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March 3, 2014. NURS 330 Human Reproductive Health. 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
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March 3, 2014 NURS 330 Human Reproductive Health
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
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 after pill” is not an appropriate name • Must 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 (the mini pill) • Mostly 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
Injectiblesunder 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
DiaphragmCervical 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)
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 Sterilization
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 stomach-irritating 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