Appendices and Resources Appendix 1: Contraceptive Options Post-Pregnancy
A range of contraceptives can be used right after birth, including while breastfeeding, as follows: 47 • contraceptive implant • contraceptive injection • progestogen-only pill • male condoms • female (internal) condoms • IUD (coil) or IUS (hormonal coil) As above, these include the most effective methods of contraception, Long-Acting Reversible Contraceptives (LARCs), such as implants which last 3 years and Intrauterine Devices (IUDs) which last up to 10 years, depending on type. IUDs can be fitted at caesarean section or within the first 48 hours after vaginal birth with no increased risk of complications. 48 If not fitted in the first 48 hours, fitting must be postponed for 4 weeks to allow the uterus to return to its pre-pregnancy
size, making postnatal units an opportune time and place for provision. 49 Combined hormonal contraception should not be used in the first 3 to 6 weeks postpartum because of associated risk of venous thromboembolism. It should not be used in the first 6 weeks postpartum if breastfeeding due to a lack of sufficient safety data. 50 Fertility awareness-based methods are complicated to use and less reliable in the immediate post pregnancy period and when breastfeeding. 51 All contraceptive methods can be safely and immediately initiated after uncomplicated abortion, miscarriage, or ectopic pregnancy. With the exception of an IUD, the same is true after uterine evacuation for gestational trophoblastic disease. 52 The immediate post-pregnancy provision of a woman’s preferred contraceptive method at the time of birth, abortion or in healthcare settings caring for women with miscarriage, ectopic pregnancy or gestational trophoblastic disease is supported by the College of Sexual and Reproductive Healthcare, Royal College of Obstetricians & Gynaecologists as well as equivalent professional bodies around the world. 53
Importantly, male contraceptive options such as condoms and vasectomy should equally be part of the conversation to ensure equal divide of responsibility for reproduction across partners.
47 College of Sexual and Reproductive Healthcare . UK Medical Eligibility Criteria for Contraceptive Use (UKMEC). 48 Rosa Bolling K, Wahdan Y, Warnock N, et al. Utilisation, effectiveness, and safety of immediate postpartum intrauterine device insertion: a systematic literature review. BMJ Sex Reprod Health 2023; 49:e1. 49 Lopez LM, Bernholc A, Hubacher D, Stuart G, Van Vliet HA. Immediate postpartum insertion of intrauterine device for contraception. Cochrane Database Syst Rev 2015(6); Sonalkar S, Kapp N. Intrauterine device insertion in the postpartum period: a systematic review. Eur J Contracept Reprod Health Care 2015; 20:4–18.
50 Tepper NK, Phillips SJ, Kapp N, et al. Combined hormonal contraceptive use among breastfeeding women: an updated systematic review. Contraception 2016; 94:262–274. 51 James J Redmond, Elizabeth T Jensen, Joseph B Stanford et al. Effectiveness of fertility awareness-based methods for pregnancy prevention during the postpartum period. Contraception 2022; 114, 32-40. 52 CoSRH Guideline: Contraception After Pregnancy. 53 CoSRH Guideline: Contraception After Pregnancy. American College of Obstetricians and Gynaecologists Committee on Obstetric Practice. Committee Opinion No. 670: immediate postpartum long-acting reversible contraception. Obstet Gynecol 2016; 128:e32–e37.
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