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Postpartum IUD Insertion

You all know I love IUDs. Like really ❤️. Like I think they are the best thing to happen to gynecology in the past 3 decades.


BUT...

This is my answer to your question about immediate postpartum IUD insertion and here are the reasons I’m not a fan:


1️⃣You didn’t have a period for 9 months. Your body just expelled the placenta that was stuck to the uterus and bleeds from that area. This is all normal and is why you have bleeding 4-8 weeks after a delivery. Your uterus is healing and getting the lining (and size) back to normal. Sticking in an IUD with progesterone which initially causes continued lining sloughing, can prolong that process and the copper IUD can also cause prolonged bleeding (not great for getting to mikvah earlier).


2️⃣During and soon after pregnancy, the uterus is softer and larger than usual. That means it’s easier to poke through (uterine perforation). The cervix is still a bit dilated so we see a higher rate of IUD expulsion when placed immediately after delivery. The IUD is also meant to fit nicely inside of a normal size uterine cavity (up to 9cm). After a baby comes out, the uterus does not shrink down immediately. It’s a bit lower than your belly button. Now we’ve put this little device in a much bigger uterus and there is a higher potential for it to move around.


3️⃣Progesterone-only birth controls generally do not interfere with milk production for lactation. But could you be that person who does have a small decrease in supply from it? Maybe. That’s why, if you are committed to using your milk (nursing or pumping) it’s always best to establish your supply in the first 4-6 weeks before starting any hormonal method that could possibly affect it. (Don’t forget, a new pregnancy can also decrease milk supply which is why postpartum contraception is still important if you want).


4️⃣You shouldn’t be having sex in the first month after delivery anyways, or at least while you are still bleeding. Let yourself heal.


🤔The only value I can see to placing them soon after delivery is if it’s the only reliable form of birth control someone can use and the chances of them following up for an insertion appointment is essentially none.

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