Family Planning Background: by Tiyas K

6/7/2016
Background
FAMILY PLANNING Human Rights declaration pasal 25:
By Everyone has the right to a standard of living
Tiyas K adequate for the health and wellbeing of himself
and of his family, including food, clothing,
housing, and medical care and necessary social
services , and the right to security in the event
of unemployment, sickness, disability ,
widowhood, old age or other lack of live-hood
in circumstances beyond his control
Airlangga University-Faculty of Airlangga University-Faculty of

Nursing-2012 Nursing-2012
Background METHODS
International Conference on Population and Ammenhorea Lactation Method (ALM)
Development(ICPD) th 1994, Kairo:
Fertility Awareness-based Methods (FAB)
Reproductive health is a state of complete
physical, mental and social well-being in all Barrier Methode
matters relating to the reproductive system, and Intra Uterine Device
to its function and processes...... Intra Uterine Systems
Indonesian Population Growth 2008= 1.175%
Hormonal Methode
Population Growth # Economic Growth
Unwanted pregnancy rate Tubal Ligation & Vasectomy
Others

ALM FAB
Available for women with baby under 6 month Calendar
Prolactin >> GnRh release << LH << no - track lenght of last 6 cycles
folicel stimulation no ovulation ammenorhea ovum hold for 24hr, sperm stays on uterine 72hr, ovulation hapen in the
middle of sicle.
Conditions: intensive breastfeeding - physical n psychology condition base
5,2% failure of ALM working women - failure rate >>
CI: mother with HIV, Hepatitis B without vaccine on
baby, active Tb, breast Ca on theraphy Basal Body Temperature (BBT)
- assumtion body temperature decrease 1224 hr pre-ovulation and
increase couple days after
- morning measure same place
- physical n psychology condition base

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METODE BARIER
Billing Method/cervical mucous Men Condom
- recognise spinnbarkeit mucous Women Condom
- some women producing more mucous Diafragm combine with spermicidal
Sympto-thermal method
billing method + cervix consistency examination & sign
of ovulation (lower abdomen pain, hardnes in breast,
emotional changes, etc)

Female Condom
Plastic sheath
with ring
at both ends
Outer ring Inner ring
Grasping female condom

Airlangga University-Faculty of forUniversity-Faculty
Airlangga insertion of
Insertion

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Diapraghm
Inserted up to 18 hours before
intercourse and can be left in for a total of
24 hours
Condom
Combining condoms with spermicides
raises effectiveness levels to 99%

Drawbacks IUDs
condom:
Efectiveness 510 years
Interruption of coitus
Insertion when menstruation time
Decreased sensation
IUS (Intra Uterine System)
plus Mirena (levonorgestrel)20g/day

Timing of Insertion of
Mechanism of Action
Intrauterine Contraception
An IUD prevents sperm from meeting an Timing Pros Cons
egg. Ensures patient
Scheduling;
With menses interim
An IUD may stop a fertilized egg from not pregnant
pregnancy
growing inside the uterus. Convenience;
Must rule out
Midcycle anytime low rate of
Prevents fertilization by creating a hostile expulsion
pregnancy
environment (a sterile inflammatory Emergency Convenience;
reaction) for sperm and for a fertilized contraception pregnancy Pregnancy
(copper IUD) prevention
ovum
Alvarez PJ. Ginecol Obstet Mex. 1994.
OHanley K, et al. Contraception. 1992.

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The IUS: Mirena

Mirena releases 20 mcg levonorgestrel/day
Failure rate very low: only 0.3% over 5 yrs
Ectopic rate very low : 0.02%
5 years (as effective as CuT380 at 7 years)
Not for EC
STI protection relative, not for sex workers
Good for women with heavy periods
Expulsion rate as other framed devices

Advantages of the IUD Side Effect

Spotting, light bleeding, heavy or longer
Provides long-term birth control. menstrual periods are common in the
Cost effective. first 3 6 months of IUD use
Can be removed when a woman would like Pelvic pain after insertion
to become pregnant.
Convenient - a woman does not need to
remember it daily or weekly.

Contraindications Complications
Multiple sexual partners PID
History of PID Uterine perforation
Immunocompromised (e.g., HIV, sickle Ectopic pregnancy
cell disease) Menorrhagia and metrorrhagia
Known/suspected pregnancy IUD expulsion
Small uterus (<6 cm in length)

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Fertility Rates in Parous Women After

Discontinuation of Contraceptive HORMONAL
Combination pills (estrogen & progesteron)
100 Mini pills (progestin)
Monthly injectable (estrogen & progesteron)
Pregnancies
80
Trimester injectable ( DMPA) progesteron
(%)
IUC
60
OC Implant (etonogestrel)
40 Diaphragm Transdermal administration (Evra)
Other methods
Transvaginal administration (vaginal-Nuva ring)
20
0
0 12 18 24 30 36 42
Months After Discontinuation
Based on data from Vessey MP, et al. Br Med J. 1983.
Norplant Implant

COCs Mechanism of Action:

Mechanism Ovulation Suppression
Estrogen suppresses follicle-stimulating hormone
(FSH) and therefore prevents follicular emergence. Normal Menstrual Cycle Cycle Modified by COCs
Progesterone suppresses the midcycle

Follicular ovulation Follicular
development development
gonadotropin-releasing hormone (GnRH) surge,

which suppresses luteinizing hormone (LH) and Pituitary
hormones
Pituitary
hormones
therefore prevents ovulation. LH
LH
Causes thicker cervical mucus FSH
FSH
LH
LH
FSH
FSH
Causes decreased motility of fallopian tube Natural ovarian

hormones
Synthetic
hormones
Causes endometrial atrophy estrogen

estrogen
progestin
progestin
progesterone
progesterone
estrogen
estrogen
1 14 28 1 14 28
days of menstrual cycle days of active hormone-free
pill-taking interval
Adapted from: Senanayake and Potts, 1995.

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Benefits of Oral Contraceptives Hormonal SE

Decreases risk of ovarian cancer by 75% Fats deposit>>, increase body weight
Decreases risk of endometrial cancer by 50% higher trombosites
Decreases bleeding and dysmenorrhea High blood pressure
Regulates menses Amenorrhea
Cloasm
Protects against pelvic inflammatory disease (PID)
Headache
(thicker mucus)
Nausea
Protects against fibrocystic change, ovarian cysts,
ectopic pregnancy, osteoporosis, acne
Nonbreastfeeding postpartum women should wait
three weeks before starting estrogen-containing
contraceptives because of the increased risk of
thromboembolism

Return to Fertility After Contraindications of Oral

Stopping DMPA Use Contraceptives
Thromboembolism
Cerebrovascular accident (CVA) or coronary artery disease
Percent of Women Having Conceived
(CAD)
100 Breast/endometrial cancer
Cholestatic jaundice
80
Undiagnosed vaginal bleeding
60 Hepatic disease
Oral Contraceptives (0=last pill taken)
IUD (0=device removed) Known/suspected pregnancy
40
DMPA (0=15 weeks after last injection) Concomitant anticonvulsant therapy
20 Some antibiotics
0 Relative contraindications: Migraines, hypertension (HTN),
0 4
Months 8 Stopping
After 12 16 20
Contraceptive 24 lactation
Source: Tieng, 1982.
Taking the Pill Sterilization

Once a day at the same time everyday Tubal Ligation ( Tubectomy )
Use condoms for first month
- pengikatan
Use condoms when on antibiotics
- pemotongan
Use condoms for 1 week if miss a pill or take one
late - Essure nickel titanium insertion on
The pill offers no protection from STDs each tubal by histeroscopy
Vasectomy
note: use condom until 15 ejaculation

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LAPAROSCOPY-BAND-AID
STERILIZATION
Figure 25.1a

VASECTOMY


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Complication OTHER METHODS

Poststerility syndrome: Pelvic Coitus interuptus / withdrawl
pain/dysmenorrhea, menorrhagia, ovarian Spermisides gel
cyst Vaginal douche
Fistula formation: Uteroperitoneal
fistulas can occur, especially if the
procedure is performed on the fallopian
tubes < 2 to 3 cm from the uterus.

Postpartum Contraceptive Screening & Counseling Goals

Options for Providers
Delivery 3 weeks 6 weeks 6 months onward
All women
Condoms/spermicides Review contraceptive options with
IUD patients
Diaphragm/cervical cap
Female sterilization
Breastfeeding women Allow patients to hold contraceptive

Lactational Amenorrhea Method
devices
Progestin-only methods/Natural Family Planning
Combined estrogen-progestin
Non-breastfeeding women
Progestin-only methods
Promote successful use of chosen
Combined estrogen-progestin methods/Natural Family Planning method
more
Male sterilization

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Screening & Counseling Goals Considerations in Choice of

for Providers (Continued) Contraceptive Methods
Effectiveness Patient choice
Allow time for questions
Side effects Reversibility
Convenience Non-contraceptive
Provide written materials in the appropriate language and
literacy level Duration of action benefits
and Cost
childbearing plans Privacy

Insertion Technique
The new
Open package carefully
Mirena
Ensure the slider is furthest away from fitter
Inserter Check IUS arms lie in a horizontal plane prior
to loading
Practical tip
To make sure arms are horizontal,
align on a flat, sterile surface whilst
maintaining moderate pressure

Important to note when handling with the new inserter
Hold the slider firmly with your

forefinger or thumb when pulling on
the system into the tube
Tube bends easily after 4th mark Knobs at the end of arms close and
(cm scale) if forced too much form a rounded end with a small gap
in between the knobs

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Insertion Technique Insertion Technique

Pull on threads to place IUS in Mirena is now ready to be
insertion tube inserted
Fix threads in cleft at the end of Hold the slider firmly with
shaft the forefinger/ thumb in
Set upper edge of flange at the furthermost position
uterine sound measure Move inserter gently into
uterus until flange is about
Practical tip 1.5 - 2 cm from cervix.
The measurement obtained from
sounding the uterus should correspond to the
Gives sufficient space for
distance from the end of the loaded inserter to arms to open
the edge of the flange nearest to the cervix
New Insertion Technique New Insertion Technique

Holding inserter steady, release Release the IUS by pulling
arms by pulling slider back to the slider back down all the way
the mark
Remove the inserter from the
Push inserter gently inwards
until flange touches cervix
uterus
Mirena should now be in fundal Cut the threads to leave about
position 2cm visible outside the cervix
Practical tip Practical tip

To ensure IUS is in fundal position, continue When removing inserter, make sure the threads
to advance insertion tube until resistance is
run freely through the tube and do not draw
met at fundus. The flange may be pushed along the
tube by the cervix. Since the arms are unfolded and
the system from its fundal position
in absence of strong force, there should be no added
risk of perforation Airlangga University-Faculty of Airlangga University-Faculty of
References
F. Gary Cunningham...[et al.](2005) Williams
obstetrics/[edited by]. 22nd ed
Helen Varney Burst, Jan M. Kriebs, Carolyn L.
Gegor(2004) Varneys midwifery 4th ed.
I. Youngkin, Ellis Quinn. II. Davis, Marcia
Szmania(2004) WOMEN'S HEALTH: A
PRIMARY CARE CLINICAL GUIDE - 3rd Ed.
Sylvia K. Rosevear(2002) Handbook of
gynaecology management
Varney, Helen.
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Airlangga University-Faculty of
Nursing-2012
11

Family Planning Background: by Tiyas K

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6/7/2016

Airlangga University-Faculty of Airlangga University-Faculty of

Airlangga University-Faculty of Airlangga University-Faculty of

Airlangga University-Faculty of Airlangga University-Faculty of

Airlangga University-Faculty of Airlangga University-Faculty of

Outer ring Inner ring

Grasping female condom

Airlangga University-Faculty of Airlangga University-Faculty of

Airlangga University-Faculty of Airlangga University-Faculty of

Airlangga University-Faculty of Airlangga University-Faculty of

Airlangga University-Faculty of Airlangga University-Faculty of

The IUS: Mirena

Airlangga University-Faculty of Airlangga University-Faculty of

Advantages of the IUD Side Effect

Airlangga University-Faculty of Airlangga University-Faculty of

Airlangga University-Faculty of Airlangga University-Faculty of

Fertility Rates in Parous Women After

Airlangga University-Faculty of Airlangga University-Faculty of

COCs Mechanism of Action:

Progesterone suppresses the midcycle

gonadotropin-releasing hormone (GnRH) surge,

Causes decreased motility of fallopian tube Natural ovarian

Causes endometrial atrophy estrogen

Adapted from: Senanayake and Potts, 1995.

Benefits of Oral Contraceptives Hormonal SE

Airlangga University-Faculty of Airlangga University-Faculty of

Return to Fertility After Contraindications of Oral

Taking the Pill Sterilization

Airlangga University-Faculty of Airlangga University-Faculty of

Airlangga University-Faculty of Airlangga University-Faculty of

Airlangga University-Faculty of Airlangga University-Faculty of

Airlangga University-Faculty of Airlangga University-Faculty of

Airlangga University-Faculty of Airlangga University-Faculty of

Complication OTHER METHODS

Airlangga University-Faculty of Airlangga University-Faculty of

Postpartum Contraceptive Screening & Counseling Goals

Breastfeeding women Allow patients to hold contraceptive

Airlangga University-Faculty of Airlangga University-Faculty of

Screening & Counseling Goals Considerations in Choice of

Airlangga University-Faculty of Airlangga University-Faculty of

Airlangga University-Faculty of Airlangga University-Faculty of

Important to note when handling with the new inserter

Hold the slider firmly with your

Airlangga University-Faculty of Airlangga University-Faculty of

Insertion Technique Insertion Technique

New Insertion Technique New Insertion Technique

Practical tip Practical tip

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