Contraception after pregnancy

Question 1

When should contraception after childbirth be discussed/provided?

Answer 1

Maternity services should give women opportunities to discuss their fertility intentions, contraception and preconception planning

Effective contraception after childbirth should be initiated by both breastfeeding and non-breastfeeding women as soon as possible, as sexual activity and ovulation may resume very soon afterwards.

Discuss and make available LARCs

Question 2

How long should a woman wait before trying to conceive again?

Answer 2

Women should be advised that an interpregnancy interval (IPI) of less than 12 months between childbirth and conceiving again is associated with an increased risk of preterm birth, low birthweight and small for gestational age (SGA) babies.

Question 3

Which methods of contraception are safe to use after childbirth?

Answer 3

Women should be advised that although contraception is not required in the first 21 days after childbirth, most methods can be safely initiated immediately, with the exception of combined hormonal contraception (CHC).

If IUCD not inserted in first 48 hours then need to wait until >28/7

Question 4

Can women who breastfeed effectively use lactational amenorrhoea method (LAM) as contraception?

Answer 4

Women may be advised that, if they are less than 6 months postpartum, amenorrhoeic and fully breastfeeding, the lactational amenorrhoea method (LAM) is a highly effective method of contraception.

Women using LAM should be advised that the risk of pregnancy is increased if the frequency of breastfeeding decreases (e.g. through stopping night feeds, starting or increasing supplementary feeding, use of dummies/pacifiers, expressing milk), when
menstruation returns or when more than 6 months after childbirth.

Question 5

When can women start:

Progestogen-only implants (IMP)

Answer 5

at any time after childbirth including immediately after delivery.

Question 6

When can women start:

Progestogen-only injectable (POI)

Answer 6

POI can be started at any time after childbirth, including immediately after delivery.

Question 7

When can women start:

Progestogen-only pills (POP)

Answer 7

POP can be started at any time after childbirth, including immediately after delivery.

Question 8

When can women start:

Combined hormonal contraception (CHC)

Answer 8

All women should undergo a risk assessment for VTE postnatally.

CHC should not be used by women who have risk factors for venous thromboembolism (VTE) within
6 weeks of childbirth. These include immobility, transfusion at delivery, BMI ≥, PPH, post-caesarean delivery, pre-eclampsia or smoking.

This applies to both women who are breastfeeding and not breastfeeding.

Women who are not breastfeeding and are without additional risk factors for VTE should wait until 21 days after childbirth before initiating a CHC method.

Question 9

Contraception for women with GTD

Answer 9

IUCD should be avoided until HCG negative and resolution of follow up

Other forms of contraception can be offered