Activity No.

5 (week 7)

A married primipara from a rural area has just been delivered in a district hospital. She has a
stable relationship with her husband and they decide to have their next infant in five years’
time. The patient would like to have an intra-uterine contraceptive device inserted.

1. Is this an appropriate method for this patient?

IUD is known to offer long-term protection against pregnancy for 3 to 12 years, it’s an
effective method because there is no chance of making mistakes. Thus, it lessens the risk of
developing pelvic inflammatory disease.

2. When should the device be inserted?

An IUD can be inserted immediately after delivery but ideally, it’s preferred to place it at least
six weeks postpartum or more to rule out the possibility of the uterus expelling the device
later on.

3. Could the patient, in the meantime, rely on breast feeding as a contraceptive method?
As matter in fact, breastfeeding is considered as a natural contraceptive method, and this
can only be effective when exclusive breastfeeding is practiced to prevent pregnancy.
However, this method doesn’t offer a long-term protection against pregnancy, so it’s not
exactly the safest option especially when the risk of pregnancy is quite high. A more
guaranteed method is advisable such as injectables and progestin only pills, while still the
device is not inserted yet.

4. The patient asks if the intra-uterine contraceptive device could be inserted before she is
discharged from hospital. Would this be appropriate management?
Yes, it’s effective either way whether it’s inserted immediately after delivery or six weeks
postpartum, the only disadvantage of placing it after giving birth is raising the risk of
expulsion.