5.10: Summary
5.1 Contraception: The Nurse’s Role
Contraceptive education and access empower persons to plan for education, create a career, become healthy prior to pregnancy, and choose when to start a family. The nurse aids in this process by providing education on different methods of contraception that are individualized, safe, and affordable. A history and physical exam is performed. Contraindications, side effects, and effectiveness of different methods are discussed, and shared decision making concludes with the person choosing a method they are confident in using.
5.2 Natural Methods of Contraception
Natural methods of contraception are one way for a person to take control of their sexual health and their fertility. The cost of FAM, coitus interruptus, or abstinence is minimal to zero, and there is no need to obtain a prescription. However, the risk of pregnancy with these methods, except for abstinence, is higher than with pharmacologic methods. Both partners need to agree to use any of these methods, and it takes planning and self-control. A bonus of FAM is that when the individual/couple decides to conceive, they are aware of when they are most likely to be ovulating. FAM offer no protection against sexually transmitted infections.
5.3 Barrier Methods of Contraception
Barrier methods of contraception provide protection from pregnancy and STIs. These methods can empower people to be in control of their sexuality and fertility. Some barrier methods are cost-effective and do not need a prescription and health-care visit. The nurse can help educate persons on each barrier method, stressing the importance of using that method with each act of intercourse.
5.4 Short-Acting Reversible Hormonal Methods of Contraception
Choosing a hormonal contraceptive method for pregnancy prevention or menstruation management is a very big decision. The nurse can be an active member in the health-care team providing evidence-based education, using informed decision making, and performing high-level assessments to ensure patient safety throughout the process. All hormonal contraceptive options should be discussed, including mechanism of action, side effects, adverse effects, effectiveness, education on use, and contraindications to aid in decision making. Hormonal contraceptives do not protect against sexually transmitted infections.
5.5 Long-Acting Reversible Contraception
LARCs are the most effective contraception choices available. There are many benefits, including pregnancy prevention, menstrual relief, cancer prevention, and relief from symptoms associated with migraines or other issues that worsen around menses. Although uncommon, there are complications associated with LARC placement and use, and nurses provide education about these complications. LARCs do not protect against sexually transmitted infections. Additionally, nurses teach about the side effects after placement, including what is expected and not expected, when to call the office, when to go to the emergency department, and when to return for follow-up visits.
5.6 Emergency Contraception
Emergency contraception can be used to prevent pregnancy when contraception was not used or failed. There are oral EC options, one being over the counter, as well as an intrauterine contraceptive option that also offers long term contraception. EC is unique because it is used after sex, rather than before, to prevent a pregnancy. Having this type of contraception can empower people to take control of their sexual health. The nurse is a key health partner providing education and advocating for the person. The nurse can teach about EC options, timing of EC, its side effects, and what is expected and not expected. The nurse also encourages persons to have a form of EC available at all times.
5.7 Sterilization
Permanent sterilization is one of the most effective contraceptive methods. Female sterilization can be performed in the hospital after birth or at a later date as an outpatient procedure most often under general anesthesia. Male sterilization is performed under local anesthesia and is completed in an outpatient setting. Both procedures are safe and permanent. The nurse can provide education about permanent sterilization to patients to ensure they are fully aware of the permanence of their contraceptive decision.
5.8 Induced Abortion
Abortion care is a sensitive topic. Anticipatory guidance from the nurse to the patient about what to expect is essential. The person deciding to have a medically induced abortion needs to understand that this is a 48- to 72-hour procedure and that follow-up will be necessary to be sure all products of conceptions have been expelled. Additionally, the person needs to understand that they may experience intense nausea, cramping, bleeding, and will experience passage of tissue so that they are prepared to deal with the discomfort and sight of blood and tissue contents.