CONTRACEPTION DURING POSTNATAL PERIOD

Contraception during postnatal period

Contraception during postnatal period

Introduction

Each year, more than 100 million women worldwide make decisions about the use of a method of contraception after childbirth.These decisions include not only making a choice regarding a contraceptive method but also deciding the best time for initiation of the chosen method. These decisions may be more complex for breastfeeding women, because both the choice and timing of hormonal methods of contraception may effect both milk production and infant growth and development. (Hatcher, et al., 2004)

It has been well documented that breastfeeding provides excellent nutrition for infants as well as protection against a variety of infectious diseases, including lower respiratory infections and otitis media. There is also strong evidence that mothers who breastfeed have reduced postpartum bleeding, more rapid uterine involution, and delayed resumption of ovulation with increased child spacing. Setty-Venugopal observed that a 3-year interval between births decreases neonatal and postneonatal mortality as well as child mortality for the second child. Longer birth intervals also decrease maternal complications such as third-trimester bleeding, postpartum endometritis, and anemia. Therefore, spacing of births by using contraception after childbirth provides important health benefits for mothers as well as their offspring. This article provides a brief review of the physiology of lactation and the contraceptive effect of lactation. The literature regarding the use of contraception in lactating women is reviewed. One important caveat is that most of the research on this topic was conducted during the 1970s and 1980s; little additional research has been conducted in the past 20 years.

Physiology Of Lactation

The two primary hormones that are needed for lactation are prolactin and oxytocin. Prolactin stimulates milk biosynthesis within the alveolar cells of the breast and oxytocin stimulates contraction of the myoepithelial cells that surround the alveoli, causing the milk to be ejected into the ducts leading to the nipple. Breast growth is stimulated by increasing prolactin secretion throughout pregnancy. Lactation is inhibited during pregnancy by progesterone produced by the placenta. Progesterone interferes with prolactin binding to the receptors on the alveolar cells within the breast, thereby directly suppressing milk production. The hormonal trigger for the initiation of lactation after birth is primarily the rapid decline in the level of placental progesterone. The amount of milk produced is correlated with the amount that is removed with suckling. The optimal quantity and quality of breast milk are also dependent on other factors, such as the availability of thyroid hormone, insulin and insulin-like growth factors, cortisol, and the intake of nutrients and fluids. (Speroff et al., 2005)

Contraceptive Effect of Lactation

Lactation itself has a contraceptive effect and is a vitally important factor in child-spacing and limiting family size in developing countries. Elevated levels of prolactin that occur with breastfeeding inhibit the pulsatile secretion of gonadotropin-releasing hormone from the hypothalamus. This in turn interferes with the hypothalamic- pituitary- ovarian axis, preventing estrogen secretion and ovulation. With weaning, prolactin levels decline and ovulation resumes within 14 to 30 days.5 The lactational amenorrhea method (LAM) relies on breastfeeding ...