Women can use birth control right after giving birth, experts say

The use of contraceptives soon after childbirth is still a subject little discussed in the prenatal routine. According to Mariane Nunes de Nadai, a professor at the Faculty of Medicine of the University of São Paulo – Bauru, a specialist in human reproduction and contraception, it is, however, a matter of paramount importance and should be proposed for discussion by patients to their gynecologists. early in pregnancy.

According to Febrasgo (Brazilian Federation of Gynecology and Obstetrics Associations), unplanned pregnancy affects a large number of women in Brazil and in the rest of the world.

More than 100 million or approximately 18% of those living with their partners in developing countries want to avoid it but do not use contraception. In our country, about 55% of women get pregnant without planning.

This reinforces the importance of the culture of family planning, with measures instituted since prenatal care, which can also be carried out in the immediate postpartum period. These actions, experts say, could have a major impact on reversing this scenario, leading to a reduction in unplanned pregnancies and an increase in the interval between pregnancies.

There are many safe methods. It is up to the obstetrician-gynecologist to indicate what best suits the needs and particularities of the patient.

Oral contraceptives, also known as the pill, one of the methods most used by women, are contraindicated in some situations. The “drawback”, so to speak, is having to remember to take it daily to ensure effectiveness.

Among the reversible and highly effective long-term contraceptive methods available in the country are IUDs (intrauterine devices) and implants.

Copper and progestogen IUDs, as well as the etonogestrel implant, can be inserted in the immediate postpartum period. The puerperal woman can even leave the maternity hospital with the device in the vast majority of cases, after discharge from childbirth.

The copper IUD is a T-shaped device inserted into the endometrial cavity. In this way, it releases copper ions that immobilize the sperm, making fertilization difficult. Efficacy is 99.4%, lasting from three to ten years.

Hormonal IUDs, on the other hand, act on the cervical mucus, preventing the passage of sperm, also altering the motility (movement) of the tubes. Basically, they release low doses of progesterone, in a controlled way, leaving the uterine layer thin, decreasing or even ceasing the menstrual flow. The hormonal IUD has no estrogen in its composition and its effectiveness is 99.7%.

The subdermal contraceptive implant, in turn, is a contraceptive device inserted in the forearm, under the skin. It releases the hormone etonogestrel, which is a progestogen, into the bloodstream.

This hormone blocks the ovulatory action of the ovaries, in addition to increasing the hostility of cervical mucus, reducing the ability of sperm to move into the cavity of the uterus.

Nadai points out that, in the first weeks postpartum, the patient cannot use anything with estrogen, as there is a greater risk of thrombosis. Also, breastfeeding women should not use estrogen for six months after giving birth.

Finally, Nadai reinforces the importance of increasing the intergestational interval, that is, of having greater distance between pregnancies. The shorter these time windows, the more risks there are for the mother and baby, increasing the chances of maternal and fetal death.