Wednesday, 14 August 2019 13:15

The low-down on Family Planning by Sr Victoria Black of Protea Nursing Services (proteanurse@outlook.com)

You have just had a baby less than 2 months ago, you are visiting your midwife or obstetrician for a routine post-natal visit. The last thing you are thinking about right now, is having another baby, unless you are the exception to the rule.

Family planning is not just about contraceptives and preventing pregnancy. It is so much more. It is about being aware of your own reproductive needs, whilst considering your general health, finances and the practicality of having another baby. This is often a conversation that you have already had with your partner about the number of children you intend to have. As a midwife we just reinforce the process during a family planning counselling visit.

WHAT DOES A FAMILY PLANNING VISIT ENTAIL?

A family planning counselling visit would entail:

  • A general health and wellness examination: to ascertain your overall health and wellbeing to more effectively advise you on the appropriate contraceptive method that suits your health needs.
  • History taking of reproductive health: whether you have had a baby or not this history taking is essential in providing the health care provider that is providing family planning advise to suit your lifestyle. With so many different options available on the market, one is truly spoilt for choice.
  • A pap smear (depending on how long ago the last screening was done): routine screening that is done 6 weeks post birth and then annually to screen for cervical cancer in women.
  • Discussion on planned number of children: this guides the healthcare provider to advising you on a family planning method that is suited to the number of children you would like to have.
  • Discussion on contraceptive options and choices: an in-depth discussion of the appropriate methods that are suited to you so that you and your partner can make an informed decision about your reproductive health.

WHAT ARE MY OPTIONS?

Type of Contraceptive

Description

Fertility Awareness

Fertility Awareness or Natural family planning (NFP) helps women recognise the fertile and infertile times of their menstrual cycles to plan or avoid a pregnancy by monitoring some of their natural circadian cycles. NFP teaches you to recognise and record the different natural signs or indicators of fertility each day of your menstrual cycle.

Barrier Methods

Barrier methods of contraceptives are used as a physical barrier to prevent pregnancy. It is a short acting method as it requires diligent use every time you want to have sex. There are primarily two barrier methods:

·         Condoms: This is probably the most common barrier method available on the market. It is easy to come by and easy to use. A new condom needs to be applied every time you have sex.

·         Cervical Cap and spermicide: It’s a silicone cap that is placed in a women’s vagina to cover the cervix. It is used in conjunction with spermicide. In the South African context, they are often hard to come by and needs to be ordered from an online store.

Barrier methods contraception is usually advised to be used in tandem with other contraceptive methods to ensure the highest efficacy.

Combined Oral Contraceptive

The combined oral contraceptive is also known as “the Pill”. There are many different types, but all contain two hormones: oestrogen and progestin. The main way the Pill works is by stopping the ovaries releasing an egg each month (ovulation). It also stops sperm reaching the egg by thickening the mucus from the cervix and stops an egg from settling in the womb. You must take the pill every day without a break for it to be an effective contraceptive.

Progesterone-only Pill

This is locally known as the “mini pill”. It is a progestin only oral contraceptive that is like any oral contraceptive. You must take the pill every day for it to be an effective contraceptive. This is usually more suited to women who cannot take estrogen-based contraceptives due to their health history or women who are currently breastfeeding.

Progesterone Injectables

The contraceptive injection contains a hormone called progestin and is a long-term method of contraception. It's injected into a muscle and the hormone is released very slowly into the body. There are two types of injection available on the South African market:

  • Depo-Provera provides contraceptive protection for three months (12 weeks).
  • Nur-Isterate provides contraceptive protection for two months (eight weeks).

The Patch

The patch is a thin, sticky plaster that works like the combined oral contraceptive. It requires less maintenance though, as you only must apply it to your skin once a week, for three weeks out of a month, for it to be an effective contraceptive method. One week per month you will give it a break, by not applying a new patch. Usually during this week, you will menstruate.

Vaginal Ring

The vaginal ring works like the combined oral contraceptive, it contains both estrogen and progestin. It requires less maintenance though, as you only must insert a new ring in your vagina once a week, for three weeks out of a month, for it to be an effective contraceptive method. One week per month you will give it a break, by not inserting a new ring. Usually during this week, you will menstruate.

Intrauterine Devices

The intrauterine system (IUS) is a small, T-shaped device that is inserted into a women’s uterus by a doctor or a nurse. There are two main types available on the South African market:

·         The hormonal intrauterine device contains the hormone progestin. The hormone is absorbed through the lining of the uterus into the bloodstream. There are several different ones available on the market.

·         The copper intrauterine device is a non-hormonal intrauterine device. It works by irritating the lining of the uterus to prevent implantation of a fertilized egg.

Two soft threads are attached to the end and hang down a little way into the vagina, so you can check it's in place. It is a long-term contraceptive method.

Male & Female Sterilisation

Sterilisation is the only permanent method of contraception and involves cutting, blocking or sealing the tubes in men and women that carry either the sperm or eggs.
It's more than 99 per cent effective. Failure of this method is uncommon, but can happen when the tubes that carry the sperm or eggs rejoin. This method is usually only advised when you are not planning on having any more children in the future.

 

WHERE DO I GO FOR FAMILY PLANNING?

In South Africa there are many different facilities and practitioners who specialise in sexual and reproductive health. Ranging from the public health sector to the private health sector. It is not just a service you would receive at the Gynae’s office. Most families would choose a facility based on where they gave birth, who looked after them during pregnancy and where this facility is based. Contraceptives and family planning is offered in most:

  • Local clinics
  • Private Pharmacies
  • Specialist Women’s Health clinics
  • Most public and private hospitals

Whilst being spoilt for choice, families are urged to discuss and make informed decisions about family planning. It helps in the long term to relieve the stress of an unplanned pregnancy. In this day and age where good quality health care is a precious commodity, it is even more important for prospective parents as well as parents who have had children before to take care of their sexual and reproductive health, just as you would your diet, exercise and lifestyle.