creams, jellies & Vaginal suppositories
 Non-oxynol 9??
Long-term Methods
• IUD
• Female Sterilization
• Male Sterilization
Intrauterine Device (IUD)




Tiny T-shape plastic or copper device inserted into uterus
Multiple theories on how it works
Insertion can be painful, heavy cramping and menstrual flow
Two currently available in the United States:
– Progestasert (~ 10 years)
– ParaGard (~ 1 year)
Sterilization
WOMEN
Laparoscopy- closing the tubes by
electrocauterization
–
–
–
–
Minilaparotomy-tubes are tied
off or sealed
Culpotomy-tubes tied and cut
Culdoscopy- Same as Culpotomy;
however, leaves less visible scars
Hysterectomy-surgical removal of
the uterus
MEN
Vasectomy
 cut or tie off the
Vas deferens
Abortion
• Spontaneous abortion
– aka miscarriage
– Loss of baby before 20 weeks of pregnancy
• Induced abortion
– Surgical
– Drug-based
Surgical Method
• Vacuum Aspiration
– First trimester method
• Dilation and Extraction (D & X)
– Late surgical method
Drug-Based Methods
• Mifepristone (RU 486) –Injection, 0rally
– An anti-progesterone
• prevents progesterone from making uterine lining hospitable for
implantation
• If fetus is already implanted, causes the uterus to shed its lining and,
along with it, the fertilized fetus
– Approved by FDA in September 2000 for abortion
• As an alternative to surgical procedure
– Effectiveness is increased if used with another drug,
Misoprostol (95-98%)
– Most effective within 7 weeks of fertilization
Drug-Based Methods (cont)
• Methotrexate –Injection; orally (rarely)
– Prevents cell division and multiplication
– Can be used to induce an abortion
• Effectiveness is increased if used with another drug, Misoprostol (95%)
– Approved by FDA for treatment of cancer, arthritis and psoriasis
– Most effective within 7 weeks of fertilization
• Misoprostol – orally or vaginally
– Legal Drug used in conjunction with above drugs
– The second drug used to complete the abortion procedure
• Taken a day or two after administration of the first drug
– Causes the uterus to contract and expel its contents
– Approved in the US for coating the stomach of people who take stomachirritating anti-inflammatory drugs.
Abortifacient
• A method or substance that causes a fertilized
egg that has implanted in the uterine wall or
fetus to be expelled.
• Which of the drug-based methods is an
abortifacient?
Incidence of Abortions
• Nearly half of pregnancies among American women are
unintended, and four in 10 of these are terminated by abortion.
• Twenty-two percent of all pregnancies (excluding miscarriages)
end in abortion.
• In 2005, 1.21 million abortions were performed, down from 1.31
million in 2000. From 1973 through 2005, more than 45 million
legal abortions occurred.
• Each year, about two percent of women aged 15-44 have an
abortion; 47% of them have had at least one previous abortion.
Source: Perspectives on Sexual and
Reproductive Health
When women have abortions
Source: Guttmacher Institute
Cost
• Surgical
– In 2005, the cost of a non-hospital abortion with
local anesthesia at 10 weeks’ gestation ranged from
$90 to $1,800; the average amount paid was $413
(Source: Perspectives on Sexual and Reproductive Health)
• Drug-based
– most providers do charge more for this method
Abortion and the Law
• Roe v. Wade
– 1973 Supreme Court decision stating
• 1st trimester abortions cannot be regulated by states and
the decision to abort is between woman and physician
• 2nd trimester abortions permitted when mental or
physical health of mother at risk
• 3rd trimester abortions allowed when life of mother at
risk
California Law
• California does not have any of the major types
of abortion restrictions – such as waiting period,
mandated parental involvement or limitations on
publicly funded abortions – often found in other
states.
Source: Alan Guttmacher Institute
The Pro-Life and Pro-Choice Controversy
• Anti-abortion (Pro-life) position
• Pro-choice position