This is the first of a two-part series on how to space your pregnancies.
NEWLY-wed couples have a lot to think about after the blissful glow of the honeymoon has faded. One very important aspect of married life to consider is family planning.
Careful family planning helps you to space your pregnancies so that your body can recover and heal from the previous pregnancy. It also helps you to plan your family’s financial resources so that you can comfortably welcome the new addition to your family.
You can practise family planning by using contraceptive methods. There are two kinds of contraceptives: non-hormonal and hormonal methods.
Non-hormonal methods
Family planning with non-hormonal methods include the use of natural methods, or devices and procedures that do not involve hormones.
Natural family planning method €“ This is a contraceptive method that relies on Mother Nature. With this method, a woman has to keep track of her fertile period through her menstrual cycle.
A woman usually ovulates about two weeks before her cycle begins. This will be the start of her fertile period and when she should avoid sexual intercourse.
The method of counting days is not very reliable, because not all women are as regular as a clock. A more effective method of charting ovulation is the basal body temperature (BBT) method, which involves charting the temperature of the vagina every day. Just as a woman is about to begin ovulating, her body temperature will rise and her cervical mucous will increase, and become clear in colour and “stretchy”. You can check this with a basal body thermometer - different from a normal thermometer - every day.
A new development in this method is the ovulation predictor, which tests the urine for oestrogen metabolites (which marks the start of the fertile phase) and the LH surge that takes place 36 hours before the end of the fertile phase.
While this method is entirely natural and does not use any chemicals or devices, it is not always suitable for every woman, especially those who have irregular cycles, are often ill, work irregular hours or are unable to keep records. It requires so much constant monitoring and abstinence from sex for more than one week every month that it may cause stress and tension between a couple.
If you are not confident in using this method correctly, it could have a high failure rate.
Barrier methods - These are probably the most common contraceptive methods. They include latex condoms, diaphragms and caps, as well as spermicides.
They work by putting up a physical barrier that prevents the sperm from being able to reach the egg inside the woman’s body. An added benefit is that they also protect against sexually transmitted infections, while other contraceptive methods don’t.
While barrier methods are easy to use and relatively cheap, they should always be used in combination with another contraceptive method. After all, condoms have been known to break, or one may forget to put in the diaphragm in the “heat of the moment”.
Lactational amenorrhoea method (LAM) - LAM is really just a fancy name for a form of contraceptive that occurs when you are breastfeeding. When you are breastfeeding, your body undergoes hormonal changes that suppress ovulation and menstruation. This method offers 98% protection from pregnancy.
However, your breastfeeding routine must follow strict guidelines. You must practise exclusive breastfeeding (only giving baby breast milk) on demand. If you do give supplemental foods, such as other liquids or solid foods, they must not exceed 5-10% of the baby’s total daily diet.
The intervals between feeding must not exceed four hours (in the daytime) or six hours (in the night).
The contraceptive effects of breastfeeding are an added benefit of breastfeeding, but they are not foolproof. When your baby reaches the age of six months, or if you begin menstruating, you should use another family planning method.
Intrauterine devices (IUDs) - Intrauterine devices are suitable for monogamous women in stable relationships who want a reliable, long-term, non-hormonal method of contraception.
An IUD is a T-shaped copper device inserted in the uterus to inhibit fertilisation of the egg by the sperm. It is highly effective (94-99% success rates), lasts for five to 10 years, can be reversed easily, and best of all, allows for sexual spontaneity without having to worry about taking a pill or putting on a condom.
While IUDs have few side-effects, they can cause heavy menstrual bleeding, or spotting between periods. In rare cases, the IUD may be pushed out of the uterus into the vagina, or perforate the wall of the uterus.
There is also a type of IUD that works by releasing hormones into the body. Ask your doctor about the benefits and drawbacks of each type, and whether it is suitable for you.
Sterilisation - Finally, there are couples who may want a permanent method of birth control - meaning they are not planning to have any more children.
There are sterilisation methods for both men and women. For women, the procedure is called “tubal ligation”, which involves cutting, sealing or blocking the fallopian tubes (the tubes between the ovaries and the uterus, through which eggs travel). This prevents the eggs from reaching the sperm and becoming fertilised.
For men, sterilisation involves a vasectomy. This is a small operation to cut the vas deferens (the tube that takes sperm from the testes to the penis). Once the vas deferens is cut, sperm can no longer get into the semen that is ejaculated during sex.
You and your partner have to be absolutely sure that you no longer want children before you agree to undergo either of these procedures. Although they are reversible, you will have much lower chances of being fertile after that.
Ultimately, the family planning method you choose is a decision best left up to you and your partner. In my next article, I will describe the hormonal methods of contraception and the considerations that should guide your choice.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). For further information, visit www.primanora.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
