Postpartum Contraception

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.