1. The client/caregiver can discuss the use of birth control and issues to be considered when choosing a method of birth control.
    1. To have control over if and when to become a parent, birth control, or whether contraception needs to be used.
    2. There is no “best” method of birth control. Each method has its pros and cons. Some methods are more effective than others.
    3. There is no method of birth control that is 100% effective. Any method of birth control is more effective if used correctly all of the time. Abstinence is the only way never to get pregnant.
    4. Things to consider when choosing a birth control method are
      • Your overall health
      • How often you have sex
      • The number of sexual partners you have
      • Whether you want to have children
      • How effective is each method for preventing pregnancy
      • Any possible side effects
      • How comfortable are you or your partner in using the method
    5. Most birth control methods do not protect you from HIV or sexually transmitted diseases.
    6. Birth control methods may work in different ways. These include
      1. Blocking sperm from getting to the eggs (condoms, diaphragms, etc.).
      2. Keep the woman’s ovaries from releasing eggs that could be fertilized (birth control pills).
      3. Prevent the fertilized egg from attaching to the lining of the uterus.
      4. Sterilization is a permanent method for women and men.
    7. Margaret Sanger, a public health nurse, opened the first birth control clinic in the United States in Brooklyn, New York, in 1971.
  2. The client/caregiver can list birth control methods and their effectiveness.
    1. Periodic abstinence or fertility awareness methods are means for the fertile days of the female menstrual cycle, there is no sex or the use of a “barrier” method of birth control is employed. This method is 75% to 99% effective if done properly. Ask for more information on how to calculate your cycle safely.
    2. Use a male condom. If used properly, they are 84% to 98% effective. Latex or polyurethane condoms are the only method (other than abstinence) that protect against HIV or sexually transmitted diseases.
    3. Oral contraceptives or the “pill” are taken daily to block the release of eggs from ovary. They are 95% to 99.9% effective. Contraindications for using oral contraceptives are
      1. It may increase risk of heart disease, hypertension, and blood clots.
      2. The risks increase if you smoke.
      3. The risks also increase if over the age of 35, have a history of blood clots and breast, liver, or endometrial cancer.
    4. The mini pill has only one hormone, progestin.
      1. One advantage of this method is that it can be used with mothers who are breastfeeding.
      2. It is 92% to 99.9% effective.
      3. It needs to be taken at the same time each day. If more than 3 hours late, a backup method of birth control is needed.
    5. Intrauterine devices are placed inside of the uterus. There are different types of intrauterine devices, but they average 98% to 99% effective. Depending on the type of intrauterine device, it can remain from 1 to 12 years.
    6. The female condom is worn by the woman, and it uses the barrier method of birth control. It is 70% to 95% effective. They can be purchased at drug stores.
    7. Depo-Provera is an injection of progestin every 3 months. It should not used for more than 2 years continually because of possible bone loss. It is considered to be 97% effective.
    8. A diaphragm, cervical cap, or shield is also an example of the barrier method of birth control. The diaphragm and cervical cap require a physician to fit them because they come in different sizes. They are used with spermicide and are placed over cervix prior to sexual intercourse. Both are 84% to 94% effective if used correctly. The effectiveness of the cervical cap drops to 68% to 74% if used after the delivery of a child. The cervical shield needs a prescription for purchase, and it is 85% effective.
    9. The contraceptive sponge was reapproved by the Food and Drug Administration in 2005. It is another example of the barrier method of birth control. It is 84% to 91% effective for women who have not had a child and drops to 68% to 80% effective for women who have had a child. There is a risk for toxic shock syndrome if left in place longer than 30 hours. It also can be purchased at the drug store without prescription.
    10. Ortho Evra Patch is worn on skin on the lower abdomen, buttocks, or upper body. It uses both progestin and estrogen. It is changed once a week for 3 weeks, and then no patch is used the fourth week. It is 98% to 99% effective (less effective for women who weigh more than 198 pounds).
    11. The hormonal vaginal contraceptive ring is inserted into vagina and is worn for 3 weeks. It is 98% to 99% effective. It is not recommended for use if breastfeeding. It needs a prescription.
    12. Surgical sterilization for either male or female is used when a permanent method of birth control is desired. They are 99.9% effective.
    13. Nonsurgical sterilization (Essure Permanent Birth Control System) is the first nonsurgical method of sterilizing women. An implant is inserted through the vagina and uterus and placed in the fallopian tubes. The implant will irritate and cause scar tissue and block the fallopian tubes. Because it takes up to 3 months to complete, a backup method of birth control is recommended. It has been shown to be 99.8% effective.

Resources

Food and Drug Administration888-463-6332www.fda.gov
Planned Parenthood Federation of America800-230-7526www.plannedparenthood.org/
The American College of Obstetricians and Gynecologistswww.acog.org/

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Inc.Cohen, B. J., & Taylor, J. J. (2005). Memmler’s the human body in health and disease (10th ed.). Philadelphia: Lippincott Williams & Wilkins.Novak, J. C., & Broom, B. L. (1999). Maternal and child health nursing. St. Louis: Mosby, Inc.Taylor, C., Lillis, C., & LeMone, P. (2005). Fundamentals of nursing. Philadelphia: Lippincott, Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.© 2008 Jones and Bartlett Publishers, Inc.www.jbpub.com

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