Post-partum contraception

Question 1

What is lactational amenorrhoea?

Answer 1

Breast-feeding delays return of ovulation
Disrupts frequency and amplitude of gonadotrophin surges

Women who are fully breastfeeding day and night and are less than 6 months postpartum and amenorrhoeic can expect this method to be 98% effective

Efficacy decreased after 6 months if:
Period returns
Breastfeeding frequency reduces
Night feeding stops
Separation of baby
Baby receives supplements
Mother/baby ill

Question 2

When can postpartum women start POP?

Answer 2

Any time postpartum
After day 21, additional contraception should be used for first 2 days
Small about of progesterone enters breast milk but is not harmful to infant

Question 3

When do women require contraception after giving birth?

Answer 3

After day 21

Question 4

When can COCP be started?

Answer 4

At 3 weeks if not breastfeeding
Started at day 21 - will provide immediate contraception
Started after day 21 - additional contraception for first 7 days

Can be started if 6 weeks postpartum and breastfeeding

Question 5

When is COCP contraindicated

Answer 5

If breast feeding < 6 weeks postpartum
- not recommended until 6 months postpartum
COCOP may reduce breast milk production

Question 6

When can progesterone implant be inserted?

Answer 6

Not until 6 weeks in those breastfeeding

Question 7

When are depot injections recommended?

Answer 7

Not until 6 weeks in those breast feeding

Medroxyprogesterone acetate IM 12 weekly can start 5 days postpartum if bottle feeding

Question 8

When should intrauterine contraceptive devices be inserted?

Answer 8

Within first 48 hours postpartum or delayed until 4 weeks

This is to miniseries risk of uterine perforation at insertion

Question 9

What % of breast milk feeding gives lactational amenorrhoea cover?

Answer 9

> 85% breast fed

Therefore only protected til day 21 if <85%