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Postpartum contraception: A matter of guidelines.

Giovanni Grandi1, Maria C Del Savio1, Alice Tassi2

  • 1Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy.

International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics
|June 19, 2023
PubMed
Summary

Postpartum family planning offers diverse contraceptive options. Guidelines vary on combined hormonal contraceptives for breastfeeding mothers, emphasizing personalized choices for postpartum contraception.

Keywords:
breastfeedingcontraceptionintrauterine devicelong-acting reversible contraceptionpostpartum periodsubcutaneous implantthrombosis

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Area of Science:

  • Reproductive Health
  • Family Planning
  • Obstetrics & Gynecology

Background:

  • The postpartum period is a critical window for initiating family planning services.
  • Existing guidelines present discrepancies regarding the use of combined hormonal contraceptives (CHCs) in breastfeeding postpartum individuals.

Purpose of the Study:

  • To analyze and compare international guidelines on postpartum contraception, focusing on hormonal methods, implants, and intrauterine devices (IUDs).
  • To highlight variations in recommendations for breastfeeding versus non-breastfeeding postpartum individuals.
  • To emphasize the importance of individualized contraception selection over strict adherence to guidelines.

Main Methods:

  • Comparative analysis of World Health Organization (WHO), Faculty of Sexual and Reproductive Healthcare (FSRH), and Centers for Disease Control and Prevention (CDC) guidelines.
  • Review of recommendations for combined hormonal contraceptives, progestin-only pills, implants, and IUDs in the postpartum period.
  • Examination of timing recommendations for postpartum contraceptive insertion, including postplacental IUD placement.

Main Results:

  • WHO contraindicates CHCs in breastfeeding individuals (6 weeks–6 months postpartum, MEC category 3), while FSRH and CDC permit their use.
  • Progestin-only pills and implants are generally recommended for non-breastfeeding postpartum women (MEC category 1).
  • Guidelines differ on IUD insertion timing, with postplacental insertion showing potential to reduce unintended pregnancies, especially in high-risk settings.

Conclusions:

  • Significant variations exist in postpartum contraceptive guidelines, particularly for CHCs in breastfeeding women.
  • Implants and IUDs are viable options, though timing recommendations vary.
  • Postpartum contraception should prioritize individualized patient needs and optimal timing rather than solely relying on guideline adherence.