Group 2 by

Jess Higgins

jessicahiggins0798 — 2020-10-14 16:30:48 UTC

Contraception can be an exceptionally sensitive subject, particularly postpartum. As professionals, it would be inappropriate to presume resumption of sexual behaviour following birth. This means that regardless of sexual history, or previous use of contraceptive methods we must approach these conversations openly.
Some women may not wish to go onto contraception straight away for various reasons; they may be planning to have another child relatively quickly, although you would need to inform them of the potential risks of doing this, you will support the woman's decision. They may be breastfeeding, and this may be their preferred choice of contraception.

The progesterone only pill (POP) is an affective form of contraception and safe to use postpartum although this may not be for everyone. POP can be the cause of erratic bleeding patterns for some (Contraception choices for women- Maggie Cooper). Women who have experienced high levels of blood loss in labour may find they don't wish to use this form of contraception for that reason as increased bloody loss post birth can be quite traumatic for the woman.

Kirsty Hague

2020-10-14 17:33:01 UTC

As midwives, our role also extends to family planning and contraceptive advice. A woman can get pregnant as early as 3 weeks after giving birth. So often we are asked about contraception and which would be best for them to have.

It all depends on what way the woman would like to have contraception as there are different modes of taking it whether that be orally, injection, patch, implant, Intrauterine devices or natural methods.

Progesterone Only Pill (POP) is an oral method that is taken at the same time every day continuously. There are two types: Progesterone only which is the traditional pill which works by thickening the mucus in the cervix to prevent sperm from reaching an egg. The other type is desogestrel which is a more modern version and works in the same way except this version can stop ovulation.

The POP needs to be taken at the same time every day for maximum protection (99%) but there are small windows of time in which the pill can be taken without causing an affect on protection.

Traditional progestogen-only pill – must be taken within 3 hours of the same time each day

Desogestrel progestogen-only pill – must be taken within 12 hours of the same time each day

The POP can be taken any time through the menstrual cycle days 1-5 no further protection is needed as you are protected straight away. Any time after this, additional protection is advised for a week from starting the pill.

If the woman has been or is currently vomiting or suffering diarrhoea within 2 hours of taking the pill then another pill will need to be taken and additional protection used for 7 days following.

This POP can be used after pregnancy from 21 days from giving birth. If taken exactly 21 days protection is immediate but if taken after 21 days additional protection should be used for two days after starting the pill. The advantage of this pill is that it does not interfere with breastfeeding. So if a mother is exclusively breastfeeding she can use additional contraception without affecting her baby. If the woman decides that she would like to try again for another baby, there is no delay in fertility returning once the pill is no longer being ingested.

The POP can be used by women who are over the age of 35 and women who are also smokers. This gives an option for older women and smokers to have protection.

Irregular bleeding is a side effect of this pill. 10-25% of women discontinue this type of contraception to the irregular bleeding that can happen with the use of this form of contraception (Hussain, N. A. 2011). Up to 70% of women on this type of contraception experience breakthrough bleeding in one or more of their cycles.

Other side effects are

- Skin disorders

- Breast tenderness

- Nausea and vomiting

- Dizziness

- Altered libido

Hussain, N. A. (2011) ‘The progesterone only pill’, INNOVAIT, p. 515. Available at: https://search-ebscohost-com.libezproxy.bournemouth.ac.uk/login.aspx?direct=true&db=edsbl&AN=RN299505727&site=eds-live&scope=site (Accessed: 14 October 2020).

Lisa Atkinson

2020-10-16 10:11:27 UTC

The performance of progesterone only pill (POP) was evaluated on breastfeeding women and non breastfeeding women. It was discovered that POP provided safe contraception for the breastfeeding women and caused no negative effect on the infants growth. It was reported that pregnancy rates where below 1% making the POP a highly effect and safe form of contraception for breastfeeding women.

POP is available from a GP on prescription, usually started 21 days after birth. Although additional contraception is advised for the 7 days. Midwives are to inform women during pregnancy about the effectiveness of different contraceptions.

Gill Halls

2020-10-16 10:12:14 UTC

The discussion regarding that of contraception postpartum is something that needs to be explored soon after birth.

The Progesterone Only Pill (POP) can be started anytime after birth, however, to allow for physiological recovery of the body following birth a period of 21 days is advisable before commencement.

If oral intake of POP is commenced within the first 21 days following birth then no additional contraception is needed, however, from day 22 it is advisable that should sexual intercourse take place an additional barrier of contraception should be used.

The hormones within the POP impact on that of the lipid profile, coagulation, blood sugar, and metabolic status within the body. Therefore, if the women suffers from any of the following; hypertension, diabetes, cardiovascular disease, migraines, and liver of gall bladder issues, alternative methods of contraception should be considered.

Oral intake of POP when postnatal vaginal bleeding is still present can cause an increase in blood loss whilst also extending the duration of such loss. Thus being an important area to discuss with the women in your care who may not wish for this to be the case.

If the POP is started too soon after birth and in conjunction with breastfeeding, suppression of lactation can be present (although there is little research to back this theory). Therefore, should the women in your care be breastfeeding it is important to make them aware of such, discussing the delay of commencement if preferred and alternatives of contraception during this period of time.

Sources used for research;

Medforth, J, et al, (2017) 'Contraception' OXFORD HANDBOOK OF MIDWIFERY. 3rd ed. Oxford: Oxford University Press. Chapter 6, pager 631-682.

NICE. (2019). Starting a progesterone only pill. Available: https://cks.nice.org.uk/topics/contraception-progestogen-only-methods/management/progestogen-only-pill/#advantages-disadvantages. Last accessed 16th November 2020.

www.breastfeedingnetwork.org.uk

2020-10-16 10:12:23 UTC

How to take

Starting the first pack:
You can start taking the POP at any time in your menstrual cycle.

Start on day 1-5, it will work straight away, no extra contraception needed.
If you start on any other day, or have a short cycle, use extra contraception for 2 days.

After childbirth
"POP can be initiated immediately after childbirth and before 21 days without the need for additional precautions. If started on Day 21, then additional contraception is necessary for 2 days." (FSRH, 2017)

Continuing use:
Take one pill each day - until the pack is empty.
There are two types of progestogen-only pills (NHS England):
3-hour progestogen-only pills - must be taken within 3 hours of the same time each day.
12-hour progestogen-only pill - must be taken within 12 hours of the same time each day

Due to these time frames, the woman should be advised to choose a convenient time to take the first pill when she starts, a time that she will be able to take the pill (and remember to do this!) each day.
When she finishes one pack, she should take the first pill from the next pack on the very next day. (WHO)

NHS England. 2018. The progestogen-only pill: Your contraception guide [online]. NHS England. Available at https://www.nhs.uk/conditions/contraception/the-pill-progestogen-only/

The Faculty of Sexual and Reproductive Healthcare (FSRH). 2017. FSRH Guideline Contraception After Pregnancy. London: FSRH

World Health Organisation (WHO). 2018. WHO: Family Planning: a global handbook for providers [online]. WHO.

Hayley Mitchell

2020-10-16 10:19:05 UTC

https://www.breastfeedingnetwork.org.uk/contraception/

Hayley Mitchell

2020-10-16 10:20:18 UTC

https://www.nhs.uk/conditions/contraception/the-pill-progestogen-only/

Jane Bendell As a midwife it is important to discuss with the mother her family planning options to avoid unwanted pregnancies. This should take place within the postnatal appointments following delivery. Women should not feel pressured to decide instantly, therefore the midwife could provide and talk through using the ‘Family Planning Association’ leaflet (Fraser, 2009). This will allow the mother time to decide to be discussed at the next postnatal appointment. Pregnancy can happen within several weeks after the birth of the baby if sexual relations return and if the mother is not exclusively breastfeeding. Providing advice within 7 days of delivery reduces the of inter pregnancy interval of 12 months or less.

2020-10-16 10:20:18 UTC

Methods of contraception vary and it is important to inform women who choose to start the progesterone only pill (POP) that the pills are taken every day. There is no break in between like other oestrogen contraceptive pills and this can sometime cause a confusion (Walker, 2020).

References

Fraser, D., 2009. Myles Textbook For Midwives. 15th ed. Edinburgh: Elsevier Churchill Livingstone, p.706.

Walker, S., 2020. BMJ:. [online] The BMJ. Available at: [Accessed 16 October 2020].

2020-10-16 10:22:33 UTC

A study containing participants from Scotland and the Philippines found that POP had no effect on participants sex drive 4 months into using the contraception method in comparison to a placebo.
Bancroft, J., Farley ,T.M., Graham, C.A., Maglaya, C., Ramons, R., (1995). The effects of steroidal contraceptives on the well-being and sexuality of women. Contraception [online], 52 (6), 363-369. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8749600 [Accessed 14th October 2020].

https://www.fpa.org.uk/sites/default/files/your-guide-to-contraception.pdf

2020-10-16 10:23:44 UTC