Contraception and breastfeeding.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington DC 20007-2113, USA.Clinical Obstetrics and Gynecology (Impact Factor: 1.53). 10/2004; 47(3):734-9. DOI: 10.1097/01.grf.0000139710.63598.b1
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ABSTRACT: Injectable contraception includes progestin-only and combined estrogen and progestin agents that provide safe and highly effective birth control for one to three months. Injectable agents are widely available and play an important role in family planning programs worldwide. Depot medroxyprogesterone acetate, available for intramuscular injection and subcutaneous injection, is the best known and most broadly distributed injectable contraceptive agent, and is an ideal agent for women who have contraindications to estrogen use. Despite their effectiveness, progestin-only injectables are associated with high rates of discontinuation due to bothersome side effects including abnormal bleeding, health controversies including decreased bone mineral density, and increased risk of human immunodeficiency virus acquisition. Injectables do offer non-contraceptive benefits including symptom control related to endometriosis and fibroids, and decreased risk of endometrial cancer. Research is ongoing to determine new injectable hormone formulations that provide longer-acting contraceptive protection and fewer side effects.01/2015; DOI:10.1007/s13669-014-0106-7
Article: Postpartum Contraception[Show abstract] [Hide abstract]
ABSTRACT: As birth spacing has demonstrated health benefits for a woman and her children, contraception after childbirth is recognized as an important health issue. The potential risk of pregnancy soon after delivery underscores the importance of initiating postpartum contraception in a timely manner. The contraceptive method initiated in the postpartum period depends upon a number of factors including medical history, anatomic and hormonal factors, patient preference, and whether or not the woman is breastfeeding. When electing a contraceptive method, informed choice is paramount. The availability of long-acting reversible contraceptive methods immediately postpartum provides a strategy to achieve reductions in unintended pregnancy.Clinical Obstetrics and Gynecology 09/2014; 57(4). DOI:10.1097/GRF.0000000000000055 · 1.53 Impact Factor
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ABSTRACT: Abstract Background: This study describes the patterns of planned use and actual receipt of immediate postpartum depot medroxyprogesterone (DMPA) prior to hospital discharge among low-income breastfeeding initiators. Materials and Methods: Bivariate analyses among DMPA recipients by prenatal planned/unplanned use and the sensitivity of DMPA self-report relative to pharmacologic record were calculated. Results: Among immediate postpartum DMPA recipients (n=58), 72.4% (n=42) did not plan to use DMPA. The sensitivity of self-reported DMPA use was 89.7% (95% confidence interval, 85.2, 94.2). Conclusions: Clinically, it is unclear if the immediate postpartum period is the appropriate time to obtain consent and administer a long-acting contraceptive method. In our sample, women accurately recalled receiving DMPA in the immediate postpartum period. However, the majority did not plan to use this contraceptive method. Further high-quality qualitative and quantitative research regarding women's contraceptive plans and perception of the postpartum DMPA consent process and the healthcare provider's attitudes regarding consent and prescription of immediate postpartum DMPA are warranted.
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