Episode Transcript
Dr. Jones: You just had your first baby. I mean JUST and the doctors ask you what you want to use for contraception. You blink, go blank, and say, "I'll think about that later." But the best time to think about planning your next baby might be right now. This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at the Ï㽶ÊÓƵ of Utah Health Care, and this is postpartum contraception on The Scope.
Announcer: Covering all aspects of women's health, this is The 7 Domains of Women's Health with Dr. Kirtly Jones on The Scope.
Dr. Jones: Traditionally women and doctors have talked about planning for the next baby and spacing your children at the six week postpartum visit. And that's good, but a very high percent of women have already had sex before their first postpartum visit, and a very high percent of women don't even go to their postpartum visit.
Life and the new baby get in the way but there is a very good evidence that it's a very good idea to space your children at least two to three years apart. So what's the evidence? First, there's the case for the mom. Mom needs to have their uterus to heal, especially if they've had a caesarean and about one out of five women American women are going to have a caesarean, and in some places, one in three. And babies born sooner than 18 months from the last pregnancy are more likely to be smaller and more likely to be premature.
And women, hopefully, can breastfeed for 6 to 12 months, which is pretty good contraception, and another pregnancy can get in the way of breastfeeding. So women who've had a caesarian and get pregnant right away are more likely to tear open their uterine scar, rupture their uterus.
But babies need extra time too. We mentioned breastfeeding, but there's also very important mom time that helps with language development and emotional development. Some studies suggest that the ideal spacing for babies is three years apart. Kids should be able to walk, talk, feed themselves, and other important bodily functions before they face competition from another kid. Kids born closer than three years apart are less likely to be reading-ready when they start for school. So why should you think about planning for your next baby right after you've had one, and what can you do?
Number one. If you don't do something, you could get pregnant as soon as 28 days after delivery. This is the earliest that non-breastfeeding women can ovulate after the delivery. Babies born within the same year are affectionately called 'Irish twins'.
Two. You could use breastfeeding as your contraceptive method, but you have to breastfeed exclusively. No bottles, no formula, no food, no juice, no sleeping through the night.
Three. If you're sure that you've finished your family, you can consider having your tubes tied while you're still in the hospital; sometimes, within hours or so of delivery. Of course, you can send your man to have his tubes tied while you're recovering in the hospital from your delivery.
Four. You can have low dose hormonal implant put in your arm in the hospital before you go home. It doesn't affect breastfeeding and it lasts three years.
Five is to have an IUD placed right after the baby and the placenta come out. If you've had a caesarian section, it can be placed right in the operating room, and then you don't have to think about it. You'll have 5 to 12 years of protection depending on what kind of IUD you choose, or you can it removed in a couple of years and plan your next baby.
Are there problems with putting in an IUD so soon? There's an increased chance that it might fall out. The uterus is big, the IUD is tiny, and the cervix is open from the birth. Your doctor should check when you come back for a visit that it's in the right place if you have it placed right after the baby is born. Another problem is not all doctors know how to do this, but we've been doing this at the university hospital for several years now. Insurances may not want to pay for a contraceptive method that usually is done in the clinic when it's done at the time of birth, but several states have taken steps to remove this barrier.
If you're interested in any of these options, make sure that you talk with your doctor or midwife during your pregnancy so they can be ready to get you what you need after you deliver. Putting some time between babies is good for moms and good for babies. Think about what you would like to do and talk about it with your health care provider when you're pregnant. We can give you options that are highly effective and highly reversible and highly forgettable until you're ready for your next baby.
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