Postpartum Contraception

So you’ve had a baby! Contraception is probably the last thing on your mind, but it’s an important conversation to have with a healthcare provider…know your options!

So you’ve had a baby! Contraception is probably the last thing on your mind but, it’s an important conversation to have with a healthcare provider (Midwife, Obstetrician, GP, Family Planning Services) to discuss what will best suit you- and there’s quite the array!

If you are breastfeeding, postpartum contraception options include:

Lactational Amenorrhoea Method (LAM) – When you’re exclusively breastfeeding bub, the hormonal process can effect menstruation, halting ovulation (voila contraception!). The World Health Organisation accepts this as an effective method of contraception, and is considered 98% effective (the same efficacy as the pill) when used according to the guidelines. These guidelines should be discussed with a healthcare provider (this is very important…don’t want any surprises!)

Three criteria can be used to predict the return of your fertility.

  • Have you had a menstrual bleed? (for the purposes of LAM this is defined as any bleeding, on any two consecutive days, that occurs 2 months after the birth)
  • Are you giving regular supplementary foods or foods or fluids to your baby in addition to breastfeeding?
  • Is your infant older than 6 months of age?

If you answer no to all the above three questions, then you potentially meet the requirements for the LAM.

Progesterone only Pill (POP) – Progesterone only pills are considered safe whilst breastfeeding. POP works by thickening the cervical mucosa making it harder for sperm to penetrate. The important thing to note with the mini pill is that it needs to be taken at the same time each day (so set that alarm clock!)…because if you miss it (by 3 or more hours, that window is considered a missed pill, and extra contraceptive precaution will be needed).

Implanon® – is a progesterone implant, which may be suitable from 6 weeks. A conversation for your 6 week check up, perhaps?

Depo-Provera®/ Depo-Ralovera® – Progesterone intramuscular injection. Commence anytime from 6 weeks postpartum.

Mirena® – is an IUD. Dependent on hospital policy/doctor’s policy, the IUD may be able to be inserted within 48 hours postpartum. If this is not possible, it should be left until 4 weeks after childbirth. Its effective within 7 days, lasts 5 years and is a localised progesterone. If at any point you don’t want it anymore, it can be taken out…no 5 year lock in contract!

Note: women who have had a caesarean section should not have a IUD inserted prior to 6 weeks postpartum due to the increased risk of perforation.3

Side note: I have one of these bad boys, and they’re fab! 5 years contraception…tick…peace of mind.

Condoms – Can be used immediately.

Diaphragms – make sure size and fit is correct, and it is advised to wait 6 weeks.

Combined oral contraceptive Pill (COCP) – Not recommended to be used for the first 4-6 weeks. If breastfeeding is established, and no other methods are deemed suitable, this is an option to discuss with your GP etc.  The reason COCP is not recommended for the first 4-6 weeks, is because the combination of hormones can reek havoc with breastmilk supply establishing.

Non-breastfeeding mamas you really are spoilt for choice! All contraceptive methods are suitable. On average, for non-breastfeeding mamas, first ovulation cycle returns 45 days postpartum. 

Don’t take it lying down – evidence on birth positions

When you think of a woman having a baby and the position she assumes, what do you see? The evidence will surprise you…

When you think of a woman having a baby and the position she assumes, what do you see?
I’d always imagined what I saw portrayed in movies* and TV shows* – a woman labouring and pushing on her back. But is this the ideal birthing position?

The majority of Australian women (78%), do indeed assume this position when giving birth to bubs, but when you look at the evidence to suggest this isn’t the optimal position for labour, why the disconnect? Of course, labour and pregnancy alike are exhausting, and I love nothing more than kicking my feet up (not pregnant!) at any given moment, so I see how women gravitate towards the bed…but what does the evidence for everything but the bed, show?

In 2012, a Cochrane study, Gupta et. al was undertaken assigning 7,200 women into two groups; upright positions for birth (birthing stool, kneeling, squatting, all-fours) and non-upright positions for birth (semi-lying, lying down with bed head up, side-lying or in lithotomy (on your back, legs a part) .

When comparing the two groups, the women assigned to upright positions were:

The result of this study concluded that women, without an epidural, should be encouraged to birth in upright positions due to the decreased risk of assisted deliveries (vacuum-assisted or forceps and episiotomy).

When breaking it down logically, being in an upright position – gravity is on your side; the weight of baby and the position of baby is better applied to the cervix…stimulating contractions…helping bub descend and move through the pelvis. Hey Presto!

A midwifery professor, Hannah Dahlen, wrote an article on The Conversation a few years ago, Stand and deliver- upright births best for mum and bub, that looked into why so many women in Australia, do indeed recline to have their babies. The short and simple may indeed be birthing unit design. Like most hospital rooms, the bed takes prime position (pretty convenient for the Midwives and Doctors). To their defence, many women do receive admission CTGs…so immediately they head on over to the bed, get comfy, and then…well 78%…

Being armed with the knowledge of positions to assume in labour, to help bubs work their way down, to relieve back pain etc., is worth investigating. Again, it comes down to what you want, so why not spice things up and try a few, this way you will find out what works for you.

 

e3459e38009cab836a7b6f0c362bdb26

*Movies – Knocked Up, Father of the Bride II, Nine Months, Juno, What to Expect When You’re Expecting

*TV shows – Offspring, Love Child

Vitamin K: Prophylaxis or Poppycock

The Vitamin K injection, does seem to sometimes, albeit unfairly, get lumped into the vaccination category by some people. It’s not a vaccine. More info here…

So I’m putting it out there, I’m pro-vaccination (insert horror and all things evil). I believe in herd immunity, and I believe that vaccinations against nasties such as whooping cough and chicken pox are a good thing! The Vitamin K injection, does seem to sometimes, albeit unfairly, get lumped into the vaccination category, and therefore is shoved into the evil corner by some with all the other vaccines – so this post will be about debunking the Vitamin K ‘vaccination’ and rather putting out there all things Vitamin K ‘injection’ related. It is an injection. Not a vaccination!

Vitamin K is a vitamin that naturally occurs in our bodies and is essential in helping our blood to clot and prevent serious bleeding. Babies cannot produce this for the first few months of life….so consenting to the Vitamin K injection helps bubs have enough Vitamin K to clot their blood (and prevent HDN – a rare bleeding into the brain).

There have been no reported reactions to the injection within Australia, since its implementation 25 years ago. There are two ways in which to give a baby Vitamin K:

1. Injection at birth

2. Oral doses (more complicated- a dose at birth, another 3-5 days old, and at 4 weeks).

There are some medical contraindications as to why you wouldn’t give a bubba Vitamin K… these are if they are sick, premie or if their mama took medication throughout pregnancy for certain reasons (talk to your midwife or doctor if you’re at all concerned).

If you’re seeking more info, it’s a great topic to bring up antenatally with your partner, midwife, obstetrician or GP. Of course at the end of the day, it’s your baby, your call!

For adults wanting to increase their Vitamin K stores within the body, as it is great for bone health (Vit. K helps calcium absorption) eating varied leafy green veggies should do the trick; think spinach, kale, celery as well as carrots, blackberries, raspberries, blueberries, sundried tomatoes….

For more information on Vitamin K please click resources and blog references below:

Vitamin K Royal Hospital For Women NSW

18 Foods high in Vitamin K for stronger bones

Vitamin K in neonates: facts and myths

Vitamin K for newborn babies Australian Government

image via theberry.com
image via theberry.com

The impact of 90 seconds on Bub

1/3 of a baby’s blood it outside of its body at birth. By waiting 90 seconds before cutting the umbilical cord, it has the ability to….

Delayed cord clamping was something I knew nothing about before studying midwifery. I thought, baby comes out…baby goes onto Mum’s chest…the cord gets clamped and cut. But there’s so much more to it!

Delayed cord clamping (waiting 1-3 minutes after birth) is recommended for all births of well babies, not requiring resuscitation, according to the World Health Organisation (WHO) guidelines (2012). This is something that can be carried out for both vaginal and caesarean births. Simply put, it’s waiting until the cord stops pulsing and blood transfusing to the baby is somewhat completed. WHO reported that 29% of all newborn deaths around the planet, are a result of babies not getting enough oxygen at birth (birth asphyxia). So if you consider the ability to increase your baby’s blood supply…increasing its oxygen carrying components (red blood cells)….it’s something to consider.

1/3 of a baby’s blood is outside of its body at birth- the rest is still inside the umbilical cord and the placenta, the way in which Bub has been receiving its oxygen and nutrients for 9 months. By delaying cutting and clamping the umbilical cord by 90 seconds it allows iron-rich, oxygen-rich, stem cell-fuelled blood to enter Bub’s little body. This has the ability to:

  • give your baby 30% more blood
  • give it a natural iron supplement – minimising childhood anaemia risks
  • increase their oxygen carrying cells – whilst they’re transitioning to life outside
  • 60% more red blood cells
  • transfuse stem cells – which prevent and repair damage throughout the body
  • improve systemic blood pressure
  • reduce the chance of baby needing a blood transfusion

Some people are worried that by delaying clamping, you’re giving baby “too much blood”, and there have been reports that delayed cord clamping causes jaundice. The fact of the matter is that since 1980, according to Mercer and Erikson-Owen’s, there has not been a randomised controlled study to show statistically significant findings in a link between increased jaundice levels and symptomatic polycythemia with delayed cord clamped Bubs.

So why isn’t delayed cord clamping happening all the time?! Personally, I believe the reason behind slow reimplementation of it is personal habit of practitioners as well as ‘patience versus intervention’. Living within a fast paced society, sometimes the hardest thing to do, is not much at all. We, as people living in 2015, are all trained for intervention. No one wanders lost (we have GPS and iPhones), we tap cards to pay for just about everything and have access to information (sometimes too much!) at our fingertips. We’re all about what’s next, what’s easiest, what’s faster, what’s quicker… but what if slowing down Bub’s first few moments, and allowing them the time to take a second to soak up as much nutrients as possible, before they’re officially their own little unit, is the first decision you have to make as new parents? It’s something worth reading up on, and making an informed decision about – and let your midwife of doctor know your view. After all, life is fast paced, should it have to start out that way?

00e6d2372e0c662ebbf4a4506cb0cecc

Image via journeyofparenthood

References:

http://www.who.int/elena/titles/full_recommendations/cord_clamping/en/

Alan Greene’s Ted Talk: //www.youtube.com/watch?v=Cw53X98EvLQ

Mayri Sagadi Leslie, 2015, “Perspectives on implementing delayed cord clamping, http://nwh.awhonn.org

%d bloggers like this: