Advances in contraception: new options for postpartum women

ABSTRACT

Introduction: short interval repeat pregnancy increases maternal and neonatal morbidity, and provision of postpartum contraception provides primary protection against these adverse outcomes. Confusion regarding effects on breast feeding and thrombosis risk delaying initiation of contraception in the immediate post-partum interval. Delaying contraception provision until the 6-week postpartum visit misses many women who either do not attend or have resumed ovulation and/or intercourse prior to this visit. Because of this, recent studies have looked into initiation of highly effective contraceptive methods at earlier intervals including immediately postpartum. These data provide strong evidence for immediate post-partum initiation of the most effective long-acting reversible contraception (LARC) methods, intrauterine devices and implants.

Areas covered: We review the data for safety and efficacy, timing of initiation, and continuation rates of various contraceptive methods in the postpartum period. We also evaluate effects on initiation and continuation of breastfeeding for each contraceptive method discussed.

Expert opinion: It is important to counsel patients antenatally regarding the full spectrum of contraceptive options available with a focus on long-acting reversible contraceptive (LARC) methods. When a woman chooses a LARC method, her provider should consider placement in the immediate postpartum period.

KEYWORDS:

• Postpartum contraception
• LARC
• breastfeeding

Article Highlights

• For many women, ovulation postpartum returns prior to the 6-week postpartum visit Initiation of highly effective contraception is necessary to reduce unintended pregnancy and short interval pregnancy rates

• All women should be counseled on the importance of postpartum contraception and a plan for contraception should be made during the course of prenatal care

• LARC methods are more effective than other contraception methods, are continued for longer periods of time, and are safe to initiate in the immediate postpartum period

• LARC methods should be encouraged, including a discussion of LARC placement immediately postpartum

• LARC methods may safely be used by breastfeeding women, and do not affect rates of breastfeeding initiation, continuation, or neonatal outcomes

This box summarizes key points contained in the article.

Declaration of interest

JT Jensen has received grants/research support from from AbbVie, Evofem, Bayer, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Merck, Population Council, Gates Foundation, Medicines360 and Estetra SPRL; and consultancy fees from: Agile, Abbvie, ContraMed, Bayer Healthcare, Evofem, Merck, MicroChips, HRA Pharma, Population Council and Teva. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.