Maternity - Preconception, part 1: Behavioral and Barrier Methods of Contraception
by Meris Shuwarger BSN, RN, CEN, TCRN August 25, 2021 Updated: June 16, 2022 6 min read
Welcome to the Maternity Nursing series! This series follows along with our Maternity Nursing Flashcards which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
In this article, we begin our coverage of contraception, starting with behavioral and barrier methods.
Contraception is birth control; preventing pregnancy as a result of sexual intercourse by preventing a sperm from reaching an egg to become fertilized and implanted in the uterine wall.
The term conception commonly refers to the process of becoming pregnant, where a sperm meets an egg, producing a zygote (fertilized egg) and implants into the uterine wall, to grow. Contraception is the prevention of that process. Contra- means against, and -ception is just a shortened form of conception.
Want to learn more word parts? We created our Medical Terminology flashcards to make breaking down words into their parts easy, so you never have to be confused by an unfamiliar word on an exam!
Different forms of contraception prevent conception at many points along the timeline. Contraception may:
- prevent semen from entering the body (abstinence, withdrawal, condoms),
- remove sperm from semen (vasectomy),
- reduce or remove sperm's ability to "swim" to the egg (spermicide, IUDs),
- physically block the sperm from the egg inside the body (diaphragm),
- prevent eggs from being available to fertilize (natural family planning, oral contraceptives, hormonal IUDs, tubal ligation),
- or prevent a fertilized egg from implanting (oral contraceptives, IUDs).
Behavioral methods of contraception
Behavioral methods of contraception are ways that one can alter their behavior around the timing or presence of sexual intercourse, in an attempt to prevent pregnancy. There are several behavioral methods of contraception to be aware of: abstinence, withdrawal, and natural family planning.
Abstinence means the complete avoidance of sexual intercourse. Not having sexual intercourse is the only 100% effective way to prevent pregnancy.
Withdrawal is the removal of the penis from the vagina before ejaculation occurs during sexual intercourse. Withdrawal is not a very effective method of preventing pregnancy, which is something that you would want to counsel your patients on.
Natural family planning
Natural family planning is a method of monitoring the menstrual cycle, basal body temperature, or cervical mucus consistency and attempting to estimate which days someone is most fertile, to avoid sexual intercourse on those days.
Natural family planning requires work, planning, tracking, and is not always reliable. Therefore, it is not an especially effective method for preventing pregnancy.
Behavioral methods of contraception and STIs
Abstinence is the only behavioral contraception method that protects against sexually-transmitted infections (STIs). Withdrawal and natural family planning do not protect against STIs
Barrier methods of contraception
Barrier methods of contraception place a physical barrier between the uterus and sperm.
A diaphragm (in the context of birth control, not the respiratory system) is a flexible silicone dome placed over the cervix that is used with spermicide to kill the sperm and prevent it from getting past the diaphragm. Spermicide must be reapplied around the rim of the diaphragm prior to each act of intercourse.
A diaphragm can be inserted up to 6 hours prior to sexual intercourse, and must be left in for at least 6 hours after, but no more than 24 hours total.
A diaphragm must be fitted by a provider, and is not available over the counter. Patients must be refitted every two years, with a weight change of more than 10lbs, after pregnancy, or abdominopelvic surgery.
Diaphragms have fallen in popularity since the hormonal birth control pill came on the market in the 1960s.
Condoms are made of latex or polyurethane.
Male condoms are placed over the penis. Proper application of the male condom requires pinching the tip of the condom during application to leave a reservoir for semen.
Did you know there are female condoms? These condoms are also called internal condoms, and were actually renamed internal condoms by the FDA in 2018.
An internal condom looks like a plastic tube with rings on either end, and is inserted into the vagina. The interior ring of the internal condom sits around the cervix and the exterior ring is outside the vagina. Sales of internal condoms are much lower than sales of male condoms in the United States.
Male condoms and internal condoms cannot be used at the same time due to risk of tearing.
Condoms are the only method that offers protection against STIs during sexual intercourse.
Hi, my name is Meris, and in this video, I'm going to be talking to you about behavioral and barrier methods of contraception. I will be following along using our maternity nursing flashcards. These are available on our website on LevelUpRn.com. And if you have a set of your own, I would definitely invite you to go ahead and follow along with me. All right, let's get started.
Okay, so first up, we are talking about behavioral methods of contraception. As the name may imply, this is something that involves altering your behavior in some way.
So first up, is abstinence. Abstinence, excuse me, means the complete avoidance of sexual intercourse. So this is the only way that is 100% effective at preventing pregnancy is by not having sexual intercourse.
Withdrawal. Withdrawal is going to be removing the penis from the vaginal penetrative sex before ejaculation occurs. This is not very effective. And this is definitely something that you would want to counsel your patients as not being a strong method of contraception.
And then lastly, is natural family planning. Natural family planning looks at the menstrual cycle and attempts to estimate which days someone is most fertile and therefore which days they are least fertile. Now, this can help for couples to avoid having sex when the other person is most likely to conceive. This, again, requires a lot of work, a lot of tracking, and is not always reliable. So this is, again, something you would want to teach your patients is not especially effective.
None of these, however, except for abstinence, provide any protection from sexually transmitted infections. This only changes the likelihood of actually becoming pregnant.
Moving on to barrier methods of contraception. Barrier methods are going to be those which put a physical barrier between the uterus, essentially, and in semen.
So the first on this list is a diaphragm. These are not very common now. Most of my experience is working in OBGYN. And every now and then, we would get a patient who wanted a diaphragm. Diaphragms require fitting. They are of different sizes. And a health care provider must fit the diaphragm to the patient. So that's first thing that you need to know. It's not something you can go pick it up at the grocery store or whatever. It's something that you have to have an appointment with a health care provider. And then there's a lot of bold red texts and a lot of bulleted text here, which tells you it's pretty important stuff to know. So I'll let you go through all of these on your own.
But one of the things that is nice about the diaphragm is it can be inserted up to six hours before sex happens, which is great because you don't have to necessarily put it in right before or anything. But it can also be left in place for six hours after. And in fact, it must be left in place for six hours after intercourse to make it the most effective. But do not leave it in for more than 24 hours in total. Additionally, a patient should use spermicide with this method because that helps to both kill the sperm and prevent it from getting past the diaphragm. And then there is refitting that is required.
So just like you have to be fitted the first time, the patient needs to be fitted again in an ongoing basis. Look at this card for that information.
And then condoms. There are both condoms that are called male and female condoms. Male condoms are what you are probably most familiar with. This is going to be the piece of latex that is placed over the penis.
But female condoms are sort of a-- they kind of look like two rings that have a plastic bag around them connecting them. And these are inserted into the vagina. So there's an interior ring that sits around the cervix and an exterior. And then this is going to act sort of like a condom, but it is worn by the person with the vagina. This is the only method that provides any sort of protection from STI, Sexually Transmitted Infections. Very important to know that when you're talking to your patients so that they know how to keep themselves safe. And then there is some information on how to actually apply these that I would definitely recommend reviewing.
So that is it for behavioral and barrier methods of contraception. I hope that review was helpful. If it was, please like this video so that I know you enjoyed it. I'd love to hear a comment below if you have any kind of funny ways to remember this or good stories to help remember this information. And be sure to subscribe to our channel so that you are the first to know when the next video comes out. The next video in this series will be talking about actual hormonal methods of contraception, which is very important for your nursing school exams and practice. I hope I see you there. Thanks so much and happy studying.
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