Clinical Considerations
Assessing patient candidacy
Immediate postpartum LARC is safe and effective for most women and should be offered routinely as an option for postpartum contraception.
This section contains published guidance, including assessing patient candidacy and contraindications to immediate postpartum LARC placement.
Expulsion
Despite the higher expulsion rate of immediate postpartum IUD placement over interval placement, evidence strongly suggests the superiority of immediate placement in reduction of unintended pregnancy.
This section addresses research and guidance on immediate postpartum IUD expulsion.
Breastfeeding
Systematic review findings show that progestin-only contraceptives do not appear to adversely affect a woman’s ability to successfully initiate and continue breastfeeding or an infant’s growth and development. Given available evidence, women who are considering immediate postpartum hormonal LARC should be counseled about the theoretical risk of reduced duration of breastfeeding, but that the preponderance of the evidence has not shown a negative effect on actual breastfeeding outcomes.
This section addresses research and guidance on immediate postpartum hormonal LARC use and breastfeeding.
Insertion & Removal
Insertion of IUDs immediately postpartum requires a different set of skills than for interval placement. The technique for implant placement immediately postpartum does not differ from that for interval insertion.
Follow up may be required for women who have received LARC immediately postpartum for routine or special cases.
This section reviews methods for placing IUDs following both vaginal and caesarean birth, and how to receive the FDA required training for implant insertion. It also includes information on removal of LARC devices placed immediately postpartum.
