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LECTURE: Family Planning With Nurse Ogoma O. Peace (@Omos) Part 2
Date Posted: 18/Dec/2017
It is the Right of every woman of child bearing age to have access to family planning. She should be given independent of her spouse or his decisions. The  family planning provider must not discriminate based on their culture or religious beliefs, the client's age, financial status or gender. Simply put, all clients are equal... Lecture Date: Saturday 16th Dec 2017, Time: 8pm, Venue: Nursingworld Nigeria WhatsApp Group
 
Hormonal Method
This birth control method works by suppressing ovulation and also causes the cervical mucus to thicken thereby making it difficult for sperm to get through the cervix to the uterus. There are 2 main  classes of Hormonal contraceptive
1. Combined contaceptives: Contains both estrogen  (ethinylestrondo) and progestin.
2. Progestin only contraceptive: Contains only progesterone (progestin) 
 
Hormonal contraceptive comes in different form's
(A) pills💊👉oral contraceptive pills 👉like  :
. Combined Oral Contraceptive(COCs): Most common is colloquially taken once a day for 21 days followed by 7 days break(contains 28 tablets. 21 tablets are the active pills and the remaining 7 tablets have a different colour and are non active tablet)
- Progestin only pills, POPs(minipills): This is taken1 once per day it contains synthetic female hormone in the family of progesterone E.g Exlution, Norgestrone, Femulen 0.5 etc
- Emergency Contraceptive Pills (ECPs): This is used for women who had sex without any type of birth control or if she thinks her method has failed. It is usually taken before 72hours after unprotected sex.
 
. Injection💉: These are long acting contraceptive containing combined estrogen and progesterone or progestogen only. Its given intramuscular. Provides protection for 1  to 3 months E.g:Depo- provera 👉3 months: Noristerat👉2months: Norigynon👉1 month
 
. Skin patches: This is applied to the skin and  worn continuously.
 
. Intra Uterine Contraceptive Device (IUD): It's a small plastic T shaped object with an attached string inserted in the uterine cavity to prevent pregnancy. It releases synthetic progestin hormone that changes cervical mucus, fallopian tubes and the uterine lining, it also stops or slows sperm and egg. Note: It lasts for 3-12years. Insertion can cause a few minutes of pain, but removal is fast and easy.
 
We have 2 types 
1)Non medicated👉made of inert plastic E.g:Lippe's loop👉not available in Nigeria
2)Medicated👉made of plastic with copper sleeve or wire around it. 👉Contains hormone Eg:copper T( Cu-T 380A)effective for 10-12 years Copper T (current 200)effective for 3years etc
 
B)Hormone releasing IUD's: e.g prosgestasert, it does not inhibit ovulation but interfere with implantation in endometrium, thickening of cervical mucus.
 
Advantages
1. Highly effective
2. May be efficacious if inserted up to 7 days after intercourse
3. Generally well tolerated.
 
Disadvantages
1. Not cost effective for short term use
2. Not recommended for  women with STIs and also can increase a woman's risk for STIs.
 
. Intra Uterine Contraceptive Device (IUD): It's a small plastic T shaped object with an attached string inserted in the uterine cavity to prevent pregnancy. It releases synthetic progestin hormone that changes cervical mucus, fallopian tubes and the uterine lining, it also stops or slows sperm and egg. Note: It lasts for 3-12years. Insertion can cause a few minutes of pain, but removal is fast and easy.
 
We have 2 types 
1)Non medicated👉made of inert plastic E.g:Lippe's loop👉not available in Nigeria
2)Medicated👉made of plastic with copper sleeve or wire around it. 👉Contains hormone Eg:
A) Copper T( Cu-T 380A) effective for 10-12 years, Copper T (current 200)effective for 3years etc
B)Hormone releasing IUD's: e.g prosgestasert, it does not inhibit ovulation but interfere with implantation in endometrium, thickening of cervical mucus.
 
Advantages
1. Highly effective
2. May be efficacious if inserted up to 7 days after intercourse
3. Generally well tolerated.
 
Disadvantage
1. Not cost effective for short term use
2. Not recommended for  women with STIs and also can increase a woman's risk for STIs.
 
. Implants:*These are also called (LARC)Long Acting Reversible Contraceptives. Implants are inserted under the skin of the inner upper arm and contain progesteron only E.g
1)Jadelle; Consists of 2rods which release a low dose of Hormones 👉last for 5years
2)Nexplanon; Which has replaced the former implanon👉has 1 rod👉lasts for 3years.
Note: The only difference between Nexplanon and implanon is that it's radio opaque and can be detected by x-ray.
 
. Surgical method: This includes sterilization
* Tubal sterilization for women .
* Vasectomy for men.
 
Vasectomy: It is a surgical procedure done under anaesthesia. A small incision is made on each side of the scrotum and the vas deference is then cut and tied or blocked. The vas deference is the tube that carrys sperm from the testicles to the opening of the penis.
 
Advantages
*Vasectomies are VERY effective.
*Vasectomies are permanent and one of the most effective kinds of birth control 
 
Disadvantages
*It causes regrets for men who later have a change of mind about conception e.g A man who lost his wife or had a divorce and wants to re-marry may want to make the new wife pregnant.
*it does not protect against STIs
*Bleeding may result in haematoma.
*Reversibility is difficult and expensive
 
. Tubal ligation: This involves blocking the fallopian tubes by cutting them, electrically sealing them or putting clips/rings on them thereby preventing the passage of both sperm and ova. The operations performed are 
*Laparoscopy
*Culdoscopy
*Colopotomy(incision into the vagina)
 
Advantages
*Tubal ligation is a permanent method of birth control offering immediate and highly effective protection against unexpected pregnancy.
*The woman might forget to take a birth control pill, but once  tubes are tied, there's no chance of human error
*It doesn't affect a woman's hormones unlike birth control methods such as the pill and the shot, tubal ligation doesn't change the levels of estrogen and progesterone flowing through a woman's body. She will still get her period, and it won't affect her mood or sex drive.
 
Disadvantages
*It's very expensive to reverse. Yes, the woman can change her mind later. Surgery can re-open tubes, but the success rate depends on her age and how much of the tube was left over after the original surgery.
*Most often, there could be an accidental injury to the bowel, bladder, or arteries which may lead to complications for the lady.
*There's still a very small risk of getting pregnant. And there's a greater chance that, if it does happen, the pregnancy will be ectopic, meaning the fertilized egg implants somewhere other than the uterus. An ectopic pregnancy can become life-threatening especially if it's not quickly detected.
*It does not protect against STIs
 
THE ROLE OF NURSES IN FAMILY PLANING
Nurses have a major role to play in achieving the objectives of family planning. Nurses can distribute most methods of contraception and disseminate information and show films on family planning. They can give talks in rural areas . They can also hold family planning camps; and they can speak at parent-teacher meetings. In antenatal and postnatal clinics and in surgical wards, they can talk with mothers and make sure that their family planning needs are made known to the community health centers in their villages when they return. Nursing administrators can organize seminars, symposiums, inservice education programs and panel discussions for the nursing staff.
 
Approach In Family Planing Counselling Acronym👉 GATHER
* Greet the client respectfully.This will make the individual relax and pour out his mind to you.
* Ask them about their family planing need.
* Tell them about different contraceptives options and methods.
* Help them to make decision about  of method
* Explain and demonstrate how to use the method
* Return /Refer, Schedule and carry out a return visit and follow up.
 
Thank you for taking time to go through this.
 
I Remain Nurse Ogoma O. Peace (@Omos)

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