Initiation of contraception during the postpartum period (time immediately after giving birth) is important to prevent unintended pregnancy and short birth intervals, which can lead to negative health outcomes for mother and infant (1). Recently, Center for Disease Prevention and Control (CDC) assessed evidence regarding the safety of combined hormonal contraceptive use during the postpartum period. These updated recommendations state that postpartum women should not use combined hormonal contraceptives (i.e., those that contain both estrogen and progestin) during the first 21 days after delivery because of the high risk for venous thromboembolism (VTE or blood clots) during this period. During 21--42 days postpartum, women without risk factors for VTE generally can initiate combined hormonal contraceptives, but women with risk factors for VTE (e.g., previous VTE or recent cesarean delivery) generally should not use these methods. After 42 days postpartum, no restrictions on the use of combined hormonal contraceptives based on postpartum status apply.
Importance of Contraception During the Postpartum Period
Half of all pregnancies in the United States are unintended, and these pregnancies have been associated with adverse pregnancy behaviors and outcomes, including delaying prenatal care, decreased likelihood of smoking cessation, increased incidence of low birth weight, and decreased breastfeeding (3). In addition, short intervals between pregnancies can lead to negative consequences such as low birth weight and preterm birth (4). The postpartum period is an important time to initiate contraception because new mothers are accessing the health-care system and might have increased motivation to avoid another pregnancy. Ovulation can occur as early as 25 days postpartum among nonbreastfeeding women, underscoring the importance of initiating contraception in the very early postpartum period (5).
However, safety of contraceptive use among postpartum women also must be considered. Hematologic (blood) changes that occur normally during pregnancy, including an increase in clotting factors and a decrease in natural anticoagulants that control bleeding, result in an increased risk for VTE during the postpartum period. In addition, many postpartum women have additional risk factors that further increase their risk for VTE, such as age ≥35 years, smoking, or recent cesarean delivery. This is of concern when considering postpartum contraception options because combined hormonal contraceptives are themselves associated with a small increased risk for VTE among healthy women of reproductive age (6).
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1. CDC. MMWR 2009;58:821.
2. CDC. MMWR 2010;59(No. RR-4).
3. Gipson JD, Koenig MA, Hindin MJ. Stud Family Plann 2008;39.
4. Zhu BP. Int J.Gynecol Obstet 2005;89(Suppl 1):S25-33.
5. Jackson E, Glasier A. Obstet Gynecol 2011;117.