Previously,
couples were discouraged from sexual intercourse until after 6 wks chek-up.
Now couples resume once episiotomy heals & lochia flow stops, usually end of 3rd week. Advise:
vaginal dryness, KY-Y jelly needed as lubricant. Change in position may ease discomfort. Nursing mothers should nurse prior to
lovemaking. Interference such as baby
crying, poor self-image with PP body, etc. Return
to prepregnant levels of sexual varies by couple and may take a few monts to
year.
Patient
Teaching: Clients will ask questions. If patient receives Rubella vaccine,
teach avoid pregnancy for 3 months. Vaccine can be teratogenic.
Methods:
Any method of birth control is safer statistically than pregnancy & giving
birth
Fertility
Awareness: natural family planning; periodic abstinence & recording of certain
events during cycle; cooperation of partner important. Only method approved
by Roman catholic Church. Failure rate: 25%; no protection against HIV, STDs.
BBT or
Basal body temperature: upon awakening,
prior to any activity, take temp; based on temp drops before ovulation & rises & remains up. Couples avoid
intercourse that day + 3 days. Record keeping.
Calendar
0r rhythm method: ovulation 14 days (+
or – 2 days) before start of next menstrual period. Sperm are viable 48 – 72 hrs, ovum 24 hrs. Record cycles 6 – 8 mos.
Fertile period is 18 days from END of shortest recorded cycle . EX: cycle is 24 – 28 days; fertile time is day 6 – 17,
abstinence necessary. Least reliable of fertility awareness method.
Cervical
mucus or ovulation method or Billings method. At ovulation,
cervical mucus (estrogen-dominant) is clearer, more stretchable , called spinnbarkeit.
Mucus assessed daily; abstain from
intercourse 1st sign of slippery, clear to 4 days after last wet mucus. Can be used by women with
irregular cycles: based on hormonal changes.
Coitus
interruptus – withdrawal; doesn’t
protect against STIs or HIV; failure rate 19%;
requires self-control & preejaculatory
fluid contains sperm. Better than
nothing!
Douching
- facilitates conception ↑ sperm into birth canal
Barrier
methods: male & female condoms,
spermicides, diaphragms, cervical caps. Can protect against spread of STIs; spermicides failure rate is 26%, messy; condoms
failure rate 14%, latex allergies, lack of knowledge on correct usage; diaphragm
protects, allergy , objection to insertion of a device, toxic shock, need to
refit q 2 years or with weight change
Intrauterine
devices – small T-shaped devices loaded
with either copper or a progestational agent; Failure rate 0.1% to 2.0%, risk for PID, uterine perforation,
infection
Hormonal
methods - over 30 kinds including combined estrogen-progestin
steroidal medications or progestin-only agents
which are administered orally, subdermally, patch, or by implantation;
emergency contraception using high doses of
OCPs;r no protection against STIs, most effective form, not suitable for heavy
smokers, 35+ women with HTN, hx of vascular
disease, familial DM
Emergency
contraception: 2 kits: Preven & Plan B, “morning after” pill
Sterilization,
male & female: permanent; Nurses
must be aware of informed consent for voluntary sterilization
Clinical
interruption – abortion - purposeful interruption of a pregnancy
before 20 wks gestation; legal in US since 1973.
1st trimester: D&C, minisuction, or vacuum
curettage. 2nd trimester: D & E (dilatation &
extraction), hypertonic saline,
prostaglandins; Complications of
bleeding or infection, religious & moral considerations
mifepristone
(RU 486): may be used medically to induce abortion during 1st 7 wks, up to 49
days/p conception; returns in 2 days for
misoprostol to induce contractions to expel embryo/fetus; returns to MD 12 days to confirm successful abortion.