One of our previous blogs “Just Do It” discussed sexuality both during pregnancy and the postpartum period. It was mentioned that it is not unusual for women to have decreased sex drive postpartum due to emotional and physical changes that occur after delivery. However, for those that feel up to the big event, avoiding unwanted pregnancy soon after delivering is highly desirable. Ovulation may occur as early as 25 days after delivery, but may take as many as 42 days after delivery. Because of the irregularity in bleeding both in breastfeeding and nonbreastfeeding women, using reliable contraception is even more critical in avoiding an unwanted pregnancy. I thought this would be a great opportunity to discuss with my readers the brand new “hot off the press ” guidelines published by the CDC on July 8, 2011 concerning the revised recommendations for the use of contraception immediately following delivery.
New recommendations by the CDC (Center of Disease Control and Prevention) are that women less than 21 days postpartum not use combined hormonal contraceptives, combined hormonal patch, or combined hormonal vaginal ring. Barring other medical risk factors it is deemed safe to use these methods after this time frame.
Oral contraceptives normally cause a slight increased risk of venous thrombosis regardless of pregnancy status.
Postpartum women carry an additional risk of DVT of 22 to 84 fold higher compared to women that were not pregnant in the exact same age group. This added risk is greatest immediately after delivery and declines after 21 days but reaches baseline only after 42 days. This increased risk is probably related to the increase in coagulation factors due to elevated hormone levels. In addition, women that are obese, immobilized due to a cesarean section, age over 35, previous history of blood clots, have had postpartum hemorrhage, preeclampsia, smoking, or previous history of a clotting disorder (thrombophilia) adds even greater risk to the formula.
No, regardless of breastfeeding status, combined oral contraception should not be used within the first 3 weeks after delivering.
Progesterone only pills, progesterone shots, contraceptive implants, intrauterine devices (IUD’S), and condoms can be used safely immediately after delivery.
IUD’s are not recommended in any woman who developed infection after childbirth. IUD’s, both copper-bearing and hormone releasing, can be inserted within 10 min or later after delivery of the placenta.
The cervical cap or the diaphragm can be used generally within 6 weeks of delivery when the cervix has returned to its original configuration.
There is no effect on infant weight between breastfeeding mothers using oral contraceptives and those who do not. No adverse effects have been demonstrated on infants exposed to combined oral contraceptives through breast milk although there are few very good, reputable studies. There may be some variation in milk production in women who breast feed and use oral contraceptives.
Use of combined oral contraceptive pill within the first 21 days postpartum is not recommended due to the increased risk of venous thrombosis and the unlikely possibility of pregnancy risk at this time.
Women with additional risk factors (under 35 and smoking, postpartum hemorrhage, postpartum transfusion) use of oral contraceptives returns to baseline only after 42 days postpartum and initiation of therapy should wait beyond the 3 weeks. Mothers with a history of pulmonary embolism, cardiomyopathy postpartum, thrombogenic mutations, and previous DVT should not use oral contraceptives postpartum altogether.