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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1682
Location: Nottingham
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 Posted: Mon Oct 29, 2007 9:12 am Post subject: Advice for breastfeeding women about contraception |
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Immediately
Lactational amenorrhoea method (LAM)
Start immediately postpartum to provide effective contraception. Remind women that the LAM is an interim method effective for the first 6 months postpartum only.
Intrauterine device (IUD)
Insert within the first 48 hours postpartum to provide immediate protection.
Condoms and spermicides
Can be used immediately.
Female sterilisation
Can be performed at the time of Caesarean section if there has been appropriate counselling and consent antenatally.
Last edited by Nick Raine-Fenning on Mon Oct 29, 2007 9:17 am; edited 3 times in total |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1682
Location: Nottingham
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| Posted: Mon Oct 29, 2007 9:13 am Post subject: |
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Under 4 weeks
Progestogen-only pill (POP)
May start any time postpartum. If started up to Day 21 postpartum no additional contraceptive protection required. If started after Day 21 additional contraceptive protection is required for 2 days.
Progestogen-only implant
Insert up to Day 28 postpartum without the need for additional contraceptive protection. If inserted after Day 28 additional contraceptive protection is required for 7 days. May be considered before Day 21 if a woman is unlikely to return for insertion, if the risk of pregnancy is high, and if other methods are unacceptable. Counsel regarding bleeding.
Emergency contraception (EC)
Indicated if there has been unprotected intercourse or potential contraceptive failure after Day 21. Progestogen-only EC can be used without restriction in breastfeeding women.
Last edited by Nick Raine-Fenning on Mon Oct 29, 2007 9:16 am; edited 1 time in total |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1682
Location: Nottingham
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| Posted: Mon Oct 29, 2007 9:14 am Post subject: |
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From 4 weeks
Intrauterine device (IUD)
Insert from 4 weeks postpartum.
Levonorgestrel-releasing intrauterine system (LNG-IUS)
Insert from 4 weeks postpartum with additional contraception for 7 days.
Last edited by Nick Raine-Fenning on Mon Oct 29, 2007 9:15 am; edited 1 time in total |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1682
Location: Nottingham
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| Posted: Mon Oct 29, 2007 9:15 am Post subject: |
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From 6 weeks
Progestogen-only injectable
Give from 6 weeks postpartum if reasonably certain woman is not pregnant with additional contraceptive protection for 7 days. May be considered at less than 6 weeks if the risk of subsequent pregnancy is high and other contraceptive methods are unacceptable.
Combined oral contraception (COC)
May be started from 6 weeks if breastfeeding is established and other contraceptive methods are unacceptable. Additional contraceptive protection is required for 7 days.
Diaphragms and cervical caps
Fit for a new diaphragm or cap from 6 weeks when uterine involution is complete.
Sterilisation
Male and female sterilisation can be considered after an appropriate interval following pregnancy. |
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Xerxes I
Century Club
Joined: 01 Mar 2007
Posts: 192
Location: Winchester
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| Posted: Thu Mar 27, 2008 4:46 pm Post subject: |
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| Quote: |
Progestogen-only implant
Insert up to Day 28 postpartum without the need for additional contraceptive protection. If inserted after Day 28 additional contraceptive protection is required for 7 days. May be considered before Day 21 if a woman is unlikely to return for insertion, if the risk of pregnancy is high, and if other methods are unacceptable. Counsel regarding bleeding.
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But why is it 28 days for implanon and 21 days for the others? Besides, it takes 7 days to start working, doesn't it? |
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Xerxes I
Century Club
Joined: 01 Mar 2007
Posts: 192
Location: Winchester
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| Posted: Thu Mar 27, 2008 4:57 pm Post subject: |
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I always wondered what's wrong with COCPs and breastfeeding  Apparently it affects the quality and quantity of the milk 
Another thing, is it ok to give someone with current DVT, POP? It's probably a non brainer for you but I wouldn't get it right. |
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cpeedahsa
Century Club
Joined: 21 Apr 2007
Posts: 788
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| Posted: Sun Apr 20, 2008 2:44 am Post subject: |
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| Xerxes I wrote: | | Another thing, is it ok to give someone with current DVT, POP? It's probably a non brainer for you but I wouldn't get it right. |
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=7682&nbr=4481
C - Women with current venous thromboembolism should not use hormonal contraception.
This is the advice from WHOMEC-World Health Organisation Medical Eligibility Criteria for Contraceptive Use (WHOMEC)
For all types of progestogen only contraceptives (POCs) including; progestogen only pills (POPs), depot medroxyprogestogen acetate (DMPA) and etonogestrel implants (Implanon) :
In women with current DVT/PE the WHOMEC recommends that the risks outweigh the benefits and the methods is not usually recommended unless other more appropriate methods are not available or acceptable (WHO 3).
In those with current DVT/PE the use of the LNG-IUD is no longer recommended and is given a rating of WHO 3. The Cu-IUD is still rated as a WHO 1 where the benefits outweigh the risks. Similarly, all types of barrier methods are rated as a WHO 1. |
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cpeedahsa
Century Club
Joined: 21 Apr 2007
Posts: 788
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| Posted: Sun Apr 20, 2008 3:08 am Post subject: Current DVT and POP |
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This is what the FFPRHC says click here
| Quote: | MEDLINE and EMBASE from 1996 to 2005
There is no evidence available on women with current PE using the POP or LNG-IUS.
The CEU recommend that women with current PE should be counselled on the potential risk of recurrence of thrombo-embolic diseases when using the POP or LNG-IUS.
However the risk of VTE if pregnancy occurs is greater and therefore women and clinicians will need to consider this when counselling about contraceptive devices following recent VTE when currently using anticoagulants.
It is unclear whether progestogens interact with warfarin.
Women may consider the use of non-hormonal methods of contraception until warfarin therapy has ceased. |
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Xerxes I
Century Club
Joined: 01 Mar 2007
Posts: 192
Location: Winchester
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| Posted: Sun Apr 20, 2008 6:21 am Post subject: |
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This is a wonderful reply, thank you.  |
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