Contraception
Amanda White
Madelaine Yates
What is Contraception?
• Contraception is the intentional prevention of
pregnancy during sexual intercourse. Birth
control is the device and/or practice to
decrease the risk of conceiving, or bearing,
offspring. With the wide assortment of birth
control options available, it is possible for a
woman to use several different contraceptive
methods at various stages throughout her
fertile years.
Nurses Role
• Nurses interact with the woman to
compare and contrast available options,
reliability, relative cost, protection from
sexually transmitted infections (STI’s),
the individual’s comfort level, and
partner’s willingness to use a particular
birth control method.
Woman’s
Choices
• About one half of all pregnancies in the
United States are unplanned. Most women
can become pregnant from the time they are
in their early teens until they are in their late
40s. Birth control can help couples postpone
having a baby until the time is right for them
—if ever. Some types of birth control also
help protect against sexually transmitted
diseases (STDs). Today, there are many
choices of birth control for women and men.
How Birth Control Works
• Block the sperm from
reaching the egg
• Kill or damage sperm
• Keep eggs from being
released each month
• Change the lining of the
uterus so the fertilized
egg does not attach to it
• Thicken the mucus in
the cervix so sperm can
not easily pass through
it
Choosing A Method
• How well the method works and
the side effects
• How likely you are to use it
according to the directions
• Your age and overall health
• How often you have sex
• Whether a prescription is needed
• Whether you want to have children
later
• Whether it helps protect against
STDs
Special Needs
Nursing Consideration
• Choosing a form of birth control is more
complicated for women with special needs.
Sometimes this has to do with a woman's
reproductive stage—whether she is a teen,
breastfeeding, or in perimenopause, for
instance. Some women have chronic health
problems that need to be considered. Women
with disabilities also face challenges.
Barrier Methods
• Barrier methods prevent the
man's sperm from reaching the
woman's egg. Types of barrier
methods include:
– Condoms (male and female)
– Spermicides
– Sponge
– Diaphragm
– Cervical cap
• Using a spermicide with a
barrier method can help reduce
the risk of pregnancy even
more.
Condoms
• Male Version
– Made of Latex, Polyurethane, or
Animal Skin
• Latex condoms also protect against
STDs, including HIV
• Female Version
– Thin plastic pouch that lines the
vagina
• Can be difficult to insert
• Use if cannot be sure partner will use
a male condom
• Can be inserted up to 8 hours before
sex
Spermicides
Spermicides often are
used in suppositories,
foam, cream, jelly, and
film (thin sheets that
contain spermicide) to
kill sperm or make
them inactive
Sponge
The sponge is a
doughnut-shaped device
made of soft foam
coated with spermicide.
To use the sponge, it
must be moistened with
water. Once inserted in
the vagina, it covers the
cervix and blocks sperm
from entering the uterus.
Diaphragm
The diaphragm is a small,
latex, dome-shaped
device that fits inside the
vagina and covers the
cervix. It is used with
spermicide. A diaphragm
requires a prescription and
needs to be fitted by a
doctor.
Cervical Cap
The cervical cap is a
small, thin, dome-
shaped device made
of latex or plastic. It
fits tightly over the
cervix and stays in
place by suction. A
cervical cap must be
fitted and prescribed
by a doctor.
Hormonal Methods
With hormonal birth control, a
woman takes hormones similar to
those her body makes naturally. In
most cases, these hormones
prevent ovulation and change the
lining of the uterus. The hormones
also cause the cervical mucus to
thicken, which makes it hard for
the sperm to get through the
cervix to the uterus. Hormonal
birth control comes in several
forms, pill, skin patch, vaginal ring,
injection, and implant.
Birth Control Pills
There are many different
brands of pills that use
certain hormones or a
combination of hormones.
This variety allows a
woman to find a pill that is
right for her.
Skin Patch
The contraceptive skin patch is a
small (1.75 inch) adhesive patch that
is worn on the skin to prevent
pregnancy. With the patch, estrogen
and progestin are absorbed through
the skin into the bloodstream. The
patch may offer many of the same
benefits and risks as the combination
birth control pill. Once a woman
obtains a prescription for the patch,
she does not need to visit her doctor
to apply or remove it.
Vaginal Ring
The vaginal ring is a
flexible, plastic ring that is
placed in the upper
vagina. It releases both
estrogen and progestin.
The ring may have the
same benefits and risks as
those of the combination
birth control pill.
Injections
An injection or "shot" of
depot
medroxyprogesterone
acetate (DMPA) provides
protection against
pregnancy for 3 months. It
works the same way as
other forms of hormonal
birth control.
Implant
A contraceptive implant is
a single rod that is inserted
under the skin of the upper
arm. It protects against
pregnancy for 3 years. The
implant releases a
progestin that works
similar to other hormonal
methods of birth control—it
prevents ovulation.
Intrauterine Device
The IUD is a small, T-
shaped, plastic device that
is inserted and left inside
the uterus to prevent
pregnancy. There are two
types available in the
United States: the
hormonal IUD and the
copper IUD. The IUD does
not protect against STDs.
Emergency
Contraception
If a woman has sex without any type
of birth control or if she thinks her
method did not work (for instance, a
condom slipped or broke), she may
want to use emergency
contraception. Emergency
contraception reduces the risk that
pregnancy will occur. There are two
types of emergency contraception
available in the United States: Plan
B and the IUD.
Case Study/Care Map
The Sexually Active Adolescent Who Is Uncertain About
Using Contraception
A sexually-active 15-year-old comes to your clinic with her
grandmother.
During your social review you learn that she has a 13-month-old
child, multiple partners and has never used contraception. When you
inquire about her reasoning for not using contraception she says that
she is concerned about her weight and doesn't want to get the
symptoms that come with most of the methods.
Her grandmother wants her to stay in school. She would like you to
prescribe an oral contraceptive but the granddaughter is uncertain.
NANDA’s
• DECISIONAL CONFLICT
related to CONTRACEPTIVE
ALTERNATIVES
• FEAR related to
CONTRACEPTIVE METHOD
SIDE EFFECTS
• RISK FOR INFECTION related
to UNPROTECTED SEXUAL
INTERCOURSE
Outcomes
Planning is a collaborative effort among the
woman, her sexual partner (when appropriate),
the primary health care provider, and the nurse.
Verbalize understanding about contraceptive
methods
Verbalize understanding of all information
necessary to give informed consent
State comfort and satisfaction with the chosen
method
Use the contraceptive method correctly and
consistently
Prevent unplanned pregnancy or plan a
pregnancy
Plan of Care &
Interventions
• Unbiased client teaching is fundamental to initiating and
maintaining any form of contraception.
• A care provider relationship based on trust is important for
adherence by the client.
• To foster a safe environment for consultation, a private setting
should be provided in which the client can feel free to be open.
• Distractions should be minimized, and samples of birth control
devices for interactive teaching should be available.
• THE NURSE counters myths with facts, clarifies misinformation,
and fills in gaps of knowledge.
• The ideal contraceptive should be safe, easily available,
economical, acceptable, simple to use, and promptly reversible.
Evaluation
• Patient was able to
choose a birth control to
suit her needs with the
understanding of its side
effects (good & bad).
• Patient able to verbalize
understanding on how to
use birth control safely
and effectively.
Women’s Health &
Pregnancy Community
Resources
• Planned parenthood -
(517) 351-0550
• MSU’s Olin Health Center
Gynecology Clinic - (517)
355-4510
• Women, Infants and
Children - (517) 887-4326
• Ingham County Health
Department - (517) 887-
4300
Test Questions
1.Which Contraception practice is BEST?
A. The ideal contraceptive should be safe, easily available, economical,
acceptable, simple to use, and promptly reversible.
B. Morning After pill
C. Use it once remember
2. T or F
The pill, contraceptive patch, injection and the IUD all protect against STD’s.
3. T or F
With a 97% effectiveness rate, the condom also protects against STD’s.
4. T or F
The injection works by getting a shot in the butt daily for the whole time you are on it.
5. T or F
There are NEVER prescriptions needed for any contraception used.
References
Ball, J.W., & Bindler, R.C. (2008). Pediatric Nursing, Caring for Children (4th ed.).
Upper Saddle River, NJ: Pearson Prentice Hall.
Berenson, AB. (2008). More Factors to Consider in Selecting Contraceptive Methods,.
American Journal of Obstetrics and Gynecology, 199, 351.
Editorial. (2006). Can we Improve Contraceptive Use? Contraception, 73, 1-3.
Feldman, M.D. (2006) Primary Care: Clinics in Office Practice. Adolescent
Medicine, 33, 405-431.
Guttmacher Institute. (2008). Facts on Contraceptive Use. Retrieved November 21, 2008,
from http://www.guttmacher.org/pubs/fb_contr_use.html.
Planned Parenthood. (2008). Birth Control. Retrieved November 21, 2008, from
http://www.plannedparenthood.org/health-topics/birth-control-4211.htm.
Speidel, J., Harper, C., & Shields, W.C. (2008). The Potential of Long-Acting Reversible
Contraception to Decrease Unintended Pregnancy, Contraception, 78, 197-200.
Thomas, M.A., & Shields, W.C. (2007). Leadership and Diversity: A Call for New
Directions in Reproductive Health Education and Practice. Contraception, 75,
163-165.
Trussel, J., & Wynn, L.L. (2008). Reducing Unintended Pregnancy in the United States.
Contraception, 77, 1-5.
