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Course: Maternity Nursing

Topic: Family Planning- Hormonal Methods

The Nurses International Community

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Module Goals

Learners will be able to:

Discuss appropriate patient education associated with various contraceptive methods.
Recall the indications for use of various hormonal methods
Describe side effects, contraindications and danger signs of hormonal contraceptives
Describe the nurses role in patient education on family planning.

Contact info: info@nursesinternational.org

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What is Family Planning?

‘Family planning allows people to attain their desired number of children, if any, and to determine the spacing of their pregnancies. It is achieved through use of contraceptive methods and the treatment of infertility.’

World Health Organization (2021)

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Why is Family Planning Important?

Family planning (FP) helps:

Delay first pregnancy
Space subsequent pregnancies
Limit the total number of pregnancies
Limit pregnancies in women of high parity, advanced age or poor health
Help avoid unintended pregnancies

FP improves quality of life!

FP save lives!

(Population Reference Bureau, 2009)

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Family Planning

Nine human rights principles that guides family planning services:

Non-discrimination
Availability of contraceptive information and services
Accessible information and services
Acceptable information and services
Quality
Informed decision-making
Privacy and confidentiality
Participation
Accountability

(WHO, 2018)

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Family Planning

Important considerations:

The provider/client must be certain that the client is not pregnant

Before starting new FP methods/contraceptives
Before starting over after either missing pills or misuse of methods See checklist

Clients must be evaluated for medical eligibility before using FP method by certified practitioner

Client must have a thorough counselling of all FP methods available, even if the method is not available in the counsellors facility!!!

Contact info: info@nursesinternational.org

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What client’s need to know?

Reliability/efficacy
Correct use
Common side effects
Health risks and benefits
Sign & symptoms necessitating return for care
Information on return to fertility
Where and how they can obtain their choice
Cost
Who to contact if any concerns

Contact info: info@nursesinternational.org

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Family Planning Methods/Contraception

This slide deck provides basic information on hormonal methods:

Combined Oral Contraceptives
Monthly Injectables
Combined Patch
Combined Vaginal Ring
Progestin-Only Pills
Progestin-only Injectables
Progesterone-releasing Vaginal Ring
Emergency Contraceptives Pills
Implants

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Combined Oral Contraceptives (COCs)

Pills that contain low doses of progesterone and estrogen
Prevents release of eggs from the ovaries
93% effective with common use
1 pill taken orally everyday
Nearly all women can use, smoker under age 35 years
Need backup methods with the first 7 days of COCs

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What would the nurse do?

A client came to clinic really worried about irregular bleeding she has been having after using COCs since two months. The client said ‘, The family planning counsellor from the other clinic told me that this was the best method for me and asked me to use it. She did not tell me taking these pills would mess up my monthly bleeding. I was afraid of it causing me harm. So, I stopped using it and came here to seek help.’

What should the family planning counsellor have done to ensure client was satisfied with the family planning method?

What would be the first priority if the client wanted to use family planning method again?

Contact info: info@nursesinternational.org

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Monthly Injectables

Contains progestin and estrogen hormones
Prevents release of ovum from the ovaries
97% effective with common use
Injected once every month
Important: clients must remember to take injection every month!
Can be used only by certain smokers
Must use backup method for the first 7 days after injection

Contact info: info@nursesinternational.org

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Combined Patch

Small adhesive patch containing progestin and estrogen hormones
Primarily prevents release of ovum from the ovaries
93% effective with common use
Client wear one patch every week for 3 weeks followed by a patch-free week, and repeat the same cycle
Must use backup method for the first 7 days after wearing patch for the first time

Contact info: info@nursesinternational.org

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Combined Vaginal Ring

Flexible ring containing progestin and estrogen hormones
Primarily prevents release of ovum from the ovaries
93% effective with common use
Ring placed in vagina for 3 weeks and removed at the end of 3rd week. New ring inserted after seven days.
When using first time, backup method is needed for the first 7 days of its use

Contact info: info@nursesinternational.org

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Progestin-only Pills (POPs)

Pills contain low doses of progestin (like progesterone hormone) only
Can be used by those who cannot use estrogen containing methods
Thickens cervical mucus, prevents release of ovum from the ovaries
99% effective with common use in breastfeeding women

97% effective with common use in non-breastfeeding

1 pill taken everyday, exactly or within 3 hours of usual time
Need backup methods with the first 2 days of POPs use

Contact info: info@nursesinternational.org

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Progestin-only Injectables

Injectable contraceptives that contains progestin only
For those whom methods with estrogen is not suitable
Primarily prevents release of ovum from the ovaries
96% effective with common use
Injected once every 3 months or once every 2 months
Clients can self-inject subcutaneous injections

Important: clients must remember scheduled dates for injections

Contact info: info@nursesinternational.org

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Progesterone-Releasing Vaginal Ring

Flexible ring releases progesterone hormone
Primarily prevents ovum release from ovaries
Specifically designed for breastfeeding women in the first postpartum year.
99% effective with common use
Ring placed in vagina for 90 days, replace new ring on day 91
Backup method needed for first 2 days of its use for either first time or use after misuse

Contact info: info@nursesinternational.org

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Levonorgestrel Intrauterine Device (LNG-IUD)

T-shaped plastic device that releases levonorgestrel (a progestin hormone)
Works by preventing sperm from fertilizing an egg.
99% effective
Inserted into the uterus by a specifically trained provider
Provides protection from pregnancy for 5 years
Needs to use backup method for first 7 days after insertion

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Implants

Flexible rods/capsules, each size of a matchstick, release progestin
Prevent release of ovum from ovaries, thicken cervical mucus
Use by those who cannot use methods with estrogen
Provides upto 5 years of protection, depending on type
More than 99% effective
Trained provider inserts implants just under the skin of upper arm through minor surgical procedure
Need to use backup for 7 days after insertion

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What Would a Nurse Do?

A 15-year-old primigravida had a normal delivery in a district hospital. She has never used contraception. Her mother asks you for contraceptive advice for her daughter after delivery. The patient’s boyfriend has deserted her.

Does this young teenager require contraceptive advice after delivery?

The patient and her mother are worried that the long-term effects of an implant or injectable form of contraception could be harmful to a girl of 15 years. What would the nurse know about long-term effects of these contraceptives?

Contact info: info@nursesinternational.org

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Emergency Contraceptive Pills (ECPs)

Pills that help woman avoid pregnancy after having sex without contraception
Safe for all women
Primarily prevents or delays release of ovum from ovaries
98 -99% effective with common use
Take one pill within 5 days of having unprotected sex

The sooner they are taken, the better

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Contraindications

Hormonal contraceptives are contraindicated in clients with :

blood clots in a vein or artery
breast cancer
disease of the liver or gallbladder

Estrogen methods contraindicated if clients have or has had:

a heart problem or a disease affecting your blood circulatory system (including high blood pressure)
lupus (systemic lupus erythematosus)
migraine with aura
diabetes with complications

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Danger Signs

Sudden chest pain
Cough up blood
Dyspnea
Pain in lower leg
Very bad headache
Unusual vaginal discharge
Fever or chills
Pain during sex or urination/Bleeding after sex or between monthly bleeding
A tender pelvic mass
Pain when the abdomen is gently pressed or rebound tenderness

Client needs to get immediate medical help!

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Barriers to Family Planning

Difficult access to modern contraceptive methods
Low quality health care services
Little perceived risk of becoming pregnant
Fears about contraceptive side effects

Greatly affects compliance to FP methods

Lack of knowledge about contraceptive methods or sources of supply
Opposition from husbands, families, communities

Intimate partner violence, culture values/beliefs against FP methods

Unmet needs of special populations

Postpartum women, teenage adolescents, HIV populations

Contact info: info@nursesinternational.org

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Nurses Role in Patient Education of Family Planning Methods

Introduce the concept of FP and its benefits to the client during prenatal visits
Ensure client gets effective FP counselling by a certified FP counsellor before discharge after childbirth
Encourage/provide opportunities to clients to ask questions/concerns
Listen carefully to client’s concerns, respect their opinion and address them appropriately
Provide resources to the client to help understand FP methods better
Ensure she can reach you or concerned expert whenever she has concerns regarding FP methods

Contact info: info@nursesinternational.org

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What Would a Nurse Do?

When nurse came to take vitals signs of Rita, a 3 day postpartum mother, Rita sighly and reluctantly said, ‘Well, you see during family planning counselling I was asked to think about which method I wanted if I wanted to prevent future pregnancy. I am feeling very uncomfortable about using hormonal tablets or rings because it might harm my body in some way. Do I really need family planning now? Am I not safe from pregnancy for a couple of months at least?’.

What would the nurse say to the client?

What would the nurse be concerned about ?

Contact info: info@nursesinternational.org

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References:

NHS UK (January 2018). The progestogen-only pill. Retrieved from: https://www.nhs.uk/conditions/contraception/the-pill-progestogen-only/

Planned Parenthood (2021). How do I use the birth control pill?. Retrieved from: https://www.plannedparenthood.org/learn/birth-control/birth-control-pill/how-do-i-use-the-birth-control-pil l

World Health Organization (2018). Family Planning: A Global Handbook for Providers. Department of Reproductive Health and Research (WHO/RHR) and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), Knowledge for Health Project. Baltimore and Geneva: CCP and WHO, 2018. Retrieved from: https://apps.who.int/iris/handle/10665/260156

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