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Post Natal Contraception
After having a baby, many women want to be able to prevent another pregnancy in the near future. The choices a woman has, depends on her needs and whether she is breast feeding or
Lactational Amenorrhoea
This literally means having no periods when one is breast feeding. This gives a woman the indication that she has yet to return to fertile, ovulating menstrual cycles. It is not100% reliable. If a woman is fully breast feeding her infant (no supplement feeding), is six months or less post delivery, and has had no resumption of periods, there is 98% protection from pregnancy. After six months, this protection rate reduces.
Breast Feeding
When breast feeding, many types of contraception are safe. A good discussion with your doctor will cover the reliability of each method and the safety for you and your baby. They will also be able to discuss current research with you which will assist you in making an
Suitable methods for breastfeeding women are:

Mini Pill:
• A progesterone only pill, which is taken at the same time every day. • Can be started immediately but best to wait until any bleeding has settled, so 3 - 6 weeks post delivery is often recommended. • Is effective after 3 pills are taken (48 hours).
Depo Provera:
• Medroxyprogesterone acetate; an intramuscular injection taken every 12 weeks. • Best to be started 6 weeks post delivery to reduce bleeding problems.
Implanon:
• A progesterone only implant. The implant is approximately the size of a matchstick and is inserted in the inner upper arm. It releases progesterone slowly for up to three years (it can be removed before that if required). • Can be started 6 weeks post delivery. Milk volumes are not reduced and hormonal transfer to the milk is very low when using these Version No: 1
Date Approved: Sept 2008
Date for Review: Sept 2011
Original Approval Date: Sept 2008
IUD: Copper and Mirena
• The copper IUD is an intrauterine device placed in the uterus during a minor procedure: it works to inactivate the sperm and provide a changed intrauterine environment that prevents implantation of a fertilised egg. • It can be placed in the uterus 4 - 6 weeks post a normal vaginal delivery and 12 weeks • A copper IUD lasts for five to ten years and can be removed before this if required. • The Mirena IUD is an intrauterine device placed in the uterus during a minor procedure. The shaft of the Mirena has a progesterone hormone infused section that releases progesterone slowly over five years. This acts to reduce bleeding which can sometimes be a problem for Copper IUD users. The Mirena changes the intrauterine environment, thus preventing the implantation of the fertilised egg. • It can be placed 6 to10 weeks post a normal vaginal delivery and 12 weeks post a Caesarean section delivery. The Mirena IUD lasts for five years but can be removed
Diaphragm:
• A dome shaped rubber cap with a flexible ring that fits into the vagina and covers the cervix. It acts as a barrier preventing sperm entering the cervix. • It can be used as soon after delivery as is comfortable, but as the birth canal has been stretched for delivery, a fitting is best done at least 6 weeks after delivery. If a diaphragm was used before pregnancy, a re-fitting must done as the shape of the vagina will have
Cervical Cap:
• A dome shaped rubber cap that fits directly onto the cervix. It acts as barrier preventing • It can be used as soon after delivery as is comfortable. The cervix should return to normal
If not breast feeding, all the above methods can be used, plus:

The Pill:
• Is a pill taken every day, containing the combination of oestrogen and progestogen • Can be started 3 weeks after delivery. • It will be effective after seven hormone tablets are taken. Version No: 1
Date Approved: Sept 2008
Date for Review: Sept 2011
Original Approval Date: Sept 2008
The Mini Pill:
Can be started immediately but best to wait until any bleeding has settled, so 3 - 6 weeks post
Depo Provera:
• Can be started after 48 hours but best to wait until any bleeding has settled, so 3 - 6 weeks
Implanon:
• Can be started at 6 weeks post delivery to avoid any bleeding problems.
Diaphragms and Cervical Caps:
• Can be started as soon after delivery as comfortable, they may need to be refitted - see
Copper and Mirena IUD

Sterilisation:
For women who want permanent contraception, sterilisation is an option. Tubal Ligation can be performed at the same time as a Caesarean section birth but there is a slightly increased risk of failure. Tubal Ligation is best performed at least three months post delivery and in Australia is performed under general anaesthetic. There appear to be more regrets felt by women, if Tubal Ligation is performed within a year of the birth of a child. The failure rate is approximately 2 to 3 per 1000. An alternative to Tubal Ligation which does not requires a general anaesthetic, is the insertion of micro-coils, Essure pbc, into the fallopian tubes. This procedure can be performed under local anaesthetic while the patient is awake. This procedure is permanent and unlike tubal ligation, can never be reversed. Vasectomy is the sterilisation option for men. Under local anaesthetic the spermatic cord is cut to prevent sperm from reaching the ejaculate. Failure rate is approximately 1 to 2 per 1000. See the FPV Sterilization pamphlet for more detailed information on these procedures. For further information on benefits, side effects and details of the mechanism of action regarding the above methods, see the individual FPV pamphlets and approved literature. A full discussion with your doctor will also help aid your decision. Version No: 1
Date Approved: Sept 2008
Date for Review: Sept 2011
Original Approval Date: Sept 2008

Source: http://www.wrhs.org.au/consumer/images/Post_Natal_Contraception_Brochure.pdf