OBS2 Flashcards

Question

Should breastfeeding women use OCP?

Answer 1

No. Interferes with breast milk production.

Answer 2

To reduce risk of VTE - nonbreastfeeding women should wait 3 weeks before commencing OCP use; relative contraindication in women with pregnancy related hypertension; monitor closely

Answer 3

1. Lactational amenorrhoea BF - Yes 97% effective in the first 6 months if woman is fully demand breastfeeding and amenorrhoeic; ovulation may occur before menstruation recommences 2. Condoms BF - Yes Can be used at any time 3. Diaphragm BF -Yes Needs to be refitted after 6 weeks postpartum 4. Progestogen only pill (POP) BF- Yes There is no evidence that progestogen only contraceptives have – norethisterone an effect on breastfed infants. However, many guidelines advocate – levongesterol commencing at 6 weeks in keeping with WHO recommendations. The POP must be taken regularly at the same time each day. In Australia, none of the progestogen only contraceptives are registered for use during breastfeeding 5. Depo-medroxydepoprovera (MDP) BF - Yes - Can be given within 48 hours of delivery but generally withheld until 6 weeks; may cause increased or irregular bleeding; ensure the woman is not pregnant at time of administration; avoid use in women with postnatal depression 6. Implanon BF - Yes See as for MDP 7. IUCD – copper, progestogen (Mirena) BF - Yes Can be inserted at time of delivery but to avoid high expulsion rate is usually inserted at 4–6 weeks (progestogen IUCD can cause irregular bleeding) 8. Oral combined contraceptive pill (OCP) BF - No Interferes with breast milk production. To reduce the risk of thromboembolism, nonbreastfeeding women should wait 3 weeks before commencing OCP use; relative contraindication in women with pregnancy related hypertension; monitor closely 9. Tubal ligation BF Yes May be performed at time of elective LUCS if informed consent gained antenatally; may be performed after 6 weeks postpartum after careful assessment 10. Vasectomy BF Yes May be performed at any time with due consideration and informed consent

Answer 4

Microlut Levonorgestrol 30mcg

Answer 5

The hormone in the POP changes the mucous of the cervix (neck of the womb) so that sperm cannot swim up into the uterus. Usually the POP does not stop you ovulating (producing an egg each month) but in a small number of women this pill also stops ovulation.

Answer 6

The POP should be started within 21 days of your baby being born and can be started straightaway after the baby’s birth. If you wait longer than 21 days before starting the mini-pill you will need extra contraception (condoms) until you start the pill including the first week after starting it. It is very important that the mini-pill be taken at the same time each day. If you are more than three hours late taking this pill you will need to take the pill you missed straight away, and use condoms when you have sex, until you have taken the pill at the correct time of day for three days in a row. If you have vomiting or diarrhoea you may not absorb the POP, so you should also follow the advice about what to do if you miss a pill.

Answer 7

If you have, or have had, breast cancer  If you have liver disease  If you have active hepatitis caused by a virus Some medicines make the POP less effective, for example some drugs taken for epilepsy. Ask your doctor if you are unsure about medicines (or herbal preparations) you take.

Answer 8

If you are fully (exclusively) breast feeding and take the POP correctly it is more than 99% effective. Once you stop, or decrease, your breastfeeding the POP is 98% effective as long as it is taken correctly

Answer 9

If you are fully breastfeeding and taking the POP it is likely you will have no periods at all. Once you decrease the number of breastfeeds your periods may return as a regular cycle. In some women (30- 40%) their periods return but are irregular, so they happen in some months and not others or occur at different times of the month. **When can I fall pregnant again?** If you are no longer fully breastfeeding and stop taking the POP you can fall pregnant immediately.

Answer 10

The POP has very few side effects - occasionally women report feeling bloated, or having headaches. Please discuss problem or side effects of the POP with your GP before stopping your contraception.

Answer 11

Generally we recommend the POP for the first 6 months of breastfeeding but if you cannot tolerate the POP you may commence the COCP at 6 weeks after your baby is born. However, if you do this your breastfeeding must be completely established otherwise the COCP could dry up your breast milk.

Answer 12

Fully breastfeeding women have a slightly less than 2% chance of falling pregnant. However, to rely on this method, you must: 1.  Be less the 6 months after the birth of your baby 2.  Have no periods 3.  Must be exclusively breastfeeding (no supplemental feeds)

OBS2 Flashcards

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