1) Role of A Midwife In A Discussing Contraception And Sexual Health
During Puerperium
The role of the midwife in contraception and sexual health in puerperium is to
have a wider conversation with the woman about the pregnancy for example
discussion about unintended pregnancies, spacing of children and also
include women’s future plans. This is done to establish a meaningful
connection between the midwife and a woman. Initiating contraception
discussing different types of contraception that are available obtaining history
of previous contraception, why the contraception was discontinued. In all
discussion and initiating medical eligibility should be considered.
2) Types of hormonal contraceptive methods
1) Combined oral contraceptives plus combined with oestrogen and
progesterone taken daily for 21 days followed by a seven day pill-free period
or seven placebo EG triphasils.
2) Injectable
Containing both oestrogen and progesterone EG Medroyprogesterone.
150mg given imi every 3 months. Nuristerate 200mg given imi every 2
months.
3) IUCD
It is a small T-shaped plastic device which is inserted into the uterus. It
releases small amounts of progesterone which thickens cervical mucus
making it harder for sperm to enter fallopian tubes. It stays for 5 years.
4) Implanon
It is inserted sub dermal, it releases levonorgestrel over period of 3 years.
3) Types of barrier methods
1) Condoms
There are male and female condoms made of latex rubber inserted on the
penis or in the vagina before sexual intercourse preventing semen and
other bodily fluids from being shared or semen entering the vagina.
2) Cervical diaphragm
It is a dome shaped synthetic or latex device placed over cervix prior
sexual intercourse to prevent sperm entering the vagina.
3) Spermicides
They are inserted in the vagina prior to sexual intercourse. They contain
ingredient which either kill spermatozoa or weakens them.
4) Hormones
Hormones found in the combined pills are:
Oestrogen and progesterone
5.1) Mode of action in the combined oral contraceptive pill
The viscosity of the cervical mucus increases due to progesterone
influence making it impenetrable to sperm
Changes to the endometrium render it unfavourable for blastocyst
implantation
Capacitation of sperm in the endometrial fluid is impaired.
It inhibits tubal transportation of the ovum and zygote and possibly
transportation of spermatozoa is inhibited.
Production and secretion of hormones Gonadotropin which is
responsible for the release of follicle stimulating hormone is
diminished and hence follicle maturation is prevented.
The midcycle luteinizing hormone peak is suppressed. The follicle
wall does not rupture and sequently ovulation cannot occur.
Progesterone Only Pill
Cervical mucus viscosity increases and trancervical sperm transport is
inhibited.
Decreased glandular development of the endometrium and an acyclical
secretory effect render the endometrium unsuitable for embryology.
The motility in the fallopian tube is inhibited epithelium becomes altered and
consequently zygote transport is impeded.
Follicle stimulating hormone levels are usually lowered but in an
unpredictable manner. Patient ovulates in their 50-70% of cycles.
5.2) Postpartum considerations of combined oral contraceptive
and the progesterone only pill
Combined oral contraceptive should not be used in lactating mothers
because of the negative effects oestrogen could have in milk production
and quality. Oestrogen has a negative effect in blood clotting therefore the
increased risk of thromboembolism in the first months after delivery.
Progesterone only pill
They are particularly useful in the lactating patient they have no negative
effect in the milk production or quality. Since lactating patients have a
menstrual cycle in which ovulation does not occur progesterone only pills
are very reliable.
6.1) Term Lam
Lactation Amenorrhea is a way for breastfeeding to temporarily help prevent
pregnancy. It must be used correctly to work. Lactation means the body is making
breast milk and Amenorrhea. There are no monthly periods.
6.2)
1) The baby is under 6 months of age
2) The mother is amenorrheic meaning she not getting her monthly periods
3) There is an exclusive breastfeeding on demand day and night. The baby is
not getting any food or liquids on breast milk
7.1) Benefit of Contraception and health life expectancy of the mother
- Prevent unintended pregnancies
- Woman can have a number of babies that she desires
- Woman can have the number of babies she can afford
- Woman can space out her children the way she wants
- Delay pregnancies that occur at an early age and prevent pregnancies that
occur at a very advanced maternity age as both are at risk of health
- Reducing adolescent pregnancies to prevent risk of low birth right babies
therefore neonatal mortality is reduced which may have psychological effect
to the woman
- Woman can make informed choices about their sexual and reproductive
health
- Help to reduce unintended pregnancies in women living with HIV resulting in
fewer infected babies
Other benefits beyond preventing pregnancy.
- It helps manage endometriosis
- It can relieve symptoms of premenstrual syndrome
- It reduces risk of uterine cancer
- It reduces risk of ovarian cysts
- Reduce risk of anemia
- Prevent risk of unsafe abortion
7.2) Benefits to the family
- Children in smaller planned families receive more attention from their parents.
- Children with one or no siblings usually do better in school
- Small families usually prosper economically and socially
- Parents with fewer children can manage their finances better
- Parents with fewer children can have more time dedicated to their work or
other aspects of their lives
8.1) Tubal Ligation
Tubal ligation is a type of permanent birth control known as tubes t… or tubal
sterilization. It is surgery
