Contraception--any method used by one or both partners to prevent pregnancy--has been practiced in one form or another since ancient times. However, not until comparatively recently have techniques been devised that are statistically reliable and safe, as well as sufficiently varied to accommodate particular circumstances.
No single method of contraception is ideal from every point of view. Some methods are unquestionably more reliable than others, some are more suitable to one's particular sexual habits at a particular time of life and some are more congenial to one's aesthetic sense or personal convictions.
"Natural" Methods
Rhythm. This method entails abstention from sexual intercourse during that part of the menstrual cycle when ovulation occurs. Since every few women ovulate with exact regularity, the rhythm method is likely to have intrinsic inaccuracies. There are several ways of determining when ovulation is taking place; these include counting the number of days from the beginning of the last period, watching for the slight rise in temperature that usually accompanies ovulation or noting a change in the vaginal secretion from a thick, white, sparse discharge to a thin, clear, profuse one, another herald of ovulation. None of these is foolproof, however.
Withdrawal. This is the oldest method of contraception, and one that is still widely practiced in many parts of the world. It involves the withdrawal technique (coitus interruptus)--in which the penis is withdrawn just before orgasm, and the semen is deposited outside the vagina. This method is generally considered unreliable and unsatisfactory and causes tensions to be built into the sex act.
The Pill
The pill is the most popular and most effective reversible contraceptive method currently available. Oral contraceptives are available in two types: the combination pill, which contains synthetic estrogen and progestin and inhibits ovulation and alters the mucous secretions of the vagina, and the progestin-only pill, which alters both the mucous secretions from the cervix so that sperm cannot penetrate the barrier and the lining of the uterus so that implantation of the fertilized egg becomes impossible. Of the two, the combination pill is considered the more reliable, although both enjoy a very high success rate. Most women, especially those under the age of 30 or 35, can safely use the pill, although the combination pill is usually not recommended for women over 35 who smoke because of an increased risk of heart disease and blood clots.
Intrauterine Devices
An intrauterine device (IUD), as its name implies, is a contraceptive device that is inserted into the uterus by a doctor. Once in place, no further contraceptive action is necessary. It may be left in place for at least a year if it has been properly fitted and there are no untoward results. It is considered slightly less effective than the pill.
IUDs come in several different types, but all are supplied with a string that extends outward from the cervix into the vagina, so that the wearer can make sure that the device is in place. Correct fitting by a specialist is a critical aspect of the effectiveness of this device.
While IUDs are generally safe for most women, there are certain contraindications for their use. These include pregnancy, fibroid tumors, anemia, abnormal Pap smears, continuous treatment with cortisone-type drugs, previous ectopic pregnancy and pelvic inflammatory disease. Recent studies also indicate that IUD users are more likely to develop severe pelvic inflammatory disease than those who use other methods.
Barrier Methods
The use of barrier methods of contraception--the condom, diaphragm and spermicidal agents--has grown in recent years from a number of reasons. For example, with genital herpes and other sexually transmitted diseases reaching epidemic proportions, barrier methods probably lower the rate of spread of these diseases. For women whose sex life is intermittent rather than regular, the day-in, day-out use of the pill or the wearing of an IUD seems out of proportion to their requirements.
Condom. the condom, or "rubber," is second only to the pill as the most popular form of contraception in the United States and remains the most widely used device throughout the world. In addition to providing protection against pregnancy and disease, condoms are easily available and are now being manufactured in materials so thin that interfere with sensation has been almost entirely eliminated. Extra effectiveness and easier insertion are accomplished by the use of a spermicidal agent.
Diaphragm. The diaphragm is a soft, rubber cap surrounded by a flexible ring that is inserted into the vagina to cover the entrance to the cervix. Preceding intercourse, when the device is coated with spermicidal jelly, it provides both a chemical and mechanical barrier. A diaphragm must be individually fitted by a doctor and should be checked for proper fit about once a year, especially after pregnancy, abortion or a significant change in weight. It should also be checked periodically for holes or other damage. Other advantages include possible protection against cervical infections and sexually transmitted diseases.
Spermicidal agents. these chemicals--in the form of creams, jellies, suppositories and foams--act in two ways when inserted into the vagina before intercourse: They kill sperm cells, and they create a barrier against their passage. When used alone, they are not totally reliable. In combination with a condom or a diaphragm, they provide a fairly high rate of effectiveness if used correctly and consistently. However, some users of the various barrier contraceptives complain of the inconvenience and disruption caused by having to insert or apply them before each intercourse as directed.
Sterilization
Both male and female sterilization have increased in popularity in recent years, and it is now the leading form of contraception among couples who have been married for more than 10 years. The sterilization procedures for both sexes involve surgery and are considered permanent forms of contraception, although there have been a few instances in which reversal has been achieved. Vasectomy--the male sterilization procedure--involves making a small incision to sever the tubes through which the sperm travel. For women, sterilization may be achieved by severing or blocking the fallopian tubes to prevent the egg from reaching the uterus, or by removal of either the ovaries or uterus (hysterectomy). The latter are not recommended simply to achieve sterilization.
Summing Up
In choosing a contraceptive method, you should consider questions of safety, reliability and suitability to particular circumstances. In the case of couples, the wishes of each partner should be spelled out, so that a mutually agreeable decision is arrived at. For any given method, especially where new information becomes available regularly, you should feel free to ask your doctor about risks and benefits in order to make an informed choice. Whatever the decision at any given time, it need not be viewed as immutable. You should also understand how long it may take for fertility to be reestablished after use of an IUD or the pill. In any instance, contraception should be considered a mutual responsibility, and unless pregnancy is desired, it should be a conscious consideration before engaging in sexual relations.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
