Contraception after Childbirth
Maternity services (including antenatal, delivery, post-natal and Health visiting) should give women the opportunity to discuss contraception choices after childbirth. They should ensure that they have full access to information re; methods available and where, when and how to access those services.
Most methods of contraception can be started immediately after childbirth apart from combined hormonal contraception which cannot be started until after day 28 post childbirth.
Intra-uterine contraception IUC (copper or hormonal coil)
Intra uterine contraception can be inserted immediately after birth within 48 hrs. After 48hrs insertion should be delayed until 28 days after childbirth.
Implant, injection and mini pill
The implant can be fitted at any time after childbirth.
Combined Hormonal contraception CHC (Pills, patches and vaginal ring)
Combined hormonal contraception should not be used by women who have risk factors for venous thrombosis (VTE) including immobility, transfusion during childbirth, Body Mass Index (BMI) over 30, post partum haemorrhage, pre eclampsia or smoker. Women who are not breast feeding or without VTE risk should wait until 21 days after childbirth before commencing CHC.
Female sterilisation is a safe option for permanent contraception after childbirth. Sterilisation can be performed at caesarean section if consent is obtained prior to same.
Male and Female condoms can be safely used after childbirth.
It needs to be at least 6 weeks after childbirth before having a diaphragm fitted, this is because the size of the diaphragm required may change as the womb returns back to normal size.
Oral emergency contraception such as Levonorgestrel and Ulipristal are safe to use from 21 days after childbirth.
Emergency contraception is not needed if less than 21 days from childbirth.
The copper intrauterine device is safe to use from day 28 after childbirth and is the most effective form of Emergency Contraception.
If Ulipristal is given and the woman is breast feeding they needs to be advised not to breast feed and to express and discard the milk for 7 days after taking the medication.
Women who breastfeed should be informed that available limited evidence indicates that Levonorgestrel has no adverse effects on breastfeeding or on their infants.
Best practice would indicate, Copper IUD and then if breast feeding Levonorgestrel (within 72hrs) Ulipristal but to express for 7 days
Breast Feeding and Contraception
Available evidence indicates that progestogen-only methods of contraception Implant, Depo, Mini pill, Hormonal Coil have no adverse effects on the breast feeding, infant growth or development.
Women who are breastfeeding should wait until 6 weeks after childbirth before initiating a CHC method.
Women who are breastfeeding should be informed that there is currently limited evidence regarding the effects of CHC use on breastfeeding.
Contraception after abortion
The chosen method should be started immediately after abortion (Medical or surgical). This is including Long Acting Reversible Contraception such as Implant and IUC.
An IUC can be inserted anytime after medical abortion is complete or inserted immediately after surgical abortion.
Contraception after Ectopic Pregnancy or Miscarriage
The chosen method should be started immediately after treatment for ectopic pregnancy or miscarriage
How long should a woman wait before trying to conceive after ectopic pregnancy or miscarriage ?
Women who wish to conceive following a miscarriage there is no need to delay.
Women who have been treated with methotrexate should be advised to use effective contraception for 3 months following treatment due to medication still being in system and make effect a pregnancy in that time.
Effective contraception can be started on the day of methotrexate administration.
Contraception following Gestational Trophoblastic Disease (GTD)
Women should be advised to avoid pregnancy until GTD monitoring is complete.
Contraception should be started as soon as possible.
Most methods are safe to use apart from Intrauterine contraception. IUC cannot be inserted until hormone levels have returned to normal.
After a complete molar pregnancy women should be advised to avoid pregnancy for at least 6 months.
Sexually Transmitted infections STI’s
Being pregnant doesn’t prevent you getting a sexually transmitted infection (STI) If left untreated STIs can cause serious harm to your baby and long term problems for you, including infertility.
Protect yourself and your baby by using a condom and getting a STI check either through your midwife or attending a sexual health clinic.
STIs such as Chlamydia and gonorrhoea can be very easily tested by a self taken vaginal swab in women and a wee in a pot for a man and are easily treated by antibiotics.
Chlamydia and gonorrhoea can be passed onto the baby during delivery
If you have chlamydia that's not treated while you're pregnant, there's a chance you could pass the infection on to your baby. If this happens, your baby may develop an eye infection (conjunctivitis) or more rarely a lung infection (pneumonia).
If your baby has symptoms of these conditions, your midwife or GP can arrange for a test to check for chlamydia, and antibiotics can be used to treat the infection.
Untreated chlamydia in pregnancy may also increase the risk of problems such as your baby being born early (before 37 weeks of pregnancy) or with a low birthweight.
Blood born virus’s are routinely tested for in pregnancy. these include HIV, Syphilis and Hepatitis B.
Cold sores and genital herpes
IT's best to avoid oral sex if you or your partner has a cold sore as the same virus can cause genital herpes. If you have genital herpes for the first time during pregnancy, there is a risk that your baby could develop a serious illness called neonatal herpes.
If you develop genital herpes in late stages of pregnancy you will need to take antiviral medication continuously until delivery, this can be obtained from Sexual health services or your GP.
If you have genital herpes before becoming pregnant the risk to your baby is low, due to the fact that your protective antibodies will be passed onto your baby. This will protect your baby during birth. It may be advised that you take anti-viral medication from 36 weeks pregnant.
If you develop genital herpes for the first time during the 1st or 2nd trimester it can increase risk of miscarriage and risk of passing the virus to the baby. To prevent this you may need to take anti viral medication throughout your pregnancy. There is even a higher risk if you are in your 3rd trimester .
If you feel that you may have Genital Herpes and are pregnant please contact clinic on 01422 261370 to arrange an appointment to see one of our consultants.
Neonatal herpes is where a baby catches the herpes virus around the time of birth. It can be serious.
Babies with symptoms affecting eyes, mouth and skin will usually make a full recovery with antiviral treatment. However in cases where multiple organs are effected this can be fatal.