Advances in contraception: new options for postpartum women.

INTRODUCTION: short interval repeat pregnancy increases maternal and neonatal morbidity, and provision of postpartum contraception provides primary protection against these adverse outcomes. Confusion regarding effects on breast feeding and thrombosis risk delaying initiation of contraception in the immediate post-partum interval. Delaying contraception provision until the 6-week postpartum visit misses many women who either do not attend or have resumed ovulation and/or intercourse prior to this visit. Because of this, recent studies have looked into initiation of highly effective contraceptive methods at earlier intervals including immediately postpartum. These data provide strong evidence for immediate post-partum initiation of the most effective long-acting reversible contraception (LARC) methods, intrauterine devices and implants. Areas covered: We review the data for safety and efficacy, timing of initiation, and continuation rates of various contraceptive methods in the postpartum period. We also evaluate effects on initiation and continuation of breastfeeding for each contraceptive method discussed. Expert opinion: It is important to counsel patients antenatally regarding the full spectrum of contraceptive options available with a focus on long-acting reversible contraceptive (LARC) methods. When a woman chooses a LARC method, her provider should consider placement in the immediate postpartum period.