Now we will review contraceptive options for breastfeeding
women according to the timing of initiation.
Women who are fully breastfeeding and want to use LAM can begin
doing so immediately after childbirth. LAM is considered to
be effective for up to six months. No additional contraceptive
method is needed. However, women who cannot or choose not to
rely on LAM have the following contraceptive options.
Condoms and spermicides can be initiated at any time postpartum.
IUD insertion can be performed within the first 48 hours after
birth, and female sterilization can be performed within the
first week of birth (although preferably within 48 hours). Otherwise,
these two procedures should be postponed until four to six weeks
postpartum. Male sterilization, or vasectomy, can be performed
anytime during this period and withdrawal can be used anytime
as well.
At six weeks postpartum, all of the methods mentioned above
can be used. In addition, diaphragms, cervical caps and progestin-only
methods can be initiated. Periodic abstinence may be difficult
to use because breastfeeding women may not have signs of fertility
or, if they do, the signs may be difficult to interpret. However,
women who choose to use periodic abstinence should begin keeping
track of their menstrual cycles and watching for signs of fertility
at six weeks postpartum.
LAM can be effective for up to 12 months for some women who
are fully breastfeeding; however, it is generally considered
ineffective after six months postpartum. At this time, any of
the other methods mentioned above may be initiated. In addition,
combined hormonal contraceptives can be initiated at this time,
although they are still not a preferred option for breastfeeding
women.
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