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Midwives and Contraception in Puerperium

The document outlines the midwife's role in discussing contraception and sexual health during the puerperium, emphasizing the importance of establishing a connection with the woman and addressing her future family planning. It details various contraceptive methods, including hormonal, barrier, and permanent options, along with their mechanisms of action and postpartum considerations. Additionally, it highlights the benefits of contraception for women's health, family dynamics, and overall well-being.

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Sanda Malinga
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16 views4 pages

Midwives and Contraception in Puerperium

The document outlines the midwife's role in discussing contraception and sexual health during the puerperium, emphasizing the importance of establishing a connection with the woman and addressing her future family planning. It details various contraceptive methods, including hormonal, barrier, and permanent options, along with their mechanisms of action and postpartum considerations. Additionally, it highlights the benefits of contraception for women's health, family dynamics, and overall well-being.

Uploaded by

Sanda Malinga
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

1) Role of A Midwife In A Discussing Contraception And Sexual Health

During Puerperium

The role of the midwife in contraception and sexual health in puerperium is to


have a wider conversation with the woman about the pregnancy for example
discussion about unintended pregnancies, spacing of children and also
include women’s future plans. This is done to establish a meaningful
connection between the midwife and a woman. Initiating contraception
discussing different types of contraception that are available obtaining history
of previous contraception, why the contraception was discontinued. In all
discussion and initiating medical eligibility should be considered.

2) Types of hormonal contraceptive methods

1) Combined oral contraceptives plus combined with oestrogen and


progesterone taken daily for 21 days followed by a seven day pill-free period
or seven placebo EG triphasils.

2) Injectable
Containing both oestrogen and progesterone EG Medroyprogesterone.
150mg given imi every 3 months. Nuristerate 200mg given imi every 2
months.

3) IUCD
It is a small T-shaped plastic device which is inserted into the uterus. It
releases small amounts of progesterone which thickens cervical mucus
making it harder for sperm to enter fallopian tubes. It stays for 5 years.

4) Implanon
It is inserted sub dermal, it releases levonorgestrel over period of 3 years.

3) Types of barrier methods

1) Condoms
There are male and female condoms made of latex rubber inserted on the
penis or in the vagina before sexual intercourse preventing semen and
other bodily fluids from being shared or semen entering the vagina.

2) Cervical diaphragm
It is a dome shaped synthetic or latex device placed over cervix prior
sexual intercourse to prevent sperm entering the vagina.
3) Spermicides
They are inserted in the vagina prior to sexual intercourse. They contain
ingredient which either kill spermatozoa or weakens them.

4) Hormones

Hormones found in the combined pills are:


Oestrogen and progesterone

5.1) Mode of action in the combined oral contraceptive pill

 The viscosity of the cervical mucus increases due to progesterone


influence making it impenetrable to sperm
 Changes to the endometrium render it unfavourable for blastocyst
implantation
 Capacitation of sperm in the endometrial fluid is impaired.
 It inhibits tubal transportation of the ovum and zygote and possibly
transportation of spermatozoa is inhibited.
 Production and secretion of hormones Gonadotropin which is
responsible for the release of follicle stimulating hormone is
diminished and hence follicle maturation is prevented.
 The midcycle luteinizing hormone peak is suppressed. The follicle
wall does not rupture and sequently ovulation cannot occur.
Progesterone Only Pill
 Cervical mucus viscosity increases and trancervical sperm transport is
inhibited.
 Decreased glandular development of the endometrium and an acyclical
secretory effect render the endometrium unsuitable for embryology.
 The motility in the fallopian tube is inhibited epithelium becomes altered and
consequently zygote transport is impeded.
 Follicle stimulating hormone levels are usually lowered but in an
unpredictable manner. Patient ovulates in their 50-70% of cycles.

5.2) Postpartum considerations of combined oral contraceptive


and the progesterone only pill

Combined oral contraceptive should not be used in lactating mothers


because of the negative effects oestrogen could have in milk production
and quality. Oestrogen has a negative effect in blood clotting therefore the
increased risk of thromboembolism in the first months after delivery.

Progesterone only pill


They are particularly useful in the lactating patient they have no negative
effect in the milk production or quality. Since lactating patients have a
menstrual cycle in which ovulation does not occur progesterone only pills
are very reliable.

6.1) Term Lam

Lactation Amenorrhea is a way for breastfeeding to temporarily help prevent


pregnancy. It must be used correctly to work. Lactation means the body is making
breast milk and Amenorrhea. There are no monthly periods.

6.2)
1) The baby is under 6 months of age
2) The mother is amenorrheic meaning she not getting her monthly periods
3) There is an exclusive breastfeeding on demand day and night. The baby is
not getting any food or liquids on breast milk

7.1) Benefit of Contraception and health life expectancy of the mother

- Prevent unintended pregnancies


- Woman can have a number of babies that she desires
- Woman can have the number of babies she can afford
- Woman can space out her children the way she wants
- Delay pregnancies that occur at an early age and prevent pregnancies that
occur at a very advanced maternity age as both are at risk of health
- Reducing adolescent pregnancies to prevent risk of low birth right babies
therefore neonatal mortality is reduced which may have psychological effect
to the woman
- Woman can make informed choices about their sexual and reproductive
health
- Help to reduce unintended pregnancies in women living with HIV resulting in
fewer infected babies

Other benefits beyond preventing pregnancy.


- It helps manage endometriosis
- It can relieve symptoms of premenstrual syndrome
- It reduces risk of uterine cancer
- It reduces risk of ovarian cysts
- Reduce risk of anemia
- Prevent risk of unsafe abortion

7.2) Benefits to the family

- Children in smaller planned families receive more attention from their parents.
- Children with one or no siblings usually do better in school
- Small families usually prosper economically and socially
- Parents with fewer children can manage their finances better
- Parents with fewer children can have more time dedicated to their work or
other aspects of their lives

8.1) Tubal Ligation

Tubal ligation is a type of permanent birth control known as tubes t… or tubal


sterilization. It is surgery

Common questions

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Women who effectively use contraception to plan their families can experience psychological benefits, such as reduced stress from unintended pregnancies, improved confidence in making informed reproductive health decisions, and enhanced mental health from spacing children at preferred intervals and ages, which can also lessen adolescent pregnancy concerns .

The Lactational Amenorrhea Method utilizes breastfeeding's natural suppression of ovulation as contraception. Its effectiveness relies on three conditions: the baby must be under six months old, the mother must be amenorrheic (not having periods), and there must be exclusive breastfeeding on demand without supplementary liquids or foods .

Intrauterine Contraceptive Devices prevent pregnancy primarily by releasing progesterone that thickens cervical mucus, impeding sperm passage. Long-term, they are cost-effective and require minimal intervention, remaining effective for up to five years, making them a suitable option for extended pregnancy prevention .

Immediately postpartum, the use of combined oral contraceptives poses risks primarily due to oestrogen, which can negatively affect milk production and quality, raising thromboembolism risk. Therefore, they are generally not recommended for lactating women, who should consider alternative contraceptive methods .

Combined oral contraceptives work by increasing cervical mucus viscosity, altering the endometrium, hindering sperm capacitation, inhibiting tubal transportation, and suppressing ovulation through hormonal suppression. In contrast, progesterone-only pills mainly increase cervical mucus thickness, decrease endometrial receptivity, inhibit tubal motility, and unpredictably lower follicle-stimulating hormone levels, allowing for some ovulation during cycles .

Progesterone-only pills are suitable for lactating mothers because they do not affect milk production or quality. In contrast, combined oral contraceptives are unsuitable due to the negative effects of oestrogen on milk production and the heightened risk of thromboembolism postpartum .

Barrier methods such as condoms and diaphragms physically block sperm from entering the uterus, thus preventing fertilization. They are significant for not only preventing pregnancy but also reducing the risk of sexually transmitted infections, providing a non-hormonal contraceptive option .

Effective contraception allows for smaller, planned families, enabling parents to provide more attention and resources per child, which can improve educational outcomes. Additionally, families often experience better economic prosperity and social status, allowing for greater parental work-life balance and potentially reducing societal burdens .

Apart from childbirth assistance, midwives engage in broader discussions with women about contraception and their sexual health during puerperium. This involves addressing unintended pregnancies, child spacing, and future family planning, while also reviewing previous contraceptive use and reasons for discontinuation. These discussions help establish meaningful relationships and guide women towards informed contraceptive choices considering their medical eligibility .

Hormonal contraceptives offer additional health benefits, such as managing endometriosis, relieving premenstrual syndrome, reducing risks of uterine cancer, ovarian cysts, and anemia, and preventing unsafe abortions. These benefits contribute to overall better reproductive health and increased life expectancy for women .

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