Intrauterine contraception soon after childbirth

Cochrane: Women have two main choices for intrauterine contraception (IUC): one that releases the hormone levonorgestrel, and one without hormones that contains copper. Beginning IUC use right after childbirth and before hospital discharge can be good for many reasons. The woman knows she is not pregnant, and the time and place are convenient for starting a method that works well. We looked at whether IUC would be more likely to come out on its own if put in right after birth of a baby. For women who wanted IUC but did not have it placed right away, we studied whether they returned later for insertion.


Until 1 April 2015, we ran computer searches for randomized trials of IUC inserted within 10 minutes of placenta (afterbirth) delivery. We wrote to researchers to find more studies. Trials could compare different times for insertion as well as types of IUC and ways to insert the device.

We found 15 trials. Seven recent studies compared IUC insertion right after childbirth versus early insertion (before hospital discharge) or later insertion (weeks after discharge). Four had full reports, although three were small studies. Insertion was as likely to occur when placed right after childbirth as when planned for later placement, except in a study from Uganda. For the four trials overall, the IUC came out more often on its own when placed right after childbirth than when inserted weeks later. Use at six months was more likely with insertion right after childbirth than weeks later. In single studies, the groups did not differ in use at 3 months or 12 months.

Eight older studies looked at types of IUC put in right after childbirth. Changing IUC design did not seem to affect whether IUC stayed in or whether it was used later on. Inserting IUC by hand or with a holding instrument did not seem to make a difference.

We found newer trials with full reports that compared placement times. The studies were of good quality. Ongoing trials will provide additional data, although some sample sizes are small. Larger studies would provide better information on whether the IUC came out on its own and on whether side effects occurred.

Authors' conclusions:
Recent trials compared different insertion times after vaginal or cesarean delivery. Evidence was limited because studies with full reports generally had small sample sizes. Overall, the quality of evidence was moderate; abstracts and older studies had limited reporting. Ongoing trials will add to the evidence, although some are small. Trials of adequate power are needed to estimate expulsion rates and side effects.

The benefit of effective contraception immediately after delivery may outweigh the disadvantage of increased risk for expulsion. Frequent prenatal visits during the third trimester provide the opportunity to discuss effective contraceptive methods and desired timing for initiation. Clinical follow-up can help detect early expulsion, as can educating women about expulsion signs and symptoms.