Introduction
Postpartum IUD placement is necessary because the postpartum period is a significant time to consider a patient's need for contraception. Postpartum IUD placement is most successfully implemented in a setting of shared decision-making where patients are fully informed of all available options and assisted in choosing the ones that best suit their lifestyle.
Both hormonal and non-hormonal IUDs are advantageous, extremely effective, and well-tolerated options. The placement of IUDs is recommended per the national guidelines, whether immediate (within ten minutes of placental delivery) or early postpartum (after ten minutes but before four weeks after placental delivery).
How Is the Postpartum IUD Placement Made Effective?
The most successful implementation of a postpartum contraception program takes place in a setting of shared decision-making, where patients are fully informed about all available options and guided towards reliable methods to use in their situation and effectively meet their needs and preferences for lifestyle. Shared decision-making also considers the needs and preferences of patients who do not want to use contraception after giving birth regarding family planning.
Although the optimal time to discuss family planning has not been determined, an analysis of the pregnancy risk assessment monitoring system found that patients who received contraceptive counseling either prenatally or postpartum were twice as likely to choose an effective method of contraception postpartum, mainly if counseling occurred both prenatally and postpartum, when compared to patients who received no counseling.
What Is the Best Time for IUD Placement?
It is crucial to consider a patient's need for contraception during the postpartum period. Within the first two years following childbirth, nearly two-thirds of patients across 21 countries report a lack of family planning services.
The mean day of first ovulation in patients who are not breastfeeding has been measured as early as 45 days postpartum, allowing for rapid repeat pregnancy. Furthermore, 53 % of patients begin sexual activity six weeks after giving birth, so family planning counseling before the postpartum visit is essential. Finally, a lot of patients skip the postpartum visit.
This implies that there are many obstacles in the way of visiting the physician, that the visit is not required for women who are recovering well after giving birth, or that patients who choose not to return for this visit will require alternative health care delivery. Additionally, immediate placement of postpartum LARC (long-acting reversible contraception) is the best practice.
What Is the Technique Involved?
Briefly, prepare the vagina and cervix for vaginal delivery by switching to a new pair of sterile gloves after the placenta is delivered. To view the cervix, depress the posterior vagina using a vaginal retractor or the rear blade of a speculum. A ringed forceps should be placed on the cervix's anterior lip.
This straightens the cervical canal's curve by applying traction to the cervix. A ringed or placental forceps is used to gently grasp the IUD at its vertical shaft while angling it slightly away from the IUD strings after it has been taken out of its inserter. Be careful not to crush the IUD's shaft by holding it like an egg.
Put the IUD into the lower uterine segment and cervix using the forceps. To further straighten the lower uterine segment's curve and direct the forceps/IUD to the fundus, set the forceps or IUD holding the cervix aside and use the other hand to palpate and gently depress the fundus. Before removing the forceps from the uterus, open them once it has reached the fundus and move them laterally away from the shaft to prevent transferring the IUD. Cut the strings at the external OS level.
Similar techniques are used during cesarean deliveries, but the IUD is placed at the fundus using ringed forceps before closing the hysterotomy. After completing the hysterotomy, the IUD's strings should be tucked towards the cervical OS. While reaching the fundus after vaginal delivery with the shorter copper IUD inserter may be more challenging, some clinicians choose to use it instead of forceps for immediate postpartum IUD placement.
What Are the Complications?
The following are a few of the more typical IUD side effects: During IUD placement, one may experience cramping and discomfort. Following the placement of an IUD, these symptoms may last for a few days or weeks. If someone tried a pill, patch, or ring in addition to other hormonal methods, it is familiar to have adverse effects like headaches, sore breasts, and mood swings. Similar side effects are possible with hormonal IUDs, but the good news is that they typically subside after a few months of use.
Ovarian cysts can develop in some hormonal IUD users. Although it sounds frightening, they typically disappear on their own and are not dangerous. For a few months, copper IUDs may result in heavier clotting or spotting between periods. Hormonal IUDs tend to reduce menstrual cramping.
A few side effects happen less frequently. One can always discuss your concerns with a doctor, who can assist in balancing the advantages of birth control against the risk of side effects. The uterus may occasionally force out the IUD. This is most likely to happen during the first few months of use.
Someone who has recently given birth is slightly more likely to experience it. The IUD can get stuck in the side of the uterus in extremely uncommon situations. This most frequently occurs during insertion. Although it may sound alarming, this usually doesn't hurt or have long-term effects.
Surgery may be required to remove it in some circumstances (again, scarce). Most doctors will perform a follow-up exam 4 to 6 weeks after IUD insertion to ensure the device is still positioned correctly. One can also find out if something feels different by frequently checking where the IUD strings are. In most cases, the strings' placement indicates something is not right.
The infection could quickly spread to your uterus if you already have a genital infection when the IUD is implanted. To avoid this, many doctors will perform an STI (sexually transmitted infections) check before inserting an IUD.
Conclusion
The higher risk of IUD expulsion with postpartum placement versus interval placement is likely compensated for by greater access to placement. The technique for placing a postpartum IUD differs slightly from that of interval placement, but it is easily taught. Finally, postpartum IUD placement can be successfully implemented in hospitals using a team-based approach and self-monitoring of outcomes.
