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.
The lecture Postpartum Contraception by Veronica Gillispie, MD, MAS, FACOG is from the course Postpartum Care. It contains the following chapters:
How effective is natural family planning if used correctly and perfectly?
Which of the following is a non-hormonal long-acting reversible contraception option?
Which of the following statements is true about the hysteroscopic tubal ligation procedure?
Which of the following physiological changes occur while a woman is breastfeeding and how do they affect her chances of conceiving during that time?
Which of the following is NOT a mechanism of action of progestin intrauterine contraceptive devices?
If used correctly, how effective is the barrier plus spermicide method in preventing pregnancy?
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