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  • Title: Postpartum options: matching the method to individual needs.
    Author: Townsend S.
    Journal: Netw Res Triangle Park N C; 1990 Aug; 11(3):12-5. PubMed ID: 12342904.
    Abstract:
    Various contraceptive methods accessible to postpartum women are summarized. Male and female sterilization are options offering effective protection against pregnancy. Both types of sterilization are safe, convenient, and cost-effective. The most frequently used procedure for postpartum female sterilization is minilaparotomy. Couples considering sterilization should receive counseling since this method is not reversible. Postplacental insertion of an IUD is also an option which is effective, safe, and easily inserted. 1 concern of this particular method is an observed increase in expulsion rate in postpartum women compared to non postpartum women. 1 factor affecting IUD expulsion rate is correct fundal placement in the uterus; therefore, it should be inserted high in the uterine fundus. IUDs inserted by abdominal incision are also available to women who deliver by cesarean section. Side effects associated with this device include bleeding and an increased likelihood of pelvic inflammatory disease; this method is not recommended for women with sexually transmitted diseases. Although hormonal methods such as oral contraceptives and injectables are very effective, there is much concern about their effect on breast milk. Usage of progestin-only mini-pills in nursing mothers should not begin until 6 weeks postpartum. Restrictions involved with the mini-pill are following a daily regime and unavailability in some developing countries. The combined progestin-estrogen oral contraceptives are not recommended for breastfeeding mothers. However, it may be an option if the mini-pill is unavailable and if its usage is not initiated until 6 months postpartum. Progestin-only implants and injectables are long- acting methods, but it is uncertain as to when to begin usage. Methods not affecting breast milk include condoms, spermicides, and vaginal barriers. Limitations associated with condoms include poor acceptance and availability. Diaphragms and cervical caps are not designed for immediate postpartum use; they must be fitted 4-6 weeks postpartum. Natural family planning involves recording body temperatures and cervical mucus to detect ovulation. This method is only recommended for women skilled in fertility awareness.
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