Avon Medical Practice

Antenatal Discussions

• Everyone expects an expanding waistline in pregnancy but physical changes that occur as a result of pregnancy are much more than these.
• For some the changes are subtle, for others much more obvious so much so that some people are unrecognizable after they give birth
Pregnancy changes affect your whole body, from your head to your toe nails. The changes include the following;

• One of the earliest signs of pregnancy is breast tenderness. Your breast will progressively increase in size and the area around the nipple , the areola will darken. As your breasts grow, ensure you wear well fitting firm bras to provide adequate support throughout pregnancy.
• In early pregnancy, if breast tenderness is intense, your may need to ask your partner to avoid touching them. Closer to delivery, wipe the nipple with some gauze dipped in olive oil to ensure the ducts are patent and ready for breast feeding. Your breasts may leak colostrum in late pregnancy.

• Increased blood volume may lead to a runny nose and nasal congestion which may be worse at night. Saline drops can help with this. Your respiratory rate rises to compensate for increase maternal oxygen consumption to meet the demands of the growing fetus.
• As a result , pregnant women may pant and often feel out of breath with minimal exertion.

This comprises your heart and blood vessels. More blood vessels are formed as your uterus grows, your blood volume increases and the pressure of the expanding uterus on the heart decreases the rate at which blood returns to the heart. Your heart beats faster, and dilation of blood vessels cause your blood pressure to drop. This may cause dizziness and fainting spells.
The pressure of the uterus may also cause varicose veins. Increased blood flow may lead to headaches and migraine in some women.

• The increased blood volume cause an increased urinary output. As a result , you tend to urinate more frequently. Also, as the uterus expands , the pressure of the baby on the bladder makes one constantly feel pressed.
• The pressure on the bladder may also lead to bladder control problems especially in women who have had multiple vaginal deliveries. Laughing, sneezing or coughing may cause leakage of urine. Your can help prevent this by doing Kegel’s exercises after the baby is born.

• The placenta secretes hormones estrogen and progesterone which cause several changes in the pregnant woman. She may experience hot flushes and increased body temperature caused by increased hormonal levels and basal metabolic rate.
• Near the end of pregnancy, your body secretes oxytocin which initiates labour and after delivery, prolactin which causes milk production.
• Pregnancy hormones may also cause the gums to bleed easily.
• There may be increased sexual urge at sometime in pregnancy.
Hormonal changes may also account for mood swings and increased irritability. You may be emotionally labile and burst into tears for no justified reason.

• Progesterone causes relaxation of the intestines which slows down digestion and increases the likelihood of vomiting and causes constipation. This same action also increases the risk of heartburn which may be worsened by the growing uterus displacing internal organs, the stomach and intestines.
• This displacement may also cause early satiety in which one feels full after eating just a little. To ensure you get adequate nutrition, eat small frequent meals if this is a problem. There is also an increase risk of hemorrhoids so drink as much fluids as you can and eat a lot of fruits and vegetables.

• There is a realignment of spinal curvature to accommodate the strain of carrying the growing fetus. This accounts for the peculiar gait of late pregnancy.
• Increased laxity of the ligaments contributes to back pain but is necessary to cause stretching of the pubis symphysis in readiness for delivery.
• Abdominal muscles stretching to accommodate the growth of the uterus may cause pain in the sides and around the navel.
• Your feet and ankles may also swell due to fluid retention.

• Hyperpigmentation occurs which causes generalized darkening of the skin. In addition, the central line running down the abdomen called the Linea Nigra darkens as well as the face. Facial hyperpigmentation may be uneven resembling eczema and this is called Chloasma ( Mask of pregnancy)
• Stretch marks over the expanding abdomen, hips and thighs may occur.
• Hair and nails will grow thicker and longer as they become locked into an extended growth cycle due to the growth of the fetus.

• The growing fetus requires a huge amount of calcium and inadequate intake in the mother can have adverse consequences for the health of her bones and teeth.
• Lack of calcium or magnesium or muscle fatigue from carrying around the extra weight of the baby can lead to muscle cramps which funnily seem to occur often at night.
• If you do get one, get out of bed immediately and stand up. This usually causes the cramps to cease.
All in all, the journey of pregnancy should be a much cherished and enjoyable one. Embrace the physical changes and try to enjoy your time while pregnant as much as possible.

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A healthy diet should be part of a healthy lifestyle for everyone but is even more important in pregnancy. Aside from genetics, dietary consumption determines to a large extent how healthy your baby will be after it is born.
Eating healthily also gives you the strength and stamina to cope with the stress and demands of pregnancy and also ensures that you remain healthy even after the baby is born.
A healthy diet focuses on the following food groups;
• Carbohydrates
• Protein
• Fruits and vegetables
• Dairy

• These are important sources of energy and supply vitamins and fiber in addition.
• They include breakfast cereals, bread potatoes, rice, sweet potatoes and yams.
• They should be part of every meal. Eat wholegrain rather than processed(white) carbohydrates as much as possible.

Protein is very important in pregnancy for your developing baby.
Good sources of protein include;
• Meat ( not liver which is high in Vitamin A)
• Poultry ( this should be cooked without the skin with as little fat as possible)
• Fish (especially oily fish e.g. Titus, sardines, mackerel)
• Beans
• Nuts
• Eggs ( should be properly cooked to avoid food poisoning)

Milk and other dairy products are important sources of calcium which is vital for the developing fetus. They are also great sources of protein. When choosing yogurt, low fat, low sugar varieties are the best kind.
FOODS HIGH IN SUGAR OR FATS OR BOTH should be kept to a minimum. These include; all spreading such as butter, salad cream, chocolate, crisps, biscuits, pastries such as meat pies, doughnuts etc, cake, ice cream and fizzy drinks.
1. These foods are high in calories which will contribute to unnecessary weight gain for you and the baby.
2. Expected weight gain in pregnancy should not exceed 10-12.5 kg. For women who were already overweight, the expected weight gain should be a little less than this.
3. The weight gain comes from the growth of the fetus, the placenta, amniotic fluid surrounding the baby, the thickened muscle layer of the uterus, increased breast size, increased fat stores, increased blood volume and extracellular fluid.
4. A woman should gain about 2.5kg during the first 20 weeks of pregnancy and 8-10.5kg during the last 20 weeks.
5. You may feel hungry in between meals very easily in pregnancy.
6. Try not to fill up on unhealthy snacks such as biscuits, cake and meat pies, rather choose from the items below:
• Low fat yogurt,
• Sandwiches with healthy filling such as tuna,
• Fresh fruit,
• Unsweetened fruit juice,
• Low sugar milk drinks.

1. Drink lots of fluids to keep well hydrated and prevent constipation which is common in pregnancy. Limit caffeine intake as too much caffeine can cause low birth weight.
2. Note that caffeine is present in tea and chocolate as well as coffee. Keep herbal and green teas to a minimum as the effect on the unborn fetus is not well documented.

1. Food cravings may occur but as long as you are getting all your nutrients they are not harmful.
2. You should not see yourself as eating for two which will lead to over eating and unnecessary weight gain.
3. Prenatal vitamins are very important and should be commenced once pregnancy is establish.
4. Folic acid is vital in preventing Spina bifida, a condition in which the spinal column fails to close properly during fetal development.
5. Iron is essential for development of the fetal brain and prevention of anemia in the pregnant mother.
6. In summary, the future health of your baby is determined in utero. Eating right during pregnancy can mark the difference between a complication free pregnancy and delivery and one fraught with challenges.

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• Occurs in the first trimester and is caused by elevated levels of human chorionic, gonadotropin and changes in carbohydrate metabolism.

• Eat dry crackers before arising
• Avoid brushing teeth immediately after arising
• Eat small, frequent, low fat meals during the day
• Drink liquids between meals rather than after meals
• Avoid fried foods and spicy foods

Usually occurs in the first trimester. It may be triggered hormonally or caused by the increased blood volume, anemia, fatigue, sudden position changes, or lying supine.

• Sit with feet elevated
• Change position slowly
• Change position to the lateral recumbent to relieve the pressure of the uterus on the inferior vena cava

Occurs in the first and third trimester. It is caused by pressure of the uterus on the bladder.

• Drink adequate amount of fluid during the day
• Limit fluid intake in the evening
• Void at regular intervals
• Sleep side lying at night
• Wear perineal pads if necessary
• Perform kegel exercises

This can occur from the first through the third trimester. It is caused by levels of estrogen and progesterone.

• Wear a supportive bra
• Avoid the use of soap on the nipples and areola area to prevent drying

Can occur from the first through the third trimesters. It is caused by hyperplasia of vaginal mucosa and increased mucus production.

• Wear cotton under wear
• Proper cleansing and hygiene
• Avoid douching
• Consult the nurse mid-wife or consultant if infection is suspected.

This results from increased estrogen, which causes swelling of the nasal tissue and dryness. It occurs from the first through the third trimesters.

• Use humidifier
• Avoid nasal sprays or antihistamines

Occurs usually in the first and third trimester. Usually results from hormonal changes.

• Arrange frequent rest periods during the day.
• Use correct body mechanics
• Do regular exercises that are muscle relaxing and strengthening for the hip and leg joints.
• Avoid eating and drinking foods containing stimulants through out the entire pregnancy.

Occurs in the second and third trimesters as a results of increased progesterone levels, decreased gastrointestinal motility, and esophageal reflux and displacement of the stomach by the enlarging uterus.

• Eat small frequent meals.
• Sit upright for 30 minutes following a meal.
• Drink milk between meals.
• Avoid fatty and spicy foods.
• Perform tailor sitting exercises.
• Take antacids only if recommended by your physician or midwife.


Occurs in the second and third trimesters. Results in vasodilation, venous stasis, and increased venous pressure below the uterus.

• Elevate leg at least twice a day.
• Sleep on the side.
• Wear supportive stockings.
• Avoid sitting or standing in one position for long periods of time.


Occurs in the second and third trimesters. Results from weakening walls of the veins or valves and venous congestion.

• Wear supportive hose.
• Elevate the feet when sitting.
• Lie with the feet and hip elevated.
• Avoid long periods of standing or sitting.
• Move about while standing to improve circulation.
• Avoid leg crossing.
• Avoid constricting articles of clothing.

Occurs in the second and third trimesters. Results from changes from blood volume and vascular tone.

• Change position slowly.
• Apply a cool cloth to the fore head.
• Eat a small snack.
• Use acetaminophen only if prescribed by the physician or mid-wife.

Occurs in the second and third trimesters. Results from increased venous pressure and constipation.

• Soak in a warm sitz bath.
• Sit on a soft pillow.
• Eat high fiber foods and avoid constipation.
• Drink sufficient fluids.
• Increase exercises such as walking.
• Apply ointment, suppositories, or compresses as prescribed by the physician or mid-wife.

Occurs in the second and third trimesters. Results from decreased intestinal motility, displacement of the intestines, and taking iron supplements.

• Eat high fiber foods.
• Drink sufficient fluids.
• Exercise regularly.
• Avoid laxatives except prescribed.

Occurs in the second and third trimesters. Caused by exaggerated lumbosacral curve resulting from enlarged uterus.

• Use correct body mechanics and posture.
• Rest.
• Wear low heeled shoes.
• Perform pelvic rocking and abdominal breathing exercises.
• Sleep on a firm mattress.

Usually occurs in the second and third trimesters. It is as a result of altered calcium phosphorus balance and pressure of the uterus on nerves or from fatigue.

• Get regular exercises especially walking.
• Dorsiflex the foot of the affected leg.
• Increase calcium intake.

Can occur in the second and third trimester. Results from pressure on the diaphragm.

• Allow frequent rest periods.
• Sleep on the side with head slightly elevated.
• Avoid overexertion.
• Perform tailor sitting exercises.

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Pregnancy for most women is a happy time. While most mothers will experience an uneventful pregnancy, there are certain dangers associated with this condition that can result in serious health complications for mother and baby. Knowing what these complications are can help reduce your risk of experiencing them. These signs include;
• Vaginal bleeding
• Abdominal cramping
• Raised blood pressure
• Persistent fatigue
• Swollen calves
• Decreased fetal movement
• Severe nausea and vomiting
• Fluid leaking from your vagina
• Blurred vision
• Excessive thirst and hunger
• Preterm contractions

• Vaginal bleeding at any stage in pregnancy must be reported to a doctor at once. Many causes of vaginal bleeding exist and the likely cause depends on how advanced the pregnancy is.
• Bleeding in early pregnancy is diagnosed as a threatened miscarriage and not much medication aside from bed rest is usually offered. A number of miscarriages are due to genetic abnormalities and are Natures way of taking care of the problem. 20% of pregnancies end in miscarriage.
• Later in pregnancy, vaginal bleeding may be caused by Placenta previa in which the placenta is lying across the neck of the womb or by placental abruption in which the placenta detaches from the womb while the baby is still in utero.
• Vaginal bleeding may be accompanied by back pain and abdominal cramps.

• Raised blood pressure in pregnancy may be due to a condition known as pre-eclampsia which is associated with swelling of the feet and protein in the urine, detectable via urine test in ANC. It occurs after the 20th week of pregnancy and can only be totally resolved by delivery of the baby. Other symptoms include headache, blurred vision and stomach pain.
• Raised blood pressure can also occur in isolation. Especially in women who were hypertensive outside pregnancy but were undiagnosed.

• Tiredness is common in the first and last trimesters but persistent tiredness may be a sign of anemia. Associated feeling of dizziness, feeling faint and shortness of breath may occur.
• The doctor may prescribe folic acid and iron supplements.

The hands and feet may swell during the course of pregnancy but any painful one sided swelling of the legs should be reported as it may be a sign of Deep vein Thrombosis, a potentially life threatening condition in which blood clots form in the lower limbs which can dislodge and cause blockage in the lungs leading to sudden death.

• Any noticeable decrease in your baby’s movement should not be ignored and must be reported at once.
• The doctor may ask you to keep a fetal kick chart in which you make notes each time the baby moves.
• Persistent concerns about fetal movement late in pregnancy may cause your obstetrician to plan for a C-section.
• An anterior lying placenta may mask fetal movement.
• Some degree of nausea and vomiting is common in pregnancy but when it becomes excessive such that you are unable to hold anything down at all, you may require hospitalization.
• Nausea can be combated by eating small regular meals to keep blood glucose steady rather than 3 large meals.
• A bland diet and ginger tea can also be of tremendous help.
• Any sensation of fluid flowing out from your vagina or the underpants being wet may indicate that your membranes (which surround the baby and protect it from infection) have ruptured.
• As a risk of infection may be present, you must see the doctor at once.

• Gestational Diabetes usually occurs during the second trimester and is due to the mothers inability to produce adequate insulin.
• One way of avoiding this is ensuring that one does not gain too much weight in pregnancy.
• The treatment is usually diet and/or insulin.
• Tablets are not prescribed for Diabetes in pregnancy.

• Abdominal contractions before 37 weeks gestation are called preterm contractions and may signify early labour.
• Occasionally, the contractions cannot be stopped and the woman goes into labour prematurely. Most babies can be cared for without complications beyond the 28th week of pregnancy but preterm delivery indicates a prolonged hospital stay as incubator care for the baby will be required.

• Report at once to the hospital if you experience any of these signs so appropriate action can be taken.

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Labour is the last stage of pregnancy and a process by which the fetus, placenta and membranes are delivered. A full term pregnancy is 38-42 weeks.
Signs of Labour are:

• Regular uterine contractions that feel stronger and last more than 30 seconds. Uterine contractions for a first timer may feel similar to very bad period cramps. As labour gets established, contractions tend to become longer, stronger and more frequent.
• During a contraction, the muscles in the womb contact and the pain increases, the abdomen feels hard to touch. When muscles relax, the pain fades and the hardness eases off. The contractions are pushing the baby down and opening the cervix (entrance to the womb) ready for the baby to go through.
• Contractions that lead to labour must be differentiated from Braxton Hicks contractions.
• Braxton Hicks contractions occur once or twice per hour and no more than a few times a day, do not increase in intensity and resolve with ambulation or a change in activity.
• Contractions that lead to labour however, may initially be infrequent but will progress to one every 2-3 mins, last longer and are more intense than Braxton Hicks contractions and lead to cervical change.

As the uterus contracts regularly, the neck of the womb know as the cervix progressively dilates ( widens) to accommodate the final passage of the baby. Full dilatation is 10cm. Cervical dilatation is assessed in labour by intermittent vaginal examinations conducted by the doctors and midwives.

While pregnant, a plug of mucus is present in your cervix. Just before labour starts or in early labour this plug comes away and is passed out through the vagina. This small amount of sticky, jelly like pink mucus is called a “show”. Sometimes it can be more bloody than pinkish which occasionally causes alarm.

Most women’s waters break during labour, but it can also happen before labour starts. The unborn baby develops and grows inside a bag of fluid called the amniotic sac. When it is time for the baby to be born, the sac breaks and amniotic fluid drains out through the vagina. For some people, it resembles a slow leakage rather than a large gush and one may feel one has wet one’s pants. However, the leakage is uncontrollable. Healthy amniotic fluid is a clear, pale straw color.
Occasionally the sac has to be ruptured by the doctor to hasten the progress in labour.
Passage of smelly or colored amniotic fluid is a danger sign and continuous drainage of amniotic fluid also known as liquor must be reported at once. Without the amniotic membrane intact, the risk of fetal infection is high.


Pressure from the baby’s head as it descends in your pelvis can cause significant back pain. When full dilatation is approaching you may feel the urge to bear down or push, which is similar to the urge to pass stool. In some cases, this urge may occur before full dilatation occurs. If one bears down on an improperly dilated cervix, the risk of cervical laceration and post partum hemorrhage is high.


• You can be up and about if you feel like it. Drink fluids and a light diet to keep your energy up. Time your contractions, this will help the doctors assessment when you come into hospital. As the contractions get stronger, you can try breathing exercises.
• A massage from your partner may help with the back pain. Prepare for your waters breaking by using a sanitary towel.
• Do not expend your energy shouting, leaving you with little energy to push. Labour is rather painful, for those who feel they will be unable to cope epidural anesthesia is available on a private basis.

• During labor, the following will be done;
• Fetal heart monitoring every 15-20 mins.
• Intermittent vaginal examinations to monitor cervical dilatation and descent of the fetal head.
• Monitoring of maternal vital signs.


• Despite the fact that most women long for vaginal deliveries, a percentage of women will be delivered surgically to save the life of baby and mother and to ensure a successful outcome to the pregnancy.
• Your labour may be interrupted if ;
• Your cervix fails to dilate properly
• Your baby’s heart rate increases or decreases inappropriately signifying fetal distress.
• If your vital signs e.g. blood pressure, temperature etc become abnormal during labour



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Feeding of an infant or young child with breast milk directly from a female breasts via lactation.
Breastmilk is free, easier to digest, contains the right balance of nutrients and antibodies, always at the right temperature, fat content changes according to baby’s need.

• Exclusive breastfeeding (no water, solid food nor formula) for 6months offers protection from illnesses such as respiratory problems, stomach viruses, ear infections, meningitis.
• Reduces risks of type 1and2 diabetes, childhood leukemia, obesity, heart disease , SIDS (sudden infant death syndrome).
• Protects your baby from developing allergies.
• Boosts your child’s intelligence.
• Protects your child from obesity.

• The hormone released causes contraction of the womb hereby reducing excessive bleeding , lowers blood pressure.
• It lowers the risk of post partum depression.
• It is cost effective.
• It helps in weight loss.
• It helps in bonding.
• It lowers the risk of breasts and ovarian cancer.
• It lowers the risks of type 2 diabetes and high cholesterol later in life.

• First trimester – increase in size is rapid ,don’t wear tight fitting bra, wear your size.
• Avoid wearing under wired bras, they might hamper the functioning of the milk glands Very tight bra, may press down the nipple and block the milk ducts.
• Regular increase in breast size, it tends to change color and nipple darkens. Sometimes the nipple might appear too rough and might develop cracks lightly massage apply blue seal Vaseline, lanolin or coconut oil.
• Some people have inverted nipples. These people can gently pull the nipples out so that the nipple are in correct position when the baby is born.
• In the last trimester, prepare your breasts for lactation by using Vaseline or olive oil with gauze pads 5minutes before taking your bath to open up the pores for easy flow of breast milk.

Nurse early and often(within the 30 mins to one hour after birth)
– Milk removal stimulates milk production
– Baby consumes important nutrients
– Sucking helps uterus to contract
– Prevents engorgement.
You will be required to put your baby to breast every 2 hours after birth. Frequent feeding encourages lactation and reduces the likelihood of babies developing jaundice.
All sucking at the breast
– At least the first 14days
– No pacifiers, no other foods, no pumping
Length and frequency of feedings determined by baby.
– No mother
– No clock

Breast milk is very light. Hence, breast fed babies require frequent feeds- about every 2 hours. The quality of your breast milk is determined by what you eat. Eat properly so your baby is healthy
Position the baby so nursing is comfortable
– Cross cradle, football or side-lying.
– Infant’s body aligned
-Nose , chin, and cheeks touching breast
-Keep you back supported
– Limit confusion
– Large breasts and flat or inverted nipples may present a challenge
Insure an effective latch
– Utilize newborn reflexes
– Patiently insist newborn opens mouth wide
– Place breast deeply into baby’s mouth
– You should feel tugging
Watch the baby’s output
-No of Wet 6 diapers per day (straw colored-pale yellow) not dark yellow or crystals
– Stools- 3-4 per day (green stool means baby might not be getting enough)

• Eat right during pregnancy as well as after delivery.
• You need strength and stamina to meet physical demands of caring for a new baby.
• Eat a balanced diet. 2000-2500 calories is needed daily.
• Take plenty of fluids and limit caffeine.
• If you feel hungry since your body is working round the clock to make milk for your baby, eating small meals with healthy snacks in between. Keep taking your vitamins.
• Dieting is not advised at this period.

Expressed breast milk should be used at room temperature, 3 to 4 hours , if your want to keep it longer you need to refrigerate or freeze it.
First step , clean and wash your hands, clean the bottles and sanitize the surface you are working on store the breast milk in a bottle and keep in refrigerator, write time and date to keep track.
Refrigerated longest
– In a refrigerator, it last for 8days
– In the regular freezer it will last for 3 to 6months.
– In a deep freezer it will be good for 6 to 12months.
– To defrost breast milk – place bottle in a cup of warm of warm water, for few minutes. It can be kept in the fridge for 24hrs,or at room temperature for 1hr.

• Babies cry for various reasons. Not every cry is a reason to feed. When baby cries and you have just fed properly, check for other things e.g.
• Wet diaper
• Baby too hot
• Baby is cold ( cold hands and feet)
• Baby wants a cuddle!

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What is family planning ?
• Family planning means planning when and how many children you are going to have and how to prevent unwanted pregnancy.
• Family planning means working out a plan with your partner on how you want to deal with procreation within the context of a sexual relationship.
• This covers things as varied as when and why to get pregnant, the number of children that are wanted, how to deal with fertility issues, how to avoid getting pregnant, whether to consider an abortion or adoption if an unwanted pregnancy occurs, etc.

Definition and Concept
Family planning is having children that you planned on having, and not children conceived by accident.

The (WHO) definition:-
A way of thinking and living that is adopted voluntarily upon the basis of knowledge, attitude and responsible decision by individuals and couples in order to promote health and welfare of the family group thus contributing effectively to the social development of the country.

Family Planning day.
The 26th of September is World Contraception Day, devoted to raising awareness and improving education about sexual and reproductive health, with a vision of a world where every pregnancy is wanted. It is supported by a group of governments and international NGOs, the International Federation of Pediatric and Adolescent Gynecology, International parenthood federation etc.

Benefits of family planning
• Saves the lives of children by helping women space births.
• Improves family wellbeing.
• Helps nation develop.
• Helps women to protect themselves from unwanted pregnancies.
• Gives everyone a better opportunity for a good life.

Types and Methods

1. Natural method
Natural family planning includes the rhythm method, It involves tracking the woman’s ovulation and avoiding sex when she is fertile.
2. LAM- Lactation Amenorrhea Method
This is for mothers who are prepared to breast feed their children exclusively night and day on demand without no other feeds including water and this is only effective for six months from the day of conferment, the woman must have resumed her menses .
3. Billings ovulation method –Cervical mucus
If your religion forbids other forms of birth control, this may be an attractive option. Natural family planning has a failure rate of about 25 percent, meaning that of 100 women using this method, about 25 will become pregnant, according to the U.S. Department of Health and Human Services’ Office on Women’s Health. That failure rate might be unacceptably high to many couples.
4. Barrier method
Barrier methods include the condom, the diaphragm and the cervical cap. The diaphragm covers the entrance to the uterus, thereby blocking the sperm’s access. The cervical cap does the same thing, but can be left in longer.
• The condom keeps the sperm contained. In general, barrier methods have a failure rate of in the range of 11 percent to 20 percent, but using a spermicide along with a barrier increases its effectiveness.
5. Hormonal Method
There are several different hormonal methods of birth control. The differences among them involve: the amount of hormone, the type of hormone, and the way the hormone enters a woman’s body.

The hormones can be estrogen and/or progesterone. The hormones can be taken by mouth, implanted into body tissue, absorbed from a patch on the skin, injected under the skin, or placed in the vagina. Common types of hormonal birth control include:

• Oral pill method
The pill for women is an oral contraceptive made from synthetic hormones.
The pill is considered to be 97% to 99% effective if used properly. The pill is also fully reversible. The pill has been available since 1960, and it is estimated that more than 10 million American women currently use birth-control pills.
There are two types of birth-control pills available:
the combination pill and the progestin-only pill, known as the mini pill. (suitable for breast feeding mothers)

• Injectable
We have two types Depo provera and Noresterat
These must be injected by a health-care professional every 1/2/3 months (4/8/12 weeks). It is administered as a deep muscle (intramuscular) injection. A lower-dose formulation of the drug that is injected beneath the skin (subcutaneously) is also available. The injection must be administered within the first five days of a woman’s menstrual period. She is then protected from pregnancy within 24 hours of receiving the injection.

• Implant/Norplant
A contraceptive implant known as Implanon is available .
Implanon provides contraception by the slow release of the progestin etonogestrel over a period of three years. Implanon is a thin rod that is inserted in the upper arm under local anesthesia. Protection from pregnancy occurs within 24 hours of insertion of the rod, and the failure rate is comparable with surgical sterilization (tubal ligations). One advantage of the Implanon rod is that fertility rapidly returns after removal of the rod.
A two-rod implant containing the progestin levonorgestrel (Jadelle) was approved by the FDA for 5 years of use.
Similarly, the Sino-Implant II contraceptive implant is similar to Jadelle, but is designed to remain in place for 4 years.
Preliminary studies of the product showed that it was generally well tolerated and effective in preventing pregnancy. However, these studies showed that irregular bleeding is a possible side effect of the product.
As with all other hormonal methods of birth control, Implanon will not protect a woman against sexually transmitted infections.

• Device
IUD stands for internal uterine device. An IUD is inserted into a woman’s uterus by a doctor to prevent pregnancy. When the woman is ready to become pregnant, her doctor removes the device. The IUD has a failure rate of about 1 percent. Copper T and Mirenal are the common types around. Newer devices, such as the Nuva-Ring, have a failure rate of about 5 percent.

6. Permanent method
• Both men and women can undergo sterilization procedures, with the goal of permanently preventing pregnancy. Failure rates for both men and women are less than 1 percent — but the procedures are never fool-proof or completely effective in everyone
• BTL-Bilateral Tubal Ligation for women
• Vasectomy for men.

The birth control method you choose must take into consideration personal preferences, habits and health concerns.
Complete abstinence is the only method that prevents pregnancy 100 percent of the time, but most contraceptive methods have a very high success rate when practiced correctly.

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