Contraception
Visit a clinic that provides family planning ser- vices in your community. What are the fee sched- ules for women with and without insurance? Are local state or federal funds available? What are the hours of the clinic? Is the clinic location eas- ily accessed by public and private transportation? How long is a typical wait for a scheduled ap- pointment? What methods of contraception are available? How are women taught how to use a method?
Abortion
What are the laws in your state related to abor- tion, informed consent, and treatment of minors who request an abortion? What methods of abor- tion are available in your community? How eas- ily is emergency contraception obtained in your community?
Infertility
What adoption options are available in your com- munity? What are the services provided by each option and what are the costs? What are the pro- cedures for adoption associated with each op- tion? How well are the options publicized in the community? Is there a support network and, if so, how do prospective adopting parents gain ac- cess?
•A variety of contraceptive methods is available with various effectiveness rates, advantages, and disadvantages.
•Nurses need to help couples choose the contra- ceptive method or methods best suited to them. •Effective contraceptives are available through both
prescription and nonprescription sources. •A variety of techniques are available to enhance the
effectiveness of periodic abstinence in motivated couples who prefer this natural method.
•Hormonal contraception includes both precoital and postcoital prevention through various modal- ities and requires thorough patient education. •Emergency contraceptive methods should be ini-
tiated as soon as possible after unprotected in- tercourse, but no later than 120 hours.
•The barrier methods of diaphragm and cervical cap provide safe and effective contraception for women or couples motivated to use them con- sistently and correctly.
•Proper use of latex condoms provides protection against STIs.
•Tubal ligations and vasectomies are permanent sterilization methods that have become two of the most widely used methods of contraception.
•Elective abortion performed in the first trimester is safer than an abortion performed in the second trimester.
•The most common complications of elective abor- tion include infection, retained products of con- ception, and excessive vaginal bleeding.
•Major psychologic sequelae of elective abortion are rare.
•Infertility is the inability to conceive and carry a child to term gestation at a time the couple has chosen to do so.
•Infertility affects between 10% and 15% of oth- erwise healthy adults. Infertility increases in women older than 40 years.
•In the United States, 80% of infertility has an iden- tified cause related to factors involving the man and the woman and 20% of infertility is related to unexplained causes.
•Common etiologic factors of infertility include de- creased sperm production, ovulation disorders, tubal occlusion, and endometriosis.
•Reproductive alternatives for family building in- clude IVF-ET, GIFT, ZIFT, oocyte donation, embryo donation, TDI, surrogate motherhood, and adop- tion.
Key Points
Contraception
1 Yes, there is sufficient evidence for the nurse to discuss meth- ods of birth control that are effective but also not directly re- lated to sexual activity.
2 a. A method that does not fit the woman’s personal lifestyle is likely not to be used correctly or consistently. Personal con- siderations for a 25-year-old woman with three children may reflect the desire to prevent further pregnancies or to space her pregnancies. Questions the woman may ask herself when deciding on a method include (Trussell, 2004): Have I had problems with this method before? Does this method affect my menstrual periods? Could this method cause me serious complications? Will I have trouble remembering how to use this method? Will I have trouble remembering to use this method?
b. Efficacy or contraceptive effectiveness is the most frequently asked question about methods of birth control. Pregnancy rates for typical use (actual use including inconsistent and incorrect use) and perfect use (consistently following direc- tions for use) are often used to describe efficacy. Factors that influence efficacy include inherent efficacy (methods such as sterilization and injectable hormones allow little room for user error) and characteristics of the user (age, frequency of intercourse, imperfect use, menstrual cycle regularity). c. Arleta should be fully informed about the contraceptive
method she chooses. Informed consent includes information about risks and benefits, information about alternatives, an opportunity to ask questions, an opportunity to make her decision or to change her mind, and information about how to use the method.
3 The nursing priority at this time is to provide information about the methods that are effective but low maintenance, such as an IUD or Depo-Provera injections.
4 Yes, there is evidence that both of these methods provide ef- fective contraception with low failure rates. The failure rate for typical use for the IUD is less than 1%, whereas the rate for the Depo-Provera injections is 3%.
5 Arleta may decide that she would like to try oral contraception again, or she may decide that she would like a sterilization pro- cedure. Both would provide protection (typical failure rate for OCPs is 8% and for sterilization is less than 1%), and nei- ther would be a method that has to be used at time of sexual activity.
Abortion
1 Yes, at this stage of pregnancy vacuum aspiration is the most common procedure done. Although medical abortion can be done in the first trimester, its use is usually up to 49 days after the first day of the last menstrual period. Second-trimester abor- tions are associated with more complications.
2 a. The procedure is performed using local anesthesia in the clinic office. Meghan’s cervix will be dilated and the prod- ucts of conception will be evacuated from the uterus. Meghan may feel cramping during the procedure. She will likely have vaginal bleeding and mild cramping afterward. Excessive bleeding and infections are the most common complications. Menses should return within 4 to 6 weeks. b. Meghan may experience some fear or anxiety during the
procedure. Various feelings may be experienced after the abortion and include depression, guilt, regret, and relief. Answer Guidelines to Critical Thinking Exercises
Information about postabortion counseling may be needed. Support by the nurse and friends and family if pos- sible will help Meghan cope with any of these reactions c. The abortion is unlikely to affect future childbearing; how-
ever Meghan needs counseling about contraception. If she had unprotected intercourse because she did not like the method she was using, she may need to make another choice. She may need some counseling on how to say no or how to recognize situations that could lead to risky behaviors.
3 Nursing priorities at this time are to ensure that Meghan knows the options available and then to support her in her decision. Patient teaching about the procedure, self-care after the proce- dure, and contraception are needed.
4 Yes, there are excellent data about the safety of the procedure and about a woman’s response to the procedure (Goss, 2002; Stewart, Ellertson, & Cates, 2004).
5 Meghan does have other options. After learning about the abor- tion procedures, she may decide not to have an abortion at all, to have a second-trimester abortion, or to continue the pregnancy and either keep the baby or give it up for adoption. Meghan should be given the opportunity to discuss her feelings about pregnancy, abortion, and the impact of her choice on her future and to make her decision without feeling coerced by anyone. Infertility
1 No. Since a cause of infertility has not been determined, the type of procedure that can be used cannot be identified. The prognosis is determined by the cause and by the therapy.
2 a. Infertility increases with the age of the woman, especially in those over age 40. Fertility naturally decreases with age, and the woman may develop problems that affect fertility such as endometriosis and ovulatory dysfunction.
b. Feelings about infertility are numerous and complex. In- fertility can affect the man or woman’s self-esteem, their ca- reers, and their relationships with each other, family mem- bers, and friends. Frustration, isolation, depression, and stress are common reactions. Infertility is seen as a loss, and cou- ples must work through their grief to some resolution, whether it is choosing to try reproductive therapies or to deal with not having a child.
3 It is essential that an assessment be made first to collect data about both Bob and Shirley. This assessment should include a history and physical examination and laboratory evaluation. Crit- ical elements for Shirley include menstrual history, STIs, repro- ductive problems, coital activity, and endocrinologic factors. A semen analysis is the initial test for Bob. If a course is identified, information should then be provided about options for treatment including risks, costs, and the likelihood of being successful.
4 Yes, there is evidence to support the conclusion of correcting Shirley’s understanding about what an infertility workup is and why a treatment is not implemented until after a cause has been identified.
5 Bob and Shirley may decide not to pursue infertility treatment; they may decide to try for adoption or to live a child-free life.
American College of Obstetricians and Gynecologists (ACOG) 409 12th St., SW
Washington, DC 20024 800-762-2264
www.acog.com
American Society for Reproductive Medicine (ASRM) 1209 Montgomery Hwy.
Birmingham, AL 35316 205-978-5000
www.asrm.com
Association of Reproductive Health Professionals 2401 Pennsylvania Ave., NW, Suite 350
Washington, DC 20037 202-466-3825
www.arhp.org Contraception Online www.contraceptiononline.org Emergency Contraception Hotline P.O. Box 33344 Washington, DC 20033 888-668-2528 www.not-2-late.com Endometriosis Association 8585 N. 76th Place Milwaukee, WI 53223 414-355-2200 800-992-3636 www.endometriosisassn.org
Georgia Reproductive Services 5445 Meridian Mark Dr., Suite 270 Atlanta, GA 30342
404-843-2229 www.ivf.com
International Council on Infertility Information Dissemination 703-379-9178
www.inciid.org
Internet Health Resources–Infertility Resources for Consumers www.ihr.com/infertility/ National Abortion Federation
1755 Massachusetts Ave., NW, Suite 600 Washington, DC 20036
800-772-9100 Consumer Hotline www.prochoice.org
National Clearinghouse for Family Planning Information
P.O. Box 10716 Rockville, MD 20850 703-558-4990
National Women’s Health Resource Center 120 Albany St., Suite 820 New Brunswick, NJ 08901 877-986-9472 www.healthywomen.org Resources
Office of Population Research Princeton University 21 Prospect Ave. Princeton, NJ 08544 609-258-4870 www.ec.princeton.edu
Planned Parenthood Federation of America, Inc. 810 Seventh Ave.
New York, NY 10019 800-669-0156
www.plannedparenthood.org
Resolve—The National Fertility Association 7910 Woodmont Ave, Suite 1350
Bethesda MD 20814 301-652-8585
888-623-0744 (Helpline) www.resolve.org
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