Barrier Methods of Birth Control (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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    00:01 So, now, let's get into some of our choices.

    00:04 So, we're going to break these into categories so that it's a little bit easier to sort of keep it altogether.

    00:09 Well, first going to talk about non-hormonal methods and then we're going to talk about hormonal methods.

    00:15 That will make it simple. So, let's talk about the barrier methods first.

    00:19 Barrier methods can include spermicides, the male condom, the female condom, or diaphragm, or cervical cap. Let's look at condoms first.

    00:30 So, condoms basically work by keeping the sperm away from the vagina, pretty simple.

    00:36 So, there are several types of condoms though and we want to make sure that our clients understand so they can make a choice about which one.

    00:43 So, latex is the most common.

    00:46 So, this prevents pregnancy and it also prevents HIV and other STD infection.

    00:53 There are also synthetic condoms that are not made up of latex for clients that might have an allergy to latex.

    00:59 This also will prevent pregnancy and HIV and other STDs.

    01:04 The final condom we'll talk about, however, is a natural or lamb-skin condoms.

    01:09 This is made up of a different sort of membranous material that's not latex and it's not synthetic.

    01:14 So, it still prevents pregnancy but not as consistent at preventing HIV and some other STDs and that's because it is poorest.

    01:23 So, sperm are actually pretty large in comparison to viruses so it can keep the sperm from getting through but it's a little dicey on the others.

    01:32 So, I wouldn't recommend this except for a client who feels fairly comfortable they're in a safe relationship in terms of transmission of HIV or other STDs.

    01:41 Okay. The typical failure rate, remember we're talking about humans, is around 13%.

    01:47 Now, along with the condom, we want to think about lubricants.

    01:52 So first let's talk about some lubricants that might not be a good idea.

    01:57 So, massage oils, baby oils, lotion, petroleum jelly.

    02:02 They're lubricants, yes, however, they weaken the condom and they may cause it to tear or break.

    02:09 So, when you talk to your clients about using a lubrication with their condoms, you want to make sure you tell them what not to use, not just what to use, and tell them why because the why sometimes helps you remember.

    02:23 Now, let's talk about spermicides. Spermicides are often used also with condoms.

    02:30 What do spermicides do? They kill sperm. Get it -cide, kill sperm, spermicide altogether.

    02:38 It comes in a form of jelly or a foam like a mousse or it can come in a film that looks like one of those Listerine breath mints, or a suppository.

    02:49 So, it can look sort of like a little capsule. So those are all the ways that a spermicide might look.

    02:55 And again, it's used typically with some other methods, so any of these other barrier methods the one we talked about, the condom, and a few we're getting ready to talk about also can be used along with the spermicide to get that failure rate down just a little bit.

    03:10 Speaking of female condom, this is what it looks like.

    03:13 So, I hope you can appreciate this on the graphic, but a female condom is much larger than a male condom because it actually is inserted into the vagina.

    03:22 So there is an applicator often that goes with it and the ring is squeezed and then pushed up into the vagina and it sits right up underneath the cervix.

    03:32 It helps to keep the sperm from getting into the uterus, just like the condom does but a little bit closer to the cervix.

    03:40 It can be inserted up to 8 hours before sexual intercourse, which might be a benefit if you think about it.

    03:46 This could be placed before a night out rather than during the actual event.

    03:51 The failure rate during typical use for a female condom is around 21%.

    03:57 Now, let's talk about the diaphragm.

    03:59 So the diaphragm is a round, latex dome that actually goes inside of the vagina.

    04:06 It has a metal ring around the perimeter to help it keep its shape and then it's filled with spermicide and that spermicide is usually a jelly or cream or a foam and that has to be used with a diaphragm to achieve its full effectiveness.

    04:21 And the diaphragm is placed in the vagina all the way next to the cervix, so it creates a seal with the spermicide so that the sperm not only are unable to get through because the diaphragm is in the way, but it can even get around the edges because the spermicide creates that seal, kind of like if you've ever seen dentures and they have that cream in the middle to keep the dentures in your mouth, it does the same thing.

    04:46 That's a weird visual but go with me on that.

    04:49 Now, the diaphragm can be inserted up to 4 hours before intercourse, again which is nice if you're planning on an evening or morning or afternoon it doesn't have to be right before the intercourse actually happens.

    05:00 But here's the most important part. So what that means is that it doesn't matter how many times someone actually has intercourse, each time they would just put more spermicide into the vagina.

    05:12 They have to leave it in place so that that spermicide will actually kill all the sperm that are hanging out.

    05:19 Because those sperm, they really want to get inside the vagina and into the uterus and up to the eggs that might be there, so they're willing to wait.

    05:28 So, we have to get rid of every single one of them or the diaphragm won't be particularly effective.

    05:34 So, failure rate, if we use the diaphragm perfectly it would be around 6%, but again we're human so the typical use rate in terms of failure is more like 12%.

    05:48 Now, let's look at the cervical cap.

    05:49 So the cervical cap has a little bit more structure than the diaphragm.

    05:53 So, it's not as pliable. It's pretty hard when you compare the two.

    05:58 Now, instead of just going into the vagina, the cervical cap actually seals itself to the cervix.

    06:05 So, it's a cap, like a hat. Now you also see the spermicide, so again we have to use spermicide along with the cervical cap in order to achieve full effectiveness.

    06:16 The cervical cap, as you can see in this diagram, fits really snugly right on top of the cervix like a kiss. Right? Just reaches all the way around it. So it creates a suction there with the cap.

    06:28 Both of these methods, the diaphragm and the cervical cap have to be fitted by a provider.

    06:34 You can't just borrow someone's.

    06:36 You have your own cervical cap and your own diaphragm that fit your body.

    06:41 So, the great thing is the cervical cap can be left in the body for up to 48 hours, which is great.

    06:48 Now, it must stay in 6 hours after the last active sexual intercourse, maybe not so great.

    06:55 So, when we think about the typical failure rate for a nulliparous client, never had a baby, it's around 14%.

    07:03 A client who has had a baby, however, that failure rate goes up to around 27%.

    07:09 Now, the sponge is also a device that meets the criteria of a barrier method because it keeps the sperm from getting to the egg.

    07:18 Unlike the diaphragm and the cervical cap, however, this does not have to be fitted by a provider.

    07:25 So, the sponge is actually a sponge and their spermicide already in it.

    07:31 So, once the spermicide is activated when it's placed into the vagina, then the spermicide is already there.

    07:37 So, it fits over the cervix. Now because it's not fitted, it's going to be a little bit looser in terms of how it fits inside of the vagina. Again, it works for up to 24 hours.

    07:50 Yay, that's great, but it still must be left in the vagina for at least 6 hours after the last active intercourse so that the spermicide that's contained within the sponge can kill all the sperm.

    08:04 Typical use for someone who's never had a baby is around 14%.

    08:08 Remember that's what nulliparous means.

    08:11 For a client who's had a baby, then it goes down to around 27%.

    08:16 So, you may ask yourself, why are they different depending on whether you've had a baby or not? Because if you've never had a baby, remember your cervix is a nice tight os that makes a circle and once you've had a baby before, the tone in the uterus and the changes in the cervix make it a little bit less likely it's going to work.

    About the Lecture

    The lecture Barrier Methods of Birth Control (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Contraception (Nursing).

    Included Quiz Questions

    1. Spermicides
    2. Male condom
    3. Diaphragm
    4. IUD
    1. “Make sure to use a lubricant, like petroleum jelly, when using a condom.”
    2. “Lambskin condoms are very effective at preventing sexually transmitted infections.”
    3. “A diaphragm needs to be left in for six hours following intercourse.”
    4. “A female condom can be inserted for up to eight hours before sexual intercourse.”
    1. Up to 4 hours before intercourse
    2. Up to 8 hours before intercourse
    3. Up to 12 hours before intercourse
    4. Up to 1 hour before intercourse
    1. Diaphragm
    2. Cervical cap
    3. Male condom
    4. Female condom
    1. Cervical cap (for parous client)
    2. Female condom
    3. Male condom
    4. Diaphragm
    5. Sponge (for nulliparous client)

    Author of lecture Barrier Methods of Birth Control (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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