- Specially trained providers can safely insert IUDs:
- immediately after delivery of the placenta
- during cesarean section
- within 48 hours of childbirth
- If not inserted within 48 hours, delay 4-6
weeks
Clients should be counseled that
postpartum IUD insertions
have higher expulsion rates than do interval insertions
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The copper IUD is a long-acting and reversible method that
can be safely inserted postpartum if providers have proper training.
Postpartum insertion is convenient for the woman and may be
her only opportunity to obtain an IUD. However, like all women,
women postpartum should be carefully screened to determine if
they are at risk of STDs. The device can be inserted if laboratory
testing rules out the presence of an STD. If women are at risk
for STDs and laboratory testing is not possible, IUD use is
not recommended.
Insertion can be safely performed vaginally immediately after
the delivery of the placenta or during a cesarean section (through
the uterine incision) as long as the woman has been counseled
and has chosen the method well in advance of childbirth. If
not done immediately, insertion can be performed safely within
48 hours after childbirth.
Postpartum insertion of copper IUDs poses no greater risk of
infection, bleeding or perforation than insertion at other times.
However, IUD expulsion rates are higher for postpartum insertions
(especially those taking place after the first 10 minutes after
placental delivery) than for interval insertions (those taking
place any time after six weeks postpartum). Clients who have
IUDs inserted within the 48 hours postpartum should be told
that the risk of expulsion is greater and taught how to check
IUD strings to ensure that the device is still in place.
If an IUD insertion is not performed within 48 hours after
delivery, WHO recommends that insertion be delayed at least
four to six weeks. This recommendation is based on earlier observations
that the risk of perforation is greater for postpartum insertions
of older IUDs, such as Lippes Loop. With copper IUDs, it has
been shown that there is no increased risk of perforation when
inserted during the first 48 hours postpartum or after four
weeks postpartum. However, there are no data on the risk of
perforation between 48 hours and four weeks.
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