1ST CITY CLINICAL HOSPITAL

03/28/2024

More and more women today know about the benefits of breastfeeding and are doing their best to maintain lactation. At the same time, parents usually want to postpone the birth of another baby.

A woman after childbirth is a high-risk group for unwanted pregnancy. For breastfeeding women, the risk of unwanted pregnancy 6-8 weeks after birth is 20%, for non-breastfeeding women it is 50-60%. Moreover, pregnancy occurring during this period is accompanied by a high risk for the woman and the unborn child. On the other hand, the risk of abortion is also high.

In the hypothalamic-pituitary-ovarian system, due to the cessation of the inhibitory effect on the hypothalamus and pituitary gland of human chorionic gonadotropin and high levels of sex steroids of fetoplacental origin, the production of gonadotropins in the anterior lobe of the pituitary gland is restored, which leads to the resumption of oogenesis in the ovaries.

In non-breastfeeding mothers, menstruation usually resumes within the first 6-8 weeks postpartum, with ovulation occurring at 2-4 weeks postpartum. In nursing mothers, ovulation may occur after the 10th week of the postpartum period. In this regard, the period of contraception due to lactation lasts 8-9 weeks, after which the ovulatory cycle may resume and pregnancy may occur.

Postpartum contraception is the initiation and continuation of the use of family planning methods after childbirth in order to prevent pregnancy during the first 2-3 years after the birth of the child, when a subsequent pregnancy may harm the health of the mother or child.

The question of choosing a method of contraception for most women becomes relevant within 1.5-2 months after childbirth, since the organs of the reproductive system return to normal after an average of 4-6 weeks.

The main requirements for contraceptive methods in the postpartum period are: preservation of full lactation, absence of negative effects on the health and development of the child, high reliability of the method.

The following methods of contraception during lactation are distinguished:

• lactational amenorrhea method (subject to amenorrhea, in the first 6 months after birth, with a maximum interval between feedings of no more than 4 hours during the day and no more than 6 hours at night) - the method is not highly effective;
• barrier methods (a combination of condom and spermicide) Condoms, diaphragms and cervical caps are widely available and do not affect the success of breastfeeding, and their correct use minimizes the risk of contracting STIs. The main disadvantage of this method is the low contraceptive effectiveness, which increases when combined with spermicidal agents, which include vaginal foaming suppositories and tablets, creams;
• tableted gestagen-containing drugs (mini-pills). They do not affect the quantity and quality of breast milk or the duration of lactation, and do not affect the health of the child. You can start taking the pills 6 weeks after birth;

Non-breastfeeding women can start taking combined oral contraceptives from the fourth week

• intrauterine contraceptives (also classified as highly effective methods of contraception). For uncomplicated labor, the optimal time for administration is 6 weeks after birth. The advantages of the method include compatibility with breastfeeding, the contraceptive period is up to 5 years, and the IUD can be removed at any time. VSM is not recommended for women who have had inflammatory diseases of the uterus and appendages both before pregnancy and in the postpartum period.
• surgical methods of contraception. Surgical sterilization using laparoscopic access is widely used. The advantage of the method is the high efficiency and reliability of the method, short stay in hospital conditions. This method can be used in women over 35 years of age who have at least two children or for medical reasons.

It is necessary to separately note emergency contraception with hormonal drugs, the effectiveness of which reaches 75%. The disadvantages of the method are the possibility of uterine bleeding, lack of protection against STIs, and the impossibility of regular and frequent use.

A woman’s correct behavior, knowledge of the changes that occur in her body after childbirth, and her attitude to the doctor’s recommendations are the key to health in the postpartum period.

Every baby needs a healthy and caring mother!

Author: obstetrician - gynecologist (head) of the highest qualification category of the obstetric physiological department of the health care institution "1st City Clinical Hospital", Dvornik E.V.

Date 03/15/2024