Contraceptives in the puerperium: what you should know

Breastfeeding is the fundamental factor in choosing a contraceptive method during the puerperium. Any that could harm the newborn should be avoided.

Last update: 20 September, 2022

The puerperium is the stage immediately after childbirth. and it is very common that during this phase there are many doubts and questions about contraceptives. There are women who wonder when they can resume sexual intercourse, for example, and if there is a possibility of a new pregnancy.

The problem is that it cannot be determined when the first ovulation occurs after childbirth. This varies greatly from one woman to another and also depends on various circumstances.

The puerperium and contraception

The puerperium is the stage that goes from the moment the childbirth ends until 40 days after it. In this period, the body of a woman undergoes great changes, in order to return to the state in which she was before the deed. There are also psychological and social transformations.

The stage of infertility after childbirth is brief, especially in women who do not feed the baby with breast milk. In those cases, fertility is usually reactivated within 3 weeks. In infants it is able to return only at 6 months.

Non-lactating women almost always first ovulate between 45 and 94 days after giving birth. However, cases have also been recorded in which there was ovulation at 25 days. In infants, this occurs after 27 weeks postpartum.

One problem is that the use of some effective contraceptives in the puerperium can affect lactation. For the same, it is very important to choose a safe method with few adverse effects for the baby.

What hormonal contraceptives are indicated in the puerperium?

Hormonal methods are one of the most used options. These contraceptives carry some risks during the puerperium, since they pass into breast milk. There are two types:

  • Non-combined contraceptives: They are the ones that only have gestagens. What is indicated is that they are not used until 6 weeks after delivery in nursing mothers. Non-lactating women, however, should wait 21 days before starting them.
  • Combined contraceptives: They contain estrogens and gestagens. Nursing mothers should only take them from 6 months after giving birth; never in the puerperium. In non-lactating women, it is recommended to wait 3 weeks before starting them.

The postcoital or emergency pill can be used during the puerperium. The precaution is to respect the 21 days after delivery.

Nursing mothers should schedule the use of a non-combined contraceptive, preferably. This way they run less risk of interrupting milk production.

Other contraceptives in the puerperium

During the puerperium, other contraceptive methods, other than hormonal ones, can also be used. Each of them has its benefits and drawbacks. A woman must choose the one that best suits her circumstances and needs.

Intrauterine device (IUD)

The intrauterine device is perhaps the most widely used contraceptive method in the world. It has a failure rate of less than 1% per year and 2% to 6% after 10 years. Its total duration is between 5 and 10 years.

The IUD can be inserted postpartum, after at least 4 weeks postpartum. It is also possible to do it during the 48 hours after delivery, but not in the period between these and 4 weeks.

In this case, it does not matter if the mother breastfeeds or not. Nor if the delivery was vaginal or by cesarean section.

barrier methods

male or female condoms can be used at any time after the lochia disappears. These are a bloody discharge that occurs after childbirth and lasts between 2 weeks and 1 month.

LAM method

The LAM method is also widely used during the puerperium. It can be started after childbirth and is to use breastfeeding as protection against pregnancy.

It is only useful for the following 6 months and requires two conditions to be met:

  1. There is no menstruation.
  2. The baby is exclusively breastfed.

If menstruation appears, the effectiveness of the method decreases. The same thing happens when the baby feeds decrease. If any of these circumstances exist, another method must be added.

The efficacy of the LAM method is estimated to be 98%.

voluntary sterilization

Voluntary sterilization is a definitive method of contraception. He wants to say that it will never be possible to have children again.

The most used techniques to achieve this are the ligation of the fallopian tubes and the tubal obstruction method. In the case of men, vasectomy is used.

Some women schedule a C-section along with the fallopian tube ligation if they have decided not to have any more pregnancies in the future.

Choose the method with professional advice

The World Health Organization (WHO) has established parameters that help choose the best contraceptive method for each woman. To such guidelines must be added the fact that a woman is in the puerperium.

The parameters are known as Medical eligibility criteria for contraceptive use. Each person must establish if the method they use is in category 1 and 2; otherwise he should not use it.

The categories are as follows:

  • Category 1: the method has no usage restrictions.
  • Category 2: the advantages of the method outweigh the risks.
  • Category 3: the risks outweigh the advantages of the method.
  • Category 4: there is a great risk that it is unacceptable.

The most important thing during the puerperium is that contraceptives do not interfere with breastfeeding or the health of the newborn. Generally speaking, non-hormonal methods are the preferred option.

If there are any questions or concerns, it is best to discuss it with your doctor.

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