review for primary health care nurses in oman

1. BIRTH SPACING
Insert LOGO
ELIZABETH HOSEPH K
SSN BSN WATTAYAH HEALTH CENTER

3. Q 1.
LIST THE FIVE METHODS OF BIRTH
SPACING PROVIDED BY MOH..

4. Q 2.
BREAST FEEDING IS A RELIABLE FORM OF
BIRTHSPACING METHOD…TRUE OR FALSE [WHY]

5. Syndrome

6. Definition
• Birth spacing is an integral part of Maternal
and Child Health programs,
• It ensures child survival and well being and
reduce maternal mortality And morbidity.
An infant born to an adequately nourished mother, with a birth
Interval of 3 or more years has better chance of survival. Even
mother’s child feeding and caring ability will depend to a large
extent on her health and the number of children she has to care
for.

7. The concept

8. 1800-1900
1900--1950
1950 – till now

9. The future

10. In oman…
Birth spacing services were initiated in Oman
in October 1994 as an integrated part of the
programme of
“Maternal and Child Health Care”
Goals of the birth spacing program in Oman
• Reduction of maternal morbidity and mortality
• Reduction of infant morbidity and mortality

11. Statistics in oman
Maternal Mortality Ratio (MMR) in Oman (1994-2007)
Source: Annual Health Reports – MoH (Oman) 1990-2007.
*Ministry of National Economy (Oman).
0
10
20
30
40
1994 1995 1996 1998 1999 2000 2001 2002 2003 2004 2005 2006
Maternal mortality rate

12. Ministry of Health’s strategies for
Birth Spacing Program
To use the ANC,PNC clinics and home visits to educate and counsel women
To provide information to the users regarding various available methods,
To create and sustain a universal acceptance by the Omani community birth spacing is
beneficial to the health and well-being of mothers, children and families as a whole.
To make all Ministry of Health institutions as well as sister and private institutions,
responsible for providing birth spacing services.
To provide easily accessible suitable choice of contraceptive methods.

13. Roles of birth spacing services
1.Education 2.Counseling
3.Client’s clinical
assessment
4.Free
contraceptives
5.Follow up

14. :
GynecologicalChild HealthPostnatalAntenatal
wardclinicEPI
clinic
wardclinicwardclinicwardclinic
Community education through: community health groups, willayat health
committees.
All other mode of mass awareness such radio, television, newspapers,
magazines, public places will be utilized to enhance the knowledge of
community to promote modern contraceptive method used for birth spacing
.
1.Education

15. 2.COUNSELING
Initial
”GATHER”
GREET, ASK , TELL,
HELP,
EXPLAIN,RETURN
Method specific
Pre provision,
Post provision,
Follow up
TYPES

16. Contraceptives

17. Norplants

18. In Oman [Muscat region]
34%
12%
9%
33%
12%
COC
POP
IUCD
INJECTION
CONDOM

19. Anatomy and physiology

20. THE PILLS –COC AND POP

21. ACTION

22. Advantages Disadvantages Side effects
Highly effective. Must be taken daily. Changes in bleeding
pattern
Dose not interfere
with intercourse
Requires resupply. Mood changes,
Nausea, head ache
Easily discontinued at
any time if women
wish to become
pregnant
No protection
against STIs(HBV,
HIV).
Increased blood
Pressure,
amenorrhoea
Usually return of
fertility is immediate
May cause minor
effects
Breast tenderness
Do not affect breast
feeding(POPs)
Minor wt gain or
loss

23. Method provision and instruction for use
Switching from other method
Correcting misunderstanding
Managing a missed pill
Annual check up
Follow up
Initiation
When to start ?

24. The Injection
 Suppresses ovulation
 Thickens the cervical mucus and stop
 the sperm from entering the uterus
 Change endometrium, making
 implantation less likely.
 Reduces sperm transport in upper
 genital tract (fallopian tubes).
Each vial of 1 ml contains ( Depot Medroxy Progesterone Acetate)
150 mg/ml. It should be administered deep Intra-muscularly, as the
Preparation is released slowly into the blood stream form the site
of injection.

25. Advantages Disadvantages Side effects
Women of any age and
parity can use
Must return to clinic for
injection
Change in bleeding patte
rn for first 3 months: irre
gular, prolonged bleeding
.
Highly and rapidly
effective (< than 24 hour
s)
Cannot be discontinued
before the time of next
injection
Weight gain
Headache
Dizziness
Does not interfere with
intercourse
Weight gain or weight
loss
Abdominal bloating and
discomfort
May cause menstrual
irregularities,
Mood change
Decrease libido
Reduce bone density

26. Method provision and instruction for use
Correcting misunderstanding
Managing a late injection
Annual check up
Follow up
Initiation and the method of injection
When to start ?

27. IUCD
Intra-uterine Contraceptive Device (IUCDs) are small
flexible (T) shaped device inserted in the uterine cavity
for effective long term contraception. They are made of
plastic and are usually medicated with ‘Copper” and in
(NOVa) type with Progestin. MOH is providing (Copper T
380 A) type, which is effective for 10 years.

28. Action
Causing chemical change that
damages sperm and egg
before they can meet.
It prevent fertilization.
Cooper in device inhibits sperm
penetration, reducing sperm
motility and migration by
affecting the uteru-tubal fluid,
Cooper content induce
changes in the
endometrium,
causinginflammatory
reaction

29. Advantages Disadvantages Side effects
It most effective
reversible method and to
use convenient
no protection against
STD's and PID &
increases risk of
anemia
The copper IUD may
increase menstrual
bleeding or cramps.
Its effective for at least 10
years, not affecting
breast feeding
need to be removed
by doctor,Cannot stop
on their own
Women may also
experience spotting
between periods
Protect against endometrial
cancer
Need to check strings
monthly
low cost over time, few
follow ups
Cannot discontinue
on their own

30. Method provision and instruction for use
Correcting misunderstanding
Managing unusual situation
Follow up
Checking iucd strings
Post insertion instructions
When to insert?

31. Insertion procedure

32. The Condoms
Also called “Prophylactic” the condom is a very effective
reversible barrier contraceptive used by men
Type: 52 MM Non-colored, made of latex (Provided by MOH)
The condom collects the ejaculated
semen during sexual intercourse
preventing its direct contact with
vagina
Indications for use:
•

33. Advantages Disadvantages Side effects
Immediate effect,
inexpensive , simple use
User dependant, male
motivation
Allergy to latex
No medical supervision Risk of failure more
No pelvic exam required Interferes with pleasure
Involves male Resupply must be ready
Protective against STD Need appropriate
storage and disposal

34. Method provision and instruction for use
Correcting misunderstanding
Managing unusual situation
Follow up
Provision and storage
Use and “not to do”
When to start?

36. BSMIF
BSID
Birth spacing card
Birth spacing client based register
Revisit register
Monthly summary report
Birth spacing summaries at regional and national

37. B.S monthly summary report- part 1
[first visit]

38. B.S monthly summary report- part 1
[re- visit]

39. HEALTH EDUCATION MATERIALS

40. Group work