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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.
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Patient Teaching: Clients
will ask questions. If patient receives Rubella vaccine, teach avoid
pregnancy for 3 months. Vaccine can be teratogenic.
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Methods: Any method of
birth control is safer statistically than pregnancy & giving birth
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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.
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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.
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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.
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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.
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Coitus interruptus –
withdrawal; doesn’t protect against STIs or HIV; failure rate 19%; requires self-control & preejaculatory
fluid contains sperm. Better than
nothing!
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Douching - facilitates conception ↑ sperm
into birth canal
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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
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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
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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
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Emergency contraception: 2
kits: Preven & Plan B, “morning after” pill
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Sterilization, male &
female: permanent; Nurses must be aware of informed consent for voluntary
sterilization
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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
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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.
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