Learning Objectives
By the end of this section, you will be able to:
- Perform a history and physical for a person seeking contraception
- Explain the general information and education provided to a person seeking contraception
This section discusses the history and physical performed and education provided when a person seeks contraception. The history includes a detailed reproductive history in addition to the personal and family health history. The physical exam often includes a pelvic exam and sexually transmitted infection (STI) testing when indicated.
History and Physical for Contraception
Obtaining a health history for contraception encompasses a thorough reproductive and medical history. The nurse enquires about menarche, frequency and length of menstrual cycle, characteristics of the cycle (pain, heavy bleeding, clots, mood changes), number of pregnancies and births, pregnancy complications, previous use of contraception, STI history, desire for pregnancy and spacing of births, surgeries, infertility, family history, and genetic history, along with any risk of thrombosis or clotting. Table 5.1 lists specific questions to help the nurse and patient determine the best contraception for that patient.
| Nurse’s Question | Reason |
|---|---|
| Tell me about your periods. Are they heavy or irregular? Do you experience clots and/or pain? Do you experience other symptoms such as headaches or nausea? | Helps determine any irregularities in the cycle or any discomforts that could be relieved by noncontraceptive properties of a contraceptive method |
| How many times have you been pregnant? How many live births? | Determines past fertility; explores elected and/or spontaneous abortions |
| Were all of your pregnancies planned? | Explores if the person has been successful in preventing pregnancy and becoming pregnant on their time plan |
| If unplanned, were you using any type of contraception? | Determines what methods have worked in the past and which have not |
| Are you in a monogamous relationship? | Allows the nurse to discuss a barrier method to prevent STIs |
| Did you have any pregnancy or abortion complications? | Determines risk factors associated with pregnancy that the person should be counseled about regarding timing or contraindications for pregnancy or contraception |
Choosing a contraceptive technique should include shared decision making between the nurse and the person making the decision.
Questions to Consider Prior to Providing Contraceptive Education
The nurse becomes familiar with what is important in a contraceptive method for the person. This allows the nurse to point out pros and cons of each method related to the individual needs of that person. The nurse should determine if the person has any religious or sociocultural considerations related to pregnancy prevention, how often they anticipate having penetrative sex, and their sexual orientation and gender. The nurse must take care to ask patients who are LGBTQIA+ the contraceptive questions on the intake form. Regardless of a patient’s sexual orientation or gender identity, contraception can provide many health benefits. Table 5.2 lists other important questions to ask during contraceptive counseling.
| Nurse’s Question | Reason |
|---|---|
| What is important to you about your contraceptive method? | Allows the nurse to understand what property of the method is important to the person (long-term or short-term method, taking a pill every day, not needing to think about contraception daily, not wanting hormones, needing STI protection) |
| What contraceptive method(s) have you used before, and would you use it(them) again? | Allows the nurse to determine if a previous contraceptive method was acceptable and sheds light on what the person liked or disliked about that method |
| How important is it to prevent pregnancy? | Allows the nurse to discuss efficacy of each method |
| How well do you remember to do something daily? | Determines if a daily, weekly, monthly, or long-term method will be most effective |
| Are you planning a pregnancy in the future? When? | Important to know the plan for pregnancy to determine if long-term or short-term contraception is ideal for that person. |
Legal and Ethical Issues
Providing Birth Control to Minors
Different states have different laws regarding providing birth control to people under 18 years of age. This means some health-care providers are bound by law to inform parents or guardians about a patient’s desire for birth control. In other states, minors have the right of confidentiality and consent. Either way, health-care providers must provide informed consent and counseling in regard to birth control. This requires the patient to understand the risks, benefits, and potential side effects of the method. The nurse or health-care provider must ensure the minor understands this information prior to signing a consent form. If the minor does not understand the information, the nurse or provider can encourage the patient to call a parent or guardian to sign the consent for them.
Using the MEC Criteria by the Centers for Disease Control and Prevention
Certain contraceptive options are contraindicated due to a person’s health history. For example, methods containing estrogen come with more risk and must be chosen carefully. The Centers for Disease Control and Prevention (CDC) has developed the U.S. Medical Eligibility Criteria for Contraceptive Use (US MEC), shown in (Table 5.3), a straightforward way to assess if a patient is eligible for a type of contraception based on medical conditions or previous medical conditions (Curtis et al., 2016). The US MEC helps the nurse or clinician compare the patient’s medical history with the contraceptive they wish to use. This tool uses a rating scale to determine the safety of all contraceptive forms, with 1 being the safest and 4 being not safe at all (Curtis et al., 2016). This assists in determining the risk versus benefit of each contraceptive option and to ensure the patient has made an informed decision when choosing a contraceptive for themselves.
| MEC Number | Definition |
|---|---|
| 1 | There is no restriction for use of the contraceptive method. |
| 2 | There is an advantage of using a contraceptive method that outweighs any risk. |
| 3 | There is a risk that outweighs the advantages of the contraceptive method. |
| 4 | There is an unacceptable health risk if the contraceptive method is used. |
The nurse can print the PDF version of the MEC and hang it in clinic rooms for reference. Nurses can also download the MEC app onto their computer or smartphone. This is a great way to enhance evidence-based practice and ensure safe care for all patients during contraceptive visits.
Link to Learning
The U.S. Medical Criteria for Contraceptive Use are a great tool to help nurses assess if a patient’s contraception is appropriate and safe for them based on their current sexual activity, plans for the future, and medical history.
Safer Sex
The safest sex is abstaining from sexual intercourse. Safer sex is the prevention of STIs and pregnancy. Safer sex methods include vaccination against human papillomavirus (HPV) and hepatitis B and using internal or external condoms, spermicides, and diaphragms or cervical caps. The nurse can educate the person on using multipurpose prevention technologies, methods that protect from both STIs and pregnancy, consisting of internal and external condoms (CDC, 2023c). Decreasing the number of sexual partners and frequent testing for STIs can decrease the risk of transmission. The nurse encourages the person to talk with their partner about past partners, history of STIs, and history of drug use.
Safer sex also includes the use of reliable contraception. The nurse can help explain all the pros and cons of each contraceptive method and use shared decision making to find a method the person will use regularly and appropriately. Information on emergency contraception (EC) should also be provided by the nurse. The nurse should discuss consent for intimate touching and sex, stressing that a person can say “no” at any time during a sexual encounter. Alcohol and drugs can alter judgment and should be avoided, as they can lead to high-risk behaviors including unsafe sex.
Link to Learning
The nurse provides education on safer sex while a person is in the office. However, some patients are shy about discussing sex. The CDC provides a list of conversation tips to help patients discuss safer sex with their partner and with their health-care provider.
Contraception Education
The nurse’s role in providing contraception education is not only determining what method the patient wants but also assisting them in choosing the safest and most effective method they will use. A patient may be seeking a contraceptive method for menstrual regulation, premenstrual symptoms, preventing conception, or dysmenorrhea, which is very painful menstrual cramping that interferes with the person’s daily living. When providing education on contraception, it is important for the nurse to ensure the patient understands the information provided and feels in control of the final decision. This may include using a certified medical interpreter when the nurse and patient are not fluent in the same language. The contraceptive visit also provides the nurse with the opportunity to include education about sexuality, menstruation, reproductive health, reproductive choice, and self-care behaviors that can benefit the patient’s health and well-being.
General Information to Include When Discussing Contraception
The nurse will develop a trusting relationship with the person, reminding them that the information they discuss will remain private. The nurse assures them they are in a safe place to ask questions or discuss their sexuality. The nurse helps the patient determine what they want from the contraceptive method. Health-care providers and nurses must remain unbiased regarding their opinion of the method or reason for contraception use.
Topics Covered in Contraceptive Counseling
Contraceptive methods have different mechanisms of action, side effects, effectiveness, and contraindications. The nurse should discuss the following topics while explaining each method:
- name and classification of method
- ideal and actual effectiveness
- how the method works to prevent pregnancy
- effectiveness in STI prevention
- side effects and adverse effects
- contraindications
- lab and other monitoring
- patient education
After these topics have been discussed, the person will make an educated decision on what method is ideal. The nurse also explains that as life changes, the contraceptive method can change to meet new needs.