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n Obstetrics and Gynaecology Forum - Postpartum contraception : review
The provision of effective and safe contraception during the postnatal period is an important aspect of maternal care. There is still a high unmet need for modern contraception postpartum. The postnatal ward is not the most appropriate setting to discuss future contraception for the first time; however it should be discussed at the latest in the first week postpartum and a future contraceptive plan needs to be established by week four as women may be fertile before the return of their menstrual cycle.
Breastfeeding can prevent pregnancy based on natural postpartum infertility due to the suppression of ovulation and guidelines to improve the efficacy of breastfeeding as a contraceptive method were developed. The World health Organization provides evidence-based recommendations (World Health Organisation (WHO) Medical Eligibility Criteria (MEC) to ensure that patients with medical conditions are fit to use a particular method and can safely select the most appropriate method of contraception. Breastfeeding, modern contraceptive methods, sterilisation and emergency contraception should be considered in all cases.
There are concerns about the possible hormonal effects of combined hormonal contraceptives on the suppression of quality and quantity of milk production as well as possible absorption by the infant. The increased risk of thromboembolism postpartum is also of concern when using COCs and it is recommended that the earliest date to commence is 21 days postpartum if there are no other risk factors for the development of VTE.
Women should receive written information on contraceptives, provided with detailed advice about possible side-effects, including the availability of emergency contraception if needed and a follow-up appointment should be arranged.
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