Contraception for the postpartum woman

Abstract

The postpartum woman has the full array of contraception options available to her to prevent a subsequent pregnancy. Two factors may influence the choice of the method and the timing of the onset of use (when pregnancy risk increases): the infant feeding mode chosen and the reproductive involution process. The major controversial area regarding contraception postpartum is the use of oral contraceptives if the mother is breastfeeding (ie, if and how do steroids affect the lactation process or infant health). This article reviews the physiologic and hormonal changes that occur after birth, examines the data available in relation to the influence of steroidal contraceptives on lactation, and presents postpartum implications of the use of the spectrum of contraceptive choices. The nurse can provide an important role in counseling postpartum women regarding contraceptive alternatives and supporting families in attaining their childbearing goals.

PIP: While many forms of contraception may be available to postpartum women to postpone a subsequent pregnancy, a woman's chosen mode of infant feeding and her process of reproductive involution will influence her choice of a particular method and the onset of its use. Nurses play important roles in counseling women and supporting families in their efforts to limit and space births. This paper reviews physiologic and hormonal changes occurring after birth, data on the influence of steroidal contraceptives upon lactation, and explores postpartum implications of choosing varied contraceptives. For nurses, the paper considers communication techniques, counseling the postpartum couple, and factors to consider regarding contraceptive choice and use postpartum. The ideal postpartum contraceptive would be systemic, safe, have no adverse effect on lactation, and be capable of inhibiting or prolonging the initiation of ovulation after birth. While no such agent or method exists devoid of negative side effects, substances are nonetheless being evaluated which would decrease fertility while permitting women to breast feed. These agents are briefly discussed.