Post-pregnancy contraception

SOME say prevention is better than cure. Having pregnancies in quick succession can not only lead to a financial burden, but may also lead to a state of chronic anaemia (low blood count) and weakness.

It’s important at every visit after delivery that contraception is explained to the new mother.

Types of contraception after pregnancy

1. Lactational amenorrhea (LAM)

This is also known as “breastfeeding contraception”. The exact mechanism is not fully understood. In women who are less than six months post-delivery, amenorrhoeic (no vaginal bleeding after 56 days delivery) and breastfeeding day and night, LAM is 98 per cent effective in preventing pregnancy. Conditions such as reduced frequency of breastfeeding, separation from the baby, and stress may lead to return of fertility.

2. Barrier methods

Condoms are extremely effective in the post-delivery period. Diaphragms should be avoided until the uterus has fully returned to normal size, which occurs usually within the first two weeks after delivery.

3. Combined oral contraceptive pill (COPC)

The oestrogen in the pill causes a decrease in milk volume and quantity so it is not recommended if the mother plans to breastfeed. There is also a theoretical risk of blood clot formation; however, this is significantly decreased by day 21 post-delivery and may be used if the mother does not wish to breastfeed thereafter.

4. Progestogen-only contraception

The hormone progesterone is very effective in manipulating the ovulatory cycle and preventing pregnancy. It does not affect breast milk and is safe in pregnancy. This medication may be administered orally, intramuscularly, subcutaneously (under the skin) or intrauterine (within the uterus).

– Pill: The progesterone only pill is not available in Jamaica. The disadvantage of this pill is that it has to be taken the same time every day. If taken correctly, it is very effective.

– Depo Provera: This is the injectable form of progesterone and is administered every 12 weeks. It is also very effective; however, one of the major side effects is unscheduled bleeding which can be an annoyance.

– Subcutaneous: Two small rods containing progesterone are placed under the skin, usually on the left inner upper arm. It usually has a lifespan of five years and is effective in preventing pregnancy. Patients need to be counselled on the possibility of unscheduled bleeding.

– Mirena (intrauterine): This device is inserted into the uterus through the vagina. It lasts for five years. It not only prevents pregnancy, but also decreases the flow of the menses.

5. Intrauterine contraceptive device (copper t)

This is similar to the Mirena as it is placed into the uterus; however, it contains no hormones. As a result, it is safe in breastfeeding. It has a low failure rate, which is approximately one in 20. It can last for 10 years, and when removed results in immediate return to fertility.

6. Sterlisation

This is offered to women who have completed their family. This can be offered immediately after delivery, at an interval after pregnancy, or at the time of Cesarean section. After delivery, the uterus is still expanded and in the abdomen. A small incision can be made at the umbilicus (navel) and the Fallopian tubes can be tied and cut. This is done in the operating theatre. When the uterus has returned to its normal size, the tubes can be occluded laparoscopically (minimal invasive surgery with the use of cameras). Lastly, at Cesarean section, the tubes can be tied and cut. However, at this point it is associated with immense regret and patients should be made aware of this. There is also an increased risk of failure at Cesarean section when compared to the non-pregnant state.

7. Natural family planning

This involves timing intercourse based on the woman’s cycle and avoiding intercourse during ovulation. Ovulation can be detected with cyclical temperature changes, cervical mucus, and ovulatory kits. It must be noted, however, that the first cycles after delivery can be abnormal.

Last but not least, which is easier said than done, is abstinence. This will guarantee no future pregnancies!

Dr Daryl Daley is a medical officer in obstetrics and gynaecology at May Pen Hospital, and consultant OBGYN at Gynae Associates, 23 Tangerine Place, Kingston 10, and Shops 46-50, Portmore Town Centre, St Catherine. Telephone him at 929-5038/9 and 939-2859 or e-mail drdaryldaley@gmail.com.