Contraceptions

postpartum family planning aims to prevent unintended pregnancy and closely spaced pregnancies after childbirth

Method

• Long acting reversible contraceptions (fit and forget) – most effective
  • IUD
  • Implant
• hormonal contraception
  • COCP – combined oral contraceptive pill
  • POCP- progestogen- only contraceptive pill
  • Depo provera injection
• barrier method
  • condoms – also protect against STI
  • internal condom –
• emergency contraception
  • emergency contraceptive pill
  • copper IUD – (recommended if weight >70kg)
• fertility awareness
  • calendar method
• permanent contraception – most effective
  • vasectomy
  • tubal ligation

Long acting reversible contraceptions

IUD – Intrauterine Device

• can start within 48 hours/ delayed after 4 weeks postpartum
• prevent pregnancy for 5-10 years
• eg; levonorgestrel – releasing IUD (Mirena) – up to 7 years
• failure rates ; 1 in 1000 (0.001)
• copper IUD does not interfere breastfeeding
• return of fertility: immediate
• side effect;
  • IUD may came out of uterus
  • infection
  • injury
  • hormonal IUD (mirena) cause spotting and irregular bleeding in first 3-6 months of use, headache, nausea, depression, breast tenderness
  • copper IUD increase menstrual pain and bleeding, intermenstrual bleeding. decrease within 1 year of use

Implants

• release progestin
• can start anytime
• prevent pregnancy for 3-5 years
• failure rates ; 1 in 1000 (0.001)
• return of fertility: immediate
• does not interfere breastfeeding
• side effect;
  • irregular menses, intermenstural bleeding
  • mood changes
  • headache
  • acne
  • depression

Permanent Contraception

Female Sterilisation

• can start within 7 days / after 6 weeks postpartum
• failure rates ; 2 in 1000 (0.002)

Vasectomy

• can start anytime
• failure rates ; 1 in 1000 (0.001)
• takes about 2 to 4 months for the semen to become totally free of sperm after a vasectomy. A couple must use another method of birth control or avoid sexual intercourse until a sperm count confirms that no sperm are present.

pros;

• permanent birth control
• no daily attention require
• does not affect sexual pleasure

cons;

• may regret
• require surgery
• may not be reversible

Hormonal contraception-

Progestogen – only injectable contraceptives (Depoprovera)

• prevent pregnancy for 8-12 weeks ( 3 months )
• can start anytime
• failure rates ; 3 in 100 (0.03)
• side effects: amenorrhea
• return of fertility: months
• does not interfere breastfeeding
• side effect;
  • bone loss
  • irregular menses
  • headache
  • slight weight gain

Progestogen – only pills (POP)

• contained progestin
• taken continuously every day without a break
• can start anytime
• failure rates; 9 in 100 (0.09)
• does not interfere breastfeeding
• must be taken at the exact same time each day. If you miss a pill by more than 3 hours, you will need to use a back-up method for the next 48 hours.
• benefit; reduce menstrual bleeding or stop period altogether
• side effect
  • headache
  • nausea
  • breast tenderness
  • increase risk of breast ca

Combined oral contraceptive (COC) pills

• contained progestin and estrogen
• taken daily for 21 days followed by 7 days break when withdrawal bleeding ( menstruation) occurs
• failure rates; 9 in 100 (0.09)
• other form of COC – patch, vaginal ring
• benefit;
  • regular, lighter, shorter menses
  • reduce cramps
  • improve acne
  • reduce menstrual migraine frequency
  • reduce unwanted hair growth
• if women not breastfeeding, may start after 3 weeks postpartum unless they have rick of VTE, in which should only start COC after 6 weeks postpartum
• side effect;
  • postpartum DVT
  • interfere with breastfeeding – should not be used by breastfeeding women until baby is 6 months old
  • risk of stroke and heart attacks ( not recommended in >35 years old, smoker, HPT, DM, stroke, breast ca)
  • breakthrough bleeding, headache, breast tenderness, nausea

Barrier method

spermicide

• prevent transmission of gonorrhea and chlamydia.
• It can be stored for long periods of time.
• It may be messy, cause mild discomfort or minor allergic reaction, and can lead to yeast infections.
• may cause vaginal irritation with frequent use

diaphragm

cervical cap

condoms

• can use anytime
• failure rates; 12 in 100 (0.12)
• protect against STD
• does not interfere breatsfeeding
• cons
  • not suitable for pt with allergy to latex
  • interrupt sexual activity and may reduce sensation

withdrawal

• can use anytime
• failure rates; 18 in 100 (0.18)
• does not interfere breatsfeeding

fertility awareness based methods (FAB)

• can use anytime
• failure rates; 24 in 100 (0.24)
• not recommended post partum until women have regular menses for 3-4 cycles

Lactational amenorrhea method (LAM)

temporary method of birth control based on the natural way the body prevents ovulation when a woman is breastfeeding. It requires exclusive, frequent breastfeeding. The time between feedings should not be longer than 4 hours during the day or 6 hours at night. LAM may not be practical for many women.

emergency contraception

• levonorgestrel (LNG) emergency contraception can be used anytime postpartum regardless of whether or not a woman is breastfeeding
• high dose ethinyl estradiol either alone or in combination with progestogen (COCP) should not be used post partum due to risk of VTE
• emergency IUD is most effective method