Question

Case Study 139- Selecting a Birth Control Method

Difficulty: Beginning

Setting: Office or clinic

Index Words: contraception, birth control, oral contraceptives (OCs), injectable contraceptives, intrauterine device (IUD), natural family planning, condoms

Giddens Concepts: Reproduction

HESI Concepts: Sexuality/Reproduction

Name _________________________________       Class/Group _______________       Date _______________

Scenario

You are working in a busy obstetrics/gynecology (OB/GYN) office. The last patient of the day is P.B., a 27-year-old who is being married in 2 weeks. She wants to use birth control but is not sure what to choose. Her fiancé and she are both in graduate school and have limited health insurance, so she is anxious not to become pregnant right away. She asks you to review the various methods and help her explore what is best for her.

1. What factors influence the choice of the most appropriate method of birth control?

2. What past medical information will you need to obtain from P.B. and why?

3. What lifestyle information will help you aid P.B. in choosing a birth control method?

4. P.B. asks you about the effectiveness rating of available birth control methods. Describe the term efficacy.

5. What factors influence how effective a contraceptive method is?

6. Match the available contraceptive methods according to their efficacy ratings:

_____ 1. Cervical cap	A. Most effective, more than 99%
_____ 2. IUD	B. Highly effective, 88%–97%
_____ 3. Male and female condoms	C. Moderately effective, less than 85%
_____ 4. Combination oral contraceptives
_____ 5. Hormone implants
_____ 6. Sterilization
_____ 7. Withdrawal
_____ 8. Transdermal contraceptive patch
_____ 9. Natural family planning
_____ 10. Hormone injections

7. P.B. asks you to review the main advantages and disadvantages of the hormonal birth control methods first.

Method	Advantages	Disadvantages
Oral contraceptives
Transdermal patch
Hormone injections
Hormone implants
Vaginal ring

8. After reviewing the hormonal methods, you choose to discuss intrauterine devices. How would you describe the copper and levonorgestrel (Mirena) IUD systems to P.B.?

9. Next, you steer the conversation to barrier methods. What will you share with P.B. about the use of a diaphragm or cervical cap and condoms?

10. The major advantage of using a condom for birth control is that condoms:

1. Do not require monthly injections
2. Are easy to obtain and inexpensive
3. Reduce the risk for acquiring infections
4. Come in assorted styles, shapes, and textures

11. Describe what you would tell P.B. about the natural family planning method.  

12. P.B. wants to know about the associated costs with each method because she is on a tight budget. How would you respond?

13. She asks you which method you would pick. What do you tell her?

CASE STUDY PROGRESS

P.B. comes back in a week and tells you that she can get a low-cost oral contraceptive (OC) through a local store. You convey this information to the nurse practitioner, who examines P.B. and writes a prescription for a biphasic 28-day pill pack containing ethinyl estradiol and norethindrone. You are asked to discuss the use of the OC pill with P.B.

14. Explain how biphasic OC pills work.

15. When should P.B. take her first OC?

16. You tell P.B. that is does not matter what time of day she takes the OC, just that she takes it at the same time each day. Describe 3 suggestions you can offer to help her remember to take her pill.    

17. What should you tell her about missed pills

Answer 1