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Authors: Janet Medforth,Sue Battersby,Maggie Evans,Beverley Marsh,Angela Walker

Oxford Handbook of Midwifery (121 page)

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Basal body temperature is affected by illness, alcohol, disturbed sleep, anxiety, and stress.
Some cold and flu remedies can inhibit cervical mucus production.
A vaginal infection will make it difficult to detect changes in cervical mucus.
Advantages
It is under the control of the couple, once learned.
No side-effects.
Can be used to avoid or achieve pregnancy.
Detects the beginning and end of the fertile period.
Helps couples learn about their fertility and recognize body changes.
Acceptable to a number of religious beliefs and cultures.
Fig. 22.8
Fertility indicator chart.
Copyright © J Knight and C Pyper. Adapted with permission of Fertility UK (2005) from M www. fertilityuk.org.
CHAPTER 22
Contraception
564‌‌
Coitus interruptus
- The oldest known form of contraception, referred to in the Bible and in the Koran, and widely acceptable on religious grounds.
- The male withdraws his penis from the woman prior to ejaculation.
- Commonly called ‘withdrawal’ or ‘being careful’.
  Efficacy
- Variable.
- With careful and consistent use it may be up to 96% effective as contraception.
- Less careful use will result in it being 80% effective, at best.
  Disadvantages
- Low efficacy.
- May inhibit enjoyment during sexual intercourse.
- May lead to erectile problems.
- The woman may experience anxiety that it will work.
- No protection against STIs or HIV.
- Efficacy is markedly reduced in men with erectile problems, such as premature ejaculation.
  Advantages
- Easily used.
- No clinic appointments.
- Religious acceptability.
- It is under the control of the couple, when consciously used as a method of contraception.
  Point to remember
  2 In discussing this method, it is important to remember to emphasize that sperm are present in the pre-ejaculate and, therefore, capable of fertilizing the female, even when full intercourse with ejaculation has not occurred.
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  CHAPTER 22
  Contraception
  566‌‌
  Male condom
- This is the easiest form of contraception to obtain and use, and second only in popularity of use to the oral contraceptive pill in the under-30 age group, and to sterilization in the over-30s, in the UK.
- For a large proportion of the population it is a completely acceptable method.
- For those who have become used to alternative methods not related to intercourse, it may be completely unacceptable, even on a temporary basis.
- Male condoms come in various sizes, shapes, colours, and flavours, and are now produced from hypoallergenic latex.
- A non-latex polyurethane condom, Avanti
  ^®is available if either partner is allergic to latex.
- The main reason that men do not like to use them is the lack of sensitivity during sexual activity, but manufacturers are continually making attempts to overcome this problem.
  How is it used?
- 2 For effective use it must be used before there is any genital contact.
- Remind the woman that before opening the packet she should ensure that the condom is well away from the edge that is to be torn to
  release the condom.
- The closed end of the condom, the ‘teat’, is squeezed to expel any air and to leave about 1cm to receive the ejaculated semen.
- It is then gently rolled down the full length of the erect penis.
- After ejaculation, hold the condom firmly at the rim, to avoid any semen being spilt as the penis is withdrawn.
- It is then carefully and hygienically disposed of,
  but not down the toilet.
  Advantages
- The condom, when used carefully and consistently, is extremely effective in preventing pregnancy.
- Similarly, it is effective in preventing sexually transmitted infections and HIV.
- It is easy to obtain and use, and requires no medical supervision.
- It may protect the woman against cancer of the cervix, by preventing transmission of HPV.
- The man can take responsibility for contraception and share prevention of transmission of STIs
  Disadvantages
- It needs forward planning each time.
- It needs to be used carefully to be effective.
- It may interrupt sex, although putting and it on can be part of the enjoyment of foreplay.
- There may be possible loss of sensitivity during intercourse or loss of erection.
- It can slip off or split.
- It needs to be disposed of carefully.
  MALE CONDOM
  567
  Points to remember
In the first few weeks after birth, intercourse may be uncomfortable or sore. Advise the woman to use a water-based lubricant, if necessary.
2 Oil-based lubricants will interact with the latex and encourage the condom to split and should not be used. Baby oil will destroy up to 95% of the strength of condoms within 15min. Avoid
ad hoc
use of products from the kitchen or bathroom cupboards!
Advise the woman about the availability of emergency contraception, in case of failure to use or failure in use.
If a mother is not breastfeeding or is post-abortion, her risk of pregnancy, even in the first menstrual cycle, is real. We have all seen the woman who comes for her postnatal examination and is pregnant again!
For the mother who is fully breastfeeding, day and night, the risk of pregnancy is minimal. If this woman chooses to use a condom, she may need additional water-based lubrication, because of the very low oestrogen levels while breastfeeding.
If one or more partners is sensitive or allergic to latex, a hypoallergenic non-latex condom, Avanti
^®, is available.
Because of allergic reactions, most manufacturers do not now coat the condom with Nonoxynol
^®9 spermicide. For added protection, a
spermicidal pessary or cream may be used.
Emphasize that the condom is a ‘once only’ use and should never be
re-used.
In the UK, all contraception is free of charge and the midwife can offer the woman a supply of condoms.
Make sure you know where the local contraception and sexual health clinics are located, to be able to advise her on further supplies.
Remind the woman to check that any condom supplied or purchased has a recognized quality mark, e.g. the British Kite Mark or the European Community CE mark.
Condom use is the only method proven to be effective against the transmission of HIV.
CHAPTER 22
Contraception
568‌‌
Male sterilization
Vasectomy
- Vasectomy has become a popular method of permanent contraception in the UK.
- It is simpler to carry out than female sterilization and is commonly done under local anaesthesia as an outpatient, in the contraception and sexual health clinic, or doctor’s surgery.
- Vasectomy is a minor surgical procedure, involving incision, location and excising the vas deferens, preventing sperm from the epididymis reaching the seminal vesicles (Fig. 22.9). Sperm cannot then be ejaculated and the man becomes infertile, once the vas deferens has been cleared of sperm, which takes approximately 3 months.
  Efficacy
- Highly effective.
- The immediate failure rate is 1:1000, with a later failure rate of 1:3000 to 1:7000.
  Disadvantages
- Not easily reversible and must be regarded as permanent.
  •
  Requires a surgical procedure.
- Requires local or general anaesthesia.
- 0 Because vasectomy is not immediately effective, alternative contraception is required until two consecutive clear sperm counts are obtained.
- 0 If a man does not produce the required two sperm specimens after surgery, the couple must be warned to wait at least 3 months before discontinuing the additional contraception.
  Advantages
- Permanent
- Highly effective
- Safe and simple procedure
- Anxiety of unplanned pregnancy removed.
  Contraindications
- Urological problems
- Relationship problems
- Indecision by either partner.
  Side-effects
- Possibility of infection
- Haematoma
- Sperm granulation.
  Counselling prior to vasectomy
- This is extremely important, because of the permanency of the method.
- Consider issues of regret and grief for loss of fertility.
  MALE STERILIZATION
  569