00:01
Now let's talk about
postpartum contraception.
00:05
So when we address postpartum
contraception,
the first thing we want to address
is if our patient
is breastfeeding or not.
00:12
So this is a clinical pearl.
00:14
For women that are
breastfeeding,
contraceptive options should
be limited to progestin only
or non-hormonal options.
00:22
Options that contain estrogen
can dry up the patient's breast
milk.
00:27
So let's look at those.
00:28
And we're going these into
reversible options
and non reversible options.
00:33
So for our reversible options,
we'll start with natural family
planning.
00:37
Now prolactin increases during
breastfeeding and this causes
ovulation to cease.
00:45
It's reliable about
98% if used correctly.
00:49
Again this is also
called rhythm method.
00:52
Next is the barrier method.
00:54
This is the use of condoms
and/or spermicides.
00:57
It used together and correctly,
the effective rate is about 82%.
01:04
Next is the progestin
only birth control pill.
01:06
So the progestin only
or the mini-pill has to be taken
at the same time everyday.
01:13
It's most reliable
when done that way.
01:15
Long acting reversible
contraceptives.
01:20
LARC as they're often called
provide contraception for an
extended period of time.
01:25
And there are several options.
01:27
Let's go through those.
01:29
So for our long acting
reversible contraceptives
or LARC as they are often called,
let's start with the Copper IUC
or intrauterine contraception.
01:37
The Copper IUC is non-hormonal
and it is the only non-hormonal
IUC.
01:43
It actually provides
contraception,
by providing a sterile environment
that kills the sperm.
01:48
And it's effective for
10 years.
01:51
The progestin IUC's prevent
pregnancy by also creating
a sterile environment
that kills the sperm.
01:58
But because of the progestin,
they increase cervical mucus to
make it difficult for the sperm
to enter the cervix.
02:04
They also the make
the endometrium thin
and they can inhibit mortality
of the fallopian tube.
02:09
There are fewer progestin IUDs
on the market currently,
all of which have the same highly effective rate
and differ primarily in size and device lifespan.
02:20
Skyla
One of the smaller devices is generally marketed
towards teenagers
and is approved to last three years.
02:28
Morena, on the other hand, is larger
and has been approved to last for seven years.
02:34
And then the Loette has 52
milligrams of levonorgestrel
and it is FDA indicated
for 3 years of use.
02:42
Moving on from our intrauterine
contraceptives we have
a progestin implant,
this is known as nexplanon.
02:48
The progestin only implants
is placed underneath the skin,
approximately 3 centimeters
from the elbow crease.
02:55
It has 68 milligrams of
etonogestrel and is effective
for 3 years.
03:01
Next we have the progestin
implant.
03:05
This is medroxyprogesterone
acetate.
03:07
So this is an injection that's
given every three months.
03:11
With perfect use is it 99%
effective as are all the other
LARC's.
03:16
The side effect of
the medroxyprogesterone,
however, include weight gain,
hair loss and irregular cycles.
03:24
Now, we've talked about
our reversible methods,
let's talk about our irreversible methods.
03:32
So that would be a postpartum
tubal ligation as one option.
03:36
With postpartum tubal ligation,
this can be performed
immediately after delivery,
during a cesarean section
or up to 6 weeks after delivery.
03:44
During that time the fallopian
tube is either legated
with a device or a portion
of it is removed.
03:51
We also have the hysteroscopic
tubal ligation.
03:56
Right now the only FDA device
is the Essure procedure.
03:59
So the next option
is vasectomy.
04:03
This procedure is performed
for males.
04:05
So let's take a case.
04:09
Justine is a 20 year old gravida
3 para 0 female who presents
for her postpartum visit.
04:15
She is interested in discussing
contraceptive options.
04:19
She is breastfeeding but
not consistently due to sore
nipples.
04:23
She thinks she has
completed childbearing.
04:26
What options would you say best
fit her contraceptive needs?
A. Barrier method.
04:31
B. Oral contraceptives.
04:34
C. Long Acting Reversible Contraceptive
or D. Tubal ligation.
04:38
The answer is C.
04:41
A Long Acting Reversible Contraceptive.
04:43
She already said that she thinks
she may have completed child
bearing.
04:47
However, the young, the highest
risk of regret is a young age.
04:52
So we don't want to give her
the option or we don't want to
encourage the option
of tubal ligation.
04:58
Barrier method or contraceptive
is not as effective
because of self use.
05:03
So in this case a long acting
reversible contraceptive,
would be the best option.