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Post-pregnancy Contraception

Posted Aug 24 2008 1:49pm
ANNOUNCER: It's a miracle! The baby has finally fallen asleep and your sex drive wakes up from a long, long nap.

SUZANNE LaJOIE, MD: I usually tell women to wait about six weeks and just to check in with their doctor or whoever's providing their care before they go ahead and resume sexual intercourse.

ANNOUNCER: A woman's body after childbirth is still going through a lot of changes.

SUZANNE LaJOIE, MD: The uterus has to contract down to a non-pregnant state and the cervix, especially after a vaginal delivery, it dilates completely, so it's like wide open to let the baby out and then it takes a while for that cervix to close. And sometimes there are tears in the vagina and the perineum, you want to make sure those are really well-healed and that the woman's feeling well physically before I tell them to resume sex again.

ANNOUNCER: Many women mistakenly think that because they have just given birth or because they are nursing, that they are not ovulating and therefore cannot become pregnant. But ovulation can occur again shortly after childbirth.

SUZANNE LaJOIE, MD: When a woman ovulates after delivery is variable. In women who are nursing, lots of times ovulation is suspended for a while. A woman who is not nursing may ovulate, actually, six weeks after delivery. When women are breast-feeding, they're not as fertile. And, a lot of times, women will not get a period when they are nursing.

ANNOUNCER: But that doesn't guarantee they won't get pregnant.

SUZANNE LaJOIE, MD: My recommendation is that women don't rely on that for contraception, especially if they feel strongly that they want to hold off on getting pregnant again.

ANNOUNCER: The choices that couples have for contraception after childbirth fall into four categories: hormonal methods, barrier methods, sterilization, and natural methods.

SUZANNE LaJOIE, MD: In terms of hormonal methods of contraception, there are birth control pills, there are birth control patches, there are vaginal rings and there are injectables that can be used. There's also an IUD that has a hormone in it as well.

ANNOUNCER: But hormonal choices have to be made carefully.

SUZANNE LaJOIE, MD: If a woman is breast-feeding, I won't put her on a method that contains estrogen. I'll use either a progesterone-only pill, a progesterone-only injectable or an IUD.

ANNOUNCER: Certainly, of all the hormonal methods, birth control pills have been the most popular, particularly in women under the age of 35.

SUZANNE LaJOIE, MD: Lots of women use birth control pills before they get pregnant. It's something that they're familiar with, it's easy to use, and it's effective.

The pills that contain estrogen and progesterone are probably a little bit more effective than the progesterone-only pills. The progesterone-only pills are really good for women who are either having a medical problem that we don't want them to take estrogen or in someone who's nursing where estrogen really isn't a good idea.

ANNOUNCER: Gaining popularity are three other types of hormonal contraceptives.

SUZANNE LaJOIE, MD: It's actually a patch that women can wear on their skin, anywhere on the body except on the breasts. And they change it once a week. So it's a bit more convenient for women who forget pills, for instance.

ANNOUNCER: The vaginal ring works the same way as the patch and the birth control pills.

SUZANNE LaJOIE, MD: Women insert it into the vagina and they keep it in for actually three weeks. So this is very convenient for women who even can forget to change the patch or who travel a lot.

ANNOUNCER: Convenience is also a feature of the injectable types of hormonal contraceptives. However there has been some controversy surrounding them, even the one that's currently on the market.

SUZANNE LaJOIE, MD: It's a progesterone-only-containing contraceptive and it's an actual intramuscular injection that a woman takes every three months and that's safe to use when nursing.

ANNOUNCER: There are, however, issues of bone density reduction associated with this product and consequently this product is not for long-term use. Using injectables for more than 2 years can increase the risk for osteoporosis and other bone diseases. A safer course of long-term contraception may lie in the IUD, which comes with and without progesterone.

SUZANNE LaJOIE, MD: The IUD stands for intrauterine device. It's a device that's actually placed inside a woman's uterus by a healthcare provider. It doesn't really inhibit ovulation, but it changes the lining of the uterus so that it's not really conducive to a pregnancy.

ANNOUNCER: If, however, a woman cannot tolerate hormonal contraceptives, then she should consider non-hormonal IUDs or barrier methods as effective alternatives.

SUZANNE LaJOIE, MD: Barrier methods work by creating a physical and a chemical barrier against the sperm to prevent pregnancy. Condoms are a good form of a barrier method and they work by preventing the sperm from getting into the vagina and, therefore, prevent pregnancy. You do increase the effectiveness of condoms if you use a spermicide as well and some condoms have spermicide that are actually on them.

ANNOUNCER: Another non-hormonal solution is the diaphragm.

SUZANNE LaJOIE, MD: A diaphragm is a rubber dome that a woman inserts into the vagina before she has intercourse. She does use spermicide with it and she leaves it in after intercourse and removes it six hours afterwards and it works by, again, that chemical and that physical barrier so that a woman doesn't get pregnant.

A diaphragm can be used six weeks after a woman delivers, but it is important that she gets refitted after she has a baby, because sometimes the size can change and you want to make sure that the fit is correct.

ANNOUNCER: For those women who feel their family units are complete, surgical sterilization may be the solution to contraception with virtually no long-term health effects. The two options are tubal ligation and male vascectomy.

SUZANNE LaJOIE, MD: Some women actually have their tubes tied right after delivery or it can be done at the time of Caesarian section. Alternatively, sometimes women can have it done six weeks postpartum with a laparoscope.

I usually encourage women to really think long and hard about having their tubes tied, because it is irreversible and that's something that's — really needs to be understood and needs to be thought about.

ANNOUNCER: And if you don't want to rely on surgery, devices, injectables, or hormones, natural family planning methods allow a woman to learn about her own body cycles. In doing so, she can calculate when she is fertile and avoid sexual intercourse at those times. Although this may be fairly unreliable until regular menstrual cycles resume.

Whether your choice is a natural method, sterilization, a barrier method, or hormonal contraception, each of these alternatives should be weighed carefully after childbirth. Keep in mind, as you and your spouse get reacquainted in the bedroom, the best and safest sex, is the kind for which you are prepared. (And shhh! Don't wake the baby!)

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