CHAPTER 18:BIRTH CONTROL

Sarah Wall 6/13/11

“Reproductive choice is every woman’s right”

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Men, Women, and Birth Control Most women and men believe

that the responsibility for birth control should fall on women, but this is inappropriate and unfair. This can cause pressure on women because we usually have to do everything involving it including doctor’s visits, prescriptions, drug store visits, and even the physical effects. But a man can share the responsibility as well. He can use condoms if no other method is available at the moment, help pay for doctors visits and prescriptions,

remind us to take the Pill each day, help to put in certain methods, and check supply availability. When a man is willing to help with these things, it often makes the women feel better about herself and more respected.

Choosing a birth control method

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Diaphragm with Spermicidal Jelly/Cream

The diaphragm is made of soft rubber in the shape of a shallow cup. It must always be used with a spermicidal cream or jelly. When properly fitted and inserted, it fits snugly over your cervix. The diaphragm is completely safe, but there is still about a 20% failure rate.

Cervical Cap

A small thimble-shaped rubber cap that fits snugly over the cervix. It blocks sperm from entering the cervical opening. A spermicide is usually used on the cap. The typical failure rate is 20% for women who have never given birth. But if you have given birth, this method is less effective.

Vaginal Spermicides

Designed for use with diaphragm, cervical cap, and extra protection with condoms. The active ingredient is nonoxynol-9, a detergent that kills sperm. There are jellies, foams, creams, and suppositories. Creams and jellies are deposited just outside the entrance to your cervix at the top of the vagina.

Female Condom

Consists of a soft, loose fitting polyurethane sheath, which is closed at one end (covering the opening of the cervix). The opened end remains outside the vagina creating a passageway for the penis and also a barrier between the labia and the base of the penis. It has a failure rate of about 21%, but gives more protection against STD’s, including HIV.

Male Condom

Is a sheath made of thin, strong latex rubber, designed to fit over an erect penis to keep semen from getting into a women’s vagina. Can also be combined with spermicidal jellies for a more protection. Typical failure rate is about 14% but can also greatly prevent STD’s including HIV infection.

Natural Fertility Observation

A simple, accurate way to understand when you can and cannot become pregnant as your cycle unfolds. Based on changes in your own fertility signs.

1. Cervical fluid – tells when fertility begins and ends in each cycle. Fertility begins when cervical fluid appears, and lasts through the evening of the fourth day past the cervical fluid peak. Ovulation occurs anywhere from two days before to two days after this peak day.

2. Basal body temperature (BBT) – indicates ovulation after it has occurred, identifies postovulatory infertile days, and confirms pregnancy. Temps are lower before ovulation, 97o to 97.5oF, and higher afterward, 97.6o to 98.6oF. A sustained rise (up to 3 days) of at least 4/10 of a degree confirms that ovulation has occurred. If the BBT remains elevated for more than 17 days, pregnancy is confirmed.

3. Cephalad shift (cervix changes) – represents a change in position and feel of the cervix. When you are fertile, the cervix becomes softer and higher, and the opening widens. When the cervical fluid changes from wet to dry, the cervix becomes lower, and less open.

The Pill

Combination pills prevent pregnancy by inhibiting the development of the egg in the ovary. There are three different types of pills. There is the monophasic, which has constant doses of estrogen and progestin during the whole cycle. There is the biphasic, which has 2 phases during the cycle. They provide less progestin during the first 10 days, and more in the next 10 days. The estrogen dose remains the same during the whole cycle. There is also the triphasic, which has 3 phases. In each third of the menstrual cycle, the amount of progestin varies, or the amount of progestin and estrogen varies. In all triphasic pills, the amount of progestin slowly increases throughout the cycle.

There is a typical failure rate of about 5%. Pregnancy is more likely if you forget to take a pill. Can be combined with other methods like condoms.

Norplant

Consists of 6 match-size flexible rubber capsules, each containing the synthetic progestin levonorgestrel. They are inserted in the fleshy part of the upper arm, just under the skin, by a qualified specially trained practitioner. The hormone is slowly released through the walls of the capsules until they are removed. It is designed to last for up to 5 years. Norplant is extremely effective, with a failure rate of 0.05% in the first year, 0.5% in the second, 1.2% in the third, 1.6% in the fourth, and 0.4% for the fifth year. The overall failure rate for five years of continuous use is 3.7%.

Depo-Provera

A progestin only hormonal contraceptive. It is administered as a deep intramuscular injection of 150mg every 3 months, but actually provides up to 14 weeks of protection. Depo-Provera works by preventing ovulation, and thickening cervical fluid, making a barrier to sperm. In the first year of use, there is a 0.3% failure rate. This method can lead to delays in the return on fertility when discontinued.

Intrauterine Device (IUD)

Small devices that fit inside the uterus. Most contain copper or synthetic progesterone. One of more strings are usually attached to IUDs and when in place, the string extends downward into the upper vagina. IUDs come in different shapes and sizes. IUDs prevent fertilization. Copper IUDs cause an inflammation or chronic low-grade infection in the uterus, which causes the body to produce high numbers of white blood cells, prostaglandins, and enzymes in the uterus an fallopian tubes. These changes may damage or destroy sperm or interfere with its movement in a women’s genital tract, making fertilization impossible. Hormonal releasing IUDs thicken the cervical fluid so that sperm cannot pass through it. The Paragard T has a thin copper wire wrapped around the base and has a failure rate of 0.6%. Mirena is a levonorgestrel releasing device that has a failure rate of about 1.0%.

Tubal Litigation

Tubal litigation, or female sterilization, if effective immediately. It can be done under general, spinal, or local anesthesia, and women usually go home the same day. Laparoscopy, or “Band-Aid” surgery is the most common procedure for sterilization and takes about 30 minutes. A small incision is made in the women’s belly button and the fallopian tubes are moved into view. Another incision is made in the lower abdomen for the laparoscope, which has a viewing instrument and light. The tubes can be blocked by burning or cutting them clipping them shut, or applying rings to them.

A minilaparotomy, or minilap, involves making an incision just above the pubic bone. The tubes are moved into place, and pulled through the incision, in which they are blocked with rings or clips, or by tying and cutting them. The incision is then shown shut.

There is also a laparotomy, which involves major surgery. This is a sterilization through the vagina, but there is a much higher risk for infection and failure.

Vasectomy

Male sterilization is a simple process. It also takes about 30 minutes, but can be done in a doctor’s office or clinic. The practitioner applies a local anesthetic and makes one or two small incisions in the scrotum, locates the two vasa deferentia, or the tubes that carry the sperm from the testes to the penis, removes a piece of each, and ties off the ends. Men are not sterile immediately because sperm are already in the vasa deferentia. Another use of birth control is highly recommended for 2 months after the procedure.

Abstinence

Abstinence means making love without having intercourse. It is the most effective form of birth control. It has been used for centuries and is still very common.

Something to think about…

Do you think that birth control pills should be offered as an over the counter medication? If yes, how do we regulate guidelines as to who can and cannot purchase? (ex. Should there be an age limit?)