DON MARIANO MARCOS MEMORIAL STATE UNIVERSITY

South La Union Campus, Agoo, La Union

COLLEGE OF COMMUNITY HEALTH AND ALLIED MEDICAL SCIENCES

CLINICAL TEACHING PLAN

MIDWIFERY LEVEL II

(LABOR/DELIVERY ROOM)
 LABOR ROOM and DELIVERY ROOM

AGENCY/ HOSPITAL: Ilocos Training and Regional Medical Center

AREA: Labor Room and Delivery Room
SHIFT: 7:00-3:00
YEAR: Midwifery-II
SY: 2019-2020

Objectives:
Within two weeks of clinical exposure to the clinical setting, the students will be able to:

1. Be oriented to the clinical set-up, the nursing personnel, the medical staff, and existing rules and regulations of the area.
2. Gain more skills, knowledge and accuracy in providing health care to patients.
3. Apply nursing and health care theories learned in the actual situations in the clinical area.
4. Promote and adhere to the health care process specifically and correctly, to achieve the specific goals for the patients.
5. Acquire skills, knowledge and acceptable attitude in the care of the family and community.
 ACTIVITIES COURSE CONTENT
Week 1 ANTEPARTAL CARE
DAY 1 Focused antenatal care- is based on the premise that every pregnancy is at risk for complications. All women should receive
6:30- 7:00 am PRE CONFERENCE the same basic care including identifying complications. This model of antenatal care involves a minimum of 4 visits in normal
 Attendance, uniform and paraphernalia or uncomplicated pregnancies. It stresses quality rather than number of visit and has essential goal- directed elements
check including screening for diseases that provides more time to interact with patients thereby improving quality of care.
 Orientation to LR/DR set-up, equipments, Components:
personnel 1. General assessment of the pregnant woman
 Discussion of activities for the day 2. Screening for diseases that complicate pregnancy: hypertension, anemia, syphilis
 Discussion of daily and weekly 3. preventive measures: tetanus immunization, iron, folic acid supplementation
requirements 4. health education: self care, nutrition, and danger signs during pregnancy
 Assigning of students to a particular patient 5. Birth plan
in the areas. Objectives of Prenatal Care
1. Detection of diseases which may complicate pregnancy
7:00-10:15 am 2. Education of woman on the danger and emergency signs and symptoms
Supervision of students in the implementation of: 3. Preparation of the woman and her family for childbirth
 Health Care Measures
 Hand Washing Steps to follow in Prenatal Care
 Observing and assisting during doctor’s
rounds 1. Immediate Assessment for emergency signs (quick check)
 Assisting in Normal Spontaneous Deliveries  Unconscious or convulsing
and other related activities.
 Vaginal bleeding
 Establishing of NPI
 Monitoring progress of labor and taking of  Severe abdominal pain
vital signs.  Looks very ill
 Assisting students in implementing DOH  Severe headache with visual disturbance
programs such as: Essential Intrapartum  Sever difficulty in breathing
and Newborn Care (EINC)
 Coordination of patient care other staffs  Fever
 Maintenance of cleanliness and orderliness  Severe vomiting
in the area at all times 2. Make woman comfortable
 Greet her
10:15- 10:30 am  If first visit, register the woman and issue a mother and child book/ home based maternal
 Break for the 1st batch (endorsing their
patients to the second half of the group for record
continuity of care) 3. Assess the pregnant woman
 On first visit
10:30- 10:45 am - age
 Break for the 2nd batch (endorsing their - Past medical history
patients for continuity of care)
-OB history
 -ask or check record of pregnancy
10:45am- 12:00 pm -birthplan
 Supervise students in LR/DR routines
 Assisting students in anticipating the  On all visit
patient’s needs, problems and concerns - AOG
 Individual conference with students -danger signs of pregnancy
regarding their patient’s condition -record for previous treatments received during the pregnancy
-ask for other concerns
12:00-12:30 pm
 Lunch break for the 1st half of the group -give education and counseling on family planning and breastfeeding
 If on 3rd trimester
12:30-1:00 pm - leopold’s maneuver and FHT
 Lunch break for the 2nd half of the group -education and counseling on family planning
1:00-3:00 pm
 Continue supervising the students in their  Do not perform vaginal exam as a routine prenatal care procedure
assigned area  Always record findings
 Vital signs taking and plotting in the  All pregnancies are at risk. Encourage all pregnant woman to deliver in a health care
monitoring sheet facility
 Observe/supervise the implementation of
 Refer patients with abnormal findings to doctor or to a higher facility
EINC
- Topic for Discussion:
4. Get baseline laboratory- CBC and Urinalysis
 Antepartum, Intrapartum and Postpartum Care
5. Check for ANEMIA
nd
- Giving of assignments for the 2 day
Check for S/S
- pallor
-easy fatigability
-shortness of breath
-drowsiness
-palpitations
-headaches
- Hgb should be at least 11g/dl if its lower or equal to 8g/dl refer

6. Check for HYPERTENSION/preeclampsia

Check for S/S
-BP- 140/90 (normal BP is 90/60 to 130/80), if first reading is high repeat after 1 hour rest
- if it’s still high after rest, ask for severe headache, blurred vision and epigastric pain
-check urine for protein
- if with S/S, refer
7. Check for GESTATIONAL DIABETES
-Ask about family history
-Ask about past medical OB history like difficult labor, large baby, congenital malformations and unexplained fetal
death
-Look for S/S like obesity, polyhydramnios, fetal abnormality or large baby, vaginal infection especially CANDIDIASIS

-If with S/S, refer for glucose test at 24-28 weeks for low risks or immediately if high risk
8. Check for presence of STI’s
-ask for fever
-burning sensation on urination
-abnormal vaginal discharge
-itching at the vulva if partner has a urinary problem
9. Give IMMUNIZATION AGAINST TETANUS

TT1 first visit no protection

TT2 4 weeks after TT1 3 years protection
TT3 6 months after TT2 5 years protection
TT4 1 year after TT3 10 years protection
TT5 1 year after TT4 lifetime

 To be protected, a pregnant woman must receive at least 2 doses of tetanus toxoid. The last
dose should be at least 2 weeks before delivery
10. Give MEBENDAZOLE for areas with cases of parasitism
- single dose 500mg,once in 6 months after 1 st trimester
11. Give IRON AND FOLATE SUPPLEMENTATION
- to avoid anemia and neural tube defects
- ferrous sulfate 320mg (60 mg elemental iron)and 250mcg Folate
- if Hgb is lower that 8g/dl double the dose of iron, then refer to doctor
12. Give preventive intermittent for falciparum malaria (if endemic)
13. Provide health information, advice. Counsel on danger Signs
14. Encourage the woman to come back for return visits
-at least 4 prenatal visits
 1st visit before 4 months
 2nd visit 6 months
 3rd visit 8 months
 4th visit 9 months- return if undelivered within 2 weeks after the EDC
15. Introduce BIRTHPLAN
 A written document prepared during the first visit. Plan may change anytime pregnancy if an
 abnormality develops
 Discussed by the patient with the skilled birth attendant
 Contains information on:
 The woman’s condition during pregnancy
 Preferences for her place of delivery and choice of birth attendant. Discuss why facility
vs home delivery with skilled attendant is recommended
 Available resources (transportation, companion, money) for her childbirth and newborn
baby
 Preparations needed (blood donor, referral center) should an emergency situation arise
during pregnancy, childbirth and post partum
EMERGENCY PLAN
 Advise on danger signs, signs of labor
 Where to go?
 How to go?
 What to bring?
 With whom will you go?
 How much will it cost? Who will pay? How will you pay?
 Start saving for these possible cost now
 Who will take care for your home and other children when you are away?

INTRAPARTAL CARE
Stages of Labor
1. First Stage / Cervical Stage – period from onset of true labor contractions until full cervical
dilation and effacement is achieved.
2. Second Stage / Expulsive Stage – from full cervical dilatation until the birth of the baby
3. Third Stage / Placental Stage – from delivery of the baby to the expulsion of placenta
4. Fourth Stage / Immediate postpartum period – period from delivery of placenta until the
condition of the woman has stabilized
Steps to Follow in Intrapartal Care
1. Examine the woman for emergency signs
2. Greet the woman and make her comfortable
 Asked informed consent before examination or any procedure
 Respect her privacy
 Inform her of results of examination
  Reassure

3. Assess the woman in labor

 Take the history of labor and record on the labor room
 Review home base maternal record/ mother child book
 Review birthplan
 Assess uterine contractions; intensity, duration and interval
 Observe the woman’s response to contractions
 Perform abdominal exam; Leopold’s maneuver, FHT between contractions
4. Determine the stage of labor
 Explain to the woman that you will perform a vaginal examination and ask for her consent
 Respect her privacy
 Observe standard precautions (wash hands, wear gloves)
 Inspect the vulva
- Bulging perineum
- Any visible fetal parts
- Vaginal bleeding
- Leaking amniotic fluid, if yes is it meconium stained, foul smelling?
- Warts, keloid tissue or scars that may interfere with delivery
 Perform gentle vaginal examination (do not start during contraction)
 Explain findings to the woman. Reassure her
 Record the findings in labor or partograph
5. Decide if the woman can safely deliver. If there is indication for referral
6. Give supportive care throughout the labor
 Explain procedures seek permission and discuss findings with the woman and her family
 Examine the woman in a place where she is not exposed to people other than the examining
person and her choice of companion
 Never leave a woman in labor alone
7. Encourage woman to:
 Wash from her waist down or take a bath at the onset of labor
 Empty the bladder (every 2 hours) and bowels.
 Move freely if BOW is not ruptured
 Respect choice of birthing position
  Drink as she wishes. Contractions will make her thirsty and the sugar will give her energy for her
labor. She is on soft diet during labor
8. Monitor and manage labor.
 FIRST STAGE: NOT ACTIVE LABOR 0-3 CM
- monitor contractions, FHT, mood and behavior every hour
- VS every 4 hours and cervical dilatation
- If contractions are stronger but no progress in cervical dilatation within 8 hours, REFER
 FIRST STAGE: IN ACTIVE LABOR 4-7 CM
- monitor contractions, FHT, mood and behavior every 30 min
- VS every 4 hours and cervical dilatation
- record time of BOW rupture

Relief of Pain and Discomfort

 Suggest change of position
 Encourage mobility as comfortable to her
 Encourage proper breathing technique; breathe slowly make a sighing noise, make 2 short
breaths followed by a long breath out
 Massage her lower back if she finds it helpful

Caution:
Do not IE more frequently
Do not allow the woman to push unless delivery is imminent, pushing does not speed up
the labor, mother will become tired and cervix will swell
 Do not give medications to speed up labor, dangerous, may cause trauma to the mother
and baby
 Do not do fundal pressure, may cause uterine rupture, fetal death
 SECOND STAGE OF LABOR (10 CM TO DELIVERY OF THE BABY)
How to tell if the woman is in second stage of labor
 IE, fully dilated
 Woman wants to bear down
 Strong uterine contractions, every 2-3 mins, 4x in 10 mins
 Bulging thin perineum, fetal head visible during contractions
 BOW will rupture
Monitoring the second stage of labor:
  Check uterine contractions, FHT, mood and behavior
 Continue recording in the partograph
 REMINDERS: massaging and stretching the perineum have not been shown to be
beneficial.
 Do not apply fundal pressure to help deliver the baby, support the perineum and
the anus with a clean swab to prevent lacerations
 Ensure controlled delivery of the head
- Keep one hand on the head as it advances during contractions. Keep the
head from coming out too quickly
- Support the perineum with other hand
- Discard pad and replace when soiled to prevent infection
- During delivery of the head, encourage woman to stop pushing and
breathe rapidly with mouth open
 Gently feel if the cord is around neck
 Wipe the mouth and nose of the baby with a clean gauze or cloth
 Wait for external rotation within 1-2 minutes head will turn sideways bringing one
shoulder just below the symphysis pubis and other facing the perineum
 Apply gentle downward pressure to deliver the top shoulder then lift baby up to
deliver lower shoulder. Gently deliver the rest of the baby. Note the time of baby out
 Put the baby on mother’s abdomen in prone position. Cover with dry towel
 Thoroughly dry the baby immediately. Wipe eyes
 Discard wet cloth
 Put baby prone on mother’s abdomen, in skin-skin contact, keep the baby warm
 Exclude 2nd baby by palpating mother’s abdomen
 Give 10 units of oxytocin IM to mother within 2 minutes after baby out
 Watch out for vaginal bleeding
 Remove first set of gloves
 Clamp the cord after the pulsations are not felt (However, if pulsation is prolonged,
cut the cord within 3 mins) using plastic cord clamp 2 cm away from the abdomen.
Sweep the cord and apply a Kelly forcep 5 cm from the abdomen then cut in between.
Observe stump for oozing blood. Do not apply anything on the cord.
 THIRD STAGE (delivery of the baby to placental delivery)
 Deliver the placenta by controlled cord traction ( with counter traction on the uterus
 above the symphysis pubis)
 Massage the uterus over the fundus
 Encourage initiation of breastfeeding. Keep the baby warm on mother’s abdomen for
60-90 minutes
 Check the placenta and membranes (20 cotyledons), put in a container for disposal

ACTIVE MANAGEMENT of the third stage of labor (under supervision of doctor)

o Cord is clamped after the cord pulsations have stopped
DAY 2
6:30- 7:00 am PRE CONFERENCE
o Oxytocin is given withing 2 minutes of delivery of the baby
 Attendance, uniform and paraphernalia o Placenta is delivered by controlled cord traction with counter traction on the
check uterus above the symphysis pubis
 Discussion of activities for the day o Massage fundus
 Discussion of daily and weekly 9. Monitor closely within 1 hour after delivery (immediate post partum period) and give supportive care
requirements
 Assigning of students to a particular patient
 Check for vaginal tears and bleeding
in the area.  Clean the woman and make her comfortable
 Check BP, PR, emergency signs and uterine contraction every 15 minutes
7:00-10:15 am  Initiate breastfeeding within 1 hour when the baby is ready
Supervision of students in the implementation of: 10. Continue care after 1 hour postpartum. Keep watch closely for at least 2 hours
 Health Care Measures
 Hand Washing
 VS every 30 min for 4 hours
 Physical Assessment  Check emergency signs and hardness of the uterus
 Observing and assisting during doctor’s  Check bladder for distensions if unable to void
rounds  Advise clean cloth/napkin to collect vaginal blood
 Assisting in Normal spontaneous Deliveries
 Eat and drink high energy foods that are easily digestible
and other related activities
 Establishing of NPI
 Taking/monitoring of vital signs 11. Educate and counsel on family planning and provide the family planning method if available
 Assisting students in implementation of:  Ask what are the counsel/s plans regarding having more children
 Post partum and Newborn  Give relevant information and advice
care observing EINC  Advice that exclusive breastfeeding is the best contraceptive in the 1st months
(Essential Intrapartum and  Help her to choose the most appropriate method for her and her partner
Newborn Care) protocols. 12. inform, teach and counsel the woman on important MCH messages
10:15- 10:30 am  Talk to the woman when she is rested and comfortable
 Break for the 1st batch (endorsing their  Also give important information and advice to her companion
patients to the second half of the group for
continuity of care)
 Take time to explain, use visual aids and demonstrate important lesson
 Encourage them to participate actively in discussions and to ask questions
10:30- 10:45 am 13. Discharge the woman and her baby after 24 hours
 Break for the 2nd batch (endorsing their  The woman and her baby may be discharged 24 hours after delivery
patients for continuity of care)
 Ensure that the woman is able to breastfeed successfully before discharge
10:45am- 12:00 pm
 Supervise students in LR/DR routines  Repeat important health information
 Assisting students in anticipating the  Check understanding and arrange follow up
patient’s needs, problems and concerns
 Individual conference with students
regarding their patient’s condition
12:00-12:30 pm
 Lunch break for the 1st half of the group
12:30-1:00 pm
 Lunch break for the 2nd half of the group
1:00-3:00 pm
 Continue supervising the students in their
assigned area
 Vital signs taking and plotting in the
monitoring sheet THE PARTOGRAPH: MONITORING WOMAN IN LABOR (WHO)
 Observe/supervise the implementation of Monitoring: VS, progress of labor, contractions, bladder/urine, FHT, perineum-show, rupture of BOW,
EINC presenting part, bulging, cord prolapsed, bleeding, ability to manage pain
- Topic for Discussion:
 Partograph PARTOGRAPH – a tool advocated by WHO to be used by the nurse-midwife, midwife, and medical doctor
-Evaluation and Brainstorming to assess the progress of labor and to identify when intervention is necessary
- started only when the woman is in the active phase labor with cervical dilation of more than 3 cm
- plotting starts at 4 cm and uterine contractions of two or more within 10 minutes, each lasting 20
seconds or more
- 3 Components of the Partograph
WEEK 2 o PROGRESS OF LABOR – monitoring uses parameters cervical dilatation, descent of head,
DAY 1 and uterine contractions
6:30- 7:00 am PRE CONFERENCE o FETAL CONDITION – monitoring uses parameters FHT, amniotic membranes and liquor,
 Attendance, uniform and paraphernalia
and molding of fetal skull
check
 Discussion of activities for the day o MATERNAL CONDITION – monitoring uses parameters, pulse, BP, temp, urine, drugs, IVF,
 Discussion of daily and weekly oxytocin
requirements - Some Principles in the Use of Partograph
 Assigning of students to a particular LR/DR o The active phase of labor commences at 3 cm cervical dilation. Plotting in the partograph
areas.
is started when the cervix is 4 cm dilated
7:00-10:15 am o the latent phase of labor should not last longer than 8 hours in primigravida, when the
Received endorsements and join nurses rounds. cervix dilates at a rate of 1 cm per hour
Supervision of students in the implementation of:
 Health Care Measures o In multigravida, the latent phase lasts for about 4 hours, when the cervix dilates at the
 Hand Washing rate of 1.5 cm per hour
 Physical Assessment o during active labor, the rate of cervical dilatation should not be slower than 1 cm per hour
 Observing and assisting during doctor’s o A lag of 4 hours between a slowing in labor and the need for intervention is unlikely to
rounds
 Assist in Delivery/ Nursery Cases
compromise the fetus or the mother and avoids unnecessary intervention
 Establishing of NPI o vaginal examination should be performed as infrequently as is compatible with safe
 Taking of vital signs practice, once every 4 hours is recommended
 Assisting students in implementing o the partograph shows graphically the rate of progress of labor
Essential Intrapartum and Newborn Care
 the rate or cervical dilation
10:15- 10:30 am
 Break for the 1st batch (endorsing their  the rate of fetal head descent
patients to the second half of the group for  the duration and frequency of uterine contractions
continuity of care)  monitoring VS
10:30- 10:45 am o palpation of uterine contractions is done every half hour in the active phase (q 1 hour in
 Break for the 2nd batch (endorsing their
the latent phase)
patients for continuity of care)
10:45am- 12:00 pm o with the partograph, there are only two observations made, FREQUENCY and DURATION
 Supervise students in DR/NICU routines of uterine contractions
 Assisting students in anticipating the o in uterine contraction monitoring, the number of contractions in 10 minutes is recorded.
patient’s needs, problems and concerns In the active phase, the partograph should be started when contractions last more than 20
 Individual conference with students
regarding their patient’s condition seconds and with two or more contractions in 10 minutes
o With the partograph, listening to the FHT is done immediately after a contraction with the
12:00-12:30 pm woman in lateral position. FHT is recorded every half hour in the first stage of labor.
 Lunch break for the 1st half of the group o The partograph should be enlarged to full size before use
12:30-1:00 pm
- Values of the Partograph
 Lunch break for the 2nd half of the group
1:00-3:00 pm o prevention of prolong or augmented labor
 Continue supervising the students in their o reduced risk of postpartum hemorrhage, sepsis, obstructed labor, and uterine rupture
assigned area o improvement in maternal outcomes: reduced number of augmented labor and operative
 Vital signs taking and plotting in the
interventions like CS
monitoring sheet
 LR/DR cases completion o Improvement in the neonatal outcomes: reduced intrapartum fetal deaths and neonatal
 Post conference morbidity
- Topic for Discussion:
 Antenatal/Prenatal Visits
  Family Planning Programs
- Giving of assignments for the 2nd day

DAY 2
6:30- 7:00 am PRE CONFERENCE
 Attendance, uniform and paraphernalia
check
 Discussion of activities for the day
 Discussion of daily and weekly
requirements
 Assigning of students to a particular patient Antenatal/prenatal visits
in the area. Prenatal Visit Period of Pregnancy
1st Visit As early in pregnancy as possible before four months or during the first trimester
7:00- 10:15 am 2nd Visit During 2nd trimester
Supervision of students in the implementation of: 3rd Visit During 3rd trimester
 Health Care Measures Every 2 weeks After 8th month of pregnancy till delivery
 Hand Washing
 Physical Assessment Recommended Schedule of Post Partum Care Visits
 Observing and assisting during doctor’s 1st visit Ist week post partum preferably 3-5 days
rounds 2nd visit 6 weeks post partum
 Getting LR/DR cases
 Establishing of NPI FAMILY PLANNING PROGRAM
 Taking of vital signs  The overall goal of Family Planning is to provide universal access to family
Assisting students in implementing DOH planning information and services wherever and whenever these are
programs such as:
 Maternal health program
needed.
 Essential Intrapartum and  Family Planning aims to contribute:
 Reduce infant deaths
Newborn Care  Neonatal deaths
Health teachings regarding:  Under-five deaths
 Family planning program  Maternal deaths
 Child health programs
 It has the following objectives:
 Expanded program on immunization
 Addresses the need to help couples and individuals achieve their desired family size
 within the context of responsible parenthood and improve their reproductive health
10:15- 10:30 am to attain sustainable development
 Break for the 1st batch (endorsing their  Ensure the quality FP services are available in DOH retained hospitals, LGU managed
patients to the second half of the group for health facilities, NGOs, and private sector
continuity of care) Family Planning Methods
10:30- 10:45 am Types Advantages Disadvantages
 Break for the 2nd batch (endorsing their Female Sterilization o Permanent method of o Uncommon complications of
patients for continuity of care) - Safe and simple surgical procedure contraception surgery: infection, bleeding, injury
10:45am- 12:00 pm which provides permanent o Nothing to remember to internal organs
 Supervise students in LR/DR routines contraception for women who do not o Does not interfere with sex o In rare cases, when pregnancy
 Assisting students in anticipating the want more child. o Results in increased sexual occurs, it is more likely to be
patient’s needs, problems and concerns - Effectiveness: enjoyment ectopic
 Individual conference with students o Perfect Use: 99.5% o No effect on breastfeeding o Requires physical examination and
regarding their patient’s condition o Typical Use: 99.5% quantity and quality minor surgery by trained service
o No known long term side effects provider
12:00-12:30 pm o Minilaparotomy can be performed o Requires an operating set up
 Lunch break for the 1st half of the group after a woman gives birth o Reversal surgery is difficult
12:30-1:00 pm o Do not protect against STDs
 Lunch break for the 2nd half of the group o Limitations in physical activities
1:00-3:00 pm immediately after surgery
 Continue supervising the students in their Male Sterilization o Very effective 3months after the o Uncomfortable due to slight pain
assigned area - Permanent method wherein the vas procedure and swelling 2-3 days after the
 Vital signs taking and plotting in the deferens is tied and cut or blocked o Permanent, safe, simple, and easy procedure
monitoring sheet through a small opening on the scrotal to perform o Reversibility is difficult and
 Getting LR/DR cases skin. o Can be perform in a clinic, office or expensive
 Post conference -Effectiveness: at a primary care center o Bleeding may result in hematoma
- Topic for Discussion: o Perfect Use: 99.9% o No re-supplies or repeated clinic in the scrotum
 Family Planning Program (continuation) o Typical Use: 99.8% visits
-Evaluation and Brainstorming o No apparent long term health risks
o An option to a couple whose
female partner could not undergo
permanent contraception
o A man who had vasectomy will not
lose his sexual ability and
ejaculation
o Does not affect male hormonal
function
o Increase the couple’s sexual drive
and enjoyment
Pill o Safe as proven o Often not used correctly and
-contains hormones – estrogen and o Convenient and easy to use consistently, lowering its
progesterone taken daily to prevent o Makes menstrual cycle occur effectiveness
contraception regularly and is predictable o Has side effects such as nausea,
- How it is used: drug are taken daily o Reduces gynecologic symptoms dizziness
per orem such as painful menses and o May pose health risk for a small
- Effectiveness: endometriosis number of women
o Perfect Use: 99.7% o Reduces the risk of ovarian and o Offers no protection against STDs
o Typical Use: 92.0% endometrial cancer o Can suppress lactation
o Reversible, rapid return to fertility o Requires regular re-supply
o Does not interfere with sexual
intercourse
Male Condom o Safe and has no hormonal effect o May cause allergy for people who
-thin sheath of latex rubber made to fit o Protects against microorganisms are sensitive to latex or lubricant
on a man’s erect penis to prevent the causing STIs/HIV o Ay decrease sensation, making sex
passage of sperm cells and STD o Encourages male participation in less enjoyable for othe partner
organisms into the vagina. family planning o Interrupts the sexual act
- How it is used: condom is inserted o Easily accessible o Requires a mans cooperation for its
into the erected penis preventing the o Is used in managing premature use
sperm from getting in contact with the ejaculation
egg cell
- Effectiveness:
o Perfect Use: 98%
o Typical Use: 85%
Injectables o Reversible o Offers no protection against STDs
-contain synthetic hormone, progestin o No need for daily intake
which suppresses ovulation, thickens o Does not interfere with sexual
cervical mucus, making it difficult for intercourse
sperm to pass through and changes o Culturally acceptable by some
uterine lining women
-How it is used: drug containing o Has no estrogen related side
progestin is injected into the body to effects
suppress ovulation making sperm o Does not affect breastfeeding
difficult to pass through uterine lining quality and quantity
- Effectiveness:
o Perfect Use: 99.7%
o Typical Use: 97.0%
Lactating Amenorrhea Method or o Universally available to all o Short term FP method which is
LAM postpartum breastfeeding women effective only for a maximum of 6
-temporary introductory postpartum o Protection from an unplanned months postpartum
method of postponing pregnancy pregnancy begins immediately o Effectiveness may decrease if a
based on physiological infertility postpartum mother and child are separated
experienced by breastfeeding women o No other FP commodities are for extended periods of time
-How it is used: amenorrhea, fully or required o Full or nearly full BF may be difficult
nearly fully breastfeeding her child, o Contributes to improve maternal to maintain for up to 6 months due
infant is less than 6 months and child health and nutrition to a variety of social circumstances
- Effectiveness: o Disadvantage to women who do
o Perfect Use: 99.5% not pass any of the three criteria
o Typical Use: 98.0% to practice lactation amenorrhea
Mucus/Billings/Ovulation Can be used by any woman of Cannot be used by woman with
-abstaining from sexual intercourse reproductive age as long as she is not medical conditions that would make
during fertile (wet) days prevents suffering from an unusual disease or pregnancy especially dangerous
pregnancy condition that results in extraordinary
-How it is Used: recording of vaginal discharge that makes
menstruation and dry days observation difficult
Inspecting underwear regularly for
presence of mucus
Recording the most fertile
observation/characteristics at the end
of the day
- Effectiveness:
o Perfect Use: 97%
o Typical Use: 80%
Basal Body Temperature Very effective Requires taking BBT everyday and time
-identifying the fertile and infertile to record temperature. Couples may
period of a woman’s cycle by daily practice abstinence during fertile
taking and recording of the rise in body periods
temperature during and after
ovulation
-How it is used: thermometer is placed
in axilla or under the tongue to get the
temperature at least 3 hours of
undisturbed rest during throughout
the menstrual cycle
- Effectiveness:
o Perfect Use: 99%
o Typical Use: 80%
Sympto-Thermal Method
- identifying the fertile and infertile
days of the menstrual cycle as
determined through a combination of
observations made on the cervical
mucus, BBT recording and other signs
of ovulation
- Effectiveness:
o Perfect Use: 99%
o Typical Use: 80%
Two Day Method o Can be used by women with any o Needs the cooperation of the
-a simple fertility awareness based cycle length husband
method of FP that involves cervical o No health related side effects o Can become unreliable for women
secretions as an indicator of fertility, associated who have conditions that cause
women checking the presence of o Incurs very little or no cost abnormal cervical secretions
secretions everyday o Immediately reversible o Does not protect the client from
- Effectiveness: o Promoted male partner HIV/AIDS
o Perfect Use: 96.5% involvement in FP
o Typical Use: 86% o Enhances self discipline, mutual
respect, cooperation,
communication, and shared
responsibility of the couple for the
FP
o Provides opportunities for
enhancing the couples sexual life
o Can be integrated in health and FP
services
o Acceptable to couples regardless
of culture, religion, socioeconomic
status and education
o Not dependent on medically
qualifies personnel
Standard Days Method o No health related side effects Cannot be used by women who usually
-a new method of natural FP in which associated with its use have menstrual cycle between 26 and
all users with menstrual cycles o Increases self awareness and 32 days long
between 26 and 32 days are counseled knowledge of human reproduction
to abstain from sexual intercourse on and can lead to a diagnosis of
days 8-19 to avoid pregnancy some gynecologic problems
-How it is used: abstain from sexual o No need for counting
intercourse during fertile period, use o Can be used either to avoid or
color coded beads to mark the fertile achieve pregnancy
and infertile periods o Very little cost and promotes male
-- Effectiveness:
 o Perfect Use: 95% partner involvement in FP
o Typical Use: 88% o Enhances self discipline, mutual
respect, couples sexual life
o Acceptable to couples regardless
of culture, religion, socioeconomic
status and education
o Can be integrated in health and FP
services
o Not dependent on medically
qualifies personnel

References:
1. Philippine Clinical Standard Manual on Family Planning 2006
2. AO # 39 Series 2003, Policy on Nationwide Implementation of Expanded Program on Immunization
3. Public health Nursing in the Philippines 10 th Edition, Copyright 2007
4. Integrated Management for Childhood Illnesses Manual 2004
5. www.dohprograms.com
6. www.mchnfamilyplanning.com
7. www.phn.com