Make a list of YOUR Contraception questions, concerns, frustrations that you encounter as you care for women.
DAWN DURAIN, CNM, MPH, FACNM ASSOCIATE DIRECTOR UPENN NURSE-MIDWIFERY PROGRAM [email_address] MANAGING CONTRACEPTIVE COMPLICATIONS 2010
“ I’ve tried them all…nothing works for me, what should I do?”
“ ..the pill made me bleed, the shot made me gain weight, the patch irritated my skin, the ring fell out, the condom broke, I’m afraid of an IUD….I just had an abortion last month and don’t want another one……”
“ Don’t take my method away!!”
our path today
Ours and Hers
Underuse aka unintended pregnancy
What’s coming down the road
How do you portray risk
How do you interpret/re-interpret the current evidence
Side effect vs. complication
Do it yourself
Counting the days/periodic abstinence
Withdrawal – Don’t underestimate it!
“ I can’t get pregnant if I ……”
Sponge – it’s back!!
Caps – gone, but will return?
Diaphragm – out of fashion?
Microbicides – hopefully!
Combined Oral Contraceptives
Withdrawal Bleeding/Hormone free Interval Trends
Is this safe?
Is this acceptable?
Is this beneficial?
I heard this is dangerous, will it kill me?
I can’t put it on my breasts because it causes breast cancer, right? Wrong!
You want me to do what? Where?
I love the Nuva Ring, but….I have this problem…
It won’t make me gain weight will it?
Last time I bled the whole time…
Sub Q/self administered
new and old barriers
SILCS – one size flexible, silicone
Impregnated with ….
FC2 = second generation -- Less ‘noise’
Single rod system, 3 year efficacy
No reported pregnancies
Are you being trained?
Who is the perfect candidate?
What are the insertion criteria?
Why such low use of IUC in the US?
2% in US compared to14% China & Africa, 28% E Europe
Paraguard – ____ string color, good for ___ years
Mirena – _____ string color, good for ___ years
Conform to fundal shape
Pre and/or post coital
In trials- Carraguard gel with LNG – (- efficacy as microbicide…but….)
..and now a word about us!
Provider beliefs & behaviors
About our clients
About the methods
‘ this is how we have always done it’
Use of the ‘evidence’
Presentation of the evidence
Influence of policy
Use of the Evidence
WHO Medical Eligibility Criteria
UK Medical Eligibility Criteria
CDC Medical Eligibility Criteria
The Medical Eligibility Criteria for the United States were developed at the CDC in March, 2009. They will be disseminated widely through a CDC website, books such as Managing Contraception and Contraceptive Technology, and organizations such as Planned Parenthood, The California Family Health Council and Family Health International in Feb/March 2010
The Seven Simple Strategies for Helping Patients Understand Risks J Paling 1. Prepare by first learning about the actual difficulties that patients experience in attempting to understand risks. 2. Accept the challenge that patients' emotions will invariably filter the facts and cannot be ignored. 3. Revise the way you explain probabilities to patients. The most commonly used methods can be greatly improved with small changes. 4. Try to avoid speaking to patients in terms of relative risks. Ensure you provide context so patients get “information” and not just “data.” 5. Never just give the negative perspective but, instead, make sure the positive perspective is always provided as well. 6. Explain the risk numbers by using visual aids. These give context as well as achieving understanding for the largest number of patients. 7. Realize that sharing visual aids with patients can serve to reinforce the health care provider–patient bond, enhance trust, and encourage acceptance of the health care provider's message.
so what do we do with…
Nothing has worked in the past
I can’t do that
I don’t believe you
‘ Out the door’ Instructions
When should I come back?
Why should I come back?
Address ‘change of heart’ after she leaves your office
PRN EC use ‘just in case’….
Need for pregnancy test if Quickstarted? Opportunity to check in with her.
What’s coming on down the road?
More COCs with shorter /no Hormone Free Interval
Continuous use research - Evra, Ring
More IUC choices
MAY THE CONTRACEPTING FORCE BE WITH YOU! Thank you!