O&G · Postpartum care — contraception and reproductive planning
Postpartum contraception
Also known as Postnatal contraception · Postpartum family planning · LARC after birth · Post-placental IUD · Lactational amenorrhoea method · LAM
Exam-exhaustive FRANZCOG fellowship reference on contraception after birth — when ovulation returns, the LAM triad and its 98% perfect-use figure, the WHO/US-MEC postpartum categories, immediate versus interval intrauterine device placement and the expulsion trade-off, the implant-in-lactation evidence, the combined hormonal contraception window, sterilisation counselling, and the reproductive-justice conversation that frames every visit. RANZCOG C-Gyn 3 anchored, globally tagged to MRCOG and ABOG.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- A woman who has unprotected intercourse at 4 weeks postpartum and is not exclusively breastfeeding — she may already have ovulated
- Combined hormonal contraception prescribed before 6 weeks in a breastfeeding woman — the WHO MEC category 4 window
- Consenting a woman for tubal occlusion during labour — coercion risk and the rule that consent in labour is invalid
- Telling a woman 'breastfeeding is your contraception' without checking the three LAM criteria
- Quoting only the expulsion rate of immediate PPIUD and omitting the uptake benefit
- Missing the woman who does not return for a 6-week visit — the equity failure that drives rapid repeat pregnancy
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 moment 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]
References14ShowHide
- [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]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]Kennedy KI, Labbok MH, Van Look PF Lactational amenorrhea method for family planning Int J Gynaecol Obstet, 1996.PMID 8842819
- [4]Jackson E, Glasier A Return of ovulation and menses in postpartum nonlactating women: a systematic review Obstet Gynecol, 2011.PMID 21343770
- [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]Conde-Agudelo A, Belizán JM Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study BMJ, 2000.PMID 11082085
- [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]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]Houvèssou GM, Silveira MFD Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort Rev Saude Publica, 2024.PMID 38381892
- [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]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]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]Committee on Practice Bulletins-Obstetrics Practice Bulletin No. 183: Postpartum Hemorrhage Obstet Gynecol, 2017.PMID 28937571
- [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