Question

Gina is a 21-year-old G3 P3 being seen at 6 weeks postpartum following uncomplicated NSVD. She has no medical problems. She is coping well with three children but states she definitely wants no more right now. She is breastfeeding her infant and has had no menses since delivery.

1. What should Gina be taught regarding fertility during lactation?
2. What contraceptive methods are acceptable during lactation? What teaching can be included for the Basal-Body temperature method, diaphragm and condom use and care?
3. After discussion, Gina decides to have a levonorgestrel-releasing intrauterine device (Mirena) inserted. When can the device be inserted?
4. What teaching should Gina receive after the Mirena has been inserted?

Answer 1

#) what Gina be taught regarding fertility during lactation ?

Gina was taught regarding the possibilities of becoming fertile 3 weeks after giving birth during lactation and in the absence of menstruation .

# what contraceptive methods are acceptable during lactation .

* Progestron only pill or mini pill is considered as one of the best contraceptive during lactation because these pills are safe and does not affect the milk production adversely

* Progestron releasing IUD ( Mirena,skyla) -These are considered as safe contraceptive and provide a long term effect of contraception upto 5 years .it also does not affect the quantity and quality of milk production in lactation women .

* birth control implant ( Nexplanon,implanon) - they are effective during lactation without any adverse effect on milk production and child growth .

* Barrier methods - barrier methods like condom ,diaphragm are safe during lactation and can use safely without any concern .

what teaching can be included for basal body temperature method ,diaphragm and condom use and care .

*Basal temperature method - advice to check for the body temperature for 2-3 days from the starting of menstruation untill the body temperature rise and it indicate that the ovulation is complete and fertile period get over .

* Condoms - educate to use the condom effectively ,and educate the inappropriate use leads to get pregnant .advice not to reuse the condom

* Diaphragm - advice to go for the diaphragm use only with the help of medical personnel and instruct to keep the diaphragm for 6 hours after sex

# when does the IUD Mirena can inserted ?

​​​​​​The best time to insert Mirena is anytime after completing 4 week of child birth, at this time it reduce the risk of expelling the device by uterus .

# what teaching should Gina receive after the Mirena has been inserted ?

Advice not to insert anything for 48 hours after its insertion , also advice to avoid sexual intercouse ,bathing or swimming as the rate of expulsion of device are higher with these factors .

Advice to report immediate incase of any irregular bleeding occur

Educate that it is perfectly normal to have a small discomfort,bleeding ,cramping or spotting for first few months but it may worse in the first 1-2 week of insertion .

Educate that it may cause hormonal side effects like headache ,acne ,mood changes ,increased discharge or breast pain and normally subsided with in first 6 month .