Chapter 6

Nursing Care for the Family in

Need of Reproductive Life
Planning
Reproductive Life Planning

Includes all decisions an individual or a couple make

about having children, including
o If and when to have children
o How many children to have
o The length of time between having children
Counseling may include the topics of avoiding
conception, increasing fertility, and/or what to do if
contraception has failed.

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Contraceptives

An ideal contraceptive should be

o Safe
o Effective
o Compatible with religious and cultural beliefs
and personal preferences of user and partner
o Free of bothersome side effects
o Convenient to use and easy to obtain
o Affordable and needing few instructions for use
o Free of effects on future pregnancies after
discontinuation

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Categories of Commonly Used Birth
Control Methods

Natural family planning

Barrier methods
Hormonal contraceptives
Intrauterine devices (IUDs)
Surgical methods

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Natural Family Planning #1

Also called “periodic abstinence methods”

o No chemical or foreign material into body
o Failure rate ranges from 2% to 25%
o Need for couple to be conscious of time period
when woman is most likely to be fertile
Abstinence
o 0% failure rate
o Most effective method to prevent sexually
transmitted infections (STIs)

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Natural Family Planning #2

Lactation amenorrhea method (LAM)

o Safe method with failure rate of 1% to 5% if
 Infant under 6 months of age
 Breastfeeding with no supplements
 Menses has not returned
Coitus interruptus
o 82% effective; does not prevent STIs
Postcoital douching
o Ineffective

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Fertility Awareness Methods

 Calendar (rhythm) method

 Basal body temperature (BBT) method
 Cervical mucus (Billing’s) method
 Two-day method
 Symptothermal method
 Standard days method: CycleBeads
 Ovulation detection
 Marquette model

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Contraceptives: Barrier Methods

Barrier methods are those that place a chemical or

latex barrier between the cervix and advancing
sperm.
o Spermicides
o Male and female condoms
o Diaphragm
o Cervical cap

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Contraceptives: Hormonal Contraceptives
#1

Hormones that cause fluctuations in the normal

menstrual cycle to prevent ovulation or normal
transport
o Oral
o Combination oral contraceptives (COCs)
o Transdermal
o Intravaginal
o Intramuscular
o Subdermal hormone implants

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Contraceptives: Hormonal Contraceptives
#2

Oral contraceptives (combination of hormones)

o Monophasic
o Biphasic
o Triphasic
Oral contraceptives (progestin only)
Transdermal patches
Vaginal rings
Intramuscular injections

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Contraceptives: Intrauterine Devices
(IUDs)

A small plastic device inserted into the uterus to

prevent fertilization and/or decrease sperm
motility
o Copper T380
o Levonorgestrel-releasing intrauterine system
(Mirena or Liletta)
o Levonorgestrel-releasing intrauterine system
13.5 mg (Skyla)
o Levonorgestrel-releasing intrauterine system
19.5 mg (Kyleena)

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Contraceptives: Surgical Methods

 Tubal ligation
 Vasectomy

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Reproductive Life Planning: Emergency
Postcoital Contraception

For use in emergency only (such as rape)

o High-dose progestin-based pills
o Insertion of copper IUD
o Ulipristal acetate (known as ella)

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Reproductive Life Planning: Elective
Termination of Pregnancy
(Induced Abortion)

Termination of pregnancy performed by a

knowledgeable healthcare provider to end a
pregnancy before fetal viability

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2020 National Health Goals Related to
Reproductive Life Planning #1

Increase the proportion of adolescents who receive

formal instruction on abstinence before 18 years of
age from a baseline of 87.2% to a target of 95.9%.
Increase the proportion of females less than 15
years of age who have never had sexual intercourse
from a baseline of 82.9% to a target of 91.2%; of
males, from 82.0% to 90.2%.
Reduce the proportion of females experiencing
pregnancy despite use of a reversible contraceptive
method from a baseline of 12.4% to a target of
9.9%.

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2020 National Health Goals Related to
Reproductive Life Planning #2

Increase the proportion of intended pregnancies

from a baseline of 51% to a target of 56%.
Decrease the proportion of births occurring within 18
months of a previous birth from a baseline of 35.3%
to a target of 31.7%.

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Areas to Assess in Making Choices About
Contraceptive Methods #1

Personal values
Ability to use method correctly
Impact on sexual enjoyment
Financial factors
Length of projected relationship (short term versus
long term)
Past experience with contraception
Future plans regarding pregnancy

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Areas to Assess in Making Choices About
Contraceptive Methods #2

Vital signs, Pap smear, gonococcal and chlamydial

screening
Obstetric history, including STIs, past pregnancies,
previous elective abortions, failure of previously used
methods, and compliance history with past methods
Patients’ beliefs, needs, feelings, and understanding
of conception
Current and anticipated sexual practices, number of
partners, feelings, and body image

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Examples of Nursing Diagnoses Related to
Reproductive Life Planning

Readiness for enhanced knowledge regarding

contraception options related to a desire to prevent
pregnancy
Deficient knowledge related to use of a diaphragm
Altered sexuality pattern related to fear of
pregnancy

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Examples of Nursing Diagnoses and
Outcomes Related to Reproductive Life
Planning

Nursing Diagnosis Outcome

Readiness for enhanced knowledge Patient/partners will identify and
regarding contraception options use the contraception option most
related to a desire to prevent likely to fit their belief system,
pregnancy needs, and resources.
Deficient knowledge related to use Patient is able to demonstrate
of a diaphragm proper diaphragm insertion.
Altered sexuality pattern related to Couple will be able to identify
fear of pregnancy specific factors related to fear of
pregnancy that may contribute to
the altering of their usual pattern
of sexuality.

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Quality & Safety Education for Nurses
(QSEN)

Patient-Centered Care
Teamwork & Collaboration
Evidence-Based Practice
Quality Improvement
Safety
Informatics

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Interventions Related to Reproductive Life
Planning
Nursing Diagnosis Possible Nursing and
Therapeutic Interventions
Readiness for enhanced knowledge • Help patient/partners choose the
regarding contraception options contraceptive method that best
related to a desire to prevent fits their beliefs, needs, and
pregnancy resources.
• Teach patient/partners how to
use their chosen contraceptive
method.
Deficient knowledge related to use • Teach or review with the woman
of a diaphragm the steps in proper diaphragm
insertion.
Altered sexuality pattern related to • Explore with the couple their
fear of pregnancy beliefs and feelings related to
use of various types of
contraception.
• Discuss failure rates of various
contraceptive methods.
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Evaluating Outcomes Related to
Reproductive Life Planning

Nursing Diagnosis Expected Outcomes

Readiness for enhanced knowledge • Patient/partners report that they
regarding contraception options are successfully using their
related to a desire to prevent chosen contraception method.
pregnancy • Patient/partners report that they
are satisfied with their chosen
contraception method.
Deficient knowledge related to use
of a diaphragm ?
Altered sexuality pattern related to
fear of pregnancy ?

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Question #1

The term “reproductive life planning” best refers to

the counseling of
[Link] adult married women
[Link] who are concerned using contraception
prior to their first pregnancy
[Link] with concerns related to conceiving, genetic
abnormalities, and child-spacing needs
[Link] couples who are concerned about genetic
defects in future children

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Answer #1

C. Couples with concerns related to conceiving,

genetic abnormalities, and child-spacing needs.
Rationale: Reproductive life planning is pertinent
to any woman and man of childbearing age who is
in, or is planning to be in, a sexual relationship. It
refers to planning for both having and not having
children. Although reproductive life planning can
encompass preventing pregnancies for genetic
reasons, it is not limited to this purpose.

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Question #2

During a prephysical interview, a patient reports that she

and her husband are using the “rhythm method” of
contraception. This method of family planning
[Link] abstinence from sexual intercourse the week
after menstruation
[Link] abstinence from sexual intercourse 3 to 4 days
before ovulation and 3 to 4 days after ovulation
[Link] close monitoring of temperature and
assessment of cervical mucus
[Link] abstinence from sexual intercourse 2 days
before ovulation and 2 to 3 days after ovulation in addition
to monitoring temperature

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Answer #2

B. Requires abstinence from sexual intercourse 3 to 4

days before ovulation and 3 to 4 days after ovulation
Rationale: Abstinence during that time period
provides some degree of protection during the
most fertile days of the cycle. Adding additional
ways of determining when ovulation occurs, such
as monitoring cervical mucus or basal
temperature, would increase the accuracy of
predicting ovulation.

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Question #3

When a woman uses a vaginal spermicide, which of

the following actions should she be performing?
A. Insert the product by applicator no more than 1
hour prior to coitus.
B. Use a douche within 6 hours after coitus.
C. Keep a feminine hygiene product available to use in
case her supply of spermicide runs out.
D. Place the product near the vaginal orifice instead of
further back for immediate contact with sperm.

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Answer #3

A. Insert the product by applicator no more than 1

hour prior to coitus.
Rationale: Vaginal spermicides are most effective
when placed far back in the vagina where seminal
fluid and sperm tend to collect; because
spermicides have a short half-life at body
temperature, they should not be placed more than
1 hour before sexual relations. Feminine hygiene
products are not effective substitutes for
spermicides.

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Question #4

A male patient is interested in learning more about

having vasectomy. Which of the following would you
include in your teaching?
A. He will no longer ejaculate.
B. He may notice increased scrotal swelling over time.
C. He will need to continue to use contraception until
at least 10 weeks after the procedure.
D. His testes will no longer produce sperm.

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Answer #4

C. He will need to continue to use contraception until

at least 10 weeks after the procedure.
Rationale: Vasectomy does not stop sperm
production nor does it affect ejaculation. Usually,
there is no swelling of the scrotum, even
immediately after the procedure, although
occasionally a hematoma may form. Because
residual sperm may be present in the vas
deferens, birth control should be used until the
sperm count is negative.

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