06-29-2011, 09:26 AM
Combined Hormonal Contraception
CHC should not be commenced before Day 21 due to the increased risk of thrombosis. Non-breastfeeding women may start CHC from Day 21 postpartum (Grade C).
Breastfeeding women should avoid CHC in the first 6 weeks postpartum as there is insufficient evidence to prove the safety of CHC use while establishing breastfeeding (Grade C).
Use of CHC between 6 weeks and 6 months should not be recommended in fully breastfeeding women unless other methods are not acceptable or available. In partially or token breastfeeding women the benefits of CHC use may outweigh the risks (Good Practice Point).
Progestogen-only Pill
Postpartum women (breastfeeding and non-breastfeeding) can start the POP at any time postpartum (Good Practice Point).
Progestogen-only Injectables
Non-breastfeeding women can start a progestogen-only injectable method at any time postpartum (Grade C).
Breastfeeding women should not start a progestogen-only injectable method before Day 21 unless the risk of subsequent pregnancy is high (Grade C).
Women should be advised that troublesome bleeding can occur with use of depot medroxyprogesterone acetate (DMPA) in the early puerperium (Grade C).
Progestogen-only Implants
If more convenient, breastfeeding and non-breastfeeding women can choose to have a progestogen-only implant inserted before Day 21, although this is outside the product licence for Implanon® (Good Practice Point).
Intrauterine Methods
Unless a copper-bearing intrauterine device (Cu-IUD) can be inserted within the first 48 hours postpartum (breastfeeding and non-breastfeeding women), insertion should be delayed until Day 28 onwards. No additional contraception is required (Grade C).
An LNG-IUS can be inserted from Day 28 postpartum (breastfeeding and non-breastfeeding women). Women should avoid sex or use additional contraception for 7 days after insertion unless fully meeting LAM criteria (Grade C).
Barrier Methods
Women who choose a diaphragm or cervical cap should be advised to wait at least 6 weeks postpartum before attending for assessment of size requirement (Grade C).
Sterilisation
Women and men considering sterilisation should be informed of the permanence of the procedure; about the risks, benefits and failure rates associated with sterilisation; and about other methods of contraception including LARC (Good Practice Point).
Emergency Contraception
Women can be advised that unprotected sexual intercourse (UPSI) or contraceptive failure before Day 21 postpartum is not an indication for emergency contraception (Good Practice Point).
Women can be advised that progestogen-only emergency contraception (POEC) can be used from Day 21 onwards and the emergency Cu-IUD from Day 28 onwards (Good Practice Point).