Postpartum contraception

It is day 2 on the postnatal ward. She is feeding her baby, the lochia is settling, and she asks the question every woman who has just given birth asks herself: "What about next time?" This is the moment the conversation is cheapest to have and the most expensive to miss — a woman discharged without a plan is the woman back at 8 weeks pregnant, 5 months after a caesarean. The exam rewards the candidate who can recite the WHO and US medical eligibility categories by heart, name the RANZCOG C-Gyn 3 statement, and run a 90-second reproductive-intention conversation without sounding like they are reading a leaflet.[1][4]

Overview and definition

Postpartum contraception is contraception initiated from the moment of birth through the first 6 weeks — and the timing rules are the whole topic.[1]

• Immediate postpartum: within 10 minutes of placental delivery (post-placental) or up to 48 hours after birth. The window that earns an intrauterine device its uptake advantage and its expulsion premium.[1]
• Interval postpartum: 4 or more weeks after birth — the conventional return visit, where uptake collapses because many women never come back.[1][8]
• Long-acting reversible contraception (LARC): intrauterine device (copper or levonorgestrel) and the etonogestrel implant. The methods that earn the postpartum conversation their reputation for preventing rapid repeat pregnancy.[1][7]

The framework that gates every method is the WHO Medical Eligibility Criteria (and its US counterpart, the US-MEC). Category 1 is no restriction, 2 the advantages outweigh risks, 3 the risks outweigh advantages and clinical judgement is needed, 4 is an unacceptable health risk. Every postpartum method has a category by breastfeeding status and time since birth, and the categories are what the viva tests.[2]

References14Show ledgerHide ledger

1. [1]Lopez LM, Bernholc A, Hubacher D, et al. Immediate postpartum insertion of intrauterine device for contraception Cochrane Database Syst Rev, 2015.PMID 26115018
2. [2]Lopez LM, Grey TW, Stuebe AM, et al. Combined hormonal versus nonhormonal versus progestin-only contraception in lactation Cochrane Database Syst Rev, 2015.PMID 25793657
3. [3]Kennedy KI, Labbok MH, Van Look PF Lactational amenorrhea method for family planning Int J Gynaecol Obstet, 1996.PMID 8842819
4. [4]Jackson E, Glasier A Return of ovulation and menses in postpartum nonlactating women: a systematic review Obstet Gynecol, 2011.PMID 21343770
5. [5]Conde-Agudelo A, Belizán JM, Norton MH, et al. Effect of the interpregnancy interval on perinatal outcomes in Latin America Obstet Gynecol, 2005.PMID 16055588
6. [6]Conde-Agudelo A, Belizán JM Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study BMJ, 2000.PMID 11082085
7. [7]Krashin JW, Rivera-Montalvo M, Leeman L, et al. Breastfeeding after immediate vs delayed postpartum contraceptive implant placement: a noninferiority randomized controlled trial Am J Obstet Gynecol, 2025.PMID 40120732
8. [8]Grimes DA, Lopez LM, Schulz KF, Van Vliet HA, Stanwood NL Immediate post-partum insertion of intrauterine devices Cochrane Database Syst Rev, 2010.PMID 20464722
9. [9]Houvèssou GM, Silveira MFD Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort Rev Saude Publica, 2024.PMID 38381892
10. [10]Lemos MJ, Peloggia A Immediate versus delayed postpartum contraceptive implant on lactogenesis and breastfeeding: a systematic review and meta-analysis Eur J Contracept Reprod Health Care, 2026.PMID 41404833
11. [11]Buppasiri P, Lumbiganon P, Thinkhamrop J, Thinkhamrop B Antibiotic prophylaxis for third- and fourth-degree perineal tear during vaginal birth Cochrane Database Syst Rev, 2014.PMID 25289960
12. [12]Fernando RJ, Sultan AH, Kettle C, Radley S, Jones P, O'Brien PM Repair techniques for obstetric anal sphincter injuries: a randomized controlled trial Obstet Gynecol, 2006.PMID 16738150
13. [13]Committee on Practice Bulletins-Obstetrics Practice Bulletin No. 183: Postpartum Hemorrhage Obstet Gynecol, 2017.PMID 28937571
14. [14]Okeahialam NA, Wong KW, Thakar R, Sultan AH The incidence of wound complications following primary repair of obstetric anal sphincter injury: a systematic review and meta-analysis Am J Obstet Gynecol, 2022.PMID 35550375