Postpartum Care

A select issue in the postpartum period: contraception

“…14,16,17 Lactational amenorrhea can be used as an effective method of contraception provided the woman is exclusively breastfeeding (on demand, day and night more than 5 times per day, total suckling duration greater than 65 minutes, and at least 10 minutes per feed), 35 has not resumed menses and is within six months of delivery. 16,23,27 This method, when used properly, is at least 98% effective during the first 6 months postpartum.…”

“…3 IUCs, including the levonorgestrelreleasing IUC and copper-containing IUC, are highly effective in preventing pregnancy, with pregnancy rates less than 1 per 100 woman-years. 25 Excellent candidates include women who desire inter-pregnancy interval of more than 2 to 3 years, desire long-term contraception but prefer to avoid sterilization, breastfeeding women, women with side effects from hormonal contraception, and women with prior birth control failures, 17 though all women who desire highly effective contraception should be considered candidates. In general, disadvantages include the uncommon side effects of uterine perforation, expulsion and discontinuation secondary to side effects, such as increased vaginal bleeding in copper-containing devices and decreased vaginal bleeding in progesterone-releasing.…”

“…Some of the pertinent contraindications in the puerperium include postpartum endometritis and uterine anomalies. 14,17 With appropriate counseling, the IUC may be used in women with a history of ectopic pregnancy or with risk factors for ectopic pregnancy.…”

“…Condoms are often advised for postpartum women who wish to postpone a decision about contraceptive therapy or sterilization until the postpartum visit. 17 With perfect and typical use, pregnancy rates with condoms are 2% and 15% respectively. 25 Pregnancy rates for the other barrier methods are substantially higher.…”

“…14,23 Progestin-only pills should be avoided in Hispanic women with gestational diabetes who are breastfeeding, because of an increased risk for subsequent development of type II diabetes. 17 Contraindications include women with unexplained uterine bleeding, known breast cancer, benign or malignant liver tumors, or acute liver disease. …”