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Post-partum contraception.
Baillieres Clin Obstet Gynaecol. 1996 Apr; 10(1):25-41.BC

Abstract

The choice of a post-partum contraceptive method depends on many factors, including the need for a temporary versus a permanent method, the infant feeding choice and the extent to which informed consent is made prior to delivery. For maximum protection, the non-breast-feeding woman should be protected from the fourth week post-partum, even if that means using a temporary method, such as condoms or spermicides, until her method of choice is procured. Combined oestrogen/progestin methods should be avoided by all women for 2-3 weeks to avoid elevating the risk of thromboembolism. Preparations containing oestrogen should be avoided altogether during lactation because they have been associated with a reduction in milk production. POPs, implants and injectables are appropriate regardless of infant feeding choice. They can be administered immediately post-partum in bottle-feeding women, but should ideally be postponed for 6 weeks in breast-feeding women. It is best to insert IUDs within 10 minutes of delivery of the placenta, in order to minimize the risk of IUD expulsion. Insertion immediately after expulsion of the placenta requires special training, and expulsion rates are reduced with the insertion experience of the practitioner. Breast-feeding is not associated with an increase in IUD expulsion or uterine perforation, and it is associated with fewer removals for bleeding or pain. Tubal sterilization is safe, convenient and cost-effective when performed immediately after delivery, but it requires extensive counselling and fully informed consent prior to the onset of labour to avoid potential regret over post-partum tubal ligation. If the procedure is performed immediately, any effect on the establishment of lactation may be minimized. LAM is a method that can only be used by breast-feeding women. It may prove to be a useful way to time the commencement of a second, less temporary contraceptive method. Natural family planning methods require a period of abstinence for the establishment and identification of the new symptoms of fertility. When LAM is used during this interval, the need for abstinence may be reduced significantly for breast-feeding women. Breast-feeding provides health benefits for the woman and her infant, as well as the best possible nutrition for the baby. The International Planned Parenthood Federation (1990) (among others) recommends that, 'As far as is practicable, all women should be advised and encouraged to breastfeed fully'. The infant feeding decision affects the choice of a contraceptive method, and this is an important reason for the woman's physician to be interested in her infant feeding choice.

Authors+Show Affiliations

Family Health International, Research Triangle Park, NC 27709, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Review

Language

eng

PubMed ID

8736720

Citation

Kennedy, K I.. "Post-partum Contraception." Bailliere's Clinical Obstetrics and Gynaecology, vol. 10, no. 1, 1996, pp. 25-41.
Kennedy KI. Post-partum contraception. Baillieres Clin Obstet Gynaecol. 1996;10(1):25-41.
Kennedy, K. I. (1996). Post-partum contraception. Bailliere's Clinical Obstetrics and Gynaecology, 10(1), 25-41.
Kennedy KI. Post-partum Contraception. Baillieres Clin Obstet Gynaecol. 1996;10(1):25-41. PubMed PMID: 8736720.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Post-partum contraception. A1 - Kennedy,K I, PY - 1996/4/1/pubmed PY - 1996/4/1/medline PY - 1996/4/1/entrez KW - Bottle Feeding KW - Breast Feeding KW - Contraception KW - Family Planning KW - Family Planning Programs KW - Family Planning, Behavioral Methods KW - Health KW - Infant Nutrition KW - Lactation, Prolonged KW - Literature Review KW - Nutrition KW - Postpartum Amenorrhea KW - Postpartum Programs KW - Postpartum Women KW - Puerperium KW - Reproduction SP - 25 EP - 41 JF - Bailliere's clinical obstetrics and gynaecology JO - Baillieres Clin Obstet Gynaecol VL - 10 IS - 1 N2 - The choice of a post-partum contraceptive method depends on many factors, including the need for a temporary versus a permanent method, the infant feeding choice and the extent to which informed consent is made prior to delivery. For maximum protection, the non-breast-feeding woman should be protected from the fourth week post-partum, even if that means using a temporary method, such as condoms or spermicides, until her method of choice is procured. Combined oestrogen/progestin methods should be avoided by all women for 2-3 weeks to avoid elevating the risk of thromboembolism. Preparations containing oestrogen should be avoided altogether during lactation because they have been associated with a reduction in milk production. POPs, implants and injectables are appropriate regardless of infant feeding choice. They can be administered immediately post-partum in bottle-feeding women, but should ideally be postponed for 6 weeks in breast-feeding women. It is best to insert IUDs within 10 minutes of delivery of the placenta, in order to minimize the risk of IUD expulsion. Insertion immediately after expulsion of the placenta requires special training, and expulsion rates are reduced with the insertion experience of the practitioner. Breast-feeding is not associated with an increase in IUD expulsion or uterine perforation, and it is associated with fewer removals for bleeding or pain. Tubal sterilization is safe, convenient and cost-effective when performed immediately after delivery, but it requires extensive counselling and fully informed consent prior to the onset of labour to avoid potential regret over post-partum tubal ligation. If the procedure is performed immediately, any effect on the establishment of lactation may be minimized. LAM is a method that can only be used by breast-feeding women. It may prove to be a useful way to time the commencement of a second, less temporary contraceptive method. Natural family planning methods require a period of abstinence for the establishment and identification of the new symptoms of fertility. When LAM is used during this interval, the need for abstinence may be reduced significantly for breast-feeding women. Breast-feeding provides health benefits for the woman and her infant, as well as the best possible nutrition for the baby. The International Planned Parenthood Federation (1990) (among others) recommends that, 'As far as is practicable, all women should be advised and encouraged to breastfeed fully'. The infant feeding decision affects the choice of a contraceptive method, and this is an important reason for the woman's physician to be interested in her infant feeding choice. SN - 0950-3552 UR - https://www.unboundmedicine.com/medline/citation/8736720/Post_partum_contraception_ L2 - https://medlineplus.gov/postpartumcare.html DB - PRIME DP - Unbound Medicine ER -
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