Insel10ebrup Ppt Ch06


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Insel10ebrup Ppt Ch06

  1. 1. Contraception and Abortion Chapter 6
  2. 2. Principles of Contraception <ul><li>Based on the physiology of reproduction </li></ul><ul><li>Types: Barrier, Hormonal, Natural Methods, and Surgical </li></ul><ul><li>Factors affecting choice </li></ul><ul><ul><li>Advantages and disadvantages </li></ul></ul><ul><li>Effectiveness </li></ul>
  3. 3. Oral contraceptives (OCs): “The Pill” <ul><li>Estrogen and progesterone taken orally </li></ul><ul><li>Mimics the hormonal activity of the corpus luteum </li></ul><ul><li>Most common is the combination pill </li></ul><ul><li>Extended-cycle pill </li></ul><ul><li>“ Minipill” </li></ul><ul><li>Advantages </li></ul><ul><li>Disadvantages </li></ul><ul><li>Effectiveness </li></ul>
  4. 4. Contraceptive Skin Patch <ul><li>Thin 1 3/4 inch square patch </li></ul><ul><li>Releases estrogen and progestin slowly into the bloodstream. </li></ul><ul><li>Prevention the same way as OCs </li></ul><ul><li>Worn for one week, replaced on the same day for 3 consecutive weeks. Fourth week no patch </li></ul><ul><li>Advantages </li></ul><ul><li>Disadvantages </li></ul><ul><li>Effectiveness </li></ul>
  5. 5. Vaginal Contraceptive Ring <ul><li>The NuvaRing </li></ul><ul><li>Resembles the rim of a diaphragm and is molded with progestin and estrogen </li></ul><ul><li>2 inch ring slowly releases the hormones </li></ul><ul><li>During fourth week, remove the ring and use a new ring after the fourth week. </li></ul><ul><li>Advantages </li></ul><ul><li>Disadvantages </li></ul><ul><li>Effectiveness </li></ul>
  6. 6. Contraceptive Implants <ul><li>Norplant; Jadelle (Norplant II); Implanon (2006) </li></ul><ul><ul><li>Hormonal method </li></ul></ul><ul><ul><li>6 flexible matchstick capsules </li></ul></ul><ul><ul><li>Protection for 5 years </li></ul></ul><ul><ul><li>Progestin inhibits ovulation </li></ul></ul><ul><ul><li>Advantages </li></ul></ul><ul><ul><li>Disadvantages </li></ul></ul><ul><ul><li>Effectiveness </li></ul></ul>
  7. 7. Injectable Contraceptive <ul><li>Depo-Provera, Lunelle (2002 voluntary recall) </li></ul><ul><ul><li>Hormonal treatment </li></ul></ul><ul><ul><li>Injectable progestin every 12 weeks </li></ul></ul><ul><ul><li>Advantages </li></ul></ul><ul><ul><li>Disadvantage </li></ul></ul><ul><ul><li>Side effects </li></ul></ul><ul><ul><ul><li>period will subside - ovaries will not release egg </li></ul></ul></ul><ul><ul><ul><li>It may take 12 months before cycle will return </li></ul></ul></ul><ul><ul><li>Effectiveness </li></ul></ul>
  8. 8. Emergency Contraceptive <ul><li>Postcoital Pill, Morning After Pill, Plan B (OTC) </li></ul><ul><ul><li>Use a EPT kit </li></ul></ul><ul><ul><li>Most common is the two dose regimen </li></ul></ul><ul><ul><li>Prevents uterine implantation </li></ul></ul><ul><ul><li>Needs to be taken within 72 hours. Best used within 24 hours </li></ul></ul><ul><ul><li>Intrauterine Device </li></ul></ul>
  9. 9. Intrauterine Device (IUD) <ul><li>T-380A (ParaGard) 10 years of protection </li></ul><ul><ul><li>Copper </li></ul></ul><ul><li>Levonorgestral (Mirena) 5 years of protection </li></ul><ul><ul><li>Release small amounts of progestin </li></ul></ul><ul><li>Not exactly sure how it prevents pregnancy </li></ul><ul><li>Advantages </li></ul><ul><li>Disadvantages </li></ul><ul><li>Effectiveness </li></ul>
  10. 11. Male Condoms <ul><li>Thin latex sheaths </li></ul><ul><li>Protection against STD’s </li></ul><ul><li>Advantages </li></ul><ul><li>Disadvantages </li></ul><ul><li>Effectiveness </li></ul><ul><ul><li>Use with spermicide </li></ul></ul>
  11. 13. Female Condom <ul><li>Reality Brand </li></ul><ul><li>Polyurethane sheath with two flexible rings </li></ul><ul><li>Advantages </li></ul><ul><li>Disadvantage </li></ul><ul><li>Effectiveness </li></ul>
  12. 15. The Diaphragm with Spermicide <ul><ul><li>Dome shaped cup of thin rubber stretched over a collapsible metal ring. </li></ul></ul><ul><ul><li>Custom fit </li></ul></ul><ul><ul><li>Following intercourse </li></ul></ul><ul><ul><li>Advantages </li></ul></ul><ul><ul><li>Disadvantages </li></ul></ul><ul><ul><ul><li>Toxic shock syndrome (TSS) </li></ul></ul></ul><ul><ul><li>Effectiveness </li></ul></ul><ul><ul><li>Lea’s Shield </li></ul></ul>
  13. 17. Cervical Cap <ul><li>Small rubber or plastic cap </li></ul><ul><li>Must use foam kit </li></ul><ul><li>Advantages </li></ul><ul><li>Disadvantage </li></ul>
  14. 18. Vaginal Spermicide <ul><li>How it works </li></ul><ul><li>Advantages </li></ul><ul><li>Disadvantages </li></ul><ul><li>Effectiveness </li></ul>
  15. 20. Abstinence, Fertility Awareness, and Withdrawal <ul><li>Abstinence </li></ul><ul><ul><li>Without intercourse or sexual activities </li></ul></ul><ul><ul><li>Benefits: more self respect and respect for others. Security that you are being pursued for sexual reasons. Less worry about STDs and Pregnancy. </li></ul></ul>
  16. 21. The Fertility Awareness Method (FAM) <ul><li>FAM </li></ul><ul><ul><li>Calendar method </li></ul></ul><ul><ul><li>Temperature method </li></ul></ul><ul><ul><li>Mucus method </li></ul></ul><ul><li>Withdrawal </li></ul><ul><li>Combining methods </li></ul>
  17. 22. The Fertility Awareness Method (FAM)
  18. 23. Male Sterilization: Vasectomy <ul><li>Severing of the vasa deferentia </li></ul><ul><li>May return to work in 2 days </li></ul><ul><li>Semen tested in 12 weeks or 20 ejaculations </li></ul><ul><li>Reversal varies between 80% to 50%, depending on the report. </li></ul><ul><li>Complication rate </li></ul><ul><li>Effectiveness </li></ul>
  19. 25. Female Sterilization <ul><li>Tubal sterilization (laparoscopy) is most common </li></ul><ul><li>Essure system (2002) </li></ul><ul><ul><li>Sprng-like metallic implants causing scarring blocking the Fallopian tubes </li></ul></ul><ul><li>Hysterectomy </li></ul><ul><li>Surgical cases </li></ul><ul><li>Complication rate </li></ul><ul><li>Reversibility </li></ul>
  20. 27. Which Contraceptive Method is Right for You? <ul><li>Appropriate method of birth control </li></ul><ul><ul><li>Individual health risks </li></ul></ul><ul><ul><li>Implications of unplanned pregnancy </li></ul></ul><ul><ul><li>Risks of STDs </li></ul></ul><ul><ul><li>Convenience and comfort level </li></ul></ul><ul><ul><li>Type of relationship </li></ul></ul><ul><ul><li>Ease and Cost </li></ul></ul><ul><ul><li>Religious or other philosophical beliefs </li></ul></ul>
  21. 28. The Abortion Issue <ul><li>The history of abortion in the U.S. </li></ul><ul><ul><li>Mid-1800’s: Prior to 20 weeks was legal </li></ul></ul><ul><ul><li>1900’s: Physicians joined with other groups - stating untrained people were performing them. All states made abortion illegal </li></ul></ul>
  22. 29. Current Legal Status <ul><li>1973: Roe versus Wade </li></ul><ul><ul><li>Supreme Court ruled : </li></ul></ul><ul><ul><ul><li>Pregnancy divided into 3 trimesters </li></ul></ul></ul><ul><ul><ul><ul><li>1st trimester - up to women & doctor </li></ul></ul></ul></ul><ul><ul><ul><ul><li>2nd trimester - state may regulate </li></ul></ul></ul></ul><ul><ul><ul><ul><li>3rd trimester - state may regulate and bar all abortions that are not life threatening to mother </li></ul></ul></ul></ul><ul><li>U.S. Congress and federal Medicaid funds </li></ul><ul><li>17 states provide nonfederal public money </li></ul><ul><li>Current issues </li></ul><ul><ul><li>2000 Nebraska ban on partial birth </li></ul></ul><ul><ul><li>2006 Supreme Court reconsideration of Partial Birth Abortion Ban Act </li></ul></ul>
  23. 30. Moral Considerations <ul><li>Pro-life : The fertilized egg is a human being from the moment of conception and therefore an abortion is murder. </li></ul><ul><ul><li>Any women having sex knows pregnancy is possible - she has a moral obligation </li></ul></ul><ul><ul><li>Women unable or unwilling to raise the children should consider placing him/her up for adoption </li></ul></ul><ul><ul><li>Abortion has destructive effects on our traditional morals and values </li></ul></ul>
  24. 31. Moral Considerations <ul><li>Pro-Choice : There are distinct stages of fetal development and that preserving the fetus early in pregnancy is not the ultimate moral concern. </li></ul><ul><ul><li>Women should have the right to make their own decisions </li></ul></ul><ul><ul><li>If not legal then unsafe and unregulated practices would occur </li></ul></ul><ul><ul><li>Women would be divided into those who could afford and those who could not. </li></ul></ul><ul><ul><li>Some physicians would be forced to break the law </li></ul></ul>
  25. 32. Public Opinion <ul><li>U.S. public opinion seems to change depending on the situation </li></ul><ul><li>Many approve legal abortion when health or welfare consequences could result </li></ul><ul><li>The issue in later pregnancy is when does the right of the fetus take precedence over the woman’s rights </li></ul>
  26. 33. Personal Considerations <ul><li>Legal arguments </li></ul><ul><li>Moral arguments </li></ul><ul><li>Short and long term ramifications </li></ul>
  27. 35. Methods of Abortion <ul><li>Two categories </li></ul><ul><ul><li>Surgical - 98% of all abortions </li></ul></ul><ul><ul><li>Medical </li></ul></ul><ul><li>Ends a pregnancy before birth takes place </li></ul><ul><ul><li>Miscarriage/Spontaneous abortion - embryo or fetus dies in the uterus and is expelled by the body </li></ul></ul><ul><ul><li>Ending a pregnancy voluntarily - induced abortion </li></ul></ul><ul><ul><li>Approx. 88 % of all abortions are performed during the first trimester </li></ul></ul><ul><ul><li>Typically performed at a clinic, health center, or in a doctors office. </li></ul></ul><ul><ul><li>Women are usually able to return home an hour or so later </li></ul></ul>
  28. 36. Suction Curettage <ul><li>Vacuum aspiration </li></ul><ul><li>Early abortion; about 6 th to 12 th week </li></ul><ul><li>Used about 90% of all abortions </li></ul><ul><li>Vagina is washes with antiseptic, Anesthetic is injected into or near the cervix. </li></ul><ul><li>Cervix is gently and gradually stretched over a 24 hour period. </li></ul><ul><li>After dilation a tube connected to a suction machine gently empties the uterus </li></ul><ul><li>After suction a Curette (narrow metal loop) gently scrapes the walls of the uterus </li></ul><ul><li>After a few hours in recovery the woman can return home </li></ul>
  29. 38. Manual Vacuum Aspiration <ul><li>MVA </li></ul><ul><ul><li>Done within 4 or 5 weeks of last menstrual cycle </li></ul></ul><ul><ul><li>More effective and safer if performed at least 6 or 7 weeks </li></ul></ul><ul><ul><li>Gentle suction of a syringe </li></ul></ul><ul><ul><li>Cervix is dilated with meds. </li></ul></ul><ul><ul><li>Uterus is emptied with a handheld syringe </li></ul></ul><ul><ul><li>If a definitive gestational sac is not identified then women is tested for possible ectopic pregnancy </li></ul></ul>
  30. 39. Complications of Abortion <ul><li>Possible physical effects </li></ul><ul><ul><li>Fever above 100º F. </li></ul></ul><ul><ul><li>Abdominal pain or tenderness </li></ul></ul><ul><ul><li>Swelling </li></ul></ul><ul><ul><li>Backache </li></ul></ul><ul><ul><li>Prolonged or Heavy bleeding </li></ul></ul><ul><ul><li>Foul smelling vaginal discharge </li></ul></ul><ul><ul><li>Vomiting </li></ul></ul><ul><ul><li>Fainting </li></ul></ul><ul><ul><li>Delay of 6 or more weeks in resuming menstruation </li></ul></ul>
  31. 40. Possible Psychological Effects <ul><li>Possible feels after having an abortion </li></ul><ul><ul><li>Guilt </li></ul></ul><ul><ul><li>New strength in having made and carried out an important decision </li></ul></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Sense of loss </li></ul></ul><ul><ul><li>Negative feelings about sex </li></ul></ul><ul><ul><li>Relationship may end </li></ul></ul><ul><ul><li>Anger </li></ul></ul><ul><ul><li>Bitterness </li></ul></ul>
  32. 41. Contraception and Abortion Chapter 6