Family planning is the capability of couples to determine the size of their family and to space the gap between their children. Family planning is considered one of this century's ten public health achievements. Family planning has resulted in significant improvements in maternal health and the socioeconomic well-being of many families. A closely spaced pregnancy within the first year of childbirth poses risks for both the mother and the child. So, appropriate family planning is essential during this phase. One such way is the use of IUCD. IUCD means intrauterine contraceptive device. The most commonly used intrauterine contraceptive device is the copper T.
What Is a Postpartum Intrauterine Contraceptive Device (PPIUCD)?
An IUCD is a T-shaped small, thin copper wire-coated contraceptive device made of flexible plastic inserted into a woman's uterus by a healthcare professional. It is also referred to as a coil, intrauterine device (IUD), or loop. Postpartum intrauterine contraceptive devices are inserted for women who do not desire a pregnancy immediately after the delivery. The postpartum intrauterine contraceptive device provides effective contraception (use of different methods to prevent pregnancy) to women in the delivery setting. The woman leaves the hospital with effective contraception in place.
How and When Is a Postpartum Intrauterine Contraceptive Device Inserted?
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Researchers have made specific recommendations about when to insert an IUD during the postpartum period.
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Trained clinicians insert a postpartum IUCD during the postpartum (time after childbirth) period.
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PPIUCD can be inserted through the vagina or through cesarean routes.
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It is inserted within 10 minutes of the delivery or 48 hours after childbirth.
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Insertion of IUCD between 48 hours and four weeks after delivery is not usually recommended due to the higher risk of uterine perforation.
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The correct insertion time for IUCD during the postpartum period is either immediate postpartum IUCD insertion, post-placental IUCD insertion, or trans cesarean IUCD insertion.
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Post-placental IUCD Insertion - The insertion of the IUCD happens within 10 minutes of placental delivery, followed by vaginal delivery.
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Postpartum IUCD Insertion - This means the insertion of IUCD within 48 hours of vaginal delivery.
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Trans Cesarean IUCD Insertion - The insertion of IUCD during cesarean delivery. It is inserted after removing the placenta before closing the uterine incision.
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Is Postpartum Intrauterine Contraceptive Device Safe and Effective?
Postpartum IUD insertion is ideal for family planning in the postpartum period to achieve a recommended pregnancy spacing. Intrauterine device insertion is ideal for postpartum women because it does not affect the breastfeeding process, does not interfere with sexual intercourse, and allows women to obtain long-acting, safe, reversible, and highly effective contraception. It is a convenient option for the women and their healthcare providers as it can be done while they are already in the hospital. But due to their chances of expulsion, women should always be informed about the risks of expulsions when the IUCD is inserted during the postpartum period.
What Are the Advantages of a Postpartum Intrauterine Contraceptive Device?
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Insertion of PPIUCD does not affect breast milk's amount or quality.
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There is a reduced chance of heavy bleeding since breastfeeding mothers experience amenorrhea (absence of menstruation).
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In addition, the women get an effective method of contraception before hospital discharge.
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It is also helpful for healthcare providers as additional evaluation and separate clinical procedures are not required. It also saves much procedural time as it is performed on the same day of delivery.
What Are the Disadvantages of a Postpartum Intrauterine Contraceptive Device?
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The expulsion (falling out of the womb) rate of IUD is higher in the postpartum IUCD. This higher expulsion rate is due to changes in the uterus during the postpartum period as the uterus begins returning to its normal size.
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There are chances of slight pain during the insertion of PPIUCD. Mild bleeding or spotting was also noted.
What Factors Affect the Use of Postpartum Intrauterine Contraceptive Devices?
Factors like educational status, occupation, partner support, counseling, age, pregnancy care, good knowledge about PPIUCD, and awareness about an IUCD are the factors that were shown to affect the use of postpartum intrauterine contraceptive devices.
What Is an Interval Intra Uterine Contraceptive Device?
Interval intrauterine contraceptive devices are devices used to prevent pregnancy that can be inserted anytime during the menstrual period (when the woman is not pregnant) or any time after 4 - 6 weeks of childbirth or delivery.
How Is an Interval Intra Uterine Contraceptive Device Inserted?
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An IUD can be inserted any time after four to six weeks of childbirth or delivery or during the menstrual cycle.
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Before the insertion of the IUD, the healthcare provider will check the position and size of the patient's womb from the insides of the vagina.
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The person will also be tested for other infections like sexually transmitted diseases.
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The insertion of an IUD will not take more than five minutes; however, the whole appointment can take about 20 to 30 minutes.
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For the procedure, the vagina is held open, and the intrauterine device is inserted through the cervix into the womb from the vagina.
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The intrauterine contraceptive device usually has two thin threads hanging from the womb to the top of the vagina.
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The healthcare provider that fits the IUD would usually teach the female to feel the threads and check whether it is still in place.
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It is usually recommended to check whether the intrauterine contraceptive is in place a few times in the first month and after each menstrual period.
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It is highly unlikely for the IUD to come out, but if the thread is not felt or looks like it is not in place, do visit the doctor.
What Are the Main Differences Between a Postpartum Intra Uterine Contraceptive Device and Interval Intra Uterine Contraceptive Device?
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In an interval IUCD, the expulsion rate (chances of the contraceptive device falling out) was low. But for an immediate postpartum or an early postpartum IUCD, the expulsion rate was seen to be moderately or slightly higher.
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Chances of perforation of the uterus are seen in an interval IUCD. But there is a low risk of uterine perforation in a PPIUCD compared to interval IUCD because of the thick wall of the uterus due to pregnancy.
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Due to normal uterine changes, initial side effects of the IUD, like cramping or bleeding, won't be felt or known in a PPIUCD. But in an interval IUCD, these side effects can cause discomfort and problems in women.
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The chances of infection in PPIUCD are very low compared to an interval IUCD.
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Even though the expulsion rates for postpartum IUD insertion are high, they offer numerous advantages over an interval IUCD.
Conclusion:
Postpartum intrauterine contraceptives and interval intrauterine contraceptive devices are effective devices used to prevent pregnancy. Even though PPIUCD has more advantages than an interval IUCD, choosing birth control is always an individual choice. So, it is recommended to discuss it with the healthcare provider and choose the appropriate birth control option.
