Post-partum contraception

Question 1

After what period of time post-partum does fertility return?

Answer 1

After 21 days

Question 2

What is the earliest date of ovulation in a non-breastfeeding woman?

Answer 2

28 days post-partum (therefore contraception required from 21 days post-partum as sperm can survive up to 7 days)

Question 3

When can the POP be started post-partum?

Answer 3

Any time postpartum (breastfeeding or not)

Question 4

When is additional contraception required when starting the POP post-partum?

Answer 4

If starting >21 days post-partum, requires

Question 5

What is the UKMEC for COCP post-partum?

Answer 5

• UKMEC 4 = Breast-feeding <6 weeks post-partum
• UKMEC 2 = Breast-feeding 6 weeks - 6 months post-partum

COCP may reduce breast milk production.

Question 6

When is additional contraception required if starting the COCP post-partum?

Answer 6

Immediate protection if started from day 21. After day 21, additional contraception should be used for the first 7 days.

Question 7

What is the lactational amenorrhoea method?

Answer 7

LAM is 98% effective providing woman is fully breast-feeding (no supplementary feeds, and to be considered effective baby must get at least 85% of its feeds from breast-feeding), amenorrhoeic, and <6 months post-partium

Question 8

When can the copper IUD be inserted post-partum?

Answer 8

Within 48 hours post-partum or >4 weeks post-partum. Should not be inserted in between then due to risk of uterine perforation.

Question 9

What are the risks associated with inter-pregnancy intervals of <12 months?

Answer 9

• Preterm birth
• Low birth weight
• SGA babies