Postpartum contraception

Abstract

Recently-delivered women who wish to avoid pregnancy should initiate contraception before ovulation. Since the return of ovulation is not predictable, regardless of the woman's lactation status and duration of postpartum amenorrhea, contraception should be initiated as soon as is reasonable after delivery. The choice of contraceptive method will depend on several factors, including: the woman's lactation status, the preference of the woman and her partner, and the health status of the newborns. For women who do not wish to have additional children, tubal sterilization through a minilaparotomy incision is the procedure of choice. For other women who are not lactating, all methods, with the exception of the use of cervical caps and diaphragms, may be initiated immediately after delivery. However, preference should be given to IUD use by lactating and non-lactating woman, especially for women who may not return for any additional postpartum care.

PIP: How soon contraception should be initiated in postpartum women is a problem faced by many in postpartum family planning programs. Several factors need to be considered: 1) the woman's lactation status; 2) accessibility to contraceptive services after leaving the hospital; and 3) safety of postpartum contraceptives. Lactation delays the return of menstruation and ovulation and has a contraceptive effect. However, it is not a perfect contraceptive and 3 to 10% of lactating women have been known to become pregnant before resumption of menstruation. It is recommended that contraception be initiated in lactating women no later than 6 weeks after delivery. Immediate postpartum contraception is not a necessity in many women in the U.S. as they are able to return to the clinic for their 6 week postpartum visit. In countries with limited medical resources however, immediate postpartum contraception is a necessity for demographic impact and reduction of incidence of future high-risk pregnancy and associated higher perinatal and infant mortality. The choice of contraceptive methods will depend on the woman's lactation status, the preference of the woman and her partner, and the health status of newborns. Tubal sterilization via minilaparotomy incision is the method of choice for those who have completed their family size. All methods, except cervical caps and diaphragms can be initiated immediately after delivery for nonlactating women, while IUD use is preferred for lactating and nonlactating women who may not return for additional postpartum care. The risks and benefits of various contraceptives (oral contraceptives, injectable contraceptives, IUD, and sterilization procedures) are also discussed.