In this episode, Erin talks to Dr. Hannah about postnatal contraception. Hannah is a senior resident medical officer in obstetrics and gynecology who also happens to be a sewist. Counseling women on contraceptive options, particularly in the postpartum period, is a big part of her job. In this episode, Hannah introduces several different contraceptive options and explains what you need to consider about them specifically in the postnatal period.
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You can find Hannah on Instagram as theemptyuterus. Her account is focused on women’s sexual and reproductive health (and is actually super fun and funny and informative all at the same time!). Hannah recommended looking on Planned Parenthood and Family Planning New South Wales for additional online information about postnatal contraception.
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Transcript:[0:11] Welcome to the second episode of the maternity sewing podcast. Maternitysewing.com is your source for maternity, nursing, and postpartum friendly sewing patterns. The maternity sewing podcast is we we have frank conversations, share stories and offer help and inspiration on things like sewing and body positivity especially during pregnancy and postpartum. Hi. I’m Erin Weisbart. Today I’m talking with Hannah, a sewist and a senior resident medical officer in obstetrics & gynecology. Today she’s going to talk to us about postnatal contraception. She’ll introduce a few different options and let us know things that you need to consider specifically in the postnatal period. For those of you with family members listening we are spending this episode talking about contraception so if that’s not something that you want to share with other people listening then now is a good time to switch to another episode. [1:07] Hi Hannah. Hi Erin. Thanks for having me. We’re so excited to have you. Do you mind introducing yourself? Yeah. As you said my name is Hannah. I work in Obstetrics & Gynecology. I’m an SRMO which means I’m a doctor and I work from public hospitals, mostly between birthing suites, operating theatres, antenatal clinics and gynecology clinics. So I see a broad spectrum of women’s health and a lot of what I do is counseling women in the postnatal period about appropriate
contraception options for them. [1:40] So just to dive right in – why does postnatal contraception why is it any different than contraception at another time? Yeah it’s a really great question. So I guess the main thing in terms of the postnatal period that makes it differ is that if women are breastfeeding their limit their options are slightly more limited than women who aren’t breastfeeding. And that’s because we know that estrogens, which are a common component of lots of contraceptives, can reduce your milk supply in the postnatal period which is obviously going to be an issue if you are trying to breastfeed. I guess if you’re not breastfeeding, most of the contraceptive options are there for you, but for breastfeeding women we tend to focus more on the non-hormonal or progesterone only options. The other issue with the estrogens is that they can actually increase the risk of clots in the early postpartum period, so in the first 21 days. So that’s clots in the legs that can also cause clots in the lungs and we want to avoid that because that early postnatal period you’re at increased risk anyway so we don’t want to add that additional risk of introducing estrogen. That’s why it’s slightly different for women who have just had a baby. So estrogen – that’s like in the pill? [3:03] Yeah so the commeon the combined oral contraceptive pill it usually has well it does have a combination of an estrogen and a projestogen.
So there are options that have purely [3:19] progesterone in it which obviously exclusive estrogens and the complications that come along with it. So yeah we do at the counseling around [3:28] appropriate options that avoid that milk reduction and also the risk of clotting. Can you explain what some of these options are just talk some of them through for us? Of course. The general I guess we think about contraception in terms of hormonal and non-hormonal options. All the non-hormonal options are perfectly safe for women who have just had babies and are breastfeeding so that includes things like barrier methods – condoms, female condoms, diaphragms, cervical caps all those sort of things are perfectly fine. But usually we like to avoid putting anything inside the vagina for that first six weeks after birth. So then we think about some other options. As I sort of touched on before the progesterone only pill is a really good option for women who are breastfeeding. It’s similar to the combined pill that has estrogen. It’s a tablet that you take everyday but you have to be really strict with the progesterone only pill to take it at exactly the same time every single day because there’s a little bit more room for error if it’s not like I can really strictly at the 24 hour mark. I can imagine that might be something that’s a little difficult for anyone with a newborn trying to keep track of what time of day it is much less remembering something specific that you have to do at the same time. [4:57] And for that reason it’s not really my personal favorite that I recommend to women just because I know that sort of. [5:05] There’s much going on when you just had a baby and you’re trying to establish a routine and your sleep patterns and all of that sort of stuff and so there is room for human error code. So I tend to prefer options that sort of reduce the human error component that make it a little bit more reliable. So the Implanon is another really good option. It’s the rod that sort of sits just in the subcutaneous tissue in the arm. It’s a good option cuz as I said ti removes that human error and it can stay in for up to3 years and it’s a progesterone only option as well. [5:40] And it can go pretty much it can go straight after you’ve had your baby so there doesn’t need to be any sort of delay and it works
pretty much immediately so it’s a really good option. Some women do have a bit of irregular bleeding when that first goes in but it’s pretty well tolerated. Is that something you could do at just any do you need to make a special appointment with your OB or gynecologist about that or how do you get it put in? [6:09] So I don’t know if it’s different in the US but here in Australia when the women have had their babies and say they’re in the hospital overnight or for a few nights or whatever we always discuss contraception with them at that point and if Implanon is something that they would like we usually try and arrange to have it done before they leave the hospital with their baby just so that they’re all sorted when they got home. Some women are still a bit undecided before they go home and that’s completely fine cause they’ve obviously got other things going through their head. So I know in Australian lots and lots of GPs are happy to put them in. It’s just done with a little bit of local anesthetics and it doesn’t take long at all so GPs can do it. Otherwise you can get a referral to a gynecologist or even a Hospital Gynecology clinic and they can usually do them. When I I mean I honestly can’t even remember I had a baby and was in the hospital for a day
well you know we got there in the middle of the night so it like 1 the next night there and but I barely [7:12] remember I don’t remember. I remember that being discussed when I went back for a 6 or 8 week appointment. It’s possible it happened. A lot goes on when you’ve just given birth. But I don’t remember that being discussed for me at all and I know care, postnatal care especially is different from country to Country and region to region so it’s interesting to hear and I would I would imagine if you are [7:49] that that’s something you could just bring up even if it’s not presented to you. It’s good to have that information that you can raise with your provider even if it’s not immediately discussed with you. Exactly and I think for some women who have really complicated deliveries and issues in the postnatal period it’s hard to sort of bring up those sort of less urgent topic discussions I suppose because there’s other issues that are more important. So we often if we don’t have time to sort of have a really good discussion about contraception before they go home we like to provide written information so they can at least think about it when they have you know a few minutes to themselves and are awake enough to do some reading. So what other kind of contraceptives options are there? [8:38] So I’m a big fan of the intrauterine devices so. [8:44] there’s a hormonal version which here in Australia we call Mirena. I’m not sure if it has the same trade name over there. I think so. The Mirena is good. It can stay in for 5 years and it’s usually again really easy to put in for women who have had babies before so it’s really similar to like when you go to have a pap smear. [9:06] The healthcare provider just uses a speculum and it just is slotted in through the cervix and sits in the uterus and it can stay in for 5 years. And one of the really good things with that, other than the fact that has like 99% efficacy for as a contraceptive it also has good impacts on vaginal bleeding and most women find that they have shorter periods and lighter periods and some women have a reduction in their bleeding like a cessation sorry in their bleeding altogether. So I really like that because we also see women with lots of heavy bleeding problems and things so it’s a good one. It stays in for 5 years. And then there’s the non-hormonal option which is the copper IUD. [9:48] Here in Australia there’s two versions – a five year one or a 10-year one. So again, easy to put in for women who have had babies but it is also an option for women who haven’t, and unlike the Mirena it can sometimes make bleeding a little bit heavier so it sort of depends on the individual circumstance about their preference in terms of hormones and also if they have bleeding issues in terms of their normal periods. Again I love those because they really remove human error from the picture. So the hormonal IUD that doesn’t have estrogen so you don’t have to worry about that as you were saying with the other hormonal? Exactly its levonorgestrel which is a progesterone only form of contraception so and it’s really good too because the hormone is just being secreted locally in the uterus so it doesn’t have lots of the systemic side effects that we see with things like oral the pill that or the depo. [10:48] It’s mostly well tolerated. You read lots of horror stories on the internet but most of the women that I see at the gynecology clinics really love it and do well on it. So why postnatal contraception so important? You know if you’re going home with a brand new baby it kind of seems like the last thing that might be on your mind yes? Yes that’s it that’s very true sorry. I guess I always look at it you know you’re having a baby is such a massive thing to happen in your life and you need time to recover not just physically but emotionally and I think one of the great things about living in 2018 is that we have the freedom to plan families now and I think that’s great that women can decide when and how they want to have babies. I guess a particularly important situation is women who have had cesarean sections. So we recommend that they [11:41] wait to fall pregnant for at least 12 months preferably 18 and that’s because they just need a really good amount of time for the scar on their uterus to heal particularly if they’re wanting to try for vaginal birth on the next pregnancy and obviously that’s because the stress of labor when your uterus is contracting it’s it has a lot of stress on that scar that’s there so the more time it has to heal the better. Because if you have a vaginal birth soon after a cesarean there’s a risk of uterine rupture in that sort of thing so it is it is really in the physical best interest of the woman but also I think in times of just [12:22] being able to plan your life around when you have kids is a really good thing. Great. So who might what other resources other than this quick introduction on our podcast might a woman reach out to for more information when you know planning ahead? [12:40] Yeah so I think always a good place to start is the midwives or the obstetric team before you leave hospital but as you said before there’s often other issues going on so that isn’t always possible. Your GP is always a really good resource and then online there’s lots and lots of information about different types of contraception. So where I work I often refer women to the Family Planning New South Wales website but I know in America they have a really excellent Planned Parenthood website which sometimes we use here as well. There’s lots and lots of information and it’s just important that you’re getting it from the right places so I would always start with your GP or those reliable online resources. Great. Thank you so much Hannah. We really appreciated having you on today. [13:29] No worries. Thank you for having me. That’s it for today’s episode of the maternity sewing podcast. You can find maternity sewing at maternitysewing.com.
You’ll find our curated pattern shop of maternity, nursing and postpartum friendly sewing patterns. Our blog where we have sewing tutorials and inspiration for pregnant nursing and postpartum sewist and the show notes from all of our podcasts. I’m Erin Weisbart, co-owner of maternity sewing. You can find me at Tuesdaystitches.com and on Instagram as Tuesday stitches. Today I talked with Hannah. You can find her on Instagram as theemptyuterus, an account focused on women’s sexual and reproductive health. You can look at our show notes and on our website at maternitysewing.com/podcast for links to everything we talked about as well as all the ways you can stay in touch with maternity sewing like our Facebook page, and Facebook group you can also find us on Instagram as maternitysewing.