CONTRACEPTION OPTIONS AFTER BABY
Contraception in the immediate postpartum period
The postpartum period places women at an increased risk for blood clots due to the hormonal and physiologic changes that occur. Additionally, some estrogen-containing contraceptive methods can diminish breast milk supply during the immediate postpartum period, thus further limiting contraceptive options. The most commonly used contraceptive options that may be used within 3 weeks of giving birth are the progestin-only injection and the progestin-only pill since they do not diminish milk supply. It is also possible to place a progestin-only implant or IUD during this early postpartum period. Combined hormonal contraceptive methods are typically delayed until 6 weeks postpartum to allow an adequate milk supply to develop and to decrease risk of blood clots.
Please see Part 1 of The Contraception Series for more information
Permanent sterilization
Permanent sterilization is a term used to describe irreversible methods of contraception. The first option is an immediate postpartum tubal ligation. This can be performed after a vaginal delivery or during a Cesarean section. If the procedure is performed after a vaginal delivery a small incision is made below the umbilicus (belly button), both fallopian tubes are visualized, tied and cut, and the incision is closed. During a Cesarean delivery, the fallopian tubes will be tied and cut after the baby has been safely delivered.
The hysteroscopic bilateral tubal occlusion is a procedure that is performed vaginally and does not require an abdominal incision. An instrument is inserted into the cervical canal and uterine cavity, and the openings of the fallopian tubes are closed with small coils. These coils cause scarring where the fallopian tubes meet the uterus, thereby blocking the fallopian tubes. Three months after this procedure, an imaging study is done to make sure the fallopian tubes are blocked. Until this is confirmed, a backup form of contraception is required.
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The laparoscopic tubal ligation is a procedure performed after the 6-week postpartum period. It requires several small incisions on the abdomen. Operative instruments are used to burn and cut the fallopian tubes, place clips, or place rings over each tube.
A vasectomy is a procedure performed on the male partner where the tube that transports sperm from the testes to the penis is cut. This procedure also requires a follow-up confirmation test, and backup contraception is needed until this confirmation is obtained.
Prior to having any permanent sterilization procedure, a woman should be very certain that she does not desire to have any more children. If she had had a tubal ligation of any kind and subsequently changes her mind, a tubal reanastomosis (“tubal reversal”) can be attempted, but is a technically difficult procedure that does not have guaranteed success. Another option for pregnancy after a tubal ligation is in vitro fertilization (IVF), which can be quite costly. If you have had a tubal ligation and want to conceive, please consult your OB/GYN or a Reproductive Endocrinology and Infertility Specialist (REI) to further discuss what options are available to you.
FREQUENTLY ASKED QUESTIONS
How long should I wait to attempt to conceive after stopping a contraceptive method?
A woman can attempt to conceive immediately after removal of an IUD or progestin-only implant. Many physicians recommend waiting one full cycle to conceive after stopping combined OCPs or other combined hormonal contraceptive methods (patch or vaginal ring). In regards to the progestin-only injection and implant, one can attempt to conceive soon after stopping it, but it can cause a delay in getting pregnant by 4 to 6 months.
What if I get pregnant while using contraception?
If a woman gets pregnant while using OCPs, the patch, vaginal ring or progestin-only injection she should stop it immediately and see her OB/GYN for further guidance. In regards to the progestin-only or copper IUD, she should see her OB/GYN as soon as possible to discuss removal of the IUD or other plan of care. The IUD is typically removed if the strings are visualized on exam or the IUD is located in the cervix. If strings are not visualized, the OB/GYN may recommend leaving the IUD in place based on the risks to the pregnancy of removing it versus leaving it in. Your doctor will also need to make sure that the pregnancy is within the uterine cavity and not an ectopic pregnancy (pregnancy outside the uterus). A progestin-only implant will be removed if pregnancy is confirmed.
What contraceptive methods are available for women after age 35?
Women after 35 may use all of the above-mentioned contraceptive methods, unless there is a medical contraindication that would make one of the above options unsafe. A major exception to this rule is a woman older than 35 years who smokes. These women are not candidates for combined hormonal contraceptive methods (estrogen/progestin) because it has been shown to increase the risk for heart attack in this population of women.
For Part 1 of the Contraception Series click here!